Stents as Good as Surgery at Preventing Stroke
Less Invasive Approach Works as Well as Gold Standard
WebMD News Archive
Feb. 26, 2010 (San Antonio) -- A less invasive approach for clearing clogged
neck arteries proved just as effective and safe as surgical treatment for
preventing strokes in high-risk patients, according to the largest comparison
of the two procedures.
Stenting, in which flexible mesh tubes are used to prop open blocked blood
vessels, is widely used to clear plaque-clogged coronary arteries, which cause
heart attacks. More recently, it has been used to open blocked neck arteries
that lead to strokes, but surgery called carotid endarterectomy remains the
The new study shows that "we now have two good options for patients," says
researcher Wayne Clark, MD, of Oregon Health & Science University.
The choice may come down to the individual patient's age, health, and
preferences, he tells WebMD.
The study, presented at the American Stroke Association's (ASA)
International Stroke Conference, showed that in the weeks after the procedure,
patients who received stents suffered slightly more strokes, and patients who
underwent surgery had slightly more heart attacks.
But an average of 2.5 years later, "there was no significant difference in
the number of events between the two groups," Clark says.
About 2% of patients in both groups suffered a heart attack or stroke or
died -- the lowest rates of adverse events ever seen in a stroke trial pitting
stenting against surgery, he says.
Interestingly, patients under age 70 appeared to benefit slightly more from
stents, while older patients benefited slightly more from surgery, says lead
researcher Thomas Brott, MD, of the Mayo Clinic in Jacksonville.
"Most of us thought the less invasive procedure would be better suited for
older patients, but based on our data we have to question that," he tells
The study was funded by the National Institute of Neurological Disorders and
Stroke with supplemental funding from stent maker Abbott Vascular.
Stenting vs. Surgery: European Trial Has Conflicting Results
The findings were announced just hours after European researchers reported
that stenting is inferior to surgery when it comes to preventing stroke.
Those results, published online by the journal Lancet, showed that
patients who received the stents had a much higher rate of stroke, heart
attack, or death than patients who underwent surgery.
The University of Miami's Ralph Sacco, MD, president-elect of the American
Heart Association, tells WebMD that patient selection might explain the
The European study enrolled only patients whose neck blockages caused
symptoms such as swishing in the ears or vision problems; the North American
study included patients with and without symptoms. Those with symptoms are
presumably sicker and would benefit more from surgery, Sacco says.
Also, the doctors who performed the stent procedures in the North American
study were more experienced, Brott says.
There were also differences in the types of stents used, Clark says. In the
European trial, doctors were allowed to use any approved stent, while the North
American doctors all used Abbott's Acculink Carotid Stent System.