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.”
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 WebMD.
Eight years later, slightly more angioplasty patients than surgery patients (11.3% vs. 8.6%) had experienced strokes, although the difference wasn't statistically significant.