Surgery Better Than Angioplasty for Narrowed Neck Artery

British study finds a reduced risk of stroke afterwards

By Ed Edelson
HealthDay Reporter

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FRIDAY, Aug. 28 (HealthDay News) -- The latest results from the longest-running study yet confirm that surgery is better than artery-opening angioplasty in preventing strokes caused by blockage of the carotid artery, the largest vessel carrying blood to the brain.

"In contrast with endovascular treatment [angioplasty], surgical patients had about half the rate of strokes in long-term follow-up," said Dr. Martin M. Brown, a professor of stroke medicine at University College London Institute of Neurology, and a senior author of two reports in the October issue of the Lancet Neurology.

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Brown is a leader of the so-called CAVATAS study, which has followed 504 people with carotid artery stenosis -- narrowing -- who were randomly assigned to have either the surgical procedure called endarterectomy or angioplasty.

"This was the first trial ever started comparing endovascular treatment with surgery," Brown said. Some participants in the trial have been followed for as long as eight years.

Carotid surgery is not a major operation, because the artery is close to the surface of the neck. It sometimes is done under local anesthesia. The surgeon clamps the artery shut and cuts fatty deposits from its wall. Angioplasty uses an inflatable balloon to improve blood flow.

One of the reports said there were more minor strokes in the 30 days after treatment in the angioplasty group than in the surgery group. The incidence of strokes, as well as the mini-strokes called transient ischemic attacks (TIAs), was higher in the angioplasty group over the next eight years -- 19.3 percent, compared to 17.2 percent in the surgery group.

But the number of people in the trial was small, so confirmation of the findings are needed from larger trials that are now in progress, the report said.

The second study reported on 413 CAVATAS participants who had periodic ultrasound examinations of the treated carotid arteries over the following five years. The study found that the incidence of severe re-narrowing of the carotid artery was much higher in the angioplasty group -- 31 percent over five years, compared to 11 percent in those who had surgery. Strokes or TIAs occurred in 23 percent of those who had severe re-narrowing, compared to 11 percent of those who didn't.

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