Healthy lifestyle, medications superior to stent for preventing stroke
Stroke patients, and at risk for a second event, fare better with medical treatment. Compared to a brain stent, taking medications that include statin drugs and blood-thinners, combined with aggressive lifestyle risk factor modifications, was found to be superior to brain stenting in a large national study.
Stent trial halted from higher stroke rates
The study that stopped enrolling patients in April 2011, found more participants were having strokes and dying at 30 days when they were given brain stents that open arteries to restore blood flow.
But scientists still think stents may have a place for stroke prevention.
Dr. Cathy Sila, Director of the Stroke and Cerebrovascular Center in the University Hospitals (UH) Case Medical Center, and the principal investigator of the UH clinical research site said,
“Stroke specialists are all disappointed that stenting did not have the beneficial impact we thought it would have. We have always known that it is much more difficult to stent a blockage in the brain than in the heart but we cannot abandon this technology. We need to better understand the tolerances of the brain vasculature and continue to reengineer our tools.”
Dr. Sila, who is also Professor of Neurology at Case Western Reserve University School of Medicine notes stroke prevention from healthy living and “aggressive patient care” found in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) study is a “major achievement”.
In the study, 14.8 percent of patients given a brain stent, combined with medical therapy had another stroke or died, but for those given aggressive medical interventions the rate was 5.8 percent at 30 days.
The stent used in the procedures was the Gateway-Wingspan intracranial angioplasty and stenting system. The authors speculate the wire mesh device, which is inserted into a block artery then expanded once it’s placed, might dislodge clots, explaining the lack of success from the device.
Over a less than one year follow-up, stroke rates with medical therapy and brain stents continued to climb. Compared to medical treatment and lifestyle intervention, the stent group death and stroke rates climbed to 20 percent, but was 11 percent for participants given medications and lifestyle interventions.
Marc Chimowitz, M.B.Ch.B., of the department of neurosciences at the Medical University of South Carolina in Charleston, and first author of the NEJM article said "The SAMMPRIS study results have immediate implications for clinical practice. Stroke patients with recent symptoms and intracranial arterial blockage of 70 percent or greater should be treated with aggressive medical therapy alone that follows the regimen used in this trial as closely as possible.”
Smoking cessation, lowering cholesterol, keeping blood pressure in check, exercise and diabetes control was the focus of lifestyle management in the study. Medications included a daily aspirin and the blood thinner clopidrogel or Plavix given for 90 days after stroke occurrence.
The study shows living healthy and taking prescribed medications can help prevent stroke and disability. Brain stents failed to show benefit in the study that included patients who had experience a “mini-stroke” – a warning sign for major stroke.