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To: R.C.L. who wrote (402)	4/1/1998 12:50:00 AM
From: R.C.L.	Respond to of 2887

One more positive-- ents Show Promise For Stroke Treatment NEW YORK (Reuters) -- Tiny tubes called stents are often inserted in diseased heart arteries to help keep them open after balloon angioplasty. Now, it appears that stents may also be useful in treating patients at risk for stroke. The devices are placed in the carotid arteries, the blood vessels in the neck that are crucial for supplying blood to the brain. Narrowing of the carotid arteries with fatty plaque reduces blood flow to the brain, increasing stroke risk. Nearly 2,600 stents have been placed in the carotid arteries of patients with a technical success rate of greater than 98%, reported Dr. Michael H. Wholey at the annual meeting of the Society of Cardiovascular and Interventional Radiology in San Francisco, California, on Monday. Wholey, an assistant professor of interventional radiology at Louisiana State University in New Orleans, surveyed radiologists who have performed the procedure at 24 international medical centers. The overall complication rate, including the risk of strokes and death in the patients, was 5%. This is "within the guidelines of acceptable risk" for patients suffering from symptoms of reduced blood flow to the brain, but somewhat higher than the guideline of 3% risk for patients not experiencing such symptoms, Wholey said. In the survey, 63% of patients given stents had recently suffered a stroke or were having transient ischemic attacks or "mini-strokes." The remaining 37% had artery blockage identified by an ultrasound or other procedure. Of the 2,591 stent placements, there were 61 minor strokes (3.05%) and 25 major strokes (1.25%). The 30-day mortality rate was 1.3%, and the rate of re-blockage or restenosis -- a common problem in coronary arteries -- was 2.89% in six months in Wholey's own practice. The restenosis rate was roughly 4% to 4.5% at one year in other studies. "This is fairly acceptable," Wholey said. At this point, carotid artery stenting should probably only be done in patients experiencing symptoms, according to the Louisiana researcher. "As stents and devices improve, the risk will come down, and (carotid stenting) will become more widespread," he said. Patients can also have severe blockages removed with endarterectomy, a surgical procedure that has risks of its own. Stenting may be preferable to carotid endarterectomy for patients in whom the surgery has failed or in patients who are poor surgical candidates, Wholey said.