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New Bypass Surgery for Stroke Riskier Than Drug Treatment
Date:11/8/2011

ery 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 reim
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