Angioplasty with stenting can be effectively and safely extended from coronary arteries to the carotid artery to prevent stroke, according to a presentation at the annual meeting of the Radiological Society of North America (RSNA).

An Italian study involving 180 patients with carotid artery disease showed that angioplasty and stenting were as effective as surgery, with comparable rates of neurologic complications and a similarly low rate of restenosis.

During the procedure, physicians inserted a catheter through an incision in the femoral artery in the groin and threaded it through to the carotid artery. A filter was opened distal to the carotid lesion to protect the brain from any material loosened during the procedure, and then a balloon at the tip of the catheter was inflated, widening the artery. To prevent restenosis, a wire mesh stent was put in place.

"Stenting is less invasive than surgery," said Gianluca Piccoli, MD, of the Santa Maria della Misericordia Hospital of Udine in Italy. "Our goal was to find whether you can receive the same or better results as with surgery."

The current method of treatment, endarterectomy, is usually successful but has significant risks, Piccoli said.

"The surgeon will usually clamp the carotid artery to prevent bleeding, so the flow of blood to the brain is interrupted, increasing the risk of brain injury, although some surgeons use a temporary external shunt to prevent this problem. Also, the stress that comes from surgery can cause potentially fatal complications like heart attack and stroke," Piccoli said.

To avoid these risks, the Italian research group used minimally invasive angioplasty and stenting procedures to treat carotid artery disease. After 3 years and 180 patients, the results showed that carotid angioplasty and stenting had the same amount of neurologic complications as surgery (3 percent) and the same rate of restenosis after treatment (4 percent).

"Today, these procedures are largely used for the heart, but I think that in the future they will be used for every artery and every part of the body," Piccoli said.
"With surgery you need three to four days, sometimes even a week of recovery in the hospital," Piccoli said. "But with carotid angioplasty and stenting, you can go home the day after the procedure."

In August, the Food and Drug Administration approved the first carotid stenting system for use in the United States.