Fewer heart attacks, more strokes with carotid stents: study

Posted at 10/13/10 10:31 AM

WASHINGTON - Stents to keep blocked carotid arteries open are not as effective as surgery in preventing strokes, but nevertheless are associated with a lower rate of heart attacks, researchers said Monday.

A study from the Journal of the American Medical Association's Archives of Neurology concluded that stenting leads to some increased risks but has some advantages over surgery in preventing heart attacks.

The researchers at the New York University School of Medicine and the Harvard Clinical Research Institute published the results of what they called the "largest and most comprehensive meta-analysis" comparing the use of stents as a nonsurgical alternative to carotid endarterectomy.

Stenting has emerged as a popular alternative to surgery to treat blockages in the carotid artery that supplies blood to the brain, but its safety and effectiveness remain controversial.

The researchers said some patients may benefit from one treatment or the other but that "strategies are urgently needed to identify patients who are best served by carotid artery stenting versus carotid endarterectomy."

The study found that in the first 30 days, carotid artery stenting was associated with a 65% increased risk of death or stroke and a 67% increased risk of any stroke.

However, the stent procedure was associated with a 55% lower risk of heart attack and 85% reduction in cranial nerve injury in the same timeframe.

Over the longer term, carotid artery stenting as compared with carotid endarterectomy was associated with a 19% increase in the risk of stroke as well as a 180% increase in the risk of restenosis, or a renewed narrowing of the carotid artery.

"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," said Louis Caplan of Beth Israel Deaconess Medical Center and Thomas Brott of the Mayo Clinic in an accompanying editorial.

In addition, they said that "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."