More treatment options available for leading cause of stroke

Posted May 26, 2010
By Jordanna Heller

Dr. Michael Hill (left) with stroke patient Max Copeland, looking at a stent similar to the one inserted in Max's arteryA new multi-centre North American clinical trial that finds the use of a non-invasive treatment is safe for patients suffering from blocked arteries. The study is published May 26 in the on-line issue of the prestigious New England Journal of Medicine.

Dr. Michael Hill is the lead physician-scientist in Calgary, one of three Canadian sites involved in the study. "This study gives us treatment options. It confirms that surgery is the gold standard for preventing stroke when there is narrowing of the carotid arteries.  We also found that stenting is a safe, effective alternative for those who are unable to have surgery for technical or medical reasons," says Dr. Hill, Director of the Stroke Unit at the Foothills Hospital, Alberta Health Services, Associate Professor in the Department of Clinical Neurosciences, as well as a member of both the Hotchkiss Brain Institute and the Libin Cardiovascular Institute of Alberta.

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a randomized clinical trial that compares stent-assisted carotid angioplasty (CAS) to the traditional and accepted surgical approach for the treatment of blocked arteries.

Marie McClellan, Clinical Trial Nurse Coordinator with patient Max CopelandMax Copeland suffered from a stroke three years ago and received a stent in his left carotid artery as part of the study. Now he’s healthy and able to joke about his experience.

“I was in Safeway on a Sunday morning,” says Copeland, describing his stroke in the spring of 2007. “All of a sudden my right arm started to pull towards my body, my left leg started to lift up and I went down in the aisle. It was a wet cleanup in aisle four.”

While in the Foothills Medical Centre Copeland took little time in deciding to be part of the study. He realized that if a stroke could happen to him, it could happen to anyone. Participating in the study was a way he could help others.

“It’s through studies like this that they find out what works and what doesn’t work,” he says. “If they don’t do these studies, and if people like me don’t participate who is going to know?”

The first long term study of its kind, CREST followed over 2500 patients at 110 different centres. Participants were randomly assigned to undergo either surgery or stenting. All patients were followed for four years.

The results of the clinical trial also show “excellent safety and long term results for patients with warning signs for stroke as well as for patients without such warning signs,” says the principal investigator, Dr. Thomas G. Brott, Professor of Neurology and Director for research at the Mayo Clinic campus in Florida. 

One of the largest risk factors for stroke is the narrowing of the carotid arteries, which is usually caused when cholesterol, fat, and other substances build up in the inner lining of the arteries. “We estimate that of the 50,000 strokes occurring each year in Canada, approximately one quarter are caused by narrowing of the carotid arteries,” says Dr. Hill. “Imagine if we could use early detection and treatment to help prevent more than 12,000 strokes each year.”

CREST is sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institutes of Health (NIH).

Biography: Michael D. Hill, MD, MSc, FRCPC is an Associate Professor in the Departments of Clinical Neurosciences, Community Health Sciences, and Medicine at the University of Calgary’s Faculty of Medicine. He is a member of the Hotchkiss Brain Institute (HBI) and the Libin Cardiovascular Institute of Alberta. He is also the Director of the Stroke Unit for the Calgary Stroke Program, Alberta Health Services, an Alberta Innovates – Health Solutions Health Scholar and holds a Professorship in Stroke Research funded by the Heart and Stroke Foundation of Alberta, NWT and Nunavut.

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