Drugs and lifestyle changes beat surgery, when it comes to stroke prevention, according to a new federally-funded comparative study.
The findings, published in The Lancet, show that with narrowed brain arteries don't benefit as much from a surgical technique called stenting as those who use medication to reduce their cardiovascular risks and exercise more, stop smoking, improve their diets, and lose weight.
The results were so striking that the researchers halted the study two years early, when it became apparent that stenting was associated with a higher risk of early strokes and death.
"Surgical interventions often have increased risk of complications early on, so we continued to follow the patients to see if the long-term effects of surgery were beneficial," said lead researcher Colin Derdeyn, M.D., professor of radiology at Washington University School of Medicine in St. Louis and director of its Stroke and Cerebrovascular Center at Barnes-Jewish Hospital. "That did not turn out to be the case."
The study — led by researchers at Washington University School of Medicine, the Medical University of South Carolina, Emory University, and the State University of New York at Stony Brook — was funded by the National Institutes of Health and involved 451 patients at high risk of having a repeated stroke.
All participants had a brain artery with at least a 70 percent narrowing that had already caused a stroke or mini stroke. Researchers divided the study participants into two group.
In one group, a metal stent was surgically inserted into the narrowed brain artery to open it up and participants received medications to reduce clot formation and lower cholesterol and blood pressure. The second group received the same medications but did not receive stent implants.
Over the course of the study, both groups were encouraged to exercise, quit smoking, improve their diet, and lose weight.
"We were expecting that at some point the incidence of new strokes in those who had surgery would drop below that of those who did not, but that didn't happen," said Dr. Derdeyn. "This proves that medical therapy is better than surgery for these patients."
Each year in the United States, about 800,000 people have a stroke. In 1 in 10 cases, those strokes are thought to result from a narrowed artery inside the brain.
This study was funded, in part, by the National Institutes of Health.
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