Stroke: Surgery Safer Than Angioplasty?
Better Long-Term Outcomes Seen With Carotid Artery Surgery, Study Shows
Aug. 28, 2009 -- Surgery is safer and slightly more effective than balloon
angioplasty for preventing strokes, new research shows.
Two newly published investigations join a growing body of research showing
worse outcomes in patients who have balloon angioplasty to clear the clogged
neck arteries that supply oxygen-rich blood to the brain.
The findings could have a big impact on clinical practice, especially in the
United States where balloon angioplasty is now performed far more often than
surgery to open blocked or narrowed carotid arteries.
Both procedures carry their own risk of stroke, but it has not been clear if
one was safer or worked better than the other.
“Taking all the studies together, the risk of stroke is now clearly higher
with angioplasty,” stroke researcher Peter M. Rothwell, MD, PhD, tells WebMD.
“What these two (new) papers now also show is that the long-term outcome is
also worse with angioplasty. This is therefore a double-blow for
Angioplasty Considered Safer
Narrowing of the carotid artery because of buildup of fatty plaque is one of
the main risk factors of stroke.
The plaque can either be removed surgically or the narrowed artery can be
opened by inflating a tiny balloon threaded up to the neck through a narrow
catheter inserted into a groin artery. These days, a wire mesh stent is almost
always inserted during angioplasty to keep the artery open.
Balloon angioplasty with stenting has become the procedure of choice in the
U.S. in recent years, largely because it has been considered safer than
surgery, says Larry B. Goldstein, MD, who directs Duke University Medical
Center’s stroke center.
It is now clear that this is not the case, Goldstein tells WebMD.
The new studies, both performed by the same international research team,
include the longest follow-up yet of patients treated with surgery or
angioplasty for coronary artery disease.
Researchers followed 251 patients who had surgery and 253 who had
angioplasty for up to 11 years, lead investigator Martin M. Brown, MD, tells
Eight years later, slightly more angioplasty patients than surgery patients
(11.3% vs. 8.6%) had experienced strokes, although the difference wasn't
The angioplasty group also had more minor strokes within the first 30 days
of having the procedure, compared to the surgery group (eight vs. one). The
surgery group had more cases of cranial nerve palsy (22 vs. zero), a temporary
nerve injury, and hematoma that needed surgery or longer stay in the hospital
(17 vs. three).
In the second study, the researchers used ultrasound imaging to look for
plaque buildup in the carotid arteries of 213 patients following surgery and
200 following angioplasty.
After five years, three times as many angioplasty patients had severe artery
blockage (31% vs. 10%). “Patients who had angioplasty with stents had a lower
risk of plaque recurrence than those who had angioplasty alone.
“The trials make it clear that surgery is the best option, but it is
important to understand that the difference is not that great,” lead
investigator Martin M. Brown, MD, tells WebMD. “Patients who can’t have surgery
or don’t want it are still likely to do well.”