Percutaneous transluminal angioplasty (PTA) for atherosclerotic carotid disease is an experimental therapy of unproven value. Nonetheless, claims for its safety and efficacy are increasingly made. Many of us have concerns that these claims are premature and exaggerated. It is also widely rumored that carotid angioplasty is being indiscriminantly used for questionable indications, often by individuals with little or no knowledge of the nervous system. A comparison of what is known about carotid atherosclerosis and its surgical treatment with the scant literature on carotid angioplasty illustrates how little is known regarding the safety, efficacy, and durability of carotid angioplasty.
The vast majority of carotid atherosclerotic plaques occur at the region of the common carotid bifurcation and involve the carotid bulb in particular. They are frequently complicated by the presence of hemorrhage, calcification, ulceration, and thrombus, all of which are more likely the greater the stenosis. Most strokes related to carotid plaques
Ferguson GG. Angioplasty for Carotid Disease: No. Arch Neurol. 1996;53(7):698–700. doi:10.1001/archneur.1996.00550070140024
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