Surgery trumps angioplasty for clearing blocked arteries to the brain, from the Harvard Heart Letter

The brain depends on the carotid arteries in the neck to deliver a steady flow of oxygen-rich blood. If one or both of these arteries becomes clogged with cholesterol-filled plaque, choking off blood flow, a procedure to reopen the vessel may be needed. But which one?

The traditional approach is carotid endarterectomy, an operation to open the artery and clean it out. Doctors and medical device companies have hoped that a less invasive approach called angioplasty—opening the blocked artery with a balloon and then propping it open with a stent—would rival endarterectomy. But that hasn't come to pass, reports the June issue of the Harvard Heart Letter.

The main goal of the two procedures is to prevent a stroke, the most feared complication of a narrowed carotid artery. Both do this quite well, with similar recovery times. Yet surgery often turns out to be better than angioplasty, especially for older people, because it has lower rates of post-procedure stroke and death. Although the latest head-to-head trial comparing carotid angioplasty and surgery showed that differences between the two are getting smaller and that in expert hands angioplasty can be a viable alternative, surgery still offers a small extra margin of safety.

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