Surgery Better Than Angioplasty for Narrowed Neck Artery

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Implanting a stent -- a flexible tube that helps keep the artery open -- did reduce the incidence of blockage by about half in those who had angioplasty. But the overall superiority of surgery in reducing the risk of stroke was clear, the study authors said.

The CAVATAS results reinforce those of trials with shorter follow-ups, said Dr. Peter M. Rothwell, a professor of clinical neurology at the University of Oxford, who wrote an accompanying commentary in the journal.

"Taken together, all of the trials now show a substantially higher stroke risk associated with endovascular treatment compared to surgery," Rothwell said.

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The findings apply only to people who have symptoms -- such as temporary loss of vision or speech -- because of carotid narrowing, Brown noted. Symptomless carotid stenosis sometimes is detected in the course of a routine physical examination, and the decision on whether to treat, and the appropriate treatment, is then up to the physician and patient, he said.

"In North America, most physicians would recommend surgery," Brown said. "In the United Kingdom, they are much more reluctant to operate on patients and would recommend medical treatment."

That medical treatment would include drugs to control high blood pressure and high blood cholesterol, as well as lifestyle changes, he said.

The difference in treatment choice is not due to the nationalized health care system in Britain, Brown said. Rather, "in the British system you do not see a surgeon unless you see a physician first. In the United States, many patients go straight to the surgeon," he said.

There are many surgeons in the United States, and "patients in the United States are more likely to want to have something done at once," he added.

There is still a place for angioplasty in the treatment of carotid stenosis, Rothwell said. After an initial diagnosis, some people prefer not to have surgery, he said.

More information

The American Heart Association describes carotid stenosis and its treatment.

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