Choosing the Best Stroke-Prevention Procedure

The best approach depends on your age.

Stroke ranks higher than heart attack in scaryness, say surveys. So stroke prevention is something we all care about.

Of the two main stroke-prevention procedures, new research points to which is the better choice.

It turns out that both are safe and equally beneficial for men and women at risk for stroke, but the best procedure varies by age, say researchers at the University of Alabama at Birmingham (UAB) in collaboration with other North American stroke investigators.

Stroke is the third leading cause of death in the nation. Stroke is caused by an interruption in blood flow to the brain by a clot or bleeding. This can happen due to buildup of cholesterol in the wall of the neck's carotid artery, called atherosclerotic plaque. The carotid arteries on each side of the neck are the major source of blood flow to the brain.

The two main options are endarteroctomy, a surgical procedure to clear blocked blood flow and prevent stroke, and carotid stenting, a newer procedure of threading a stent and expanding a small protective device in the artery to widen the blocked area and capture dislodged plaque.

Both procedures have essentially the same overall safety and efficacy. The have equal benefits for men and women, and for patients who previously have had a stroke and for those who had not, say the researchers.

However, the patient's age makes a difference, according to George Howard, Dr.PH., chair of biostatistics in UAB’s School of Public Health and a co-investigator.

"The fascinating finding is that in young people, say age 69 and younger, the stenting is better than the surgery. The younger the patient, the better stenting works," Howard says. "In contrast, in older people, defined as greater than age 70, the surgery is better than the stenting, and the benefits are greater as the age of the patient increases."

The study, known at CREST, is one of the largest randomized stroke-prevention trials in history, involving 2,502 patients at 117 centers in the United States and Canada during a nine-year period. People with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, so the CREST trial tracked the rate of heart attacks, stroke and death.

“We like to counsel patients that they have some very good options for stroke prevention, these procedures are performed regularly and they can extend life and improve the quality of life significantly,” says William Jordan, M.D., chief of vascular surgery at UAB. Twenty-one CREST patients are enrolled in Alabama.

Source: University of Alabama at Birmingham