Carotid Artery Balloon Angioplasty and Stenting
Balloon angioplasty has been used in many arteries of the body including the femoral and iliac arteries of the leg and the coronary arteries of the heart. It was only a matter of time before it was tried in the carotid arteries. The procedure remains under investigation at this point and some of the surgeons who were initially enthusiastic about this procedure have had this enthusiasm tempered by less than satisfactory outcomes. It must be remembered that the balloon angioplasty and stent procedure is designed to crush plaque-NOT to remove it. Many strokes are considered to be caused by fragments of carotid artery plaque traveling from the neck to the brain. It would be expected that crushing a plaque with a balloon angioplasty and stent technique could lead to more fragments than the complete removal of a plaque from within the artery using meticulous surgical technique. Whereas a small piece of plaque traveling downstream from an angioplasty site may be easily tolerated in the leg or even the heart muscle, the consequences of such plaque fragmentation in the brain can be devastating.
The standard carotid endarterectomy operation has been perfected to the point that most surgeons are reluctant to allow their patients to undergo the less successful carotid angioplasty/stenting procedure. Some vascular surgeons who routinely advise angioplasty/stenting of arteries in the abdomen, legs and heart will not advise carotid angioplasty/stenting. At this point in time carotid angioplasty/stenting is still an investigational procedure that must be compared with the carefully studied and clinically proven technique of carotid endarterectomy surgery. No long-term follow-up studies are available to permit a comparison of the durability of carotid angioplasty/stenting with carotid endarterectomy surgery.
Comparison of Carotid Endarterectomy Surgery and
Carotid Balloon Angioplasty/Stenting
Carotid Endarterectomy Surgery |
Balloon Angioplasty/ Stent |
Stroke risk of 1.5% |
Stroke risk of 5.0% |
Small incision |
No incision |
Average one day in hospital |
Average one day in hospital |
"Full recovery"- 7-10 days |
"Full recovery"-3 days |
Very durable- Good follow-up studies |
Follow-up data unavailable |