Stroke prevention safer with neck surgery than stents

Patients at risk for having a stroke are more likely to benefit from surgery to strip fatty plaque out of the arteries in the neck than from a stent, or tube-like device implanted to hold the artery open, a study found.

A stroke, heart attack or death occurred in 8.5 percent of patients with symptoms caused by narrowing neck arteries within four months of getting a stent, compared with 5.2 percent of those who underwent surgery, according to the report published in the journal Lancet. Stent patients were also three times more likely to have new lesions in their brains after the procedure, according to imaging results published in Lancet Neurology.

The metal devices from Boston Scientific Corp., Johnson & Johnson and Ev3 Inc., are used by doctors trying to reduce the risk of strokes without the danger of cutting open the carotid arteries that line the neck. No studies have proven whether the metal devices are as effective as the surgery that became the standard of care more than a decade ago, the authors said.

"If people have symptoms, possibly a mini-stroke, they need to be treated quickly," said lead researcher Martin Brown, a neurologist and professor of stroke medicine at University College London, in a telephone interview. "Surgery is overall a better choice than carotid stenting."

About 150,000 in the U.K. have a stroke each year and 10 percent would qualify for either the neck artery surgery or stent procedure, Brown said.

The study, involving 1,713 patients, was funded by the Medical Research Council, the Stroke Association, Sanofi-Aventis and the European Union. Side effects including cranial nerve palsy that creates weakness in the face and neck, and blood clots known as hematomas, were more common with surgery.

While surgery appears preferable for most patients, long- term data is needed to see whether the risks and benefits change with time, wrote Klaus Groeschel, from the department of neurology at Georg-August-Universitat Gottingen in Germany, in an editorial that accompanied the report. Certain patients may benefit more from stenting than surgery, he wrote.

"The widespread use of carotid stenting, especially its routine use as first-choice treatment for symptomatic carotid stenosis, does not seem to be justified for the time being," he wrote. "However, it is not only about whether stenting or endarterectomy will win the race," he said, using the technical name for the operation. They "could both have their place as different treatment options for carotid stenosis and should preferably complement each other."

Cortez reported from London.