Preventing Strokes: Stents vs. Surgery
Study Shows Stents Are Effective in High-Risk Patients
April 9, 2008 -- A less invasive alternative to surgery for clearing neck arteries of plaque proved as effective as surgical treatment for preventing strokes in high-risk patients in a three-year follow-up study.
Carotid artery stenting was compared to open-neck surgery in 260 patients considered less than optimal surgical candidates at high risk for strokes.
Stenting is routinely used to open plaque-clogged coronary arteries, which cause heart attacks. But it is still largely considered an experimental treatment for opening the clogged neck arteries that lead to strokes.
The newly published findings are the first to show long-term outcomes for neck stenting to be comparable to surgery in high-risk patients, University of Michigan interventional cardiologist Hitinder S. Gurm, MD, tells WebMD.
The study appears in the April 10 issue of the New England Journal of Medicine. The research was funded by Johnson & Johnson's Cordis, which makes the stent used in the study.
"This is the first data we have to suggest that these two procedures have similar long-term benefits," Gurm says. "But the findings only apply to high-risk patients. The trials examining lower-risk populations are going on now, and we hope to know more over the next few years."
Stent vs. Surgery
The patients who took part in the study were treated at 29 hospitals around the U.S. All were considered at increased risk for complications with surgery because of advanced age (over 80), co-morbid conditions (heart failure, advanced coronary artery disease, lung disease) or a history of prior neck surgery or radiation. Most also had symptoms associated with carotid artery narrowing.
Roughly half were treated with surgery, known as carotid endarterectomy, which involves opening the blocked carotid artery surgically to manually clear out accumulated plaque.
The other half got stents -- tiny wire mesh tubes threaded into the neck artery from an incision in the arm or groin. A filter designed to capture plaque and other debris freed from the arterial walls during the procedure was also used during stent implantation.
Of the participants available for follow-up, 41 of 143 stent-treated patients and 45 of the 117 patients treated with surgery had suffered a heart attack, a stroke, or had died within three years.
Most of the deaths were from cardiac or other non-stroke-related causes.
Strokes accounted for about a third of the adverse events recorded, but most were not serious enough to be life-threatening.