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STUDY: Stenting Shows Long-Term Benefit as Surgery Alternative
| Author: Tony Cappasso |
| Article Date: 4/15/2008 |
Placing tiny stents in the carotid arteries of patients at high risk of clots offers a viable alternative to carotid surgery in patients with atherosclerosis of the carotid arteries, researchers report.
Carotid artery disease, which involves clogging of the arteries in the neck that provide blood to the brain, is a significant risk factor for stroke, making these study results important for the estimated 200,000 Americans each year who would otherwise not be candidates for the treatment.
In a long term study called SAPPHIRE, a multi-center, prospective, randomized trial, researchers evaluated the safety and efficacy of stents compared with the effectiveness of surgery in 334 patients with narrowing or stenosis of the carotid artery. They compared the incidences of death, stroke or myocardial infarction within 30 days after surgery or death or same-side stroke between 31 days and three years.
Carotid artery stenting is a non-surgical, percutaneous procedure in which a small plastic tube called a catheter is inserted through an artery in the leg and threaded to the blockage in the neck. A thin wire (guidewire), which has a collapsible umbrella-like filter device attached to its end, is advanced passed the blockage. The umbrella is opened and acts as a filter to the blood flowing to the brain, preventing particles from passing to the brain and causing stroke while opening up the blockage and inserting a tiny mesh tube called a stent. The blocked artery is then dilated by inflating a balloon, which pushes the plaque in the artery against its walls and makes way for the stent, which is inserted to prop open the artery. Once the stent is in place, the umbrella filter is removed.
At three years, data were available for 260 patients, 85.6 percent of patients (143 of 167) in the stenting group and 70.1 percent of patients (117 of 167) in the surgery group. The pre-specified major secondary endpoint occurred in 41 of the 167 patients who underwent stenting (cumulative incidence, 24.6 percent) and in 45 of 167 patients who underwent endarterectomy (cumulative incidence, 26.9 percent). There was no statistical significance between these groups. Target-vessel revascularization (a procedure to re-open the blocked arteries) was infrequent in both groups, the study authors write.
They conclude that the study provides support for the role of stenting in preventing blockage of carotid arteries and resultant strokes in these patients.
Source: Society for Cardiovascular Angiography and Interventions
Carotid artery disease, which involves clogging of the arteries in the neck that provide blood to the brain, is a significant risk factor for stroke, making these study results important for the estimated 200,000 Americans each year who would otherwise not be candidates for the treatment.
In a long term study called SAPPHIRE, a multi-center, prospective, randomized trial, researchers evaluated the safety and efficacy of stents compared with the effectiveness of surgery in 334 patients with narrowing or stenosis of the carotid artery. They compared the incidences of death, stroke or myocardial infarction within 30 days after surgery or death or same-side stroke between 31 days and three years.
Carotid artery stenting is a non-surgical, percutaneous procedure in which a small plastic tube called a catheter is inserted through an artery in the leg and threaded to the blockage in the neck. A thin wire (guidewire), which has a collapsible umbrella-like filter device attached to its end, is advanced passed the blockage. The umbrella is opened and acts as a filter to the blood flowing to the brain, preventing particles from passing to the brain and causing stroke while opening up the blockage and inserting a tiny mesh tube called a stent. The blocked artery is then dilated by inflating a balloon, which pushes the plaque in the artery against its walls and makes way for the stent, which is inserted to prop open the artery. Once the stent is in place, the umbrella filter is removed.
At three years, data were available for 260 patients, 85.6 percent of patients (143 of 167) in the stenting group and 70.1 percent of patients (117 of 167) in the surgery group. The pre-specified major secondary endpoint occurred in 41 of the 167 patients who underwent stenting (cumulative incidence, 24.6 percent) and in 45 of 167 patients who underwent endarterectomy (cumulative incidence, 26.9 percent). There was no statistical significance between these groups. Target-vessel revascularization (a procedure to re-open the blocked arteries) was infrequent in both groups, the study authors write.
They conclude that the study provides support for the role of stenting in preventing blockage of carotid arteries and resultant strokes in these patients.
Source: Society for Cardiovascular Angiography and Interventions