Study: Drugs Better Than Stents To Treat Stroke Patients


heart-surgeryStroke patients who are treated aggressively with medicine have better chances of avoiding a second stroke or death than those who get a stent in addition to the drugs, according to a national study led by a Medical University of South Carolina researcher.

The difference between the two groups was so significant that officials stopped the trial early. The $20 million study, funded by the National Institutes of Health and published last week in the New England Journal of Medicine, examined 451 stroke patients at 50 hospitals nationwide. The patients randomly received either medicine or medicine and a stent, which props open blocked arteries.

MUSC doctors operate on a patient who arrived with stroke symptoms. A new study from an MUSC doctor shows stroke patients who received stents died of a second stroke at a higher rate than those who were aggressively treated with medicine alone.

Before the study, stents were “increasingly being used to treat these patients worldwide,” said lead researcher Dr. Marc Chimowitz, an MUSC neurology professor who had expected the stents to outperform medical treatment when researchers began enrolling patients in November 2008.

The study results show the once-promising stents are “significantly inferior to medical intervention” and no longer will be recommended for patients, Chimowitz said. Based on the study’s results, stroke patients whose brain arteries are at least 70 percent blocked should be treated withaggressive medical therapy alone.

After a 30-day follow-up, 14.7 percent in the group that received stents had another stroke or died. Those figures compare with 5.8 percent of patients who were treated with medical therapy alone.

Medical treatment involved daily doses of aspirin and an anticoagulant — medications that control stroke risk factors. Patients also received intense blood pressure and cholesterol monitoring and information about the benefits of exercise, nutrition and smoking cessation.

Five stroke-related deaths were reported among patients within 30 days of enrolling in the study. All of them were in the stent group. The medical treatment group had one nonstroke death.

Within a year follow-up, 20.5 percent of stent patients died or had another stroke, compared with 11.5 percent of the medical treatment patients.

The patients will be studied for two more years.

Researchers were disappointed the stent performed so poorly, Chimowitz said. But he said his team was impressed with “how effective modern-day medical management is.”

Dr. Raymond Turner, director of MUSC’s stroke center, agreed.

“Medicines are better than we thought,” Turner said. “If not for the study, we would’ve been stenting a lot more people.”

The National Institutes of Health halted new enrollment in April because early data showed a higher rate of stroke and death among stented patients than medically treated ones after 30 days.

More than 50,000 of the 795,000 strokes in the U.S. annually are caused by blocked or narrowed brain arteries, the type studied in the stent trial.

{Post and Courier/ Newscenter}