Heart patients will randomly be selected to participate in one of two methods of clearing blocked arteries: surgery and balloon stenting

Southern Oregon physicians have joined a pioneering study that will determine the best treatment for one of the most common types of stroke.

The study will compare the long-term efficacy of two tried and true procedures for repairing blocked arteries in the neck, said Dr. Kent Dauterman, director of cardiology at Rogue Valley Medical Center. Patients at 80 hospitals across the United States and Canada, including RVMC, will be randomly assigned one of the two procedures, and hospitals will track the patients’ health to see which procedure has the best long-term results.

Dauterman said the study is especially relevant because stroke — also known as "brain attack" — is the third leading cause of death in the United States. People who are fortunate enough to survive a stroke often struggle with reduced physical or mental function as a result of nerve damage.

"Stroke is one of the most feared illnesses," Dauterman said, "and 30 percent of all strokes are due to blockage in the arteries of the neck."

Dauterman noted that blocked carotid arteries have been treated surgically for years by opening the artery and physically removing the sticky "plaque" that caused the blockage. This procedure, called carotid endarterectomy, works well enough for most people, but it’s unacceptable for patients with underlying medical problems that make them too fragile for surgery.

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Blockage also can be treated with a technique called "balloon stenting." Physicians insert an ultra-thin wire in an artery in the groin and push it up to the blockage. A wire-mesh tube (a stent) inside the wire is slipped into the plaque, and then a tiny balloon is inflated to open the blockage.

A tiny umbrella-like device is inserted into the artery prior to the stent to catch any fragments of plaque that might break off when the stent is inserted. Fragments could cause blockage where the arteries narrow.

Dauterman said both procedures have good results and relatively few complications, but up to now balloon stenting has been reserved for patients who were considered too fragile for surgery. (Physicians consider inserting a wire in the artery less invasive than opening the artery and removing the plaque.)

Now researchers want to find out which technique — endarterectomy or balloon stenting — has better long-term results for patients who are healthy enough to have the blocked artery repaired surgically.

About 4,300 patients across North America will be treated in the study, which is called CREST, for Carotid Revascularization Endarterectomy versus Stenting Trial. Patients’ health will be tracked for as long as four years. All who enroll must be healthy enough that they would have been ineligible for balloon stenting prior to the study.

Patients don’t have a choice about which treatment they receive, Dauterman said. Treatments are assigned randomly by researchers overseeing the study.

The first 10 patients at RVMC are being treated with a balloon stent. One of them, Shirley Shepard of Eagle Point, is in a unique position to compare the two procedures because she had a blocked artery repaired surgically a few years ago.

"It was just awesome," Shepard said of the balloon stenting procedure. "The surgery was like an hour and a half. It was very painless. I was awake during the entire process."

Shepard had been having partial blackouts, "like somebody pulling a shade down over my eyes." Her primary-care doctor had been encouraging her to have the blockage fixed to avoid a stroke, but she was reluctant, in part because she did not want to have surgery again.

"I was in the ICU for days" after surgery, she said. "They couldn’t control my blood pressure."

Shepard said the blackouts have disappeared since the stent was installed. "I have more energy, too, and everyone says my color is better.

"Since then I’ve felt great and I’m doing great."

Dauterman said he thinks the study results may eventually determine that each procedure has its place. "Some people will still be best served by surgery."

Reach reporter Bill Kettlerat 776-4492, or e-mail bkettler@mailtribune.com.