Stenting of neck arteries tied to higher stroke risk in seniors

October 24, 2013 by Steven Reinberg, Healthday Reporter
Stenting of neck arteries  tied to higher stroke risk in seniors
Evidence review comparing stent placement to procedure called endarterectomy found mixed results.

(HealthDay)—For patients being treated for a blockage in the artery that supplies blood to the head, inserting a stent may raise the risk of stroke more in elderly patients than in younger patients, a large new evidence review finds.

However, death risk was similar for older and younger patients receiving stents. And it was not as high as it was for who underwent a different surgical procedure—called —to unblock the clogged artery.

The report was published Oct. 23 in the online edition of JAMA Surgery.

An ongoing debate exists about the best treatment for the condition known as atherosclerosis. The issue is whether placing a tiny mesh tube (a stent) to keep the plaque-clogged neck artery open is safer for older patients than endarterectomy—a surgical procedure to open the artery and remove the plaque.

For the new study, a research team led by Dr. George Antoniou, of the Hellenic Red Cross Hospital in Athens, Greece, reviewed 44 studies that looked at opening the carotid arteries with a carotid endarterectomy or by placing a stent.

These studies included more than 500,000 patients who had a carotid endarterectomy and about 75,000 patients who had a stent placed. In this type of study, called a meta-analysis, researchers try to find common patterns in a number of diverse, but similar studies.

Despite the large number of people included in these studies, Antoniou's group found the quality of the studies was poor—with each using different criteria in classifying older and younger patients.

The researchers, however, concluded that carotid endarterectomy had similar outcomes in terms of stroke among older and younger patients, but was more often fatal among older patients.

In addition, both procedures seemed to increase the risk of heart attack in older patients. Older patients who had a stent placed, however, had a greater risk of stroke than younger patients, the investigators found.

Two experts compared the findings from the new review with those of a previous, landmark study.

"This study complements and confirms the data from the Carotid Revascularization Endarterectomy Versus Stenting Trial [CREST] that suggests that endarterectomy has a lower stroke risk than stenting in older patients," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine. He had no part in the study.

The CREST study was published in October 2010 in the journal Stroke. Although the number of deaths was slightly greater in the elderly for endarterectomy in CREST, the absolute risk of dying was not that different and actually less than with stenting for both older and younger age groups, Sacco said.

"For patients under age 70, both procedures are effective in reducing the risk of recurrent stroke due to carotid narrowing after a minor ," Sacco said. "For patients over age 70, endarterectomy may have the advantage as of now, but better stents and future devices could change the picture."

Another expert said the latest findings don't really break new ground.

Dr. Richard Libman, vice chair of neurology at the Long Island Jewish Medical Center in New Hyde Park, N.Y., said the "extensive review of the literature does not add significantly to what has been found and what has been practiced, based on the largest and most rigorous clinical trial, which compared to carotid stenting."

While both procedures have their advantages and disadvantages, endarterectomy could still be considered the "gold standard" treatment but stenting is a very close second, he said.

"In addition, there are certain patients in whom endarterectomy has intrinsically high risk, such as those with severe heart or lung disease, or those who have had previous radiation to the neck, a carotid artery which had previously undergone surgery or complete occlusion of the carotid artery on the other side of the neck," Libman said.

These high-risk have been studied in another clinical trial, and have been found to have fewer complications with stenting than with endarterectomy, he said. "The picture, therefore, is not clear-cut and the decision for management in every case of carotid artery narrowing needs to be individualized," Libman said.

Explore further: Cleveland Clinic study finds lowest risk treatment for severe carotid and coronary disease

More information: To learn more about carotid artery stenting, visit the U.S. National Library of Medicine.

Abstract
Full Text
Editorial (subscription or payment may be required)

Related Stories

Cleveland Clinic study finds lowest risk treatment for severe carotid and coronary disease

July 31, 2013
Of the three most common treatment approaches for patients with severe carotid and coronary artery disease, patients who underwent stenting of the carotid artery followed by open heart surgery had the best outcomes, according ...

Procedure to open blocked carotid arteries tested

September 27, 2013
(Medical Xpress)—Doctors at Washington University School of Medicine in St. Louis are investigating a minimally invasive procedure to open blocked carotid arteries in patients whose poor health or advanced age makes the ...

Stenting for stroke prevention becoming safer in high-risk patients

January 11, 2012
Placing a stent in a key artery in the neck is safer than ever in patients ineligible for the standard surgical treatment of carotid artery disease, according to a new study published online today in the Journal of Vascular ...

Better diagnostics could reduce risky surgery for asymptomatic carotid stenosis

August 17, 2011
New research from Neurologist Dr. David Spence of The University of Western Ontario has shown that using 3-D ultrasound to identify ulcers in the carotid arteries is an effective way to pinpoint the small number of high-risk ...

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

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.