Stroke: Surgery Safer Than Angioplasty?
Better Long-Term Outcomes Seen With Carotid Artery Surgery, Study Shows
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Angioplasty Considered Safer continued...
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.”
Surgery, Angioplasty or No Treatment
Because recruitment for the trials occurred before stents were routinely
used with angioplasty, the results are not all that relevant to patients who
have the procedure today, Goldstein says.
“One criticism is that the procedures used then are somewhat outdated, but
this is an issue with any long-term interventional study,” he says. “The
technology tends to move faster than the sciences.”
Another pressing question is whether too many procedures to clear clogged
carotid arteries are being performed in the United States, he says.
The benefits of treatment are well established for patients with symptoms
associated with carotid artery disease, but this is not the case for patients
who have no symptoms, Goldstein says.
“If you have symptomatic high-grade narrowing of the carotid arteries, the
risk of stroke can be as high as 26% over two years with no intervention,” he
says. “The stroke risk for someone with asymptomatic disease is on the order of
1% to 2%.”
He tells WebMD that in the U.S. the majority of angioplasty with stenting
procedures for carotid artery disease are performed on asymptomatic
“The question now is who, if anybody, with asymptomatic disease should have
anything done to their carotid artery, because the risk of causing harm is not
small,” he says.