Study: Stents as Good as Surgery at Keeping Neck Arteries Open
Procedures Lower Stroke Risk With Low Reblockage Rates
Neck Narrowing Causes 1 in 10 Strokes continued...
One of the unique aspects of the new study, called CREST, is that only about half of the patients had symptoms such as weakness on one side of the body or blurry vision. That’s important, Lal says, because about half of the procedures to unclog neck arteries are performed in people who have not yet developed symptoms.
In the study, 1,086 patients underwent stenting and 1,105 had surgery. By two years later:
- Six percent of patients in both groups had a 70% or greater blockage in the treated section of their artery.
- Complete blockage occurred in 0.3% of stenting patients and 0.5% of endarterectomy patients, a difference so small it could be due to chance.
- Twenty stent patients and 23 endarterectomy patients needed another procedure to open up a reblocked carotid artery.
Stenting or Surgery?
So how do you decide which procedure is best for you? Among the factors to consider:
Age. The previously published findings showed that patients under age 70 with symptoms appeared to benefit slightly more from stents, while their older counterparts benefited more from surgery, the University of Miami's Ralph Sacco, MD, immediate past president of the American Heart Association/American Stroke Association, tells WebMD. He was not involved with the work.
Reimbursement. Stenting is not routinely reimbursed unless a patient is at high risk of complications from surgery. A recent study places the costs of stenting and surgery at $12,782 and $8,916, respectively, says CREST researcher Larry B. Goldstein, MD, director of the Duke Stroke Center at Duke University Medical Center in Durham, N.C.
Extent of disease. "If a patient has a lot of plaque or it is close to the skull, for example, surgery becomes high risk. There's a risk of stroke or nerve damage," Lal says.
Physician/institution. "If there's a great surgeon at your institution, you may choose endarterectomy. Similarly, if you have a terrific stenter, with low rates of complications, you may choose stenting," Sacco says.
How about drugs alone? Studies have shown that patients with symptoms gain a huge benefit from surgery over medication alone, Goldstein says.