For people with blockages in their neck arteries, a metal scaffolding device known as a stent may become more popular as an alternative to surgery to prevent strokes.
That is the prediction of Springfield doctors who helped conduct a large nationwide study comparing the treatments.
Both treatments were shown to be safe and similar in effectiveness, according to Dr. Kim Hodgson, a vascular surgeon at Southern Illinois University School of Medicine, and Dr. Gregory Mishkel, a cardiologist with Prairie Cardiovascular Consultants.
The federally funded study, results of which were released recently, compared carotid artery stenting with a surgical procedure known as endarterectomy among 2,502 patients at 117 sites around the country.
Partial or total blockages of the carotid arteries are a major cause of strokes because bits of plaque can break off and lodge in the brain.
The study's results "will probably lead to a little bit more use of stenting," said Hodgson, who performs both procedures and worked with fellow SIU doctors Robert McLafferty, Douglas Hood, Colleen Moore and Don Ramsey to enroll about 40 patients at the SIU site.
Mishkel, who performs the stenting procedure, worked with fellow cardiologist Dr. Krishna Rocha-Singh to enroll a similar number of central Illinois patients at the Prairie site. Mishkel said he was "mildly surprised" that the surgical procedure didn't turn out to be superior to the less-invasive stenting procedure.
Both doctors said the study will give doctors and patients valuable information in helping patients evaluate treatment options.
Medicine another alternative
Mishkel said it's too bad that the study didn't compare stenting and surgery to medicine alone in preventing stroke. For most patients who haven't had previous strokes or symptoms, Mishkel said, he remains skeptical of the need for treatment beyond the use of blood-thinning medicine.
The surgical procedure, used since the 1960s and performed on about 140,000 Americans each year, involves cutting open the arteries and removing plaque.
The stenting procedure is newer, but unlike endarterectomy, isn't normally covered by Medicare. Stenting involves squashing the plaque against the sides of the carotid artery with a tiny balloon and then deploying a stent, which is carried to the site through a catheter inserted into an artery in the patient's groin.
The multi-year study, funded with $23 million from the National Institutes of Health, found that the two procedures had equal benefits for men and women.
But there were differences when it came to the number of strokes and heart attacks that occurred within a month of each procedure. These complications can take place as a result of the patient's cardiovascular disease as well as from complications connected with the procedures.
Overall, the study found more subsequent heart attacks in patients who underwent surgery - 2.3 percent - versus 1.1 percent among patients who got stents. There were more subsequent strokes among patients who received stents - 4.1 percent versus 2.3 percent.
Among patients 69 and younger, however, the risk of both heart attack and stroke was lower after receiving a stent than after surgery.
And among patients older than 69, there were fewer heart attacks and strokes when surgery was used on blockages than after stenting.
Side effects few
The risks of side effects were slight but low overall for both procedures, Mishkel said.
"Every treatment comes with a 'poison,'" he said. "Either one of these procedures do what they're supposed to do, and that's preventing a stroke."
Hodgson said he believes the study will persuade federal health officials to extend routine Medicare coverage to stenting for carotid arteries, but Mishkel said he isn't so sure.
Stenting, which includes insertion of a filter in the artery to prevent bits of plaque from reaching the brain, is more expensive than the surgical procedure - $17,400 vs. $12,100, according to a 2006 study.
Mishkel said he would like to see detailed results of the Carotid Revascularization Endarterectomy vs. Stenting Trial. Complete results are expected to be published in a few weeks in the New England Journal of Medicine.
Full results are expected to point out the relative risks and benefits for patients depending on whether they had prior problems related to artery blockages, Mishkel said.
Springfield resident Jean Stites, 71, said she was glad she received a stent three years ago as part of her participation in the study at the SIU site.
"I've had no ill effects from it," she said. "I feel super."
She was referred for the study when her primary care doctor detected a circulation problem in her left foot - a sign of hardening of the arteries.
Stites, a retired laundromat owner, said she wouldn't have participated in the study if she had been put in the group receiving the surgical procedure. The thought of surgery is scarier than a stent, she said.
Donald Dooley, 73, a retired trucking company owner who lives in rural Morgan County near Franklin, said he didn't mind being assigned to the group receiving surgery.
The surgery at St. John's Hospital went smoothly, he was almost fully recovered in a few days, and he didn't mind the resulting scar on his neck. He got into the study after he sought a screening sonogram of his carotid arteries. He took that step after his adult son had a stroke.
"I'm so glad to be in this study and help someone else after what my son went through," Dooley said.
Dean Olsen can be reached at 788-1543.
Procedures
Source: The Mayo Clinic and SIU School of Medicine.
