To Stent Or Not To Stent
Posted On October 12, 2010
Got a blocked artery? Oops. Now what?
You may have heard about docs using stents to open up the pipes, but there are two study-of-studies that don’t look good for this procedure.
SYNTAX Study (New England Journal of Medicine)
- 1,800 patients. The arteries feeding blood to their heart muscle was blocked. Docs either performed 1) a Bypass surgery or 2) a Stent implant.
- Patients had fewer heart attacks and less need for further intervention with Bypass surgery than with the placement of a drug-eluting stent.
- Patients receiving the stent had more “bad outcome endpoints”, including 28% greater risk for stroke or myocardial infarction, 48% more likely to need for repeat revascularization and 22% more likely to die. The researchers feel that perhaps 5,000 or more deaths annually may be avoided if some stent patients were to have undergone CABG instead.
Comparison of 13 Clinical Trials (Archives of Neurology)
But what if your carotid artery is blocked (the big one that runs from your heart, up your neck, and into your brain)? Docs have a couple of options:
1) surgery by opening the neck, scraping away the plaque buildup that can lead to stroke.
2) Stent the artery.
- They found patients who got a carotid stent had a 19 percent higher risk of strokes or death compared with patients who had surgery.
- HOWEVER, patients who had a stent had a 55 percent lower risk of a later heart attack and 85 percent reduction in the risk of injury to the cranial nerve compared with surgery.
So, for the heart arteries, it’s clear that a bypass is better. But for arteries heading up into your brain, it’s not clear at all … you just have to decide which “risk set” you are most comfortable with.
Carotid stent has higher stroke risk than surgery | Reuters
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