Stents May Be Efficient Defense Against Stroke

Stents May Be Efficient Defense Against Stroke.


Both stents and usual surgery appear to be equally impressive in preventing strokes in people whose carotid arteries are blocked, according to into or presented Friday at the American Stroke Association's annual meeting in San Antonio continue. However, a assist stents-versus-surgery trial, published Thursday in The Lancet, seemed to give surgery better marks, so the jury may still be out on which advance is better in shielding patients from stroke.



So "I think both procedures are smashing and I'm happy to say we have two good options to treat patients," said Dr Wayne M Clark, professor of neurology and chief of the Oregon Stroke Center, Oregon Health Sciences University in Portland, and a co-author of the thrombosis association study. "I believe the ASA trial is really a positive for both stenting and surgery," said Dr Craig Narins, mate professor of medicine at the University of Rochester Medical Center in New York, who was not labyrinthine with the study. "I think this is going to change the way that physicians look at carotid artery disease extra resources.".



That study, the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), was funded by the US National Institute of Neurological Disorders and Stroke and Abbott, which makes the carotid stents. "There has been a lot of skepticism about the know-how of stenting to correspondent surgery and this grief pretty nicely shows that it does regular it overall".



But the findings from CREST need to be squared with the second trial, the International Carotid Stenting Study (ICSS). That European probationary found that surgery remained superior to stenting in the short-term, and stenting did not appear to be as unhurt as surgery. "They're very similar studies, although the European [ICSS] scrutiny didn't use embolic protection devices which are the standard of care in the US That could have skewed the results".



Embolic guardianship devices are tiny parachute-like devices placed downstream from a stent to safely drawback dislodged materials. Nevertheless "nothing is going to change overnight. It's a sea metamorphose because surgery has been the standard of care for so long. This is very positive for stenting but the European trial inserts a note of caution."



In carotid endarterectomy (CEA) surgery, doctors damage away the built-up plaque that is causing a narrowing of the artery supplying blood to the brain. In contrast, the stenting drill involves inserting a wire network device to prop the artery open. Carotid artery c murrain is one of the leading causes of stroke and occurs when the arteries leading to the brain become blocked.



The CREST examine is the largest clinical trial comparing these two approaches. In all, 2502 patients were randomly picked to make either CEA surgery or carotid artery stenting. The researchers did use embolic defence devices for the stenting procedure. Overall, there was no difference between the two procedures with a 7,2 percent hazard of stroke, heart attack and death in the stenting arm of the trial, versus 6,8 percent for surgery. The base follow-up was 2,5 years.



In the first 30 days after the procedures, there also was not any difference in heart attack, stroke or death risk between the two procedures overall: 5,2 percent with stenting and 4,5 percent with surgery. Death rates were adverse in both groups, although the take to task of all strokes (small, medium, large) was higher in the stented group, 4,1 percent versus 2,3 percent. The price of large strokes was the same.



Heart affect rates were higher in the surgery group compared with the stenting group (2,3 percent versus 1,1 percent), which was "highly significant." The overall findings applied to both patients with symptoms and those without symptoms and to men and women, said sanctum leading author Dr Thomas Brott, professor and skipper of neurology at the Mayo Clinic in Jacksonville, Fla.



Surprisingly, "there was a slight dominance to surgery for those over 70 which became greater for those as they got older. There was an advantage for those under the age of 70 which got greater as one was younger from that selective point." In the ICSS trial, which involved over 1700 patients followed for four months, risks for stroke, ticker attack or death were higher in the stented group (8,5 percent) versus those who got the artery-scraping surgery (5,2 percent).



Based on those findings, researchers led by Martin Brown, of The National Hospital for Neurology and Neurosurgery, London, concluded that "completion of long-term backup is needed to confirm the efficacy of curing with a carotid artery stent compared with endarterectomy. In the meantime, carotid endarterectomy should abide the treatment of choice for symptomatic patients suitable for surgery."



In the end, approaches to clearing clogged carotid arteries may be incontrovertible on a case-by-case basis reviews. "I regard patient preference will play a big role but older patients may do better with surgery and younger patients may incline towards the less invasive option".

tag : surgery stenting carotid percent stroke patients trial artery versus

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Author:ivankuleshov
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