More options for the prevention of strokes

(CNS): A new study has found that two very different medical procedures are both equally effective for patients at risk for stroke due to blocked carotid arteries (the arteries in the neck that carry blood and oxygen to the brain). Stroke isthe third leading cause of death in the United States and can be caused by blocked blood flow to the brain, so a number of leading hospitals in the US undertook the CREST (Carotid Revascularization Endarterectomy vs. Stenting Trial) study on more than 2500 patients to see if two separate procedures would be equally effective in treating the condition.

Doctors at Baptist Cardiac and Vascular Institute, one of the participating hospitals in the CREST study, are excited by the results because they say it gives them more options when treating patients, as strokes are often preventable.

The study is the largest study of its kind and looked at the two ways of treating someone who has blocked arteries that might cause a stroke: carotid endarterectomy, which is a surgical procedure in which an incision is made in the neck and then in the artery. The surgeon removes plaque that is blocking the artery and stitches the incisions. The other, newer procedure is called carotid artery stenting. This is less invasive and requires a tiny metal tube called a stent to be threaded up into the blocked artery through a small incision in the groin and then expanded to keep the artery open. No large incisions are involved.

A patient’s medical history and age may dictate which option is best for them. Study investigators discovered that there is a slightly higher rate of heart attack following the surgical procedure versus a slightly higher rate of stroke after stenting. Age also seems to play a role in outcomes. Those over the age of 70 had better results with surgery, while those younger than 70 did better with stents.

Further studies are ongoing to determine whether these differences are significant, and doctors continue to debate the results of the trial.

Doctors say it is essential for patients to discuss their options with their doctor, and to choose a doctor who has performed many cases, whichever treatment method is advised.