wfn.org | New Adventist Study on Stroke Preventing Therapy

["Christian B. Schäffler" <APD_Info_Schweiz@compuserve.com>]

February 12, 1999
Adventist Press Service (APD)
Christian B. Schaeffler, Editor-in-chief
Fax +41-61-261 61 18
APD@stanet.ch
CH-4003 Basel, Switzerland

New Adventist Study on Stroke Preventing Therapy:
Research Suggests Patients Over Age 80 May Have a 
Better Option Than Surgery

Takoma Park, MD/USA. [APD] Preliminary research 
conducted by a nationally known cardiologist 
suggests that a therapeutic procedure designed to 
prevent stroke is equally effective for patients 
over the age of 80 who are at higher risk for stroke 
and death compared to patients under the age of 80.

"The results may imply that the procedure, stent 
supported carotid angioplasty, may be a safer option 
than surgery for patients over age 80 with a high risk 
of stroke," noted Fayaz A. Shawl, M.D., Director of 
Interventional Cardiology at Washington Adventist 
Hospital (WAH).

Dr. Shawl and colleagues examined the combined use of 
carotid angioplasty and stents in 140 patients between 
1995 and early 1998.  Using a non-surgical procedure, 
the doctors insert a balloon-bearing catheter into the 
carotid artery (in the neck) to open blockages.  Upon 
opening the artery, the catheter makes space for a 
tube-like stent to hold open the artery that allows 
blood to continue flowing to the brain.

Washington Adventist Hospital (WAH) is one of only a 
few U.S. medical centers investigating the procedure, 
which is being researched as an alternative to the 
carotid endarterectomy, a surgical procedure which 
involves anesthesia, an incision in the neck and 
removal of plaque from the artery.

Carotid endarterectomy has been associated with 
significant morbidity and mortality in patients, 
particularly patients age 80 or older.  Carotid 
stenting may be a viable option for such patients who 
are ineligible for carotid endarterectomy.  Both 
traditional carotid endarterectomy and this research 
procedure using carotid angioplasty carry risks that 
include bleeding at the site of the procedure, possible 
slight or even major stroke, or death. It is not yet 
known if these risks are less or greater with the 
research procedure compared to carotid endarterectomy. 
Potential benefits of the procedure include rapid 
recovery and reduced costs.  Patients are awake 
throughout the procedure and most require only a 
twenty-four hour hospital stay.

Carotid artery disease is believed to be responsible 
for sixty percent of strokes annually.  This research 
procedure may enable doctors to intervene and prevent 
or reduce the number of strokes caused by carotid 
artery disease.

The patient mix of the WAH study consisted of 34 
patients over the age of 80 and 105 patients below the 
age of 80. While not examined by the study, the 
authors hypothesize that the successful outcomes were 
supported by intensive therapy prior to treatment to 
reduce a patient's risk of stroke.

"Our data demonstrate that stent supported carotid 
angioplasty is safe and effective for all age groups 
from the 215 patients we have done to date," said Dr. 
Shawl.  "But it is noteworthy that in our study the 
age group over 80 has done as well as the younger 
patients.  Usually, these patients are not offered 
standard surgical treatment (endarterectomy) because 
of the high risk of procedural complications of death 
and stroke."

In the carotid angioplasty procedure, a balloon-
bearing catheter is inserted in the femoral artery in 
the groin and guided through the blood vessels in the 
abdomen and chest into the carotid arteries.  The 
balloon is inflated two to four times to push back the 
blockage and make space for implantation of the stent. 
(A stent is a tiny, stainless steel tube which, when 
expanded by the balloon on the catheter, holds the 
vessel open, like a scaffold).  The catheter is then 
removed, equipped with a peripheral stent and 
reinserted.  The balloon is inflated and the stent 
implanted, and the catheter is removed. Clearing the 
blockage of the artery restores blood flow to the 
brain.

Located in Takoma Park, Maryland, Washington Adventist 
Hospital offers a complete range of cardiac care 
services, including research, risk reduction, 
diagnosis, arrhythmia management, intervention, 
surgery and rehabilitation. Founded in 1907, 
Washington Adventist Hospital performs more than 900 
open heart surgeries a year and more than 5,000 heart 
catheterizations and angioplasties. [99/02/07]