Safe alternative to surgery

AHS doctor studies treatment option for leading cause of stroke

An Alberta Health Services doctor is playing a key role in a North American study looking at an alternative treatment option for the leading cause of stroke.

Dr. Michael Hill is heading the research in Calgary – one of three Canadian centres participating in the clinical trial which looks at the use of a non-invasive treatment for patients suffering from carotid artery disease.

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a randomized clinical trial that compares stent-assisted carotid angioplasty (CAS) to the traditional and accepted surgical approach for the treatment of blocked arteries.

A stent is a small, mesh-like tube that is fitted inside an artery to keep it open and allow blood to flow more freely. It is commonly used for treatment of heart disease.

CAS involves the insertion of a catheter, or tube, into an artery in the groin, where it is threaded through the arteries of the body to the location of the plaque within the neck’s carotid artery. When in place, the stent expands inside the artery to hold the vessel open. It is performed under general anesthesia; patients are usually conscious during the procedure and go home a few hours later.

The study is published in the May 26 online issue of the New England Journal of Medicine.

"This study gives us treatment options,” says Hill, director of the stroke unit at the Foothills Medical Centre in Calgary, associate professor in the Department of Clinical Neurosciences at the University of Calgary and a member of the Hotchkiss Brain Institute.

“It confirms that surgery is the gold standard for preventing stroke when there is narrowing of the carotid arteries. We also found that stenting is a safe, effective alternative for those who are unable to have surgery for technical or medical reasons."

Max Copeland had a stroke three years ago and received a stent in his left carotid artery as part of the study. Now he’s healthy and says participating in the study was a way he could help others.

“It’s through studies like this that they find out what works and what doesn’t work,” he says. “If they don’t do these studies, and if people like me don’t participate in these studies, who is going to know?”

The first long-term study of its kind, CREST followed more than 2,500 patients at 110 different centres. Participants were randomly assigned to undergo either surgery or stenting. All patients were followed for four years.

One of the largest risk factors for stroke is the narrowing of the carotid arteries, which is usually caused when cholesterol, fat and other substances build up in the inner lining of the arteries.

“Of the 50,000 strokes occurring each year in Canada, approximately one quarter are caused by narrowing of the carotid arteries,” says Hill. “Imagine if we could use early detection and treatment to help prevent more than 12,000 strokes each year.”

CREST is sponsored by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institutes of Health (NIH).