Stopping strokes
Aggressive medical therapy could help prevent stroke
By Czerne M. Reid
Dr. Michael Waters and Dr. Brian Hoh discuss their findings as they walk down the hallway of the neurosurgery clinic./Photo by Maria Belen Farias
To prevent a common type of stroke, intensive medical therapy could be better by itself than in combination with surgery that props open affected arteries. But it remains to be seen whether the apparent advantage will prove true over the long term.
The findings, from a national clinical trial conducted by UF researchers and colleagues, was published online in The New England Journal of Medicine in September.
Against expectations, the short-term risk of stroke and related death was twice as high in some cases for patients whose diseased arteries were widened via balloon angioplasty and stent insertion, compared with patients who received medical therapy alone. Although the 30-day risk of stroke for the stenting patients is concerning, long-term results could be more favorable, the researchers said.
“Five years from now, who will be doing better — the patients who are being medically managed, or those who received a stent?” said study co-author Michael F. Waters, M.D., Ph.D., director of the Shands at UF Stroke Program, who along with Brian L. Hoh, M.D., the William Merz associate professor of neurological surgery in the College of Medicine, led the UF portion of the trial.
Patients with the type of stroke known as symptomatic intracranial atherosclerosis do not respond well to existing treatments. One-quarter of those patients have another stroke within 12 months.
The study will have a substantial impact on clinical practice and research, the researchers said, because it is the first randomized stroke trial to pit stenting against nonsurgical treatment for symptomatic intracranial atherosclerosis, a type of stroke caused by artery blockage in the brain. Early results clearly show that intensive medical management is key to improving health, the researchers said.
Every 40 seconds, someone in the U.S. has a stroke. Almost 800,000 people a year have a new or recurring stroke, according to the American Heart Association.