Harvard Heart Letter

Surgery or angioplasty for opening a clogged neck artery?

For now, surgery is the best choice for most people with a narrowed carotid artery.

Artery-opening balloons and the tiny, wire-mesh cages known as stents offer a safe, effective alternative to bypass surgery for treating cholesterol-clogged arteries that feed the heart. A few inches higher, in the arteries that supply the brain, it's not yet clear if stents rival surgery. It isn't that angioplasty doesn't open narrowed carotid arteries. It does. "What's missing is the evidence to show that carotid angioplasty is the equivalent of surgery in different groups of people," says Dr. Marc Schermerhorn, chief of endovascular surgery at Harvard-affiliated Beth Israel Deaconess Medical Center.

No pain in the neck

The carotid arteries are the pipelines for blood flow to the brain. They branch off the aorta and run up either side of the neck. These arteries are vulnerable to the same processes that clog coronary arteries with cholesterol-filled plaque. Buildups of plaque in one or both of the carotids usually go unnoticed unless the narrowing is fairly severe.

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