About 700,000 Americans suffer strokes each year that are primarily caused by a buildup of plaque in the carotid arteries, which are two large vessels in the neck that carry blood to the front part of the brain. Arteries can either become completely blocked with plaque, or pieces of it can break off and settle in the brain. Patients over the age of 70 who have blockages in their neck arteries shouldn’t be treated by stenting, says new research published in The Lancet.
The “gold standard” for treatment of the condition is carotid endarterectomy, a surgical procedure which widens the artery by scraping the plaque out. But a newer, less-invasive procedure called stenting inserts a catheter through the groin and threads it to the neck where a balloon is inflated to compress the plaque. A metal mesh stent is then inserted to keep the artery open.
Besides being less invasive, stenting is cheaper and requires less time in the hospital. Some experts, however, questioned its safety since earlier reports had suggested that stenting was more risky.
A study at the National Hospital for Neurology and Neurosurgery and the Institute of Neurology, University College London, United Kingdom, indicates they could be right. Data on 3,433 patients treated for blocked carotid arteries found that during the first 120 days following treatment, strokes or death were 53 percent more likely to occur in the group receiving stents. But the risk of stroke or death doubled for those getting stents who were age 70 and older.
“The harm of stenting strongly depended on age; whereas estimated risks of stroke or death in patients younger than 70 years were similar in the two treatment groups, we noted that the risk of stenting doubled among patients 70 years or older compared with the younger age group,” the authors said in a statement.
“By contrast," they said, "the risk of stroke or death associated with endarterectomy was similar in old and young patients … in conclusion, there is strong evidence that, in the short term, the harm of stenting compared with endarterectomy decreases with younger age.”
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