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Stent for stroke prevention better than surgery under age 69

Kathleen Blanchard's picture

University of Alabama researchers have compared two types of procedures to prevent stroke. One type of therapy uses a stent - a small mesh device that once inserted into the artery restores blood flow - and the other, a surgical procedure called a carotid endarterectomy to remove the diseased portion of the carotid artery. The study showed that both work well, but younger adults benefit most from stents for stroke prevention

The study is called the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). Scientists say the most significant part of the study is that stents are better for stroke prevention in individuals who are under age 69.

"The fascinating finding is that in young people, say age 69 and younger, the stenting is better than the surgery. The younger the patient, the better stenting works," explains Dr. George Howard, chair of biostatistics in UAB's School of Public Health and a CREST co-investigator. "In contrast, in older people, defined as greater than age 70, the surgery is better than the stenting, and the benefits are greater as the age of the patient increases."

The study was conducted over nine year, and included 2,502 patients at 117 sites throughout the US and Canada. The findings show that either carotid endarterectomy or stenting are both effective and equally invasive procedures that carry the same risks for stroke prevention.

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Because stroke and heart disease are closely linked, the researchers also monitored the incidence of heart attack in the CREST study.

Individuals who received carotid endarterectomy surgery to prevent stroke had a slightly higher incidence of heart attack, compared to those who received stents - 2.3 percent versus 1.1 percent. Overall, fewer people in the study had a stroke after surgery for narrowed arteries, but a stent procedure was associated with a lower heart attack rate one year later.

Choosing surgery or stenting for blocked carotid artery that can lead to stroke is something that should be discussed in detail with your physician. The study authors say there are variables to take into account when choosing which one is best, that includes age, general medical condition, and severity, location, and appearance of the blockage.

The study showed that overall, placing a stent to treat carotid artery disease is just as good as surgery under age 69, but after age 70, surgery to prevent stroke from carotid artery disease may be better.




There is an error in the above article. The overall stroke rate was 4.1% for stenting and 2.3% for surgery, while the heart attack rate was 1.1% for stenting and 2.3% for surgery. The difference in strokes was driven by "minor" strokes, those who symptoms largely resolve in several weeks. There was no difference between stenting and surgery for disabling strokes.
Thank you Dr. White - I have corrected - I so appreciate the alert.