Neck artery stents may not be worthwhile in 'real world' setting

(HealthDay)—Placing stents in the neck arteries, to prop them open and help prevent strokes, may be too risky for older, sicker patients, a new study suggests.

In fact, almost a third of Medicare patients who had stents placed in their neck (carotid) arteries died during an average of two years of follow-up.

"Death risks in older Medicare patients who underwent carotid artery stenting was very high," said lead researcher Dr. Soko Setoguchi-Iwata, an assistant professor of medicine at Harvard Medical School in Boston.

Placing a stent in a carotid artery is a way to prevent strokes caused by the narrowing of the artery. A stent is a tiny mesh tube that is placed into an artery to keep blood flowing, in this case to the brain. Although clinical trials have shown success with this procedure, this study looked at the technique in a real-world setting, the researchers explained.

Previous studies have estimated that carotid artery stenting reduces the risk of stroke by 5 percent to 16 percent over five years, Setoguchi-Iwata said. But this study suggests the real benefit is not as great, she said.

The high death rate is likely due to these patients' advanced age and other medical conditions, Setoguchi-Iwata said. "Another potential contributing factor is that the proficiency of the real-world providers of carotid stenting likely vary, whereas trial providers had to meet certain proficiency criteria," she added.

Setoguchi-Iwata doesn't know how these death rates compare with similar patients who didn't have the procedure. "We were not able to compare the mortality rate to those who did not get the stent, as we did not have the ability to identify those without stents," she said.

"The decision to do the procedure should be based on not only evidence from trials but also data like ours on the overall survival, as well as on the risk of complications and their impact on quality of life," she said.

The report was published online Jan. 12 in the journal JAMA Neurology.

For the study, researchers collected data on more than 22,500 Medicare patients, average age 76, who had neck artery stenting between 2005 and 2009.

Within 30 days after the procedure, almost 2 percent of the patients died, 3 percent suffered a stroke or mini-stroke, and 2.5 percent had a heart attack, the researchers found.

Two years later, 32 percent of the patients died. The death rate was highest among those with symptoms, such as plaque in the artery (37 percent), and lowest among those without symptoms (28 percent). In addition, patients who were at least 80 years old and who did not have the surgery as an elective procedure were among those with the greatest risk of dying, the researchers found.

Dr. Mark Alberts, a professor in the department of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center in Dallas, and author of an accompanying journal editorial, said, "Treating an artery may not really be treating the patient, since they are dying from other reasons than a plugged artery in the neck. We need to better understand the risk factors these patients have."

Patients need to have their risks evaluated before having this procedure, Alberts said, and that should include an evaluation of their risk for stroke and their overall medical condition.

"As with any procedure, patients need to live long enough to benefit from the procedure," he said.

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