Preventing Strokes: Stents vs. Surgery
In a three - year follow - up study, a less invasive alternative to plaque-clearing neck arthritis is as effective as surgery to prevent stroke in high-risk patients.
In 260 patients who were considered less than optimally operated candidates at high risk for strokes, carotid artery stenting was compared to open neck operation. Stenting is used to routinely open coronary arteries, with plaque obstructed and causing heart attacks. But the experimental therapy for opening the obstructed neck arteries that lead to strokes is still largely considered.
The newly published results are the first to be comparable to surgery for high - risk patients for , Interventional Cardiologist.
The research was founded by Johnson and Johnson's Cordis, who produced a stent used in the study. The study was written in the April 10 issue of the New England Journal of Medicine. "These are the first data we need to suggest the similar long-term advantages of these two processes, says. "But the results are for patients at high risk only; studies of the lower-risk populations are currently underway, and more are expected in the next few years."
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Stent vs. Surgery
The study was conducted in 29 hospitals throughout the United States. Everyone was considered to be at greater risk for advanced age (over 80), co-morbid conditions (heart insufficiency, advanced coronary artery disease, pulmonary disease) or history of neck surgery or radiation. Most have carotid artery artery symptoms.
About half of the patients have been treated with surgery, called carotid endarterectomy, involving the opening of the blocked carotid artery to remove the accumulated plaque manually. The other half had a stall–small mesh tubes threaded from an incision in the arm or groin in the neck artery. The filter was also used during stent implantation to capture plaque and other debris released from the arterial walls during the procedure.
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The second half had stones-tiny mesh tubes threaded from the incision of the arm or groin into the artery of the neck. During stent implantation, a filter was also used to capture plaque and other debris freed from the walls of the artery. 41 of 143 study-treated patients and 45 out of 117 surgical treatments had a heart attack or stroke or died within three years of the participants available to follow-up. Most deaths were caused by heart or other non-stroke causes.
Strokes accounted for approximately one-third of the adverse events, but most of them were not sufficiently serious to threaten lives.
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Follow-up Needed
The results suggest that surgery and stenting results are similar in patients at high risk, but that doesn't mean stenting is always the best choice for this group, says. Importantly, some patients treated with medicine alone were not included in this test. "The first thing to discuss with your doctor is if a patient who has a high operational risk needs either procedure," he says. If yes, then a doctor's previous experience with surgery or stenting should be the next consideration.
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