A new study suggests that two different methods of alleviating a major risk factor for heart attack and stroke are equally effective.
Patients who have plaque building up in the carotid arteries in their necks often require invasive surgery to clear it. Surgeons have to open the arteries and remove the plaque. If plaque is not removed, a blood clot can form in the narrowed chamber, which can cause a stroke.
But the new study, published Thursday in The New England Journal of Medicine, suggests that putting a stent in to open the clogged artery can be just as effective at preventing heart attack and stroke.
A stent is a wire mesh tube that holds the artery open to allow for normal blood flow.
Within three years:
- 41 of the 143 patients who had carotid stents had a heart attack or stroke, or died
- 45 of the 117 patients who had open surgery had a heart attack or stroke, or died.
This breakthrough could allow doctors to tailor care to patients based on whether or not they could tolerate the invasive surgery.
Surgery could be dangerous for patients with heart failure or lung disease, or who have had neck surgery, radiation or previous treatment on their carotid arteries.
In a statement, the study's lead author, University of Michigan interventional cardiologist Hitinder Gurm, said: "Patients who are undergoing a procedure want to know that they'll be protected long-term from stroke, and that the procedure is safe. This is the first study to suggest that stents do just as well long-term as surgery, in high-risk patients."
The researchers also concluded that more research is required to corroborate these findings.
The study was conducted by scientists from across the United States, including from the University of Michigan Cardiovascular Centre and Harvard University.
Abstract:
Background: We previously reported that, in a randomized trial, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy for the treatment of carotid artery disease at 30 days and at 1 year. We now report the 3-year results.
Methods: The trial evaluated carotid artery stenting with the use of an emboli-protection device as compared with endarterectomy in 334 patients at increased risk for complications from endarterectomy who had either a symptomatic carotid artery stenosis of at least 50% of the luminal diameter or an asymptomatic stenosis of at least 80%. The prespecified major secondary end point at 3 years was a composite of death, stroke, or myocardial infarction within 30 days after the procedure or death or ipsilateral stroke between 31 days and 1080 days (3 years).
Results: At 3 years, data were available for 260 patients (77.8%), including 85.6% of patients in the stenting group and 70.1% of those in the endarterectomy group. The prespecified major secondary end point occurred in 41 patients in the stenting group (cumulative incidence, 24.6%; Kaplan-Meier estimate, 26.2%) and 45 patients in the endarterectomy group (cumulative incidence, 26.9%; Kaplan-Meier estimate, 30.3%) (absolute difference in cumulative incidence for the stenting group, -2.3%; 95% confidence interval, -11.8 to 7.0). There were 15 strokes in each of the two groups, of which 11 in the stenting group and 9 in the endarterectomy group were ipsilateral.
Conclusions: In our trial of patients with severe carotid artery stenosis and increased surgical risk, no significant difference could be shown in long-term outcomes between patients who underwent carotid artery stenting with an emboli-protection device and those who underwent endarterectomy.
