What works best to prevent strokes in people at risk?

One of the largest studies ever comparing different interventions in patients at risk for a certain type of stroke has found that a new technique appears as safe and effective as surgery, which is the current standard of care.

More than 2,500 patients around the nation took part in the study, whose results were announced during theInternational Stroke Conference Feb. 23 to 26 in San Antonio. Called CREST (the Carotid Revascularization Endarterectomy vs. Stenting Trial, the study was conducted at 117 sites over nine years. It compared the safety and effectiveness of two treatments for blocked carotid arteries in the neck, which supply blood from the heart to the brain. A blockage in either artery is a major cause of stroke.

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At the University of Rochester Medical Center, Drs. Craig Narins and Karl Illig led a team of investigators who did the procedures and analyzed the results. In the more established procedure, carotid endarterectomy, surgeons cleared blocked blood flow in the arteries. The newer procedure is known as carotid artery stenting and involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque, explains university spokesman Tom Rickey.

Generally up to now, stenting has been used only in patients considered at very high risk for having complications during surgery. CREST looked specifically at people who were at risk for stroke but could have undergone either surgery or stenting.

CREST officials announced at the stroke conference that the procedures appear to be equally safe and effective for both men and women, as well as for patients who had a previous stroke compared to those who had never had a stroke.

Though the two procedures appear to be equally safe and effective, there were a few differences. Patients who had surgery were about twice as likely to have a heart attack as those who had stents, while patients who had stenting were nearly twice as likely to have a stroke following the procedure than those who had surgery. The study also found that stenting was slightly more successful in people age 69 and younger, while surgery was slightly better in patients age 70 and older.