Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Choice between stroke-prevention procedures influenced by patient age

Two stroke-prevention procedures are safe and equally beneficial for men and women at risk for stroke, but the effectiveness does vary by age, say researchers at the University of Alabama at Birmingham (UAB) in collaboration with other North American stroke investigators.

In findings reported Feb. 26 at the International Stroke Conference in San Antonio, Texas, the researchers say physicians now have better information when tailoring their treatment plans for patients at risk for stroke. The study is called the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST).

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

CREST compares endarteroctomy, a surgical procedure to clear blocked blood flow and prevent stroke, with carotid stenting, a newer procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture dislodged plaque.

The overall safety and efficacy of the two procedures essentially is the same with equal benefits for men and women, for patients who previously have had a stroke and for those who had not, researchers say. The most notable finding was the role of patient age in accounting for differences in comparing the two prevention procedures, says George Howard, Dr.PH., chair of biostatistics in UAB's School of Public Health and a CREST 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."

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. It is funded by the National Institute of Neurological Disorders and Stroke (NINDS) and led by Thomas G. Brott, M.D., of the Mayo Clinic in Jacksonville, Fla. Twenty-one CREST patients are enrolled in Alabama under the medical direction of William D. Jordan, M.D., chief of vascular surgery at UAB.

"The magnitude of the operation and the stent procedure is really about the same because even though it seems minimally invasive to use a stent, the surgical procedure really isn't that invasive, so most patients can tolerate either procedure," Jordan says. "We counsel our patients on which one to do based upon a lot of factors, including their age, their overall medical condition, and actually about the anatomy of the stenosis, about where it is, how severe it is, and what the plaque morphology is."

"The CREST trial provides doctors and patients with much needed risk/benefit information to help choose the best carotid procedure based on an individual's health history," says Walter J. Koroshetz, M.D., deputy director of NINDS. "This personalized decision-making should translate into improved patient outcomes."

Because people with carotid atherosclerosis also usually have atherosclerosis in the coronary arteries that supply the heart, the CREST trial tracks the rate of heart attacks, in addition to stroke and death.

In CREST, approximately half of the 2,502 patients had recent symptoms due to carotid disease such as a minor stroke, often called a transient ischemic attack (TIA), indicating a high risk for future stroke. The other half of patients had no symptoms but was found to have narrowing of the carotid artery on one of a variety of tests assessing narrowness and plaque.

CREST investigators did see more heart attacks in the surgical group, 2.3 percent compared to 1.1 percent in the stenting group, and they did see more strokes in the stenting group, 4.1 percent versus 2.3 percent for the surgical group in the weeks following the procedure. Overall the study found a lower stroke rate following surgery and a lower heart-attack rate after stenting a year after their procedure. The average age of CREST patients is 69.

NINDS is committed to long-term follow-up of CREST patients to learn how best to prevent stroke. Partial funding for the study is supplied by Abbott, of Abbott Park, Ill., the maker of the stents.

Others from UAB involved in the study are Virginia Howard, Ph.D., an associate professor of epidemiology, and Jenifer Voeks, Ph.D., an assistant professor of epidemiology, both in the School of Public Health. Also involved are researchers at Lenox Hill Hospital in New York; Oregon Health Science University in Portland; Central Baptist Hospital in Lexington, Ky.; Hop de L'Enfant Jesus in Quebec City, Canada; University of Medicine and Dentistry of New Jersey in Newark; University of Maryland in Baltimore; Harvard Clinical Research Institute in Boston; University of California, Los Angeles.

About UAB

Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham (UAB) is the state of Alabama's largest employer and an internationally renowned research university and academic health center; its professional schools and specialty patient-care programs are consistently ranked among the nation's top 50.

Media Contact:
Troy Goodman
(205) 934-8938

Troy Goodman | EurekAlert!
Further information:

Further reports about: Hospital NINDS UAB blood flow choice crest health services heart attacks stroke surgical procedure

More articles from Studies and Analyses:

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

nachricht New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Space observation with radar to secure Germany's space infrastructure

Satellites in near-Earth orbit are at risk due to the steady increase in space debris. But their mission in the areas of telecommunications, navigation or weather forecasts is essential for society. Fraunhofer FHR therefore develops radar-based systems which allow the detection, tracking and cataloging of even the smallest particles of debris. Satellite operators who have access to our data are in a better position to plan evasive maneuvers and prevent destructive collisions. From April, 25-29 2018, Fraunhofer FHR and its partners will exhibit the complementary radar systems TIRA and GESTRA as well as the latest radar techniques for space observation across three stands at the ILA Berlin.

The "traffic situation" in space is very tense: the Earth is currently being orbited not only by countless satellites but also by a large volume of space...

Im Focus: Researchers Discover New Anti-Cancer Protein

An international team of researchers has discovered a new anti-cancer protein. The protein, called LHPP, prevents the uncontrolled proliferation of cancer cells in the liver. The researchers led by Prof. Michael N. Hall from the Biozentrum, University of Basel, report in “Nature” that LHPP can also serve as a biomarker for the diagnosis and prognosis of liver cancer.

The incidence of liver cancer, also known as hepatocellular carcinoma, is steadily increasing. In the last twenty years, the number of cases has almost doubled...

Im Focus: Researchers at Fraunhofer monitor re-entry of Chinese space station Tiangong-1

In just a few weeks from now, the Chinese space station Tiangong-1 will re-enter the Earth's atmosphere where it will to a large extent burn up. It is possible that some debris will reach the Earth's surface. Tiangong-1 is orbiting the Earth uncontrolled at a speed of approx. 29,000 km/h.Currently the prognosis relating to the time of impact currently lies within a window of several days. The scientists at Fraunhofer FHR have already been monitoring Tiangong-1 for a number of weeks with their TIRA system, one of the most powerful space observation radars in the world, with a view to supporting the German Space Situational Awareness Center and the ESA with their re-entry forecasts.

Following the loss of radio contact with Tiangong-1 in 2016 and due to the low orbital height, it is now inevitable that the Chinese space station will...

Im Focus: Alliance „OLED Licht Forum“ – Key partner for OLED lighting solutions

Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, provider of research and development services for OLED lighting solutions, announces the founding of the “OLED Licht Forum” and presents latest OLED design and lighting solutions during light+building, from March 18th – 23rd, 2018 in Frankfurt a.M./Germany, at booth no. F91 in Hall 4.0.

They are united in their passion for OLED (organic light emitting diodes) lighting with all of its unique facets and application possibilities. Thus experts in...

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

New solar solutions for sustainable buildings and cities

23.03.2018 | Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

Latest News

For graphite pellets, just add elbow grease

23.03.2018 | Materials Sciences

Unique communication strategy discovered in stem cell pathway controlling plant growth

23.03.2018 | Agricultural and Forestry Science

Sharpening the X-ray view of the nanocosm

23.03.2018 | Physics and Astronomy

Science & Research
Overview of more VideoLinks >>>