Thursday, September 08, 2011
Winston-Salem, N.C. - Stroke experts and researchers at Forsyth Medical Center took part in a nationwide clinical study to measure the effectiveness of stenting versus aggressive medical management in a special group of high-risk stroke patients, those whose stroke is thought to be caused by a blockage (stenosis) of an artery inside the brain (as opposed to the more common blockage of the carotid artery in the neck).
The results released in today's online version of The New England Journal of Medicine, show that patients at high risk for a second stroke due to a severe blockage of an artery in the brain who received intensive medical treatment had fewer strokes and deaths than patients who also received a stent in the diseased artery. The study looked at patients in the highest risk category, those with severe, or 70 to 99 percent, blockage of the artery.
The intensive medical treatment includes daily blood-thinning medications (aspirin and/or Plavix) and aggressive control of blood pressure and cholesterol. Stenting involves placement of a self-expanding stent that widens a major artery in the brain to facilitate blood flow.
"This study helps to answer the question - what to do to prevent a devastating second stroke in patients who are high risk from a severe blockage of an intracranial artery?" said Chere Chase, MD, medical director, neurosciences, Forsyth Medical Center. "The findings show our work to aggressively manage these patients' blood pressure, cholesterol and sugar, combined with educating them about their risk factors, is an effective treatment for some patients."
Donald Heck, MD, director, interventional neuroradiology, Forsyth Medical Center, agrees. "The results of the study validate the treatment model we've been following. The study tells us the first line of treatment should be aggressive medical therapy. Stenting is considered in patients who are not responding to medical therapy, and may still be beneficial in some patients"
The study, funded by the National Institutes of Health (NIH), enrolled 451 patients at 50 sites across the U.S. It is the first stroke prevention trial to compare intracranial stenting with medical therapy and to incorporate intensive medical management into the study design.
Stroke is the fourth leading cause of death in the U.S. Blockage of brain, arteries caused by the build-up of plaque, accounts for more than 50,000 of the 795,000 strokes that happen every year nationwide. Blockage of arteries in the brain, as opposed to the carotid arteries in the neck, is particularly common in African-Americans, Hispanics, Asian Americans and people with diabetes.
Forsyth Medical Center is one of the largest stroke centers in the state by volume and was the first hospital in North Carolina and South Carolina to become a nationally certified primary stroke care center. It has earned a place on the American Heart Association's "Target: Stroke Honor Roll" and is the first hospital in the region to offer a TIA center to diagnose and treat patients who have a transient ischemic attack (TIA) or "mini-stroke"
