Brain Stents Might Help High-Risk Stroke Patients

Encouraging findings need to be confirmed in a larger trial, experts say

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MONDAY, Feb. 5, 2007 (HealthDay News) -- People at high risk of stroke because of narrowed blood vessels in the brain benefit from having flexible tubes known as stents implanted to keep those arteries open, a Chinese study finds.

That might seem to be common sense, but an American expert said it is far from common practice, and he agreed with the Chinese neurologist who reported the finding in the Feb. 6 issue of the journal Neurology that further studies are needed to prove the point.

"At present, there still has been a debate about the value of stents for people with brain vessel blockage, because the procedure itself can lead to stroke, and a high rate of procedural complications can offset the potential benefits," said lead researcher Dr. Wei-Jian Jiang, a neurologist at the Capital University of Medical Sciences in Beijing.

But his study, comparing 121 people who had artery blockage of more than 70 percent with 92 others who had a more moderate blockage, found clear benefits of stent implants for those with more severe obstructions.

The risk of a stroke for patients given stents for severe artery narrowing was 7.2 percent after one year and 8.2 percent after two years. For the moderate-blockage group, the risk was 5.3 percent after one year and 8.3 percent after two years.

"These similar results suggest while patients with severe blockage benefit from stents, patients with moderate blockage may not, since our study shows the degree of artery blockage isn't a predictor of stroke risk after stent placement," Jiang said. In other words, the potential risk of stent placement may not be worth it for patients with less clogged arteries.

Because his study was relatively small, Jiang said a large-scale, carefully controlled trial is still needed to compare stent placement with other treatments, such as medication or surgery, for patients with severe blockages.

Jiang said his group is planning such a study, but it won't be easy to do, since the "brain vessel stent procedure is still a new therapeutic method." There may also not be enough experienced interventional neurologists to perform such multicenter trials, Jiang added.

The Chinese report is "very encouraging," said Dr. Edgar J. Kenton, clinical professor of neurology at Thomas Jefferson University Hospital in Philadelphia and chair of the practice committee of the American Academy of Neurology. But he added that, "what you want at the end of the day is a double-blind study" comparing stent implantment with other treatments for high-risk persons, such as those with severely narrowed arteries and conditions such as diabetes, high blood pressure and a prior stroke.

At this time, the treatment such people receive depends in large part on the resources available at the center where they are diagnosed, Kenton said.

"It depends on the hospital," he said, "where they are, the degree of experience dealing with such patients, if they have an interventional neurologist on staff."

There is increasing evidence that "stents work, and particularly in severe cases," Kenton said, and severely affected people "are apt to be considered for stenting." But the issue will not be completely settled until a carefully controlled study is done, he said.

"At present, these high-risk patients are the target population of stent procedure in our practice," Jiang said.

More information

There's more on stenting and other stroke-prevention methods at the Cleveland Clinic.

SOURCES: Wei-Jian Jiang, M.D., neurologist, Capital University of Medical Sciences, Beijing, China; Edgar J. Kenton, M.D., clinical professor, neurology, Thomas Jefferson University Hospital, Philadelphia; Feb. 6, 2007, Neurology

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