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Age is a factor in choosing between two comparable stroke-prevention procedures
Date:5/28/2010

o-investigator.

CREST investigators did see more heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group, and they did see more strokes in the stenting group, 4.1 percent versus 2.3 percent for the surgical group in the weeks following the procedure. Overall the study found a lower stroke rate following surgery and a lower heart-attack rate after stenting a year after their procedure.

"The age-difference issue is one of the most important findings of the study, though the two treatments really were practically identical in their benefit of patients at age 70, Howard says. "At younger and younger ages, the benefit of stenting became better and better than surgery. However, this benefit of stenting was offset by better outcomes of surgery at older and older ages."

CREST is one of the largest randomized stroke-prevention trials in history, involving 2,502 patients at 117 centers in the United States and Canada during a nine-year period. It is funded by the National Institute of Neurological Disorders and Stroke (NINDS) and led by Thomas G. Brott, M.D., of the Mayo Clinic in Jacksonville, Fla. Twenty-one CREST patients are enrolled in Alabama under the medical direction of William Jordan, M.D., chief of vascular surgery at UAB.

Because people with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, the CREST trial tracks the rate of heart attacks, in addition to stroke and death. The average age of CREST patients is 69.

In CREST, approximately half of the 2,502 patients had recent symptoms due to carotid disease such as a minor stroke, often called a transient ischemic attack (TIA), indicating a high risk for future stroke. The other half of patients had no symptoms, but they were found to have narrowing of the carotid artery on one of a variety of tests assessing stroke risk.


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Contact: Troy Goodman
tdgoodman@uab.edu
205-934-8938
University of Alabama at Birmingham
Source:Eurekalert

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