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Community Doctors Can Perform Carotid Stenting

Study shows good results with training for surgery to prevent stroke

THURSDAY, Dec. 14, 2006 (HealthDay News) -- Carotid stenting -- inserting a tube to keep the main artery to the brain open to prevent a stroke -- can be done by community physicians as well as specialists, a study shows.

The study was done "to see whether the technology can be transferred, and that involves appropriate operator selection and training," said study lead author Dr. William A. Gray, director of endovascular services at Columbia University.

The answer was "yes," Gray said. The study included 3,500 patients treated by 353 doctors at 144 hospitals across the United States. The incidence of death, stroke or heart attack was virtually the same for community physicians as for specialists, the report found.

The combined rates of death, heart attack and stroke were 5.3 percent among the most experienced physicians, 6.0 percent for those with a moderate amount of experience, and 7.4 percent for those with little previous experience, differences that were not statistically significant.

The study findings are published in the January issue of the journal Catheterization and Cardiovascular Interventions.

Carotid stenting is relatively rare, compared to the implantation of stents in coronary arteries, Gray noted. Some 25,000 carotid artery stents were implanted in the United States last year, compared to hundreds of thousands of coronary stents. The carotid procedure is reserved for people at high risk of stroke because of plaque buildup in the carotid artery but who can't undergo surgery because of their medical complications.

The device used in the study was approved by the U.S. Food and Drug Administration in 2004. The study was done to assess the effectiveness of a training program tailored to the experience level of physicians interested in performing the procedure.

Previously inexperienced physicians were given a rigorous two-day course, covering such issues as the anatomy of the carotid artery and selection of patients for whom carotid stenting was appropriate, Gray said.

"One way of assessing this trial is measuring the outcome of the trial and comparing it to that of other trials," he said. "The results are very comparable, at least as good or better."

Dr. Christopher J. White, editor in chief of the journal and chief of cardiology at the Ochsner Clinic in New Orleans, said in a statement: "Because independent observers measured the outcomes of the procedure, we can have confidence that the data are robust, meaningful and applicable in community practices."

For patients told that a carotid artery procedure is needed to reduce the risk of stroke and who want to consider stenting, White's advice is simple: "You should ask your physician."

It won't be necessary to ask about drug-coated vs. bare-metal stents, White added. Drug-coated stents are used to reduce the risk that the artery might close up again, and, for some unknown reason, the rate of such restenosis for carotid arteries is very low, he said.

More information

For more about carotid artery stenosis, visit the American Heart Association.

SOURCES: William A. Gray, director of endovascular services, Columbia University, New York City; January 2007, Catheterization and Cardiovascular Interventions
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