Navigation Links
New Bypass Surgery for Stroke Riskier Than Drug Treatment

By Steven Reinberg
HealthDay Reporter

TUESDAY, Nov. 8 (HealthDay News) -- To prevent stroke in certain high-risk patients -- those with a blocked neck artery who have already had a so-called "mini-stroke" -- drug treatment appears as effective and far less risky than bypass surgery, researchers find.

Their study evaluated nearly 200 patients, about half of whom had carotid artery bypass surgery. In the 30 days after surgery, patients had a 14 percent risk of having a stroke, compared with a 2 percent risk among those treated medically, the study found.

"We were trying to figure out a way of taking people who were at high risk of having stroke and prevent that from happening," said lead researcher Dr. William Powers, chairman of adult neurology at the University of North Carolina School of Medicine, at Chapel Hill.

"The unfortunate part is that we didn't do that," Powers said. "If you made it through the surgery, your risk of having a stroke was 6 percent, but, unfortunately, the risk of having a stroke from surgery was 15 percent," he said. "This procedure should not be used for this propose."

Powers added that despite this failure, they are still looking for a safer way to get blood to the brain in patients who have a completely blocked carotid artery, the large blood vessel in the neck. "We are hoping to take what we learned and take the same type of patients and try a catheter stent-based approach," he said.

The study appears in the Nov. 9 issue of the Journal of the American Medical Association.

The surgical procedure is called extracranial-intracranial arterial bypass surgery. It involves drilling a hole in the head and attaching a blood vessel from the scalp to one of the blood vessels of the brain, bypassing the blockage in the neck, Powers explained.

In the trial, called the Carotid Occlusion Surgery Study, Powers' team randomly assigned 195 patients to carotid bypass surgery or medical management. These patients were at a high risk of having a stroke, with a 23 percent risk of having one within two years, according to Powers.

Based on early findings, the trial was stopped. Over a two-year period, the researchers found that 21 percent of the patients who had surgery died or had a stroke, compared with 22.7 percent of those on medical therapy alone -- which is not a significant difference, Powers said.

Moreover, at 30 days after surgery, 14.4 percent of the surgical patients had a stroke, compared with 2 percent of those on medical therapy. That's a 12.4 percent difference, Powers' group noted.

Commenting on the study, Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine and past president of the American Heart Association, said that "medical therapy with anti-clotting drugs, blood pressure and cholesterol-lowering drugs has improved over the years, which makes it more effective.

"Current guidelines would say there is no indication for pursuing a bypass in these patients," Sacco added. "The Heart Association says the procedures should be done with less than a 6 percent perioperative risk in symptomatic patients and 3 percent in asymptomatic patients." Perioperative refers to the period of hospitalization for surgery.

Looking at a larger picture, Dr. Joseph Broderick, professor of neurology at the University of Cincinnati College of Medicine and co-author of an accompanying journal editorial, said the effectiveness of any new therapy needs to be demonstrated before it can be used.

"Potential new therapies, particularly endovascular reopening of occluded arteries by devices, need to be tested against the standard proven approach of intravenous tPA [a drug that breaks up clots and is standard therapy for stroke]," he said.

"Yet, these devices are already being used in clinical practice since they have been cleared by the FDA for use and are currently reimbursed by Medicare for acute stroke treatment despite a lack of evidence that they improve clinical outcome in acute stroke patients as compared to standard therapy," Broderick said.

This happens because the rules for U.S. Food and Drug Administration approval and Medicare reimbursement of devices are different from the rules for approving drugs, he said. This makes it harder to get people to take part in clinical trials of devices, because they are in use before they are clinically proven to work, he added.

More information

For more information on stroke, visit the American Stroke Association.

SOURCES: William J. Powers, M.D., H. Houston Merritt Distinguished Professor and Chairman Adult Neurology, University of North Carolina School of Medicine, Chapel Hill; Joseph P. Broderick, M.D., Albert Barnes Voorheis Chair of Neurology, University of Cincinnati College of Medicine; Ralph Sacco, M.D., Chairman of Neurology, University of Miami Miller School of Medicine; Nov. 9, 2011, Journal of the American Medical Association

Copyright©2010 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. New method to grow arteries could lead to biological bypass for heart disease
2. Gastric bypass surgery increases risk of kidney stones
3. Dr. Feiz ( Asks: What Is Better for You? Lap Band Surgery/Realize Band Surgery or Gastric Bypass Surgery
4. EXCEL trial will determine safety and efficacy of drug-eluting stents vs. bypass surgery
5. Newer Blood Thinner Beats Plavix for Bypass Patients
6. UCLA study compares bypass surgery to angioplasty
7. AMD risk on the rise for Asians; retinal vein bypass may help many CRVO patients
8. Heart bypass for uncomplicated heart surgery does not reduce neurocognitive function in children
9. Study finds more Americans bypassing their personal physician when immediate treatment required
10. Arm Artery No Better Than Leg Vein for Heart Bypass, Study Finds
11. Heart Enzymes May Predict Outcome After Bypass Surgery
Post Your Comments:
Related Image:
New Bypass Surgery for Stroke Riskier Than Drug Treatment
(Date:11/26/2015)... ... November 26, 2015 , ... WorldCare ... participated in the 61st annual Employee Benefits Conference. The Employee Benefits Conference was ... November 8th through Wednesday, November 11th, 2015. The conference was held at the ...
(Date:11/26/2015)... ... November 26, 2015 , ... ... has collaborated with Women’s Web – an online resource for Indian women ... mental and emotional well-being relationship, life balance, stress, professional development, and lifestyle. ...
(Date:11/25/2015)... , ... November 25, 2015 , ... ... more aggressive than those found on mammography, according to a study published online ... additional cancers not seen on mammography may necessitate a change in treatment. , ...
(Date:11/25/2015)... ... November 25, 2015 , ... The holiday season ... and pleasing the palates of attendees is of the utmost importance. Whether you ... seasonal get-together, give these recipes a try this holiday season. , Turkey Croquettes ...
(Date:11/25/2015)... ... November 25, 2015 , ... Medical Solutions, one ... for its stellar workplace culture with the company’s Cincinnati office being named a ... Cincinnati office was named a finalist in Cincinnati Business Courier’s 13th annual Greater ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 2015 --> ... combineert immunotherapie met Bremachlorin-photodynamische therapie voor de ... ) --> ... ) Uit een ... (LUMC) blijkt dat ...
(Date:11/26/2015)... , November 26, 2015 ... addition of the "2016 Future Horizons ... of Abuse Testing Market: Supplier Shares, Country ... report to their offering. --> ... the "2016 Future Horizons and Growth ...
(Date:11/26/2015)... November 26, 2015 ... addition of the  "2016 Future Horizons ... Therapeutic Drug Monitoring (TDM) Market: Supplier ... Emerging Opportunities"  report to their offering.  ... announced the addition of the  "2016 ...
Breaking Medicine Technology: