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:5/3/2016)... ... ... Branches, Inc. is proud to have been selected as a Macy’s grant ... Miami. Macy’s is a wonderful community partner and has helped to support Branches’ student ... and academic support to elementary students 5 days a week. Summer Shade, a 7 ...
(Date:5/3/2016)... City, UT (PRWEB) , ... May 03, 2016 , ... ... Utah, recently announced that its Allegro Anti-aging Cream, a revolutionary new anti-aging skin ... signs of aging and repair damaged skin, has sold over seventy-five thousand units worldwide ...
(Date:5/3/2016)... , ... May 03, 2016 , ... Dave Newberry, broker/owner ... Interim Care Center (PICC) annual fundraiser luncheon on Friday, May 20. “We have ... the smallest victims of drug abuse,” said Newberry. , PICC is a local Kent, ...
(Date:5/2/2016)... ... 2016 , ... RNK Products, Inc. (RNK) is beta testing ... the stethoscope stream to go over the video conferencing audio channel. This ... , Remote auscultation involves two software elements on the PC: , 1)    Network transport ...
(Date:5/2/2016)... , ... May 02, 2016 , ... ProElectric Cartoon is ... Pro X. Pick and choose from a variety of electric styles including zap, sizzles, ... Users can customize shadow, dof blur, three dimensional rotation, and much more. ProElectric Cartoon’s ...
Breaking Medicine News(10 mins):
(Date:5/2/2016)... YORK , May 2, 2016 Kalorama ... EMR (Electronic Medical Records) market in a recent white ... sales, vendor switches, Increased physician usage, a growing market are ... were noted in Kalorama,s report EMR 2016: ... report marks Kalorama,s seventh complete study of the EMR ...
(Date:5/2/2016)...  Celsion Corporation (NASDAQ: CLSN ), an ... the first cohort of patients in its Phase ... combining GEN-1, the Company,s DNA-based immunotherapy, with the ... patients with advanced ovarian cancer who will undergo ... the first three patients dosed, GEN-1 plus standard ...
(Date:4/29/2016)... Jersey , April 29, 2016 ... Suite for Life Sciences, Product Development Capabilities in ... Life Science Customer Base . ... provider, today announced the acquisition of Skura Corporation,s ... global leader in adaptive sales enablement technology for ...
Breaking Medicine Technology: