Dr Barnett’s key research field is the prevention of stroke. He coordinated the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Together with a European study of similar design the NASCET provided the scientific evidence for operations on tight atherosclerotic manifestations on the carotid artery of the neck, since then one of the most important interventions to prevent recurrent stroke after transient or mild cerebrovascular warning symptoms.
Before the NASCET study, Dr Barnett was leading another extensive trial, with quite a different outcome. In North America, and some other medical centres in the world, clinics were established to perform extracranial-intracranial (EC-IC) bypass surgery in patients with total occlusion of one of the major blood vessels to the brain, the internal carotid artery. Through an opening of the skull bone, arteries on the outside of the skull were connected with those on the surface of the brain. The EC-IC bypass study showed that these operations did not bring benefit to the patients, as they were selected. In the mid 1980s, all these operations, in not being based on scientific evidence, were almost totally stopped. Today we know that before any conclusions can be made on the severity of an occluded carotid artery, an evaluation of alternative (collateral) blood flow supply to the brain is essential.
Even earlier, in 1970, Dr Barnett led the Canadian the Canadian Aspirin Trial which established, for the first time, that any antiplatelet drug could prevent diseases (in this case stroke) caused by arterial thrombosis.
Dr Barnett’s extraordinary contributions to stroke research have changed the management of millions of stroke patients, the implementation of his research having prevented innumerable attacks. He has also demonstrated the strength of research by revealing that while some routinely used procedures were evidence-based, others were not.
For information about Karolinska Stroke Update, see: www.strokeupdate.org
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