Option to open clogged arteries safely

A study found a less-invasive stenting procedure is as effective as carotid endarterectomy surgery.

Stents are mesh tubes that are used to keep clogged arteries open. Newer stents are coated with materials that prevent the development of potentially dangerous clots.

Endarterectomy is a surgical procedure used to remove plaque from the carotid artery. The procedure is commonly used in patients at high risk for stroke. According to the American Heart Association, carotid endarterectomy is successful in treating carotid arteries that are narrowed by more than 60 percent. Certain patients, though, cannot undergo the surgical procedure. These individuals may be treated with stenting, but there has been concern over this procedure based on risks associated with older stents. Now that new stents have been developed, researchers from around the United States performed the SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) to compare the two procedures.

For the study, 334 patients with carotid arteries blocked more than 50 percent were randomly assigned to either the surgery or the stenting procedure. They were followed for up to one year to observe whether or not they experienced a cardiovascular event defined as death, stroke or heart attack within 30 days or ipsilateral stroke within one year.

In the end, 20 patients assigned to stenting and 32 patients assigned to surgery experienced one of the above mentioned cardiac events. Researchers conclude that these results were not statistically significant, and they add that repeat procedures were needed in fewer patients with the stents than those who had surgery.

Study authors write, “The main finding of our randomized trial is that carotid-artery stenting with the use of an emboli-protection devise is not inferior to carotid endarterectomy in the prevention of stroke, death, or myocardial infarction among patients for whom surgery poses an increased risk.” They also point out that these results cannot be extrapolated to patients at low surgical risk.

SOURCE: The New England Journal of Medicine, 2004;351:1493-1501

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