Study: Stents as Good as Surgery at Keeping Neck Arteries Open
Procedures Lower Stroke Risk With Low Reblockage Rates
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.
But there is evidence that drugs may be sufficient for certain patients with narrowing in a neck artery who do not have symptoms, he tells WebMD. A clinical trial is planned to study the issue.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.