OCT. 3, 2005 | The University of Arkansas for Medical Sciences (UAMS) is participating in a national study that will decide the best procedure for preventing strokes caused by blocked arteries in the neck.

As many as 40 Arkansas patients could be part of the trial, funded by the National Institutes of Health and conducted in hospitals throughout the United States and Canada. The NIH goal is for 2,500 patients to take part in the four-year trial -- the largest ever for stroke in North America.

The UAMS study is led by principal investigator John Eidt, M.D., professor of surgery and radiology, division director of the Department of Vascular Surgery and director of the Vascular Center.

The results should settle an important question among doctors, patients and insurers: which procedure has better long-term results -- surgical removal of plaque in the artery or stenting, which opens the blockage by pushing the plaque against the artery wall.

“We are now joining this study because of recent data that seems to show these procedures are equivalent; both seem to have very, very good results,” Eidt said. The trial is known as CREST which stands for Carotid Revascularization Endarterectomy (the type of surgery) vs. Stenting Trial.

Surgical removal of plaque and debris has a proven track record that dates to the 1950s. The stent was developed in the 1980s. Its use has been limited because until March it was on Medicare’s list of experimental procedures.

“There’s a tremendous amount of enthusiasm for carotid stenting,” Eidt said. “That’s what makes this study so important; it will be the landmark trial that defines the role of carotid stenting for patients with carotid artery disease who are at risk for stroke.”

During the past four years, UAMS has used stenting in dozens of cases when doctors believed it was the better alternative for selected patients. That experience and expertise has resulted in UAMS being the only Arkansas hospital selected for the trial, Eidt said.

UAMS will be reimbursed for all stenting of patients who participate in the trial. Patients in the study will be chosen at random for either the stent or surgery.

Because many low-risk patients would prefer but cannot afford the less invasive stent, the trial offers some possibility of receiving one, Eidt said.

As many as 40 percent of strokes are caused when blood can’t get to part of the brain. Plaque and debris typically build up where the carotid artery forks just below the jaw. Sometimes the debris breaks off and goes to the brain where it either temporarily or permanently obstructs blood to the brain. The result is a stroke.  

Other strokes are caused by bleeding in the brain.

Arkansas has excessive risk of stroke compared to other states, Eidt said, and the state has higher rates than average for the risk factors for arteriosclerosis (blocked arteries), such as smoking, hypertension, diabetes, obesity and sedentary life styles.

“We have been listed among the top five states for the risk of stroke for many years,” Eidt said.