Medical Treatment Better Than Brain Stenting in Preventing Stroke

Patients at a high risk for a second stroke who received intensive medical treatment had fewer strokes and deaths than patients who received percutaneous transluminal angioplasty and stenting (PTAS) in addition to the medical treatment, according to a new study.

Researchers at University Hospitals (UH) Case Medical Center (Cleveland, OH, USA), the Medical University of South Carolina (Charleston, USA), and other institutions randomly assigned patients who suffered a recent transient ischemic attack (TIA) or stroke attributed to stenosis in a major intracranial artery to aggressive medical management alone, or to aggressive medical management plus PTAS. The primary end point was stroke or death within 30 days after enrollment, or a revascularization procedure for the qualifying lesion during the follow-up period, or stroke in the territory of the qualifying artery beyond 30 days.

Enrollment in the study was stopped after 451 patients underwent randomization, because the 30-day rate of stroke or death was 14.7% in the PTAS group, compared to 5.8% in the medical-management group. Beyond 30 days, stroke in the same territory occurred in 13 patients in each group. Currently, the mean duration of the ongoing follow-up is one year. The probability of the occurrence of a primary end-point event over time differed significantly between the two treatment groups, with one-year rates of the primary end point of 20% in the PTAS group and 12.2% in the medical-management group. The results were published early online on September 15, 2011, in the New England Journal of Medicine (NEJM).

“For now, we are thrilled that the effect of a very aggressive patient care plan to address all of their risk factors and make lifestyle changes to healthier living have demonstrated a significant impact in preventing stroke, and this impact is significant in as early as one month,” said lead author professor of neurology Cathy Sila, MD, director of the stroke and cerebrovascular center in the UH Neurological Institute. “I think this is a major achievement. The stroke or transient ischemic attack is the 'warning shot across the bow' and we need to get into battle mode immediately.”

A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by thrombosis or arterial embolism, or as a result of intracranial hemorrhage. Consequently, the affected area of the brain is unable to function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

Related Links:
University Hospitals (UH) Case Medical Center
Medical University of South Carolina