Stenting, Surgery Appear Comparable for Opening Neck Artery

Re-blockage rates similar for both procedures, study finds

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By Randy Dotinga

Wednesday, February 1, 2012

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WEDNESDAY, Feb. 1 (HealthDay News) -- To open a clogged neck artery, a surgeon has two options: either insert a metal stent to keep blood flowing or perform surgery. A new study finds that both approaches will likely keep the arteries clear for at least two years and help prevent stroke.

"Unlike bare metal stents placed in coronary [heart] arteries, where re-blockage occurs about 20 percent of the time, we found the re-blockage rates in the carotid artery were quite small," said study lead author Dr. Brajesh K. Lal, associate professor of vascular surgery at the University of Maryland School of Medicine in Baltimore, in a statement provided by the American Stroke Association.

"Patients and physicians can be reassured that both procedures are durable and that re-blockage rates are equivalent, so they can use different criteria to determine which procedure is right for a patient," he added.
The study was funded by the U.S. National Institute of Neurological Disorders and Stroke, and by stent maker Abbott Vascular Solutions.

Clogs in the carotid arteries -- the two large blood vessels in the neck -- cause about 10 percent of strokes.
The study looked at about 2,200 patients with a partially blocked neck artery. About half the patients received a stents in the artery, which is a minimally invasive procedure, and about half underwent an artery-opening surgery.

Over two years, the researchers found that the arteries narrowed again in close to 6 percent of both groups of patients. The arteries became entirely blocked less than 1 percent of the time in both groups.

Patients whose arteries narrowed again faced a four-fold increase in their risk of stroke.

The research into these patients will continue so physicians can see what happens over a 10-year period.

Dr. Brahmajee K. Nallamothu, an associate professor of internal medicine at the University of Michigan Health System, who's familiar with the findings, said the research is valuable.

"First, it supports the durability of carotid stenting over time, and provides additional evidence for this minimally invasive treatment option," he said. "Second, it suggests a link between the recurrence of blockages and future strokes. This is an interesting observation, which has potential implications for how we manage patients who develop recurrent narrowing in their carotid artery."

Nallamothu said patients should almost always get to decide which strategy they prefer. Carotid stenting is a bit more expensive than surgery, he noted, and "side effects are the big issue. Carotid stenting appears to lower the risks of heart attacks relative to (surgery) around the time of the procedure, while the reverse is true in regards to the risk of stroke," he added.

The study was scheduled for release Wednesday at the American Stroke Association conference in New Orleans.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

SOURCES: Brahmajee K. Nallamothu, M.D., associate professor of internal medicine, University of Michigan Health System, Ann Arbor; American Stroke Association, International Stroke Conference 2012, New Orleans, Feb. 1, 2012

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