Physicians now have two safe and effective options in tailoring treatments for their patients at risk for stroke, says a researcher at the Mayo Clinic campus in Florida who led a large national clinical trial. Results of that study, testing surgery or use of a stent to open a blocked carotid artery, are published in the May 26 online issue of the New England Journal of Medicine.
The findings show that these two procedures proved similar in overall long-term safety and efficacy, whether or not patients had symptoms of carotid disease. There were differences in the weeks following the procedure – patients who received a stent had more strokes, and those treated surgically had more heart attacks. Age also made a difference, the researchers found – people younger than 70 did better with stents while those over 70 had better results with surgery.
Nevertheless, the rate of even those early and age-related events was low, says the study’s national principal investigator, Thomas G. Brott, M.D., professor of neurology and director for research at the Mayo Clinic campus in Florida.
“This means we now have two safe and effective methods to treat carotid artery disease that can be targeted to individual patients,” he says. Such personalized decision-making should translate into improved patient outcomes.
The findings matter because stroke, caused by an interruption in blood flow to the brain, is the third leading cause of death in the United States. The buildup of cholesterol in the wall of the carotid artery is one cause of stroke.
The National Institutes of Health funded the study, known as the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). One of the largest randomized stroke prevention trials ever undertaken; the clinical trial enrolled 2,502 patients at 117 centers in the United States and Canada over a nine-year period. Large and small, public and private hospitals participated.
One of the novelties of CREST is that it reflects the fairly aggressive U.S. practice of treating both patients who have had symptoms of carotid artery disease, such as a minor stroke, as well as those who are at risk of developing stroke but have not had symptoms. By contrast, European stroke studies enroll only symptomatic patients.
The results show that not only were outcomes good in symptomatic patients, they were even better in asymptomatic patients, which suggests the aggressive approach to stroke prevention in the U.S. is warranted, Dr. Brott says.
Below is a link to an edited youtube video with Dr. Brott.