Pick One - Surgery or Stents - Both Effective

Reblockage rate similar for stents or surgery as a stroke prevention aid

(RxWiki News) Among heart patients, about 20 percent experience another blockage. That doesn't appear to be the case when opening blocked neck arteries to prevent a stroke. Metal stents appear as effective and durable as surgery.

Two years after the procedure, less than 7 percent of patients of stent or surgical patients experienced a repeat blockage. About 10 percent of strokes are caused by a blockage in the neck artery, and opening this critical artery aids with blood flow and helps prevent a stroke.

"Talk to your cardiologist about which procedure would be best for  you."

Dr. Brajesh K. Lal, lead author of the research and associate professor of vascular surgery at the University of Maryland School of Medicine, and his research team found that repeat blockage rates in the carotid artery were small.

He said the finding should reassure patients and doctors that both stenting and surgery are durable with equivalent re-blockage rates, so that other criteria can be used to determine which procedure is appropriate.

The study was part of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), and patients had partial blockages in the neck artery. Some of the participating patients had experienced a non-disabling stroke or a mini-stroke caused by the blockage.

Of the participants, 1,086 received a metal stent, while 1,105 had a surgical procedure called endarterectomy performed to open the artery. Patients received ultrasound assessments one month, six months, 12 months and 24 months after the procedure to identify participants who had developed a blockage of at least 70 percent in the previously treated area.

After two years researchers found that the two procedures had identical rates of repeat blockage at 5.8 percent. About 0.3 percent of stent patients developed a complete blockage, while 0.5 percent of surgery patients developed a complete blockage. Of the participants, 20 stent patients and 23 surgery patients had a second procedure to reopen a blocked carotid artery.

Investigators also found that re-blockage rates were doubled in women, and patients with diabetes or abnormal cholesterol levels. Stroke rates were four times higher in patients who suffered a repeat blockage.

“These may be groups we need to focus more on by monitoring them closely and aggressively controlling risk factors after the procedures,” Dr. Lal said

Previous research also indicated that the two procedures show no difference among the stroke, heart attack or death rates.

Patients will be monitored for an additional 10 years. The study was funded by the National Institute of Neurological Disorders and Stroke, and Abbott Vascular Solutions, which also donated most of the Acculink and Accunet stent systems used during the study.

The research study was presented Wednesday at the American Stroke Association’s International Stroke Conference 2012 in New Orleans.

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Review Date: 
January 31, 2012