Ischemic strokes are sometimes called “brain attacks.” Like heart attacks, they are caused by blockages in arteries. Also like heart attacks, these blockages choking blood vessels that lead to the brain can be treated by surgery or by inserting stents to keep them open.
A new review of more than a dozen rigorous clinical trials including more than 7,400 patients reports that in the first 30 days, stenting the carotid artery that brings blood to the brain is associated with a 65 percent higher risk of death and stroke than surgery to relieve the blockage. But the researchers, led by Sripal Bangalore of New York University School of Medicine and the Harvard Clinical Institute, also found that the risk of heart attack was 55 percent lower in stent patients and the risk of nerve injury was 85 percent lower in stent patients compared with surgery patients in the month after their procedures.
Patients in the trials were randomly assigned to get either stents or surgery. After an average of around two and half years, stenting was linked to a 19 percent increased risk of death or stroke compared with surgery. Patients who got stents had a 150 percent higher risk of their carotid arteries narrowing again compared with patients who had surgery.
The researchers, writing in the Archives of Neurology, say doctors and patients should carefully consider which procedure is best. Dr. Louis Caplan of Beth Israel Deaconess Medical Center and Dr. Thomas Brott of the Mayo Clinic suggest another approach in an editorial.
“Both therapeutic procedures are effective. Both procedures showed a relatively low rate of serious complications. Surgery is superior concerning some outcomes; stenting seems to have advantages in others,” they write. “Aggressive medical treatment of blood lipids, blood pressure and anti-platelets along with lifestyle changes may be as good as or better than either surgery or stenting at stroke and myocardial infarcts prevention.”
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|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
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