SAN ANTONIO — People at risk of a stroke because of narrowed neck arteries can be safely treated with a less drastic option than the surgery done now, the largest study ever done on these treatments concludes.
If Medicare agrees to cover it, hundreds of thousands of Americans a year might be able to have an artery-opening procedure and a stent instead of surgery to remove built-up plaque, doctors say.
A stent is a wire-mesh tube that props the blood vessel open. They have long been used to fix heart arteries but are approved for use in the neck only for those too sick for surgery.
The new study, in people with less severe disease, suggests stents might find much wider use.
“The sea of people is gigantic” who could benefit, said Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, the study’s main sponsor.
“We now have two safe and effective methods” to treat neck vessels, said Dr. Thomas Brott of the Mayo Clinic in Jacksonville, Fla. He led the study and presented the results Friday at an American Stroke Association conference.
The treatments, however, have different complications, and not all doctors are convinced stents are as safe. Three previous studies found they were not, including one published online Thursday by the British journal The Lancet.
The reason: Even though stents prevent strokes in the long run, the procedure itself can trigger a stroke if a bit of plaque travels to the brain.
The new study revealed a trade-off: Strokes were a more frequent complication with stents, while heart attacks were more common after surgery.
Doctors say which option patients choose may depend on their general health, what risks they are willing to accept and how badly they want to avoid surgery.
