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Stroke Prevention: Stent as Good as Surgery

New Technology Improves Stents for Stroke Prevention, Researchers Say

From the WebMD Archives

Oct. 6, 2004 -- New technology has made stents as effective as more invasive surgery for stroke prevention, according to researchers.

Every 45 seconds, someone in the U.S. has a stroke, according to the American Stroke Association. Stroke is the nation's No. 3 cause of death, behind heart disease and cancer, but stroke prevention is possible.

Arteries that supply blood to the brain can become clogged, causing a stroke, much like blocked heart arteries can lead to a heart attack. These arteries can be cleaned out for stroke prevention -- traditionally with surgery. But researchers are now looking at stroke prevention through the use of stents. Stents, which are scaffold-like devices used to hold open narrowed blood vessels, are much less invasive and can be inserted without general anesthesia.

The stroke prevention study was conducted by Jay Yadav, MD, of The Cleveland Clinic, and colleagues and appears in the Oct. 7 edition of The New England Journal of Medicine.

Stroke Prevention With Stents: New Technology

Over the past decade, using stents for stroke prevention has become more popular. However, one of the problems with this procedure has been the risk of debris inside the artery coming loose, going to the brain, and causing a stroke.

A new piece of technology makes stents much more effect for stroke prevention. Called an emboli-protection, this device traps debris "downstream" from carotid artery stents, netting debris before it can travel to the brain and cause a stroke.

The Stroke Prevention Study

The research team wanted to see how the new stent technology fared in comparison to traditional surgery, called endarterectomy, for stroke prevention.

More than 300 participants with blockages of 50% to 80% of their carotid arteries (the vessels that supply blood to the brain) were included in the study. Researchers randomly treated volunteers with stents or surgery.

They also had at least one other condition, such as diabetes, heart failure, high blood pressure, or heart disease that potentially increased their risk of complications from surgery.

As a way to evaluate stroke prevention and other factors, the researchers were looking for the number of patients who died or had a stroke or heart attack within 30 days of the procedures, and those who died or had a stroke up to one year after the procedures.

Nearly 12% of stent patients had one of those results, compared with 20% of surgery patients. After they crunched the numbers, this appeared to be a clinically insignificant difference.

One year after the procedures, fewer stent patients needed to have their carotid artery re-opened, compared with the surgery group.

The researchers conclude that stenting with the emboli-protection device works just as well as surgery for stroke prevention.

However, they caution that findings cannot be generalized to patients at lower risk for surgical complications.

Show Sources

SOURCES: Yadav, J. The New England Journal of Medicine, Oct. 7, 2004; vol 351: pp 1493-1501. Cambria, R., The New England Journal of Medicine, Oct. 7, 2004; vol 351: pp 1565-1567. News release, Loyola University Medical Center. WebMD Medical Reference in collaboration with The Cleveland Clinic: "Heart Failure: Glossary" and "Heart Disease: Carotid Artery Disease." American Stroke Association.
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