Using stents to keep neck arteries open is just as effective as invasive neck surgery for long-term prevention of fatal and disabling strokes
Using stents to keep neck arteries open is just as effective as invasive neck surgery for long-term prevention of fatal and disabling strokes, reports an international trial led by UCL (University College London) funded by the Medical Research Council and Stroke Association.
The research paper, published today in the Lancet, was authored by researchers from UCL, Basel University, Switzerland, the London School of Hygiene & Tropical Medicine, the University Medical Center Utrecht, Netherlands, Sheffield Teaching Hospitals NHS Foundation Trust, and Newcastle University.
The brain's blood supply comes from the carotid arteries, two large blood vessels that run through the neck. Carotid artery disease occurs when cholesterol and fatty deposits build up in these arteries, restricting blood flow and increasing the risk of stroke.
In the UK, carotid artery disease is most commonly treated by an invasive surgical procedure called endarterectomy. Patients are put under general or local anaesthetic and surgeons cut open the affected artery to remove the build-up and then sew the wound up. The operation leaves a scar on the neck and can lead to heart attack, short-term facial paralysis from nerve damage, and bleeding, which can prolong hospital stays.
Stenting is an alternative procedure in which a small mesh cylinder, a 'stent', is used to keep the artery open. This is inserted under local anaesthetic through a small nick in the groin and fed up to the neck using a thin wire. The procedure is less invasive, causing only minor bruising in the groin, no risk of nerve damage and a lower heart attack risk than endarterectomy.
The study followed 1,713 patients with carotid artery disease, of whom 855 were assigned to stenting and 858 to endarterectomy, for up to 10 years. The median follow-up was 4.2 years. Both techniques were found to be equally good at preventing fatal and disabling strokes, but stented patients were slightly more likely to have minor strokes without long-term effects. The risk of any stroke in five years was 15.2% in the stenting group compared to 9.4% in the endarterectomy group, but the additional strokes were minor and had no impact on long-term quality of life.
"At the moment, stenting is not widely used in the UK due to historical uncertainty over its long-term effectiveness," says study leader Professor Martin Brown from the UCL Institute of Neurology. "However, we have now shown that stenting is just as good as endarterectomy for preventing fatal and disabling strokes. We have also shown that the risk of stroke during the procedure is no higher for stenting than for endarterectomy in younger patients. The risks of each procedure are different and will vary depending on the patient, but stenting should be offered as an option to many more patients under the age of 70.
"One of the issues is that there are not many centres in this country that currently offer stenting as an option so the patient choice is not there. Now that we know stenting is effective in the long term, more staff should be trained to carry out the procedure and gain experience. Otherwise there is a vicious cycle where nobody at a centre has stenting experience so patients are only offered endarterectomy and staff cannot learn or observe the procedure. In other countries, stenting is more widespread and the safety of the procedure improves as staff gain experience."
Dr Shamim Quadir, Research Communications Manager at the Stroke Association, said: "A transient ischaemic attack, also known as a mini-stroke, can be a warning sign that someone has carotid artery stenosis, and is at risk of having a major stroke. Preventative procedures to treat such carotid artery stenosis are therefore crucial.
"Carotid endarterectomy is a common, yet invasive surgery used to treat carotid artery stenosis, and is widely used throughout the UK. Previously, far less was known about the long-term effectiveness of stenting as an alternative procedure.
"These latest research findings suggest that overall, stenting is just as safe, and equally effective for the long-term prevention of fatal and disabling strokes. Both procedures carry their own risks, and these will need to be considered for each individual patient.
"This research provides a vital step in providing another viable option which will help people significantly reduce their stroke risk."
Siobhan Pipa | Eurek Alert!
Using fragment-based approaches to discover new antibiotics
21.06.2018 | SLAS (Society for Laboratory Automation and Screening)
Scientists learn more about how gene linked to autism affects brain
19.06.2018 | Cincinnati Children's Hospital Medical Center
In a recent publication in the renowned journal Optica, scientists of Leibniz-Institute of Photonic Technology (Leibniz IPHT) in Jena showed that they can accurately control the optical properties of liquid-core fiber lasers and therefore their spectral band width by temperature and pressure tuning.
Already last year, the researchers provided experimental proof of a new dynamic of hybrid solitons– temporally and spectrally stationary light waves resulting...
Scientists from the University of Freiburg and the University of Basel identified a master regulator for bone regeneration. Prasad Shastri, Professor of...
Moving into its fourth decade, AchemAsia is setting out for new horizons: The International Expo and Innovation Forum for Sustainable Chemical Production will take place from 21-23 May 2019 in Shanghai, China. With an updated event profile, the eleventh edition focusses on topics that are especially relevant for the Chinese process industry, putting a strong emphasis on sustainability and innovation.
Founded in 1989 as a spin-off of ACHEMA to cater to the needs of China’s then developing industry, AchemAsia has since grown into a platform where the latest...
The BMBF-funded OWICELLS project was successfully completed with a final presentation at the BMW plant in Munich. The presentation demonstrated a Li-Fi communication with a mobile robot, while the robot carried out usual production processes (welding, moving and testing parts) in a 5x5m² production cell. The robust, optical wireless transmission is based on spatial diversity; in other words, data is sent and received simultaneously by several LEDs and several photodiodes. The system can transmit data at more than 100 Mbit/s and five milliseconds latency.
Modern production technologies in the automobile industry must become more flexible in order to fulfil individual customer requirements.
An international team of scientists has discovered a new way to transfer image information through multimodal fibers with almost no distortion - even if the fiber is bent. The results of the study, to which scientist from the Leibniz-Institute of Photonic Technology Jena (Leibniz IPHT) contributed, were published on 6thJune in the highly-cited journal Physical Review Letters.
Endoscopes allow doctors to see into a patient’s body like through a keyhole. Typically, the images are transmitted via a bundle of several hundreds of optical...
13.06.2018 | Event News
08.06.2018 | Event News
05.06.2018 | Event News
22.06.2018 | Materials Sciences
22.06.2018 | Earth Sciences
22.06.2018 | Life Sciences