CAROTID ARTERY STENTS REDUCE STROKE RISK

Carotid artery stenting may be the safest, most effective approach in preventing strokes among high-risk elderly patients, according to a study from researchers at UMDNJ-New Jersey Medical School (NJMS).

The study compared the stenting procedure with carotid endarterectomy, a more traditional approach in treating accumulated arterial plaque, a primary cause of strokes. Carotid artery stenting, a minimally invasive procedure, involves passing a fine catheter with a balloon end into the carotid artery through the groin. A stent made of very fine titanium/steel mesh is then inserted through the catheter into the artery to keep it open and allow blood to flow. The other procedure, carotid endarterectomy, involves surgical scraping of the carotid artery to remove accumulated plaque and restore normal blood flow.

The lead investigator is Robert W. Hobson II, MD, professor of surgery and program director in the Division of Vascular Surgery at NJMS, who helped pioneer the stenting procedure some five years ago. He performed the procedures, in collaboration with colleagues at St. Michael's Medical Center in Newark, on 105 patients (63 men and 42 women) whose average age was 70. Seventy four of the patients had previously undergone carotid endarterectomy, but required additional treatment when plaque reappeared in the arteries.

Slightly less than three percent of those who underwent the stenting procedure suffered a stroke or died within 30 days of the procedure. According to Hobson, the stroke and mortality rates for stent patients were significantly lower than other recently published trials that showed a 10 to 12 percent death rate or stroke recurrence among patients treated with other procedures, including endarterectomy. "Stenting, which is less invasive than a carotid endarterectomy, appears to greatly reduce the risk or recurrence of a stroke in individuals who are at greatest risk," he says.

This trial is part of a larger nationwide study, called Carotid Revascularization Endarterectomy versus Stent Trial (CREST). Hobson received a $22.3 million grant from the National Institute of Neurological Disorders and Stroke to conduct his work. His study was published in the June 2003 issue of the Journal of Vascular Surgery. The results of the nationwide CREST study will be published later next year.