For the past two years, Perler, like the captain of a debate team, has presented the case for the conventional approach at the annual Great Lakes symposiums, sponsored by St. John Hospital in Detroit and William Beaumont Hospital in Royal Oak. They are not routine. At least one national study of carotid stents has been stopped because patients experienced unacceptably high rates of stroke, Perler says. Blockages that occur after stents are placed in other parts of the body, including the heart, suggest that restenosis rates for carotid stents may exceed those of conventional surgery, at least for a while, Perler says. Soon, a federally funded study will begin nationwide, to compare surgery with stents.
Plans call for enrolling patients in the next two months.
Each group will be followed for 4 years and will be examined every 6 months. Harper now reserves stents for patients who have blockages high up in the neck, into the skull, and ones who have had extensive neck radiation, Berguer says. Surgery still is a better choice, he believes, for patients who need a second endarterectomy. We won't know for sure until then. Other studies are under way at places like St. John.