Comparing the Risks and Benefits of Different Acute Stroke Treatments

Carotid atherosclerosis is the narrowing of the carotid artery, the main artery that supplies blood to the brain. It is an important cause of many strokes, and the risk of recurrent stroke in patients showing symptoms of carotid atherosclerosis is increased. Evidence has shown that this risk might be significantly reduced by a surgical operation known as carotid endarterectomy, where the surgeon cleans out fatty deposits in the carotid artery, and this is the current usual treatment of choice for patients with severe narrowing of the carotid artery. The operation does however carry a small but significant risk of stroke or death around the period of surgery.

Stenting, where an arch-like device is used to hold open the walls of a partially clogged (or once clogged) artery, is a new method of treating carotid atherosclerosis. It avoids some of the complications of carotid endarterectomy but may be more hazardous, does not remove unhealthy tissue growth, which can develop within the walls of arteries over time, and has an unacceptable incidence of restenosis, the return of blood vessel blockages after treatment.

Following a related study funded by The Stroke Association, the researchers have started a large 5-year international multicentre randomised trial. This will be funded by the Medical Research Council with a contribution from The Stroke Association. This trial, known as the International Carotid Stenting Study (ICSS), will compare the risks and benefits of carotid stenting with carotid endarterectomy in patients with recent severe symptoms of narrowing of the carotid artery. It is hoped that the results of ICSS will provide data that may influence UK clinical practice.

Scientific Title: International Carotid Stenting Study (ICSS)

Classification:
Prevention, Surgical Treatment

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