Patients who experience restenosis of the carotid artery may have a better outcome with a new angioplasty-based technique than with endarterectomy, according to a presentation at the joint annual meeting of the American Society of Neurological Surgeons and American Society on Intervention Therapy Neuroradiology.

The new procedure combines carotid angioplasty with stenting with distal embolic protection. Ricardo A. Hanel, M.D., reported that there were no neurological complications with the new technique in a study involving 21 patients. In contrast, up to 10 percent of patients who undergo carotid endarterectomy after restenosis have major complications including ischemic stroke and death. Up to 17 percent of patients develop a cranial nerve palsy.

In the trial, surgeons threaded a slim catheter from the groin to the site of stenosis, deploying a tiny filter distal to the stenotic area. The filter allows blood to flow through the artery but captures pieces of plaque that can break off during the procedure, causing an embolic stroke.

After the filter was in place, the surgeons performed balloon angioplasty and deployed a stent to hold the artery open. In some cases they inflated a second balloon to further expand the stent inside the vessel. When the procedure was complete, the surgeons retracted the filter and its captured pieces of plaque.

Although the presentation results were based on 21 patients, surgeons at the trial center have placed more than 1,000 stents in this manner. Hanel said they began to use the new technique initially in patients who were not good candidates for a first carotid endarterectomy.

Hanel noted that the new procedure is expected to receive approval for use in the U.S. for both primary and secondary carotid stenosis by 2005.