Stroke Prevention Surgery May Backfire

Stroke prevention surgery may increase likelihood of early stroke and death

(RxWiki News) To prevent repeat strokes, surgeons are adapting the same methods used to open blocked heart arteries to open brain arteries. This technique, however, may not be as safe as more traditional therapies.

Traditionally, stroke patients take medications and follow lifestyle changes, such as exercising and eating healthy, to help avoid a repeat stroke. Today, physicians can place a stent (a small mesh tube) in a narrowed brain artery to improve blood flow.

But researchers recently found that this surgery was not as effective as medical therapy and lifestyle changes.

"Quit smoking to greatly reduce your risk of stroke."

Colin Derdeyn, MD, professor of radiology at Washington University School of Medicine in St. Louis and director of its Stroke and Cerebrovascular Center at Barnes-Jewish Hospital, led this study following 451 individuals at high risk of having a repeated stroke. He collaborated with researchers at Washington University School of Medicine, the Medical University of South Carolina, Emory University and the State University of New York at Stony Brook.

All patients had at least 70 percent narrowing in a brain artery that had already caused a stroke or a transient ischemic event (often called a mini stroke).

Participants were placed in one of two groups. Patients in both groups received medications to prevent clot formation and to lower cholesterol and blood pressure. The 224 individuals in one group, however, also had a metal stent surgically implanted in the narrowed artery.

Lifestyle modification coaches also consulted with all the patients and urged them to eat healthy, lose weight, exercise more and stop smoking.

Based on analysis after tracking patient progress for at least two years and for as long as four years, the researchers found that 26 percent of the stented group had had a stroke versus 19 percent in the non-stented group. About 13 percent of those with stents had a major hemorrhage versus 4 percent in the non-stented group.

At about 32 months, the researchers noted that 23 percent of the stented group had a primary endpoint event (stroke or death) versus 15 percent of the non-stented patients.

Called the SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial, this study stopped enrollment when it became clear that stenting was associated with a higher risk of early strokes and death.

“Surgical interventions often have increased risk of complications early on, so we continued to follow the patients to see if the long-term effects of surgery were beneficial,” said Dr. Derdeyn in a press release. “That did not turn out to be the case.”

He added, "This proves that medical therapy is better than surgery for these patients."

This study was published in The Lancet on October 26, the same day scientists presented findings at the joint meetings of the 6th International Conference on Intracranial Atherosclerosis and the 6th annual meeting of the Society of Vascular and Interventional Neurology in Houston.

Funding was received from the National Institute of Neurological Disorders and Stroke (NINDS).

Review Date: 
October 27, 2013