Use Of Stents For Blocked Neck Vessels May Be Viable Alternative For Those At High Risk Of Complications From Carotid Endarterectomy

April 06, 1998

DALLAS, April 7 -- Patients at high risk of complications from a surgical procedure which clears blocked blood vessels in the neck were found to be at lower risk of complications when treated with an alternative procedure to prevent stroke.

In a study in today's Circulation: Journal of the American Heart Association, researchers found that some groups of people with neck vessel blockages benefited more when treated with stents -- small coils implanted into a vessel to prop it open and restore regular blood flow -- than with carotid endarterectomy, a procedure in which a surgeon cuts open the neck vessel and removes fatty buildup which restricts blood flow and can lead to a stroke.

Patients who had a previous endarterectomy, were undergoing surgeries on vessels in the neck and in the heart, or had significant blockage in both of their carotid arteries -- the neck vessels which carry blood to the brain -- had a lower incidence of complications during the stenting procedure when compared to the incidence rates of complications from an endarterectomy.

These groups of patients have been shown to have a high incidence (11 percent, 14 percent and 24 percent respectively) of complications when they undergo carotid endarterectomy. In contrast, the incidence rates were lower (5.1 percent, 7.9 percent, 3.6 percent) in the patients getting stents.

Using stents as a way to prevent future strokes is a relatively new practice. For several years, stents have been used to keep open narrowed blood vessels to the heart.

Endarterectomy has been shown to be beneficial in people with carotid artery blockages of 70 percent or more, according to the results of the North American Symptomatic Carotid Endarterectomy Trial presented in February at the American Heart Association's 23rd International Conference on Stroke and Cerebral Circulation.

Surgeons currently using stents as an alternative treatment are attempting to demonstrate the usefulness of stenting as well as the most appropriate patients to receive a stent.

"It is important that a realistic and comprehensive classification of the neurological complications be used when a newly evolving technique such as carotid stenting is evaluated," says Gary Roubin, M.D., director, Center for Endovascular Interventions, Lenox Hill Medical Center, New York City and a co-author of the study. "The importance of independent oversight when the incidence of neurological complications is assessed cannot be overemphasized."

The scientists studied 231 patients at the University of Alabama at Birmingham Hospital who opted for stenting as a preventative measure against stroke. Of the patients in the study, their mean age was 68.7 years -- which immediately puts them at higher risk of stroke because of their age alone.

Within 30 days of the stenting procedure, 17 patients had minor strokes and two others had major strokes.

"When the safety of carotid stenting is evaluated, it is important to note that our patient population has more significant risk factors for stroke than those included in the more recent endarterectomy trials," says Roubin.

The overall incidence of stroke and death in this study was 7.7 percent of the stent-treated vessels. By comparison, the lower-risk patients in the study had a risk of any stroke or death of only 2.7 percent, comparable to results in NASCET.

Co-authors are Atul Mathur, M.D., D.M.; Sriram S. Iyer, M.D.; Chumpol Piamsonboon, M.D.; Ming W. Liu, M.D.; Camilo R. Gomez, M.D.; Jay S. Yadav, M.D.; Hollace D. Chastain, M.D.; Liesl M. Fox, M.S.; Larry S. Dean, M.D. and Jiri J. Vitek, M.D.
NR 98-4885 (Circ/Roubin)

Media advisory: Dr. Roubin can be reached at (212) 434-2609. (Please do not publish telephone numbers.)

American Heart Association

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to