5/21/2013


Surgery may be a better way to clear blockages in neck arteries and prevent strokes than less invasive treatment such as angioplasty, European researchers reported on Friday.

For many years, surgery has been the preferred way to clear away dangerous fatty deposits in neck arteries that can cause strokes. But newer, less invasive approaches using angioplasty and stents have been approved for use in higher-risk patients, stirring debate over which approach is best.

Reporting in the journal Lancet, Martin Brown of the National Hospital for Neurology and Neurosurgery in London found people who got the newer so-called endovascular treatment were three times more likely to have their arteries reclog after five years than those who got surgery.

Most of the patients got angioplasty, in which a balloon-tipped catheter was inserted into a small puncture in the groin, threaded through the circulatory system and expanded inside the artery to open up the narrowed section.

In some patients, doctors also inserted a stent -- a tiny wire mesh coil, to keep the fatty deposits from breaking off and traveling to the brain where they might cause a stroke.

They compared the treatment with surgery, in which doctors cut open the neck, scrape away the fatty deposits in the artery, and sew it back up.

After five years, 31 percent of those who got angioplasty had serious restenosis, or reclogging of the artery, compared with 10 percent of those who had surgery. Those who got a stent instead of just angioplasty were half as likely to have their arteries clog up again.

People with severe restenosis a year after treatment were more than twice as likely to have a stroke or transient ischemic attack -- a mini-stroke that resolves on its own -- within five years compared with those with no restenosis.

Several medical device makers sell carotid stents, including Boston Scientific Corp , Abbott Laboratories, Johnson & Johnson, Ev3 Inc and C.R. Bard Inc. The researchers said it is not yet clear how newer treatments will fare over time compared with surgery.

"More data from ongoing randomized trials ... are needed to assess whether modern stenting techniques are as effective as surgery for preventing restenosis in the long term," they wrote.

In a commentary, Peter Rothwell of the John Radcliffe Hospital in Oxford said, combined with recent studies, the findings suggest less invasive treatment using angioplasty and stents should be reserved for patients who are poor candidates for surgery.

Pending publication of results of two other recently completed trials, he said, "the routine use of stenting in patients with recent symptoms of carotid stenosis who are not suitable for endarterectomy can no longer be justified."



By Julie Steenhuysen

CHICAGO, Aug 28 (Reuters Life!) -

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