Percutaneous transluminal angioplasty and stenting for carotid artery stenosis

Carotid stenosis, or narrowing of one of the major arteries which carries blood to the brain, can cause a stroke. The standard treatment is to remove the narrowing by a surgical operation (carotid endarterectomy). The narrowing can also be treated by percutaneous transluminal balloon angioplasty. This involves passing a fine tube (catheter) through the skin (percutaneously) into the arterial system. The catheter has a small balloon at its tip. The catheter is moved through the arterial system until the balloon reaches the point of arterial narrowing in the carotid artery in the neck. The balloon is briefly inflated. This stretches the artery (angioplasty), and reduces the degree of narrowing. More recently a metal scaffolding (stent) is placed inside the artery to prevent it narrowing down again after the catheter is removed. Angioplasty and stenting are called endovascular treatment. This review, which included 12 trials involving 3227 participants, showed that surgery might be better than endovascular treatment in preventing early stroke or death, but there were fewer immediate neurological complications with endovascular treatment than with surgery. However, during follow up, the risk of stroke or death was similar after endarterectomy compared to endovascular treatment. Treated arteries may be more likely to narrow down after endovascular treatment than after carotid endarterectomy. Further randomised trials are needed to see which treatment yields the best chance of long-term freedom from disabling stroke or death.