Stents increase the risk of further stroke

Stroke Report: Purely drug treatment more advantageous than stents

11/10/2014

In Germany, stroke patients often receive a so-called stent („stent“), which is coated with drugs. The medical implant is actually intended to prevent a renewed brain stroke, but as an opinion found, this risk is thereby higher than with a purely medical treatment.

Common practice in German clinics
In Germany patients often do not only receive medication after a stroke, but they also receive a coated stent („stent“) are inserted into a blood vessel in the brain to prevent further strokes. A report by the Institute for Quality and Efficiency in Health Care (IQWiG) comes to a completely different conclusion. Accordingly, stents should increase the risk, rather than lowering it.

Business interests of manufacturers
Criticism of the intracranial stents are not new. In professional circles, there are always voices saying that these medical implants serve the business interests of medical device manufacturers rather than the health of patients. The Joint Federal Committee (G-BA) - the body of German hospitals, health insurance funds and doctors - commissioned the IQWiG with an investigation, because available data, which should prove the benefits of stents, were not sufficient.

Fewer strokes with purely medical treatment
For this, the institute analyzed four previous studies. The evaluation was based on the SAMMPRIS study funded by the US National Institute of Health. Currently, this is the largest study available that compares stent placement plus drug therapy with drug-only treatment and provides information on both mortality and side effects as well as other strokes. It was found that of the patients with stent significantly more had a recurrent stroke than those patients who received only medications.

No differences in mortality
However, this difference, which was observed in haemorrhagic strokes, was not present in ischemic strokes between the two groups. And also in terms of mortality, there was no relevant difference between the treatment groups. However, the interpretation of the results was made more difficult by the fact that the drugs were not used according to the German approval. For example, patients in the US investigation received drug combinations that are not approved in this country in stroke.

High-quality studies are necessary
The authors of the IQWiG report stated that it was once again shown that high-quality studies are necessary for potentially risky medical devices. Stents are not only used after strokes, but also in diseases such as arteriosclerosis or coronary heart disease. In this area, too, it had been speculated in the past that the increase in such interventions might be explained by financial interests. (Ad)