Recent studies show that patients who use intensive drug therapy have a much greater chance of avoiding a recurrent stroke than those who have had stents inserted to restore the patency of the cerebral arteries.
Scientists were so surprised by the results of the study on the best treatment modality for narrowing of the cerebral arteries that it was decided to end the experiment early. Contrary to expectations, it turned out that the risk of a repeat cerebrovascular accident, or even death, is higher in people who underwent stent implantation, which was previously considered a more effective method of stroke prevention than drug therapy. According to experts, the results recently published in the online edition of the New England Journal of Medicine, should lead to an immediate change in the way of treatment.
The popularity of percutaneous endovascular angioplasty, that is, angioplasty and stent implantation to prevent a second stroke, has been growing for several years. – Dilating arteries that have narrowed as a result of an illness is perhaps the most intuitive procedure in the event of a risk of a stroke. The tests were to confirm its effectiveness, says Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, who led the research. – Meanwhile, it turned out that this solution is not always good for the patient. Narrowing of the arteries in the brain that transport blood to the brain is one of the most common causes of an ischemic stroke, or infarction. Due to the aging of the population and increasing obesity, it is expected that this type of stroke will occur more and more frequently. African Americans and Latin Americans are particularly vulnerable. Doctors have long been looking for an effective way to prevent a recurrence of a cerebrovascular accident, especially in patients with obstruction in more than 70 percent. the main cerebral artery. Despite the meticulous use of drugs, nearly 25 percent of in patients with such advanced obstruction, a second stroke occurs within a year.
Stents are routinely used to widen narrowed or blocked coronary vessels, but implantation of stents into the brain is more risky due to the circular and therefore more complex arrangement of arteries that supply the brain.
The federally funded study involved 451 patients from 50 US health centers who had recently had a cerebral infarction and have more than 70 percent obstruction. cerebral arteries. All participants took medications, including aspirin and the blood-thinning clopidogrel (Plavix), and received intensive therapy to reduce the risk of factors leading to stroke: high blood pressure, high cholesterol, and untreated diabetes. They were all advised to increase their physical activity and quit smoking. Out of 451 patients, 224 underwent stent implantation.
Researchers assumed that, compared to drug therapy alone, stents by at least 35 percent. reduce the risk of another stroke and death within two years of the first heart attack. Meanwhile, nearly 15 percent. patients with stents had a stroke or died within 30 days of starting the tests. For comparison, 6% of the drug-only group suffered or died of a stroke. patients. After one year of follow-up, 21% of patients had a stroke or death. patients with stents and 12 percent. taking medication. This was enough to stop further testing. ‘The data are convincing enough to conclude that stent therapy is not safe,’ said study author Dr Marc Chimowitz, a neurologist at the University of South Carolina in Charleston. – We have ceased further research. We will treat patients pharmaceutically, without the use of stents.
The ABC of a healthy heart
Chimowitz admitted that the reasons for this were not clear. In his opinion, it is possible that the stents themselves cause atherosclerotic changes and lead to another stroke. Earlier efficacy tests of the stents used in the Chimowitz study – the so-called The Gateway-Wingspan system, manufactured by Michigan-based Stryker Corporation, has shown that the risk of stroke and death is reduced when used.
“People will still believe it’s a safe way to clear blockages,” Koroshetz said. – Better technology may be the solution.
Equally important is the question of why drug therapy has been so successful. Doctors unanimously praise the results obtained with aggressive pharmaceutical therapy and lifestyle changes, but add that unfortunately such close monitoring of patients is not possible outside the research program.
– The most important conclusion from this study is that it is worth making efforts to reduce the risk of factors promoting stroke, because it is the most effective way to reduce the risk of a heart attack – said Dr. Patrick D. Lyden, head of the department of neurosurgery at Cedars-Sinai Medical Center, one of the centers participating in the study . Lyden, however, defends stent implantation for some patients and facilities. In his opinion, a lot depends on the experience and skills of the doctor performing the procedure. – This study proved that the implantation of stents in the cerebral arteries is much more difficult than we thought. It turns out that such a procedure requires the hand of an experienced neurosurgeon – he added.
Text: Shari Roan