Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Surgery or stenting for carotid artery disease? Question remains

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

To automatically receive news releases from UT Southwestern via e-mail, subscribe at

LaKisha Ladson | EurekAlert!
Further information:

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

More articles from Medical Engineering:

nachricht Gentle sensors for diagnosing brain disorders
29.09.2016 | King Abdullah University of Science and Technology

nachricht New imaging technique in Alzheimer’s disease - opens up possibilities for new drug development
28.09.2016 | Lund University

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

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

Im Focus: Etching Microstructures with Lasers

Ultrafast lasers have introduced new possibilities in engraving ultrafine structures, and scientists are now also investigating how to use them to etch microstructures into thin glass. There are possible applications in analytics (lab on a chip) and especially in electronics and the consumer sector, where great interest has been shown.

This new method was born of a surprising phenomenon: irradiating glass in a particular way with an ultrafast laser has the effect of making the glass up to a...

Im Focus: Light-driven atomic rotations excite magnetic waves

Terahertz excitation of selected crystal vibrations leads to an effective magnetic field that drives coherent spin motion

Controlling functional properties by light is one of the grand goals in modern condensed matter physics and materials science. A new study now demonstrates how...

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Greater Range and Longer Lifetime

26.10.2016 | Power and Electrical Engineering

VDI presents International Bionic Award of the Schauenburg Foundation

26.10.2016 | Awards Funding

3-D-printed magnets

26.10.2016 | Power and Electrical Engineering

More VideoLinks >>>