"The most recent data on treatment options for carotid artery disease continue to be a mix of good and bad news," said Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern.
The carotid arteries, which run on the right and left side of the front of the neck, are two of the four main blood vessels that supply oxygen to the brain. These arteries can become narrowed by fatty cholesterol deposits, or plaque. If pieces of plaque break free, they can lodge in the brain, causing stroke.
Most research on carotid artery disease focuses on two treatments to prevent stroke. The more established therapy is to open the artery and surgically remove the plaque. A more recent technique, called carotid stenting, involves inserting a mesh tube to keep the artery open. The tube, or stent, is inserted through the groin.
"There are two very different groups of patients for whom surgery or stenting may be considered," said Dr. Halm. "Most people who have had a stroke or a 'temporary stroke' due to carotid disease in the past 12 months stand to benefit greatly from revascularization if they can tolerate the procedure. People who have silent or asymptomatic carotid disease have much more modest benefit from either surgery or stenting. They should make an informed decision with their doctors about the benefits and harms of all their treatment options, whether surgery, stenting or medication."
Stenting is controversial because less is known about its long-term safety and effectiveness compared to surgery. Medicare limits reimbursement for the procedure to selected situations. The appeal of stenting is that it requires no anesthesia, does not leave a neck scar, requires a shorter hospital stay and can be performed by surgeons, cardiologists, radiologists and neurologists. Both stenting and surgery can cause death or stroke.
Dr. Halm's editorial accompanies a study in the same journal written by lead author Dr. Manesh Patel of the Duke Clinical Research Institute. The Patel study examined national data on the use and outcomes of surgery and stenting in the Medicare population. The researchers found that from 2003 to 2006, use of stenting increased 33 percent, while rates of the traditional surgery dropped by 19 percent. The study also reported wide geographic variations in the use of the procedures.
"Given the national policy interest in controlling rising health care costs, the fact that where you live may influence how much and what type of care you get as how sick you are has generated great interest," Dr. Halm said. "The rise in use of stenting is probably due to the fact that it can be done by a much larger group of specialists compared to surgery alone, and stenting is less invasive, so more people may want it."
However, the "jury is still out on the appropriate role for stenting and caution is merited for several reasons," he said. For example, studies have consistently shown that surgery is better than stenting in patients 70 and older (the largest group with carotid disease). And although 70 percent to 90 percent of U.S. patients who undergo surgery or stenting are asymptomatic, it remains unproven that either revascularization strategy is superior to the type of intensive risk factor lowering that is now possible with high-potency drugs to lower cholesterol, prevent blood clots and control blood pressure.
"Studies in carotid disease have shown that physicians tend to state the risk of not doing a procedure more frequently than the risks of the procedure itself, so patients may not be getting the most balanced information about their options," said Dr. Halm, who is developing patient education materials and an interactive computer program designed to help patients better understand the pros and cons of surgery, stenting and medical therapy.
He offers the following advice to patients with carotid disease: "Ask your doctor about the potential benefits and risks of a carotid procedure given your circumstances. If you've had a stroke or temporary stroke in the past 12 months and over 50 percent of narrowing in your carotid artery, the benefits of surgery or stenting may be large. If you have had neither, you have asymptomatic carotid disease, so the benefits of revascularization are much smaller, and might not be much better than aggressive medical therapy. Treatment of asymptomatic carotid disease is not an emergency, so you have time to get the facts about the pros and cons of all three options – surgery, stenting, medical therapy alone."
This news release is available on our World Wide Web home page at http://www.utsouthwestern.edu/home/news/index.html
To automatically receive news releases from UT Southwestern via e-mail, subscribe at www.utsouthwestern.edu/receivenews
LaKisha Ladson | EurekAlert!
UCLA engineers use deep learning to reconstruct holograms and improve optical microscopy
22.11.2017 | University of California - Los Angeles
First transcatheter implant for diastolic heart failure successful
16.11.2017 | The Ohio State University Wexner Medical Center
High-precision measurement of the g-factor eleven times more precise than before / Results indicate a strong similarity between protons and antiprotons
The magnetic moment of an individual proton is inconceivably small, but can still be quantified. The basis for undertaking this measurement was laid over ten...
Heat from the friction of rocks caused by tidal forces could be the “engine” for the hydrothermal activity on Saturn's moon Enceladus. This presupposes that...
The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.
Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....
The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.
Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...
Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.
That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...
15.11.2017 | Event News
15.11.2017 | Event News
30.10.2017 | Event News
24.11.2017 | Physics and Astronomy
24.11.2017 | Health and Medicine
24.11.2017 | Earth Sciences