People at elevated risk for stroke can now undergo a preventive procedure dramatically less debilitating than surgery, doctors have found in a major study released Friday.
The largest analysis of its kind compared the effectiveness of surgery to a minimally invasive placement of a vessel-opening stent. The result: Stents are as good as surgery.
Until now, said researcher Dr. George Petrossian of St. Francis Hospital in Roslyn, the therapeutic gold standard in stroke prevention has been surgically removing plaque - reaming it out of the carotid arteries, located on both sides of the neck.
"This is a huge step forward for this procedure," said Petrossian, who led the Long Island arm of the eight-year analysis that involved 30 local patients. Petrossian, who has performed carotid stenting since 1997, said he has treated 300 patients with stents to prevent strokes.
Obstructed carotid arteries can block blood flow to the brain, prompting a stroke - a brain attack - just as clogged coronary arteries can result in a heart attack.
The investigation, involving 2,502 patients in the United States and Canada, showed that stent placement can offer not only a less invasive option but quicker recovery.
A stent is a wire mesh tube. It is mounted on a balloon that is attached to a thin wire threaded through the aorta and guided to the artery in the neck. Stents work by pressing the blockage of goo - plaque - back against artery walls, while enabling the free-flow of blood.
Currently, federal regulators approve carotid stenting only for patients who are too debilitated for surgery. Petrossian hopes the new results make stenting an option for all patients treated for stroke prevention.
The research was declared a landmark by the National Institutes of Health Friday. Stroke, which affects 795,000 people annually, disproportionately affects people 65 and older.
Results of the study were presented by a team of investigators at the International Stroke Conference in San Antonio.
"There was evidence that people who were younger than 70 did better with stents while those over 70 had better results with the surgery, but the results for all men and women were excellent," said Dr. Thomas Brott, the study's lead investigator and director of research at the Mayo Clinic in Jacksonville, Fla.
About half the people in the study had experienced a mini-stroke or TIA, a transient ischemic attack. The rest had plugged carotid arteries.
On Friday, European physicians published a paper in the online edition of the journal, The Lancet, urging caution. The European results showed a higher rate of complications.
Brott said Americans have been using stents longer, with greater success, and physicians here use a different kind of stent than used in the European trial.