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Preventing Stroke Without Major Surgery

Angioplasty and Stents Are as Effective as Surgery, Says Study
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WebMD Health News

Dec. 1, 2004 -- When it comes to preventing stroke, traditional surgery isn't the only way to go. Newer methods are just as effective, say Italian researchers.

Finding ways to ward off stroke is urgent. Stroke is the No. 3 killer in the U.S, behind heart disease and cancer. More than 700,000 Americans have a stroke every year, according to the American Stroke Association.

Traditionally, blocked or narrowed carotid arteries - blood vessels that supply the brain -- have been cleaned out surgically to help prevent a stroke. The procedure, called carotid endarterectomy, is a major undertaking with risks, including actually causing a stroke or heart attack.

That's why less invasive procedures are appealing. Options include angioplasty and stenting, two techniques commonly used to treat heart disease.

Angioplasty uses a tiny balloon to reopen blocked or narrowed arteries. Stents are small, metal mesh tubes that prop arteries open after angioplasty.

For stroke prevention, angioplasty and stents are used in the carotid arteries. Blocked or narrowed carotid arteries can impair the brain's blood supply, causing a stroke.

But do angioplasty and stenting work as well as conventional surgery? Yes, say Italian researchers including Gianluca Piccoli, MD, of Santa Maria della Misericordia Hospital of Udine in Italy.

Piccoli's team studied 171 patients with carotid artery disease. Some patients had signs of decreased blood flow to the brain while others had suffered a previous stroke.

All the participants underwent angioplasty and stenting for their carotid arteries. The researchers monitored them for three years, comparing their results to those typically seen with carotid artery surgery.

Angioplasty and stenting measured up well.

Complication rates were similar to those seen with surgery. Angioplasty and stenting also equaled surgery at preventing the carotid arteries from narrowing again.

Findings Match Earlier Stroke Research

An earlier study conducted by Jay Yadav, MD, of The Cleveland Clinic, and colleagues had similar findings. That study was reported in the Oct. 7 edition of The New England Journal of Medicine.

"Carotid artery angioplasty is a safe procedure and the results are the same as surgical ones reported in literature," say the researchers. They presented their findings in Chicago at the Radiological Society of North America's annual meeting.

Piccoli says patients who undergo angioplasty and stenting have relatively short recovery times. "With surgery you need three to four days, sometimes even a week of recovery in the hospital," he says. "But with carotid angioplasty and stenting, you can go home the day after the procedure."

Angioplasty and stenting to prevent stroke will become common, predicts Piccoli.

"Today, these procedures are largely used for the heart, but I think that in the future they will be used for every artery and every part of the body," says Piccoli in a news release.

That trend may have already started. In August, the FDA approved a stent for use in the carotid arteries.

Meanwhile, a trip to the operating room isn't the only way to prevent stroke. Diet, exercise, and healthy lifestyles can also make a difference, if time is on your side.

Time also counts if the worst case happens and stroke occurs. Immediate medical attention is crucial. Stroke medications -- used to dissolve a clot that blocks blood flow -- must be used within three hours to help minimize brain damage from a stroke.

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