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Stents and surgery for blocked neck arteries are neck-and-neck as lasting stroke prevention
Date:2/1/2012

this case, the data will help inform patient treatment that may help reduce the toll of stroke, the number four cause of death and the leading cause of adult disability in the United States."

The study participants were part of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). A previous CREST analysis showed no difference in the rates of stroke, heart attack or death among patients undergoing surgical removal of a blockage (carotid endarterectomy) or stenting.

In the new multi-center analysis, the largest to compare re-blockage rates after either procedure, 1,086 patients received stenting and 1,105 received endarterectomy. All were assessed at one, six, 12 and 24 months after the procedure with an ultrasound to identify those who had developed a 70 percent or greater blockage in the treated section.

After two years, the researchers found:

  • Identical rates of recurring blockage (restenosis) at 5.8 percent after stenting and endarterectomy.
  • Complete blockage (occlusion) in 0.3 percent after stenting and 0.5 percent after endarterectomy.
  • Combined restenosis/occlusion in six percent after stenting and 6.3 percent after endarterectomy.
  • Twenty stent patients and 23 endarterectomy patients had undergone a second procedure to open a re-blocked carotid.
  • Rates of restenosis were about double in women and patients with diabetes and abnormal lipid levels.
  • Stroke rates were 4 times higher in patients who developed a restenosis compared to those that did not develop a restenosis during follow-up.

Physicians participating in the study underwent standardized training and credentialing in the two procedures and the research protocol included a standardized way to measure restenosis. Monitoring of CREST participants will continue for 10 years.

Dr. Lal says this analysis is prompting physicians to re-think the role of stents to prevent stroke. Based on the coronary arte
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Contact: BILL SEILER
bseiler@umm.edu
410-328-8919
University of Maryland Medical Center
Source:Eurekalert

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