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Stroke: Surgery Safer Than Angioplasty?

Better Long-Term Outcomes Seen With Carotid Artery Surgery, Study Shows

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“One criticism is that the procedures used then are somewhat outdated, but this is an issue with any long-term interventional study,” he says.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 patients.

“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.

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