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Neck Surgery Less Risky Than Stents

6-Month Study Shows Lower Stroke, Death Risk With Carotid Artery Surgery
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 20, 2006 -- When it comes to opening blocked carotid arteries, surgery may be less risky than stents.

That's according to a study by French doctors including Jean-Louis Mas, MD, of the Hospitaux Sainte-Anne in Paris.

The carotid arteries run through the neck, taking blood to the brain. They can become narrowed from plaque buildup, making strokes more likely.

Mas' team found that patients who got surgery instead of stents to open the carotid arteries were less likely to die or have strokes in the first six months after their procedure.

But don't jump to conclusions.

While the French study "raises concern" about carotid artery stenting, it "cannot be considered the final word" on the topic, a journal editorialist cautions.

The study and editorial appear in The New England Journal of Medicine.

Surgery, Stents

Surgery to open a carotid artery is an older procedure than stenting.

With the surgery, surgeons first make a small cut in the neck to reach the carotid artery. They may temporarily reroute blood flow as they open the carotid artery and remove the plaque inside.

In the stenting procedure, doctors insert tiny metal mesh tubes, called stents, to open up the artery.

The stent is put into place via a specially designed catheter. This catheter is introduced through a small puncture in a blood vessel in the groin and tracked up to the carotid artery in the neck.

Though stents are used in various blood vessels, this study covered only carotid artery stenting.

French Study

Mas' team studied 527 French patients who had a carotid artery at least 60% more narrow than normal.

The patients had all experienced a non-disabling strokestroke, or "mini-stroke," because of the blockage.

The researchers randomly assigned patients to get carotid artery surgery or stents.

Over the next six months, 6% of the surgery group died or had a stroke, compared with about 11% of the stent group.

"The rates of death and stroke at 1 and 6 months were lower with endarterectomy [carotid artery surgery] than with stenting," the researchers write.

They stopped the experiment early due to those findings and called for larger, longer studies to check their results.

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