Landmark NIH Clinical Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective

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The National Institutes of Health issued a news release regarding a landmark clinical trial relating to stroke.

A stroke can be one of the most devastating medical conditions that a person can suffer. Not only can it cause immediate death (stroke is the third leading cause of death in the United States), but it can also cause severe neurologic deficits that can leave a once-healthy person with severe mental and physical limitations. Therefore, researchers are always looking at new ways to try to prevent stroke.

The National Institute of Health (NIH) recently published the results of a major nine-year clinical trial that evaluated two methods of preventing future stroke: carotid endarectomy, or CEA, which is a surgical procedure to clear blocked blood flow, and carotid artery stenting, which is a newer and less invasive procedure that implants a small, expandable device in the artery to widen the blocked area. The good news for patients is that both methods proved to be safe and effective in both men and women.

“The CREST trial results show that we now have two safe and effective methods to treat carotid artery   disease directly, the tried and true CEA, and the new kid on the block, CAS,” said Thomas G. Brott, M.D., professor of neurology and director for research at Mayo Clinic in Jacksonville, and the study’s national principal investigator. “

The study found that the two methods were not perfectly equal, however. In patients over 70 years old, for example, the surgical procedure (CEA) results were slightly superior to stenting. Also, the study noted a difference in heart attacks and strokes:

The investigators found that there were more heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group; and more strokes in the stenting group, 4.1 percent versus 2.3 percent for the surgical group in the weeks following the procedure.

What this study means to patients is that doctors now have two safe and effective means of trying to prevent future stroke, and can choose the procedure that best fits that patient.

“The CREST trial provides doctors and patients with much needed risk/benefit information to help choose the best carotid procedure based on an individual’s health history. This personalized decision making should translate into improved patient outcomes,” said Walter J. Koroshetz, M.D., deputy director of NINDS.

Added Dr. Brott, “People have some very good options for stroke prevention that we hope will not only extend the length but also the quality of their lives.”

Contributing Author: Michael Sanders



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