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Stenting as effective as surgery, study finds

A less-invasive stenting procedure to open blocked neck arteries is just as safe and effective as traditional surgery, according to a large clinical trial conducted in part at Allegheny General Hospital in the North Side.

"Each option has its pros and cons. This study shows roughly equivalent results from both procedures," said Dr. Satish Muluk, chief of vascular surgery at AGH.

Muluk was one of the principal investigators in the study, known as the Carotid Revascularization Endarterectomy vs. Stenting Trial, or CREST. Results were published Wednesday in the online edition of the New England Journal of Medicine.

Carotid stenting, less common than surgery, involves the insertion of a mesh-like tube into the neck artery through the groin. The tube expands inside the artery to increase blood flow that was impaired by plaque.

The study found that stenting came with a slightly higher risk of stroke for the 2,502 participants at 116 centers in the United States and Canada.

Patients who underwent the surgical option known as endarterectomy also had risks. The study found a higher percentage of participants suffered heart attacks after the surgery, compared with those in the stenting group.

Surgery has been the standard for removing plaque from the carotid artery. It requires anesthesia and an incision in the neck.

"One has to be very careful in choosing a procedure, depending on the patient," Muluk said. "If a patient has a tenuous heart condition, maybe they are at risk for a heart attack, and that patient should be treated with stenting."

Choosing one treatment over another should be done in consultation with a physician familiar with both techniques, Muluk said. Despite higher risks for stroke with stenting, he said, doctors use an umbrella-type device to catch plaque that might be released during the procedure.

Carotid artery disease is a leading cause of strokes, which kill almost 800,000 Americans every year. The disease develops when there is blockage in one of the two arteries that travel along the front of the neck and supply blood to the brain.

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