Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Surgery or stenting for carotid artery disease? Question remains

27.07.2010
A review of scientific studies that compares two treatments for preventing strokes due carotid artery disease provides no clear answer on which treatment is better, a UT Southwestern Medical Center physician reports in an editorial in today's issue of the Archives of Internal Medicine.

"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!
Further information:
http://www.utsouthwestern.edu

Further reports about: Halm Medicare Prostate Surgery artery disease blood vessel internal

More articles from Medical Engineering:

nachricht Visualizing gene expression with MRI
23.12.2016 | California Institute of Technology

nachricht Illuminating cancer: Researchers invent a pH threshold sensor to improve cancer surgery
21.12.2016 | UT Southwestern Medical Center

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

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

Im Focus: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

Helmholtz International Fellow Award for Sarah Amalia Teichmann

20.01.2017 | Awards Funding

An innovative high-performance material: biofibers made from green lacewing silk

20.01.2017 | Materials Sciences

Ion treatments for cardiac arrhythmia — Non-invasive alternative to catheter-based surgery

20.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>