Navigation Links
American Stroke Association Late-Breaking Science Report: Surgery, Stenting to Open Blocked Neck Arteries Similar in Safety, Efficacy, But Show Differences in Stroke, Heart Attack and Death Rates at Certain Ages
Date:2/26/2010

Study highlights:

-- Two ways to open narrowed neck arteries — surgery or stenting — proved similarly safe and effective overall.

-- Younger patients had fewer cardiovascular events with an implanted stent, while older patients had fewer events with the surgical option.

-- Stroke and death rates in the study were the lowest ever reported in a clinical trial, researchers said.

SAN ANTONIO, Feb. 26 /PRNewswire-USNewswire/ -- The two major procedures for opening blocked neck arteries to restore blood flow to the brain proved similar in overall long-term safety and efficacy, but showed differences in stroke and heart attack in the weeks following the procedure, according to late-breaking science presented at the American Stroke Association's International Stroke Conference 2010.

(Logo: http://www.newscom.com/cgi-bin/prnh/20100222/AHSALOGO)

The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), funded by the National Institute of Neurological Disorders and Stroke with supplemental funding by Abbott, is the largest randomized clinical trial comparing the surgical approach (carotid endarterectomy) to the non-surgical approach (carotid stenting) to prevent stroke among patients with and without symptoms.

In endarterectomy, a surgeon cuts into the artery and carefully removes the obstructing plaque from the vessel wall.  Surgeons have relied on endarterectomy for a half century to open narrowed carotid (neck) arteries.  In stenting, which has been used for about 15 years, a balloon catheter is inserted into the artery to open it, and a metal mesh tube is left in place to keep the vessel open.

"We found that the two procedures were similar with regard to the study's primary endpoint —overall incidence of stroke, heart attack and death," said Thomas G. Brott, M.D., lead author of the study and professor of neurology and director for research at the Mayo Clinic campus in Jacksonville, Fla.  "We also found that the rates of these events were low, and that safety for patients with and without symptoms was as good as any reported in any randomized carotid intervention trial."  

Initial findings from CREST came from a median follow-up of about two-and-a-half years.  Some patients have been followed for up to a total of four years.

Brott and his colleagues found that in the 30-day period following the procedure, the rate for stroke was 2.3 percent in the surgical patients and 4.1 percent in the stenting group.  However, the heart attack rate was higher in the surgical group, 2.3 percent, compared to 1.1 percent in the stenting group.  The difference in heart attack and stroke between the two groups was statistically significant, Brott said.

The study also found that the age of the patient made a difference in outcome.  At approximately age 69 and younger, stenting results were slightly better, with a larger benefit for stenting, the younger the age of the patient.  Conversely, for patients older than 70, surgical results were slightly superior to stenting, with larger benefits for surgery, the older the age of the patient.  

In other words, younger patients had fewer events with an implanted stent, while older patients had fewer events with the surgical option, the researchers conclude.

CREST researchers enrolled two types of patients with a partial carotid blockage.  Symptomatic participants had suffered a non-disabling stroke or a transient ischemic attack (TIA) within the previous six months.  Asymptomatic patients had not had a stroke or TIA during the same time span.

Researchers randomized 2,502 patients35 percent were female and 9 percent minorities — to receive either endarterectomy or stenting at more than 100 North American hospitals.  More than 80 percent of the participants had an artery blockage greater than 70 percent.

"It was not a healthy group with regard to risk for stroke, but we believe the group is very representative of patients with severe carotid artery disease," Brott said.

In addition, researchers found that symptomatic and asymptomatic patients, and males and females, had similar outcomes in the surgical and stenting groups.

"These were the lowest rates ever reported" in a randomized clinical trial comparing these procedures, Brott said.  

CREST patients who suffered a heart attack reported a better quality of life after recovery than patients who suffered a stroke.

Advances in technology in opening clogged carotid arteries have occurred since the procedures began.

"For the present, stenting offers a reasonable alternative to carotid artery surgery," Brott said.  "For younger patients, carotid stenting appears to be a very useful tool."

Co-authors include: Gary S. Roubin, M.D., Ph.D.; George Howard, Dr. Ph.; William Brooks, M.D.; Ariane Mackey, M.D.; L. Nelson Hopkins, M.D.; Alice J. Sheffet, Ph.D.; Virginia J. Howard, Ph.D.; Jenifer H. Voeks, Ph.D.; James F. Meschia, M.D.; Brajesh K. Lal, M.D.; Donald E. Cutlip, M.D.; and Wesley S. Moore, M.D.  Author disclosures are on the abstract.

Click here to view the perspective on the trial in a video interview with ASA Expert Perspective: Ralph Sacco, president elect of the American Heart Association.

Statements and conclusions of study authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing science content.  Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

SOURCE American Stroke Association

Back to top
'/>"/>
SOURCE American Stroke Association
Copyright©2010 PR Newswire.
All rights reserved

Related medicine news :

1. Many Older Americans Have Active Sex Lives
2. Despite grumbling, most Americans say they are happy at work
3. Record Number of Americans Lack Health Insurance
4. Longaberger Expands Horizon of Hope Campaign to Build Support for American Cancer Societys Breast Cancer Initiatives
5. AUDIO from Medialink and Pfizer: Number of Uninsured Americans Grows to 47 Million
6. New Survey Shows Americans are Still Concerned About Food Safety, Yet Still Not Smart About What They Like to Eat
7. Novo Nordisk Appoints New Leader of North American Business
8. Amid Improving Life Expectancy Rates, Risk of Premature Death is Still Significant for Americans, New Study Shows
9. Primary biliary cirrhosis more severe in African-American and Hispanic patients
10. AOA President Calls on Congress to Reauthorize SCHIP and Take Action to Ensure Health Care Coverage for All Americans
11. American Chemical Societys Weekly Presspac -- Sept. 5, 2007
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... ... Care.” , The print component of “Revolutionizing Cancer Care” is distributed ... York, Washington DC/Baltimore, and Seattle, with a circulation of approximately 250,000 copies and ...
(Date:2/12/2016)... ... February 12, 2016 , ... A lot has been reported about ... president has access to health and wellness resources most Americans could ever dream of ... individual has a schedule as frenetic as the U.S. President. , In honor ...
(Date:2/12/2016)... ... February 12, 2016 , ... Basketball is a game for everyone, not ... Peety PoppersTM series, sign language translation is featured in the top right of the ... Peety PoppersTM lessons has a sign language translator to teach kids the game and ...
(Date:2/11/2016)... ... 11, 2016 , ... “ HEALING MIND : Five Steps to Ultimate ... by Balboa Press) teaches readers how to become their own therapist. Providing a useful ... McDermott, M.Ed., LCSW, offers an understanding of how to heal one’s inner child using ...
(Date:2/11/2016)... ... 11, 2016 , ... Dr. Sadati’s recent feature in Allure ... with performing procedures, the magazine also highlights that Dr. Sadati has pioneered new ... the most common procedures he performs is his natural facelift. “As people age, ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... , Feb. 11, 2016  Kindred Biosciences, Inc. ... saving and improving the lives of pets, today announced ... of the New Animal Drug Application (NADA) for Zimeta™ ... field study (KB0120) of Zimeta for the control of ... Company. --> --> ...
(Date:2/11/2016)... -- Potrero Medical, Inc., the developer of the Accuryn™ critical ... George M. Rapier, III , MD, to its Board ... WellMed is one of the nation,s largest physician owned practice ... Texas and Florida ... internal medicine practice, he has been instrumental to the company,s ...
(Date:2/11/2016)... Feb. 11, 2016  AfterPill.com is reporting that this ... abstinence for all women who are at risk of ... each year and raises the risks of unprotected sex ... --> According to the Guttmacher Institute, there are ... of child-bearing age, who have sex without the intention ...
Breaking Medicine Technology: