‘Stents prove to be as effective as surgery in stroke’

At least 10% of strokes are caused by atherosclerosis,or stenosis,in the carotid artery that feeds the brain — occurring when plaque breaks off and causes a blockage in the organ’s smaller blood vessels.

“The CREST trial results show that we now have two safe and effective methods to treat carotid artery disease directly,” said Dr. Shakir Husain,Director,Department of Interventional Neurology & Stroke,Max Hospital,New Delhi. An earlier stents vs surgery study in 2004,called the Sapphire Study,showed that carotid stents were more effective for patients who were at higher risk for developing complications during surgery,but not necessarily for those at lower risk for surgical complications. This study puts carotid stenting on an equal footing with surgery for all patients with carotid artery blockage,including those with no symptoms warning of a stroke.

Before CREST,stenting had no role whatsoever in managing routine. Surgery to remove plaque,called an endarterectomy,has been around since the 1960s and is the second most common type of surgery in the world.

“Stenting” describes the procedure in which a mesh-like closed spring is inserted into the artery through the groin. When the long tube reaches the blockage,the surgeon opens a balloon to clear the plaque,then opens the spring,propping open the artery.

“Stenting has been common inside the heart but not as common in the carotid artery,Dr Husian said. I saw bypass surgery being replaced with stents so effectively,so I saw stents in the carotid artery as becoming the natural evolution,” Dr Husain said.

In the study it was found that patients over the age of 70 did better with surgery,and those who were younger did better with stents. Stroke ranks No. 3 among all causes of death behind heart disease and cancer.