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.
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NR 98-4885 (Circ/Roubin)

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 (Please do not publish telephone numbers.)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

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