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Carotid stenting the new anti-depressant?
July 25, 2006Oak Brook, Ill. - Inserting a stent to open a narrowed carotid artery has been found to reduce symptoms of depression that may be associated with carotid stenosis, according to a study in the August issue of Radiology.
"The patients in this study who received carotid stenting showed significantly fewer depressive symptoms than those who did not," said the study's lead author Wolfgang Mlekusch, M.D., specialist of clinical angiology and internal medicine at Vienna General Hospital and Medical School in Vienna, Austria.
Carotid stenosis is caused by the formation of plaque within the carotid artery, which supplies blood to the brain. The build-up of plaque narrows the opening in the artery and can lead to stroke. Until recently, surgery was the standard treatment for this disease, but carotid stenting has emerged as an accepted minimally invasive alternative to restore blood flow to the brain. To perform the procedure, an interventional radiologist uses an image-guidance system such as computed tomography and a guide wire to reach the site of the narrowing in the artery, expands the artery with a balloon and inserts a stent to hold the artery open.
According to the National Center for Health Statistics, cerebrovascular disease is the third leading cause of death in the United States. Recent studies have shown that some depressive disorders may be caused by cerebrovascular diseases such as carotid stenosis, which restrict blood flow to the brain. These disorders are collectively known as "vascular depression."
Dr. Mlekusch and colleagues studied 143 patients with carotid stenosis and 102 age- and gender-matched controls with peripheral artery disease (PAD) scheduled to undergo lower-limb angioplasty, a surgical procedure. All patients were tested for depressive symptoms based on the Beck Depression Inventory (BDI). BDI scores of 10 or above indicate substantial depressive symptoms.
Patients with a high level of carotid stenosis (greater than 80 percent) more frequently exhibited substantial depressive symptoms compared to controls. Forty-eight (33.6 percent) of the patients with carotid stenosis presented with depressive symptoms, compared with 17 (16.7 percent) of the control patients.
Four weeks after carotid stenting, the BDI questionnaire was administered again. This time only 9.8 percent of the patients with carotid stenosis exhibited depressive symptoms compared with 13 percent of the patients who had undergone angioplasty.
"Our findings suggest that opening the carotid artery and restoring blood flow to the brain via a minimally invasive technique under local anesthesia is associated with significant reduction in depressive symptoms," Dr. Mlekusch said. "We were able to demonstrate a clear neuropsychological benefit to patients after carotid stenting."
Dr. Mlekusch believes that stenting has now gained a major advantage over surgical treatment and should be the therapy of choice for stenosis. However, he cautions that while carotid stenting may be able to reduce symptoms associated with vascular depression, it is not a cure or treatment for major depression.
Radiological Society of North America
According to the National Center for Health Statistics, cerebrovascular disease is the third leading cause of death in the United States. Recent studies have shown that some depressive disorders may be caused by cerebrovascular diseases such as carotid stenosis, which restrict blood flow to the brain. These disorders are collectively known as "vascular depression."
Dr. Mlekusch and colleagues studied 143 patients with carotid stenosis and 102 age- and gender-matched controls with peripheral artery disease (PAD) scheduled to undergo lower-limb angioplasty, a surgical procedure. All patients were tested for depressive symptoms based on the Beck Depression Inventory (BDI). BDI scores of 10 or above indicate substantial depressive symptoms.
Patients with a high level of carotid stenosis (greater than 80 percent) more frequently exhibited substantial depressive symptoms compared to controls. Forty-eight (33.6 percent) of the patients with carotid stenosis presented with depressive symptoms, compared with 17 (16.7 percent) of the control patients.
Four weeks after carotid stenting, the BDI questionnaire was administered again. This time only 9.8 percent of the patients with carotid stenosis exhibited depressive symptoms compared with 13 percent of the patients who had undergone angioplasty.
"Our findings suggest that opening the carotid artery and restoring blood flow to the brain via a minimally invasive technique under local anesthesia is associated with significant reduction in depressive symptoms," Dr. Mlekusch said. "We were able to demonstrate a clear neuropsychological benefit to patients after carotid stenting."
Dr. Mlekusch believes that stenting has now gained a major advantage over surgical treatment and should be the therapy of choice for stenosis. However, he cautions that while carotid stenting may be able to reduce symptoms associated with vascular depression, it is not a cure or treatment for major depression.
Radiological Society of North America
Carotid Stenting Current Events and Carotid Stenting News RSSStudy shows safety and efficacy of blood flow reversal system used during carotid stenting
Results of a study on an embolic protection system during carotid stenting that uses a novel blood flow reversal system was reported today during the 20th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).
Study reveals embolic neuroprotection system reduces risk of cardiac events
Results of a study on the use of the FiberNet® Embolic Protection System in carotid artery stenting were reported today during the 20th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).
SAPPHIRE trial shows long-term benefit of carotid stenting as alternative to surgery
Carotid artery stenting is an effective option for high risk patients who are not eligible for surgery, according to a long-term study published in this week's New England Journal of Medicine. Carotid artery disease, which involves clogging of the arteries in the neck that provide blood to the brain, is a significant risk factor for stroke, making these study results important for the estimated 200,000 Americans each year who would otherwise not be candidates for the treatment.
Research sheds light on carotid artery stenting risk in elderly
Dr. Hernan Bazan, Assistant Professor of Surgery, Section of Vascular Surgery, at Louisiana State University Health Sciences Center New Orleans' School of Medicine, is the lead author of a research paper which may help physicians decide which patients with carotid artery occlusive disease should have carotid surgery or carotid stenting.
2 carotid artery stenting studies show results comparable to AHA guidelines
Two carotid stenting trials examining patient outcomes demonstrated results that are comparable to guidelines established by the American Heart Association (AHA) for patients treated with carotid artery surgery.
Broad-based group of physicians calls for improvement in stroke treatment
A coalition of physicians representing a wide range of medical specialties has issued a call to action to improve the treatment of stroke.
Cerebral embolic protection and carotid stent systems
High-risk surgical patients in community hospital settings can safely benefit from the use of new embolus-removing and stent-inserting systems, according to a study presented today at the American College of Cardiology's Innovation in Intervention: i2 Summit in New Orleans, La.
Training on virtual 'patient' improves carotid angiography skills
Cardiologists can learn to perform risky catheter procedures such as carotid angiography on a virtual patient simulator, rather than on real patients, according to a new study in the May 2, 2006, issue of the Journal of the American College of Cardiology.
New generation of cardiac interventions, therapies optimize heart disease care
Research presented today at the American College of Cardiology's 55th Annual Scientific Session and the inaugural Innovation in Intervention: i2 Summit 2006 in Atlanta, Ga., highlights critical advances in the treatment of cardiovascular disease.
Three-year SAPPHIRE and US carotid feasibility trials demonstrate durability of carotid stenting
Preliminary three-year data from the SAPPHIRE and final three-year data from the U.S. Carotid Feasibility Study (USFS) presented at the 2005 Transcatheter Cardiovascular Therapeutics meeting, demonstrate the long-term durability of carotid artery stenting (CAS) for the prevention of stroke versus carotid endarterectomy (CEA) in high risk surgical patients.
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