For many years, surgery has been the preferred way to clear away dangerous fatty deposits in neck arteries that can cause strokes.

But newer, less invasive approaches using angioplasty and stents have been approved for use in higher-risk patients, stirring debate over which approach is best.

Carotid artery stenting involves threading a wire mesh coil called a stent in the neck artery to widen the blocked area and capture any dislodged plaque that could travel to the brain and cause a stroke.

They compared the treatment with surgery, in which doctors cut open the neck, scrape away the fatty deposits in the artery, and sew it back up.

Several medical device makers sell carotid stents, including Boston Scientific Corp, Abbott Laboratories, Johnson & Johnson, Ev3 Inc and C.R. Bard Inc.

The nine-year trial, dubbed the Carotid Revascularization Endarterectomy vs. Stenting Trial or CREST trial, compared the safety and effectiveness of surgery versus stenting in 2,502 patients with or without a previous stroke.

It showed that both approaches were safe and effective overall at preventing stroke, but they did find some differences between the two approaches.

They found that patients who had had surgery had lower rates of subsequent strokes, while those who had gotten a stent were less likely to have a heart attack after the procedure.

Although the purpose of the study was to compare the two procedures, we were pleased to find that both (surgery) and stenting have become extraordinarily safe, Dr. Gary Roubin of the Lenox Hill Hospital in New York City, who presented his findings at the International Stroke Conference in San Antonio, said in a statement.

A year after the procedure, those who had suffered a stroke reported that the effects had a greater impact on their quality of life than those who had suffered a heart attack.

Age also appears to matter. People who were age 69 or younger appeared to fare slightly better if they got a stent, whole those over 70 fared better with the surgical treatment.

For stroke prevention alone, the team said surgery has proven to be safest.

It is when heart attacks are added that the results of the two procedures become similar, Dr. Wesley Moore of the University of California at Los Angeles, who helped lead the study, said in a statement.

Medicine