National stroke prevention study reveals surgery and stenting equally effective

February 26, 2010
Graphic shows how carotid artery stents help prevent strokes

(PhysOrg.com) -- A major study shows that a minimally-invasive procedure is as effective and safe as the gold standard for treating blockages of the carotid artery, giving patients who prefer a less invasive procedure a proven alternative.

The Methodist Hospital in Houston is a top 10 enrolling site for the CREST study (Carotid Revascularization Endarterectomy vs. Stenting Trials), funded by the National Institute of Neurological Disorders and , part of the National Institutes of Health.

CREST, a randomized clinical study, compared carotid endarterectomy, a common operation to treat a narrowing of the carotid artery, with the study procedure, carotid artery stenting. During stenting, a is used to deliver a stent into the carotid artery, where the stent can expand and widen the blocked area and capture any dislodged plaque. In the trial of 2,502 participants, results showed that people at risk for stroke can benefit equally from either medical procedure, designed to prevent future strokes.

Dr. Michael DeBakey performed the first carotid endarterectomy in 1953 at The Methodist Hospital.

“More than 55 years later, Dr. DeBakey’s legacy continues. He helped us set the standard for how we treat this population of patients, and now we have another viable treatment option,” said Dr. David Chiu, CREST principal investigator at Methodist and medical director of the Eddy Scurlock Stroke Center at the Methodist Neurological Institute.

One of the largest randomized stroke prevention trials ever, CREST took place at 117 centers in the United States and Canada over a nine-year period. The overall safety and efficacy of the two procedures was largely the same with equal benefits for both men and for women, and for patients with or without a previous stroke.

The study also found that the age of the patient made a difference.? At approximately age 69 and younger, stenting results were slightly better, with a larger benefit for stenting the younger the age of the patient.? For patients older than 70, surgical results were slightly superior to stenting, with greater benefits for surgery the older the age of the patient.

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.

In CREST, approximately half the patients had recent symptoms due to carotid disease such as a minor stroke, or a transient ischemic attack, indicating a high risk for future stroke. The other half had no symptoms but were found to have narrowing of the 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, the maker of the .

Related Stories

Recommended for you

Touching helps build the sexual brain

September 21, 2017
Hormones or sexual experience? Which of these is crucial for the onset of puberty? It seems that when rats are touched on their genitals, their brain changes and puberty accelerates. In a new study publishing September 21 ...

Gene immunotherapy protects against multiple sclerosis in mice

September 21, 2017
A potent and long-lasting gene immunotherapy approach prevents and reverses symptoms of multiple sclerosis in mice, according to a study published September 21st in the journal Molecular Therapy. Multiple sclerosis is an ...

Neuron types in brain are defined by gene activity shaping their communication patterns

September 21, 2017
In a major step forward in research, scientists at Cold Spring Harbor Laboratory (CSHL) today publish in Cell a discovery about the molecular-genetic basis of neuronal cell types. Neurons are the basic building blocks that ...

Highly precise wiring in the cerebral cortex

September 21, 2017
Our brains house extremely complex neuronal circuits whose detailed structures are still largely unknown. This is especially true for the cerebral cortex of mammals, where, among other things, vision, thoughts or spatial ...

Your neurons register familiar faces, whether you notice them or not

September 21, 2017
When people see an image of a person they recognize—the famous tennis player Roger Federer or actress Halle Berry, for instance—particular cells light up in the brain. Now, researchers reporting in Current Biology on ...

Faulty cell signaling derails cerebral cortex development, could it lead to autism?

September 20, 2017
As the embryonic brain develops, an incredibly complex cascade of cellular events occur, starting with progenitors - the originating cells that generate neurons and spur proper cortex development. If this cascade malfunctions ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.