Brain Stent Study Ends Abruptly | Dr. Stephen Sinatra's Heart MD Institute

Brain Stent Study Ends Abruptly
As Aggressive Non-Invasive Therapies Led to Better Results

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On Sept. 7, 2011, researchers pulled the plug on a randomized trial designed to compare treatments for an extremely common cause of stroke: atherosclerotic intracranial arterial stenosis. Reason being, the experimental group of patients who received surgical stents to help prevent strokes actually experienced a greater incidence of stroke: 14.7 percent of patients with a brain stent had a stroke within the first 30 days of the study, while only 5.3 percent of the control group did.

All 451 patients who participated in the study shared the same high risk for stroke: each had recently suffered a transient ischemic attack (TIA) or a stroke and had severe stenosis, meaning that each had a cranial artery that was 70 to 99 percent narrowed due to a build-up of plaque. So why were the patients who underwent surgery to keep their blood vessels open more prone to stroke than those in the control group? Both groups were treated with “aggressive medical management,” that is, that they received antiplatelet drugs like Plavix or aspirin and intensively managed risk factors like diabetes, high blood pressure and high cholesterol.

Did having to rely solely on lifestyle changes and medications better empower the patients in the control group to heal themselves? Did playing a more active role in their healing, as opposed to placing responsibility for their recovery in the hands of their physicians, help jump-start their bodies' natural healing capacities?

Yes, according to mind-body medicine enthusiasts (especially proponents of psychoneuroimmunology), but there’s more to it. Safely inserting a stent into a brain artery is much more difficult than inflating it within a coronary artery: the former procedure carries a higher risk of injury due to bleeding and the surgeon must thread the catheter a further distance - all the way up from the groin area to the head region.

Yet patients have undergone brain stenting procedures since 2005, when the FDA approved brain stents for high risk patients (such as the ones in this study), despite lack of studies proving the safety and efficacy of such stents. Why did the FDA make a “humanitarian exemption” for such a risky procedure? Based on the success rate of coronary artery stenting, which is the best way to improve blood flow to the heart and preserve heart muscle during a heart attack, it seemed reasonable to think that brain stents would similarly help prevent stroke and preserve brain tissue.

One benefit of the study’s outcome, said neurologists, was that the relative harm of brain stenting was discovered before the procedure became standard medical practice. On a brighter note, the study also highlighted the power in aggressively make beneficial lifestyle changes and taking personal responsibility for health.

Stenting vs. Risk Factor Management with Narrowed Coronary Arteries

Without a doubt, stenting a patient’s coronary artery can save his or her life during a heart attack. Along with angioplasty (inserting a catheter into a patient’s blocked coronary artery and inflating a tiny balloon into the artery to open it and restore blood flow to the heart), stenting “fixes” the immediate problem of narrowed arteries.

Relying on a stent as the end-all-be-all cure is not the best way to protect against future cardiac events, though, as stenting does nothing to address the underlying causes of arterial stenosis and may result in the need for additional stents. Along with anticoagulant and other drug therapies, modifying lifestyle habits which contribute to overall arterial narrowing is a much better long-term strategy for improving and maintaining cardiovascular health.

Strokes and Heart Attacks: Risk Factor Management

Managing risk factors for stroke and heart attack, such as high blood pressure, diabetes and high cholesterol (too much small particle LDL, really) is a matter of making lifestyle changes, which could require a complete overhaul in the way you live. The key is reducing inflammation in the body, and here are some techniques for doing so:

YOU ARE WHAT YOU EAT

To help prevent or manage diabetes, as well as keep blood pressure and cholesterol at healthy levels, stick to eating Non-Inflammatory Foods.

Generally, you want to avoid eating foods which generate inflammatory responses in your body, choosing instead foods which are non-inflammatory or even help fight inflammation.

Here are some basic tips for anti-inflammatory eating that also promotes healthy cholesterol, blood pressure and insulin levels:

Adopt a pan-Asian modified Mediterranean-type diet.

Eat plenty of fresh fruits and vegetables, and even make them the foundation of your diet. Fresh produce, especially when uncooked, is full of vital nutrients and fiber which strengthen your body while helping you detoxify. Additionally, fruits and vegetables are anti-inflammatory because they do not require much insulin to be digested. Be sure to consume organic produce as much as possible, though, as conventionally grown produce may be full of toxic pesticide residue which can damage the endothelium and create free radical activity in the body, and thus generally create inflammation. Thoroughly wash all produce before eating it.

If you’ve just “gotta have” sugary or other high glycemic food like white bread and pasta on occasion (we all feel that need for a serotonin boost sometimes), indulge in very small amounts of it, and always eat it with some protein and fat to slow down the insulin response. “Fill up” on low-glycemic fruits and vegetables instead. Too much high glycemic food in one sitting can cause excess insulin to be released, which can result in inflammation. If habitual, excess insulin release can lead to diabetes and the extra body weight which can cause high blood pressure. Note: steer clear of aspartame, an artificial sweetener - it will cause insulin to be released, despite being “sugar-free.”

Consume healthy fats and avoid unhealthy ones. Avoid trans-fats, which are found in fast food and anything with "hydrogenated" in the label. These killer fats can cause LDL cholesterol to oxidize in arteries and generate an inflammatory response. Choose instead omega-3 fats which are anti-inflammatory and can help lower blood pressure (See also 5 Foods that can Lower Your Blood Pressure).

To help manage blood pressure, avoid high-sodium foods (be sure to read ingredient labels).

From a cholesterol-lowering standpoint, avoid eating too many high-glycemic foods (like cakes, cookies, other “sweets,” bagels, breads, and pasta) which tend to raise cholesterol levels in the body, and try to eat foods which help lower cholesterol like fresh garlic, oatmeal (not instant) and phytosterol-rich foods like apples, nuts, olive oil, flaxseed, chia seed, and beans, which contain plant nutrients that inhibit the body's ability to absorb dietary cholesterol. Drinking green tea can help you improve your fat metabolism while helping you lower cholesterol levels.

SUPPLEMENTATION

In addition to eating high quality, nutritious food, you can get the nutrients you need to prevent inflammation and keep cholesterol and blood pressure at healthy levels by taking nutritional supplements. Take a quality multivitamin with lots of antioxidants that help prevent free radical onslaught in blood vessels. For cholesterol control, other helpful supplements include niacin, vitamin E, L-carnitine and pantethine, as well as coenzyme Q10, fish oil and garlic, which are also great for blood pressure management. Hawthorne, calcium and magnesium supplements can also help you keep your blood pressure low.

GET MOVING!

Twenty to sixty minutes per day of moderate exercise is a staple of health maintenance. Exercise is not only an effective strategy for managing weight, preventing diabetes and reducing blood pressure and cholesterol levels; it also helps lower stress hormone levels, and even helps keep the blues away. Walking, dancing, playing non-competitive sports and swimming are just some examples of lower-impact exercise that won’t stress the joints or the heart. Remember not to engage in strenuous exercise, as it can create excess free radical activity in the body and thus contribute to inflammation.

TAKE IT EASY!

Stress can be a killer, leading to high blood pressure, disease and even heart attacks. Learning not to let psycho-emotional stress get the better of you is one of the best lifestyle choices you can make to prepare yourself for unforeseen, and potentially stressful, circumstances. Regularly practicing mind-body therapies like yoga, meditation or even just deep breathing can help you train yourself to react more healthfully to stressors.

Engaging in the act of “play” – with your children (or grandchildren), pets, friends or partner can help alleviate stress, as can laughing or even crying. Massage and acupuncture are beneficial for releasing tension in the body caused by stress. For some, spirituality may come into play… belief in a higher power, whatever it may be, can help lift what seems like global weight on your shoulders.

TOUCH GROUND

Grounding is also wonderful means of assuaging the physiological effects of stress: attuning to the earth’s natural electromagnetic energy helps generate a relaxation response and balance the autonomic nervous system. Grounding also helps keep blood thin, thus may reduce risk of blood clots which can cause heart attacks or strokes.

DITCH THE CIGGIES

Quit smoking… no ifs, ands or butts.

LOVE MORE...

Knowledge is power - often your best defense. Remember, though, what you know doesn’t mean much unless you apply it. For more articles about achieving and maintaining healthy blood pressure levels, visit the following health centers at Drsinatra.com:

References and Additional Resources:

Kolata, Gina. “Study is Ended as Stent Fails to Stop Strokes.” NYTimes.com, Sept 7, 2011.
Chimowitz MI, Lynn MJ, et al. Stenting Versus Aggressive Medical Therapy for Intercranial Arterial Stenosis. N Eng J Med, Sept. 7, 2011.
Moon, Mary Ann. “Medical Therapy Superior to Stents for Intercranial Arterial Stenosis.” Esevier Global Medical News, Sept. 7, 2011.
Sinatra ST, Roberts JC, Zucker M. Reverse Heart Disease Now (John Wiley & Sons, 2007).
Sinatra ST, Sinatra J. Lower Your Blood Pressure in Eight Weeks (Ballentine Books, 2003).
Sinatra, Stephen. “Study Finds Doctors Too Quick to Insert Stents.” Drsinatra.com/blog, July 7, 2011.
Sinatra, Stephen. “Is Angioplasty Best for You?” Drsinatra.com/resources.

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What Is A Stent?

A stent is a tiny device inserted into a blood vessel, most often a coronary artery, to help keep it open after a blockage has been cleared. A surgeon places the stent into the artery via a catheter to which it is attached and threaded through the circulatory system.

Stents may be metal or drug-eluting; while metal types are coated with a drug, drug eluting stents release the drug. Since blood tends to stick to stents, anti-coagulant drugs like Plavix are often prescribed to reduce risk of blood clotting.

While stents have been shown to be life saving during heart attacks, controversy exists as to whether they are too often used in less dire circumstances.

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Why Do Arteries Become More Narrow?

Healthy arteries are flexible and clear of debris, and stay that way as long as their smooth inner lining, called the endothelium, remains impervious to toxic assailants like foreign chemicals, elevated insulin, excess stress, heavy metals, and bad fats. When exposure to such toxins damages the endothelium, immune cells begin generating inflammatory responses in blood vessels as a part of the reparation process.

Depending on the body’s relative toxicity and the amount of small-particle LDL cholesterol circulating in the bloodstream, arterial inflammation can cascade into a series of chemical events that can lead to a heart attack or stroke: plaques may accumulate and rupture, and blood clots may form, break away, then plug up arteries and block flow of blood.

The Emotional Side of Illness

Many patients see surviving a cardiac event as a second chance at life and an opportunity to explore unresolved emotional issues. Some enter into psychotherapy to develop better insight into the possible emotional reasons behind why they developed cardiovascular disease and at a particular time in life.

While facing lifelong tensions, anxieties, longings, and even the hidden, forgotten memories of childhood heartbreak may not be for everyone, for those willing to explore them, the personal growth can be exponential.