Stenting Can Open Blocked Brain Arteries

Study finds short-term benefits for stroke patients; longer-term research needed

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By Ed Edelson
HealthDay Reporter

FRIDAY, Oct. 14, 2005 (HealthDay News) -- Inserting a stent -- a flexible, wire-mesh tube -- into a brain artery in the hours after it had been closed completely by a stroke restored blood flow for most patients in a first-of-its-kind study.

Stenting is commonly used for strokes caused by partial blockage of a carotid artery, which carries blood to the brain. But there had not been much research on whether it would work for complete artery blockage, said Dr. Tudor G. Jovin. He is assistant professor of neurology at the University of Pittsburgh and lead author of the new report in the journal Stroke.

"The original approach was to say that if an artery was occluded completely, there was nothing one can do," Jovin said. "Our approach was to try to open the artery."

Stenting is a procedure in which a balloon-tipped catheter is inserted into an artery and advanced to the point of the blockage. The balloon is then inflated to open the artery, and a stent is put in place to keep the artery open.

The study trial included 25 patients who were referred for stenting because they had had symptoms of a stroke in the preceding six hours, and imaging showed complete blockage of the artery.

"The fact that we were able to open the artery of 23 of the 25 patients was a significant finding," Jovin said, adding that stenting was not possible for the other two patients.

About 40 percent of people with strokes caused by total blockage of the carotid artery suffer severe disability, and 20 percent die within three months, the researchers said. Of the patients in the study successfully stented, 10 had significant improvement of stroke symptoms 24 hours later.

But those are short-term results and "we do not have data long-term," Jovin said.

Because the study suggests that "this approach is feasible," it sets the stage for a larger, controlled trial to show whether stenting for such patients gives long-term benefits, he said.

Such a study requires money and time, Jovin said. In the meantime, University of Pittsburgh neurologists who treat stroke are using stents for some patients with complete artery blockage, he said.

"We are not talking about patients who have had occlusions for a long time," Jovin said. "We are looking at patients who have just had a stroke. When we find that the artery has closed in the last few hours or the last few days, we try to open the artery. We think we can improve stroke symptoms."

Dr. Marc R. Mayberg is director of the Seattle Neuroscience Institute and a spokesman for the American Heart Association. He said neurologists have been reluctant to try stenting because they extrapolated from previous efforts to open arteries by surgery, and "the results were mixed -- at best."

"Many of the arteries reoccluded and many patients had severe complications," he said

But those studies were done 15 years ago, when imaging technology and clot-dissolving methods were not as advanced as they are now, and patients were not getting to the hospital as fast as they do today, Mayberg said.

He agreed that a controlled trial is needed to prove the benefits of stenting for completely blocked arteries. But Mayberg said that, because of the Pittsburgh study, "I would be much more inclined to open up an occluded carotid artery, in one of two categories -- a fresh occlusion or when the occlusion occurred within a couple of days, when the patient had a specific syndrome of stroke."

More information

To learn more about stroke, visit the American Heart Association.

SOURCES: Tudor G. Jovin, M.D., assistant professor of neurology, University of Pittsburgh; Marc C. Mayberg, M.D., director, Seattle Neuroscience Institute; October 2005, Stroke

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