{"id":47787,"date":"2003-04-10T00:00:00","date_gmt":"2003-04-10T05:00:00","guid":{"rendered":"https:\/\/www.unmc.edu\/newsroom\/2003\/04\/10\/unmc-neurologist-helps-lead-study-comparing-stentingvs-surgery\/"},"modified":"2022-08-29T10:45:02","modified_gmt":"2022-08-29T15:45:02","slug":"unmc-neurologist-helps-lead-study-comparing-stentingvs-surgery","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/newsroom\/2003\/04\/10\/unmc-neurologist-helps-lead-study-comparing-stentingvs-surgery\/","title":{"rendered":"UNMC neurologist helps lead study comparing stenting\n\nvs. surgery"},"content":{"rendered":"

On April 2, Pierre Fayad, M.D., chairman of the University of Nebraska<\/p>\n

Medical Centers department of neurological sciences, presented results<\/p>\n

from the first randomized study that shows stenting is more effective than<\/p>\n

surgery for patients who were otherwise considered very high risk for standard<\/p>\n

surgery. Dr. Fayad was among this years presenters at the American Academy<\/p>\n

of Neurologys 55th annual meeting in Hawaii. He was one of three speakers<\/p>\n

invited to participate in the contemporary clinical issues plenary session,<\/p>\n

which highlighted critical neurological issues. More than 7,000 people<\/p>\n

attended the AAN meeting, which is the largest neurology meeting in the<\/p>\n

world.<\/p>\n

This is a major advancement especially for a patients at high risk<\/p>\n

for surgery, said Dr. Fayad, a Reynolds Centennial Professor at UNMC and<\/p>\n

the only neurologist on the five-member executive committee, which helped<\/p>\n

design and organize the large trial.<\/p>\n

The Stenting and Angioplasty with Protection in Patients at High Risk<\/p>\n

for Endarterectomy (SAPPHIRE) trial also combined stenting in the neck<\/p>\n

(carotid) arteries with an AngioGuard filter, a new device to prevent blood<\/p>\n

clots and other particles from reaching the brain and causing stroke.<\/p>\n

Blockages in the carotid artery are generally treated with a surgery<\/p>\n

called carotid endarterectomy, in which the plaque buildup is removed.<\/p>\n

In carotid stenting, a balloon-tipped catheter is threaded into the artery,<\/p>\n

the balloon is inflated to push back the plaque and a mesh tube, called<\/p>\n

a stent, is inserted to keep the artery open.<\/p>\n

Surgery and traditional stenting carry risks of creating blood clots<\/p>\n

or dislodging particles from the fatty deposits they are trying to clear.<\/p>\n

When such debris is unleashed and distributed it can travel to the brain<\/p>\n

and cause strokes, Dr. Fayad said. To reduce that risk during surgery,<\/p>\n

the artery is clamped while the atherosclerotic plaque is cut out. Stenting<\/p>\n

is done without stopping blood flow.<\/p>\n

In conjunction with neurologists, vascular surgeons and vascular interventionalists<\/p>\n

at UNMC provide carotid stenting to appropriate candidates, said Jason<\/p>\n

Johanning, M.D., vascular surgeon, UNMCs department of surgery. Carotid<\/p>\n

stenting offers an improved outcome for patients who would otherwise be<\/p>\n

at too high a risk for standard surgery.<\/p>\n

Trials of carotid endarterectomy done in the late 1980s and early 1990s<\/p>\n

showed the surgery was extremely helpful for some patients, but it excluded<\/p>\n

patients at high risk of surgery, Dr. Fayad said. We knew the benefits<\/p>\n

were there, but they were never tested in these patients, he said. This<\/p>\n

is the first trial that tackles this category of people.<\/p>\n

Patients at high risk of surgery include those with severe heart disease;<\/p>\n

those who have had radiation and narrowing, or blockage, of the arteries<\/p>\n

in the neck; those who already had a carotid endarterectomy and the blockage<\/p>\n

has returned; and anyone whose jaw would be dislocated during surgery.<\/p>\n

The recent trial enrolled 723 patients over three years at 30 institutions.<\/p>\n

UNMC did not participate in the trial, which was sponsored by Cordis Corporation,<\/p>\n

a Johnson & Johnson company, which pioneers less invasive treatments<\/p>\n

for vascular disease.<\/p>\n

The study results were first presented in November at the American Heart<\/p>\n

Association meeting. Complete results will be published after the patients<\/p>\n

have been followed for one year.<\/p>\n

In addition to Dr. Fayad, the executive committee includes a cardiologist<\/p>\n

from the Cleveland Clinic, who serves as the trials principal investigator;<\/p>\n

a vascular surgeon from the Cleveland Clinic; a radiologist from the Miami<\/p>\n

Heart Institute; and a radiologist from the University of Pittsburgh.<\/p>\n

Dr. Fayads research interests include different aspects of the acute<\/p>\n

treatment and prevention of stroke and cerebrovascular disease. He served<\/p>\n

as a principal investigator, chairperson or committee member in several<\/p>\n

executive and safety monitoring committees for major multi-center and muti-national<\/p>\n

clinical trials in stroke and cerebrovascular disease.<\/p>\n

Dr. Fayad has published numerous articles and book chapters in such<\/p>\n

journals as New England Journal of Medicine, Neurology, Stroke, Neurosurgery,<\/p>\n

and Journal of the American Medical Association. He is also a manuscript<\/p>\n

reviewer for several journals including Stroke, Journal of Clinical Epidemiology,<\/p>\n

Neurosurgery, Annals of Neurology, and Cerebrovascular Diseases.<\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"

On April 2, Pierre Fayad, M.D., chairman of the University of Nebraska Medical Centers department of neurological sciences, presented results from the first randomized study that shows stenting is more effective than surgery for patients who were otherwise considered very high risk for standard surgery. 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