National Trial Shows Carotid Artery Surgery and Stenting Equally Effective in Preventing Stroke

Mayo Clinic researcher says physicians can target treatment to individual patients

JACKSONVILLE, Fla.--(BUSINESS WIRE)-- Physicians now have two safe and effective options to treat their patients at risk for stroke, says a researcher at Mayo Clinic who led a large, NIH-funded, national clinical trial testing surgery or use of a stent to open a blocked carotid artery.

The results, published in the May 26 online issue of the New England Journal of Medicine, also show “excellent safety and long-term results for patients with warning signs for stroke as well as for patients without such warning signs,” says the national principal investigator, Thomas Brott, M.D., professor of neurology and director for research at the Mayo Clinic campus in Florida.

Compared to other large international stroke prevention trials, Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) is unique in that approximately half of enrolled patients did not have symptoms of carotid disease, while the other half had experienced recent symptoms such as a minor non-disabling stroke or transient ischemic attack (TIA).

The CREST results can inform treatment decisions for both groups of patients, in contrast to results from recent trials completed in Europe. This is important because more than half of the approximately 140,000 carotid surgeries and stent procedures performed in the U.S. each year are performed for patients without symptoms.

Researchers say that while the findings show surgery and stenting had very good long-term outcomes, they differed in the weeks following the procedure — patients who received a stent had fewer heart attacks, and those treated surgically had fewer strokes. Age also made a difference, they say — people younger than 70 did slightly better with stents while those over 70 had better results with surgery.

Stroke, an interruption in blood flow to the brain, is the third leading cause of death in the United States. One major cause is the build-up of cholesterol in the carotid artery and the traditional effective treatment has been carotid endarterectomy (CEA), surgery to clear the blockage. More recently, vascular specialists have used carotid artery stenting (CAS), a less invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.

But it has been unclear what the comparative risks and benefits of these two procedures are. To find out, the National Institutes of Health funded CREST. One of the largest randomized stroke prevention trials ever undertaken, CREST enrolled 2,502 patients at 117 centers in the United States and Canada from 2000-2008.

The results suggest the aggressive approach to stroke prevention in the U.S. is warranted, Dr. Brott says.

VIDEO ALERT: Additional audio and video resources, including excerpts from an interview with Dr. Thomas Brott, are available on the Mayo Clinic News Blog.
Password: CREST1

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For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world's leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients' health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information.



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