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Carotid Therapy Studied at Christ

Posted on: Tuesday, 26 July 2005, 06:01 CDT

The National Institutes of Health has selected Christ Hospital to participate in a national study to determine if minimally invasive carotid artery surgery is as safe and effective as a more traditional surgery for low-risk patients.

Both procedures are used to treat carotid artery disease and help prevent strokes.

The trial, which will include hospitals in every state and will evaluate about 2,500 patients over the next year, will compare minimally invasive stenting to the more traditional carotid revascularization endarterectomy.

In the carotid endarterectomy surgical procedure, the surgeon makes an incision in the neck and physically removes the plaque from the inside of the carotid artery. This procedure is currently the standard surgical method of treating partial blockage.

In carotid stenting, a physician inserts a catheter or tube into the artery of the leg and guides it into the diseased artery. A balloon catheter and a metallic stent are used to dilate the narrowed artery and to cover the plaque for stroke prevention.

Previous clinical trials have shown that carotid stenting is beneficial for patients with high-risk factors for traditional surgery.

The risk factors include prior carotid surgery, previous neck radiation therapy and severe heart and lung disease.

That news may not be all good, said Dr. Robert Bulas, interventional neuroradiologist with Professional Radiology Inc., director of the Carotid Stent Team at Christ Hospital, and local principal investigator for the current clinical trial.

"It's good and bad," he said. "It's good that it's been approved, but it's bad because it may become over-utilized."

Although shown to be a good treatment for patients who have high surgery-related risks, it has not yet been shown to be the better treatment for patients who have low surgical risks. Nonetheless, some doctors want to use the less-invasive surgery on for patients who do not fall into the high-risk category.

The vast majority are not high-risk patients, he said.

The current clinical trial "will scientifically determine whether minimally invasive stenting is as safe and effective as traditional surgery in relatively healthy individuals," Bulas said.

Carotid artery disease involves the buildup of plaque in one or both carotid arteries in the neck. The carotid arteries supply oxygen and blood to the parts of the brain where thinking, speech, personality and sensory and motor functions reside.

Stroke is the third leading cause of death in the United States and the No. 1 one cause of disability in adults, according to the American Heart Association.

Up to 15 percent of strokes are caused by carotid artery disease.

Source: Cincinnati Post

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