Merton student's stroke research published by Lancet Neurology
Research by Robert Hurford, a third-year DPhil Clinical Neurosciences student, has confirmed that the use of medication to treat a particular group of patients at risk of stroke is preferable to the more invasive use of a stent; the research is published in May's edition of Lancet Neurology.
Stroke is the fourth leading cause of death in the UK and has a huge associated socioeconomic burden, with an aggregate cost estimated to be £25.6 billion per year. One cause of stroke is intracranial stenosis (ICS); a narrowing of a brain-supplying artery due a build-up of cholesterol plaque. Patients with this condition were perceived to be at high risk of recurrent, often disabling stroke, and much effort has been put into trying to mitigate this risk.
One method has been to treat ICS with a stent (a scaffold to open the artery). However, two recent randomised trials had failed to show that this method of treatment was superior to risk factor management with medications alone, but the generalisability of these results to a real-life (often older) population was unknown.
Robert's research aimed to validate these trial results in 1,368 minor stroke and TIA (mini stroke) patients from the population-based Oxford Vascular Study. These patients only receive medical treatment of symptomatic ICS (not stenting) and are predominantly white – there have been few studies of ICS in white patients as they are considered a less common cause of stroke compared other groups such as East Asian or Afro-Caribbean people.
The team found that ICS was more prevalent than commonly appreciated in white patients; 17.6% had at least one ICS and the prevalence increased with age. Patients with symptomatic ICS were at increased risk of recurrent stroke compared to those without, but the absolute risk was low - and less than that reported in the trials, despite the Oxford patients being older. This demonstrated that the trial results apply to patients seen in real life and that medical management, rather than stenting, should be the treatment of choice for patients with symptomatic ICS.
