Stents as Good as Surgery at Preventing Stroke
Less Invasive Approach Works as Well as Gold Standard
Stenting vs. Surgery: European Trial Has Conflicting Results continued...
The University of Miami's Ralph Sacco, MD, president-elect of the American Heart Association, tells WebMD that patient selection might explain the disparate results.
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.
Stents Work as Well as Surgery
Each year, nearly 800,000 Americans suffer a stroke and nearly 140,000 die, making it the third leading cause of death in the United States.
The new study, called CREST, involved 2,502 patients at more than 100 U.S. and Canadian hospitals. About half underwent surgery and half received stents.
In the first 30 days after the procedure, 4.1% of stent patients had a stroke vs. 2.3% of surgery patients. But 2.3% of surgery patients had a heart attack, compared with 1.1 %of stent patients.
Patients who suffered a heart attack reported a better quality of life after recovery than patients who suffered a stroke, Brott says.
By 2.5 years later, 2.0% of patients who underwent stenting had died or suffered a heart attack or stroke vs. 2.4% of surgery patients, a difference so small it could have been due to chance.
In the European trial of 1,713 patients, 8.5% of stent patients had a stroke, death or heart attack in the first 30 days after surgery, compared with 5.2% of the surgery group.