Stents deemed safe, effective, nonsurgical option for carotid stenosis

By Martha Kerr

SAN ANTONIO, Texas (Reuters Health) – Placement of stents in occluded carotid arteries is a safe, effective option for patients in whom maximal medical management has failed to control symptoms and who are not candidates for endarterectomy, a panel of neurologists announced here Thursday.

Dr. Tim W. Malisch and colleagues at the University of Illinois in Chicago received referrals for carotid stent placement in 39 patients with 50 lesions in 49 arteries who were not considered candidates for surgery by the referring physician. Of these, 25 patients had carotid atherosclerosis, 11 had carotid artery dissections or aneurysms and 3 had stenoses as a result of fibromuscular dysplasia.

Dr. Malisch's team made their decision to perform stent placement based on a medical algorithm in which a multidisciplinary panel determined there was no other surgical, nonsurgical or other medical option.

Dr. Malisch told attendees of the American Stroke Association's 27th International Stroke Conference that his team performed only 7 stent placements in this group. He and his colleagues determined that 3 patients did not need therapy, 20 needed only anticoagulation/antiplatelet therapy, 5 underwent surgery, 5 received non-stent endovascular intervention.

There were no deaths or major or minor strokes after an average of 19 months of follow-up in the patients who received stents, Dr. Malisch reported.

"Endarterectomy is fast, effective and reliable and hard to improve upon," Dr. Malisch told Reuters Health, "but I'm optimistic that stents offer more options." He added that "this conservative management algorithm is appropriate" for assisting in the decision to perform stent placement.

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