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The heart of the matter

Doctors work to discover best treatment for carotid artery disease


Betty Wyatt is a bit of a conundrum.

To most people, the 63-year-old East Bend-area resident seems healthy for her age. She eats well and exercises often. And while she has high blood pressure, diabetes and high cholesterol, she is able to manage them well so they don’t cause her problems.

But a routine physical last year uncovered another issue with potentially serious side effects – Wyatt’s right carotid artery was 70 percent blocked. The blockage put her at increased risk for stroke, the third-leading cause of death in the United States.

This is where the puzzle begins.

Watch and wait, or intervene?

Estimates indicate as many as 3 million Americans share Wyatt’s condition of carotid artery disease, or narrowing of the carotid arteries. There are two different treatments – carotid artery stenting and surgical removal of plaque buildup in the artery – that have both proven effective.

A third course of treatment using new prescription medications and monitored lifestyle improvement programs has also been successful at reducing the risk of stroke. This treatment option has prompted doctors to question whether more invasive treatments are really necessary, or if medication and lifestyle management alone are just as effective in treating carotid blockages.

Searching for an answer

As part of a new National Institutes of Health-sponsored nationwide study, the doctors at Novant Health Forsyth Medical Center are helping to find an answer to this question.

The goal of the study, called the CREST-2 trial, is to enroll 2,400 patients to compare the effectiveness of combining either stenting or surgical plaque removal with medication management against just medication management alone.

Wyatt has the distinction of being the first patient in the country to be enrolled in the trial.

Dr. Don Heck, medical director of interventional neuroradiology and co-director of the stroke program at Forsyth Medical Center, supervised Wyatt’s enrollment in CREST-2. He said that while invasive interventional procedures work, they are expensive and carry higher risks than medication management alone. It is important to determine whether using only medication treatment options can deliver comparable results, Heck said.

“No one questions the fact that procedures such as surgery or stenting are effective and the correct treatment options for patients who have had a stroke because of a blocked artery,” he said. “But for otherwise healthy patients who are just at risk for stroke, like Wyatt, my colleagues and I debate every day the most appropriate treatment option to offer them. We can’t say definitively what the best treatment is – all we can do is give them options. So we are eager to see this question answered.”

‘God has blessed me with a second chance’

Although Wyatt knew her treatment option would be randomly chosen by a computer, she always suspected she’d be placed in the surgery group. So when the results read “surgery,” she said she wasn’t surprised in the least.

Wyatt’s plaque removal procedure was performed in early February by vascular surgeon Dr. R.B. Thomason of Novant Health Vascular Surgeons. And instead of being scared at the thought of surgery, Wyatt – who has a strong history of stroke in her immediate family – was relieved to know the blockage would be actively treated.

“Dr. Thomason told me that there was a 3 percent chance I might have a stroke during the surgery, but a 97 percent chance I’d have one if he didn’t do anything,” Wyatt said. “The surgery was so easy. I didn’t have any pain, and I was only in the hospital overnight. In fact, I went out for lunch and some shopping just four days later.”

As part of the CREST-2 trial, Wyatt has had her high blood pressure, high cholesterol and diabetes medications adjusted. She will also be monitored by her physicians over the next four years.

“I feel so honored to have all these special people taking care of me,” she said. “I didn’t worry about my health before, and I didn’t realize that I wasn’t as healthy as I thought I was. Being a part of this trial, it’s like God has blessed me with a second chance.”





Published: 3/26/2015