A pair of clinical trials comparing whether stents or carotid surgery is more effective at preventing strokes have yielded markedly different results.
Findings released Feb. 26 from a study sponsored by the National Institute of Neurological Disorders and Stroke, with funding from Abbott Laboratories Inc. (NYSE:ABT), indicate that using stents to open clogged arteries in the neck is equally effective at preventing stroke as surgical procedures, where fatty deposits are “stripped” from the primary artery leading to the head and brain.
But results from a similar study, published online earlier in the week by European investigators, found that patients treated with stents were slightly more likely to have a disabling stroke or a heart attack and recommended that carotid endarterectomy should remain the treatment of choice.
The so-called CREST trial — Carotid Revascularization Endarterectomy vs. Stenting Trial — sponsored by NIND took place at 117 centers in the U.S. and Canada over a nine-year period, comparing the safety and effectiveness of the two procedures in patients with or without a previous stroke. The trial was led by investigators at the Mayo Clinic campus in Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark.
According to the study, the safety and efficacy of the two procedures were largely same in both men and women as well as among patients previously experiencing a stroke and those who did not. But the CREST investigators also found there was a lower occurrence of heart attacks in people treated with stents — only 1.1 percent of the patients compared with 2.3 percent in the endarterectomy group — while strokes were more common in the stenting group by a margin of 4.1 percent to 2.3 percent.
Age also factored into the overall results, with patients under 69 years responding better to treatment with stents, while those above 70 years of age demonstrated slightly superior results when treated surgically.
Those results, however, contrast with a British study of 1,713 patients presented Feb. 25 in The Lancet medical journal that found higher risk of heart attacks or stroke in stenting patients compared with the surgical group.
According to the University College researchers, sponsored by the (UK) Stroke Assn. and Sanofi-Synthélabo, 72 patients suffered disabling strokes heart attacks or died within the first four months after receiving stents, a rate of 8.5 percent, versus 5.6 percent, or 44, of the patients in the endarterectomy group. The events also tended to be more serious, with three heart attacks, all fatal, among the stenting group. All four of the patients in the surgical group who had heart attacks survived.
But the stent patients were much less susceptible to cranial nerve palsy than their study counterparts and also showed less bruising of any severity.