Landmark NIH Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective
Friday, February 26, 2010
CINCINNATI–A major new study of people at risk of stroke showed that two medical procedures designed to prevent future strokes are safe and effective overall.
In a joint announcement at the International Stroke Conference in San Antonio, the National Institute of Neurological Disorders and Stroke and the Mayo Clinic reported today that physicians will now have more options in tailoring treatments for their patients at risk for stroke.
Researchers from 117 centers in the United States and Canada, including the UC Neuroscience Institute and Mayfield Clinic, compared carotid endarterectomy (CEA), a surgical procedure that clears blocked blood flow and is considered the gold standard in preventative treatment, to carotid artery stenting (CAS), a newer and less invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.
One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) involved 2,502 participants over a nine-year period.
CREST compared the safety and effectiveness of CEA and CAS in patients with or without a previous history of stroke. The trial was funded by NINDS, which is part of the National Institutes of Health, and was led by investigators at Mayo Clinic, Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark. There was evidence that people who were younger than 70 did better with stents while those over 70 had better results with the surgery, but the results for all men and women were considered excellent.
Cincinnati’s portion of the trial was led by Mario Zuccarello, M.D., Professor and Interim Chair of the Department of Neurosurgery at the University of Cincinnati and Director of Cerebrovascular Surgery, and Andrew Ringer, M.D., Associate Professor and Director of Endovascular Neurosurgery at UC. Drs. Zuccarello and Ringer are members of the UC Neuroscience Institute and neurosurgeons with the Mayfield Clinic neurosurgical practice.
Stroke, the third leading cause of death in the United States, is caused by an interruption in blood flow to the brain by a clot or bleeding. The carotid arteries on each side of the neck are the major source of blood flow to the brain. The buildup of cholesterol in the wall of the carotid artery, called atherosclerotic plaque, is one cause of stroke. Because people with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, the CREST trial tracked the rate of heart attacks, in addition to stroke and death.
Of the 750,000 strokes recorded in the United States each year, about 38,000 may be attributed to carotid artery stenosis, according to research led by Matthew Flaherty, MD, Associate Professor of Neurology and a member of UCNI.
In CREST, approximately half the patients had recent symptoms due to carotid disease such as a minor stroke, or a transient ischemic attack (TIA), indicating a high risk for future stroke. The other half had no symptoms but were found to have narrowing of the carotid artery on one of a variety of tests assessing carotid narrowing and plaque. Such patients, termed asymptomatic, are at much lower risk of stroke than those with symptoms.
Partial funding for the study was supplied by Abbott, of Abbott Park, Ill., the maker of the stents.
Read the complete news release >>
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The UC Neuroscience Institute, a regional center of excellence, is dedicated to patient care, research, education, and the development of new treatments for stroke, brain and spinal tumors, epilepsy, traumatic brain and spinal injury, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, neuromuscular disorders, disorders of the senses (swallowing, voice, hearing, pain, taste and smell), and psychiatric conditions (bipolar disorder, schizophrenia, and depression).
The only visible sign of Amber Gray’s ordeal is the long slender scar that runs along her forearm. It is the area where a surgeon carefully removed her radial artery, which was needed to bypass a damaged artery in her brain.