Surgery Called Best Treatment Before Stroke; Study Called Off

Convinced by overwhelming study results that surgery is the best treatment for patients with pre-stroke symptoms and a severe blockage of the major artery in the neck, the federal government has called an early halt to further research and will notify physicians of the effectiveness of the treatment.

The decision came after the study’s monitoring committee met earlier this week and found that the patients who had undergone the surgery, known as carotid endarterectomy, did far better than other patients who were randomly assigned to treatment with medications.

The development was announced Friday at the American Heart Assn.’s annual stroke meeting in San Francisco.

“These results are unequivocal in the opinion of the monitoring committee and our executive committee who have since looked at them,” said Dr. Henry J. Barnett of the University of Western Ontario in Canada, the scientific director of the study.

Barnett did not give further details of the study. He also announced that part of a similar study in Europe has just been stopped for the same reason.

Barnett stressed, however, that the findings only applied to patients at high risk of stroke because of blockages of between 70% and 99% in a carotid artery as well as stroke warning symptoms such as transient speech loss, visual difficulties and weakness.

The study will continue for patients who have less severe neck artery blockage. A separate federally funded study of patients who have neck artery blockages but no symptoms will also continue.

Next week, the National Institute of Neurological Disorders and Stroke, which sponsored the research, is expected to send an emergency alert to doctors, which will contain more details of the findings.

A stroke is a sudden and often severe attack of paralysis, speech defect or other problems caused by an insufficient supply of blood to part of the brain. Often the culprit is a blockage in the carotid artery, the main artery in the neck. A carotid endarterectomy is the surgery to remove the plaque deposits that block the artery.

In recent years, carotid endarterectomy surgery has been controversial within the medical community because of concerns that the risk of stroke or death related to the surgery itself might be greater than the potential benefit of preventing strokes in some patients.

The study, known as the North American symptomatic carotid endarterectomy trial, began in January, 1988. It was originally planned to involve more than 2,000 patients.

Each year, there are about 500,000 strokes in the United States and 150,000 deaths, according to the American Heart Assn. Nearly 3 million Americans who are now alive have previously had a stroke.