Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SATURDAY, February 23, 1991                   TAG: 9102230026
SECTION: NATL/INTL                    PAGE: A-2   EDITION: METRO 
SOURCE: Associated Press
DATELINE: SAN FRANCISCO                                LENGTH: Medium

STROKE SURGERY LAUDED/ STUDIES SO EFFECTIVE RESEARCHERS MOVE TO HALT TRIALS

After an all-night meeting, researchers decided Thursday that a government study of the treatment should be stopped because the surgery is too effective to deny it to the study's control group of subjects, said Dr. Murray Goldstein, director of the National Institute of Neurological Disorders and Stroke.

The move was announced Friday at the annual stroke meeting of the American Heart Association.

The researchers emphasized that the findings applied only to patients with severe narrowing of the carotid artery, which supplies the brain with blood.

However, this narrowing is one of the most common causes of stroke, Goldstein said. Strokes hit about 500,000 Americans each year, killing 30 percent of them and leaving another one-third severely disabled.

Strokes are the third leading cause of death in the United States and the leading cause of disability, according to the American Heart Association.

Dr. Henry Barnett of the University of Western Ontario directs the government evaluation of the surgery, which is called carotidendarterectomy.

At the same time, a nearly identical study in Europe has been stopped for the same reason, Goldstein said.

Goldstein, whose institute at the National Institutes of Health is funding the U.S.-Canadian trials, said the results had been sent by air express to a panel of expert reviewers. Their comments will be used to prepare an emergency alert to doctors, probably by the middle of next week.

An alert will be sent to medical organizations for relay to their members outlining the effectiveness of the surgery, which has been practiced for years. "In about 10 days, the nation's medical community ought to have the clinical alert in hand," Goldstein said.

The surgery involves the removal of a portion of the carotid artery in the neck when it is partially blocked by cholesterol deposits.

Cholesterol deposits and the associated "plaques" characteristic of hardening of the arteries can impede blood flow to the brain and produce a stroke.

When the blocked portion has been removed, the artery is reconnected, sometimes with an artificial tube or a vein from elsewhere in the body. Barnett said the surgery was clearly effective in patients whose arteries were more than 70 percent blocked, which doctors consider severe narrowing.

Trials of the surgery are continuing with patients whose arteries are only moderately narrowed, meaning that the arteries are narrowed by 30 percent to 69 percent, Barnett said.

The European study found that the surgery is not effective in patients with less than 30 percent narrowing of the carotid artery, Goldstein said. Previous studies of a different form of stroke surgery, in which a vein is used to bypass another artery that supplies the brain, showed that the surgery was not effective, Goldstein said.