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July 1996

Carotid Angioplasty: In Search of a Worthy Alternative to Endarterectomy

Author Affiliations

From the Memphis Vascular Research Foundation, Memphis, Tenn.

Arch Neurol. 1996;53(7):696-698. doi:10.1001/archneur.1996.00550070138023

Carotid endarterectomy is beneficial in selected patients with carotid atherosclerosis1-4; however, it has incontrovertible limitations. Carotid angioplasty is a potential alternative to surgical revascularization. Although angioplasty has not been submitted to a definitive clinical test, its potential advantages warrant evaluation.

Despite its beneficial overall effect in the controlled setting of clinical trials, endarterectomy's risk of death and stroke preclude surgery in some patients.5 The North American Symptomatic Carotid Endarterectomy Trial Collaborators1 and Veterans Affairs3 trial posted a perioperative death and/or stroke rate of 5.8% and 6.7%, respectively, despite excluding surgeons whose pretrial endarterectomy complication rates exceeded 6%. Conversely, the European Carotid Surgery Trialists' Collaborative Group2 did not explicitly limit surgeon participation based on complication rates and had a rate of 7.5% for the same end point. Contemporary communitybased audits,6-8 which may be more representative of actual health care delivery, suggest that disability and death from carotid

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