Can Carotid Artery Angioplasty Replace Carotid Endarterectomy?
Even in good centers, the risk of endarterectomy is not negligible. Moreover, this operation is done at high cost still often with general anesthesia. Angioplasty is done without general anesthesia; the patient is awake so that it is possible to know immediately if a neurological event happens. Moreover, if this is the case, the neuroradiologist can immediately use intraarterial fibrinolysis if necessary. All these conditions seem to favor angioplasty. Nevertheless, carotid angioplasty is still not generally accepted because of the risk of embolization of the central nervous system. However, the situation will probably change thanks to new developments of the technique, such as cerebral protection by an occlusive balloon distal to the site of angioplasty and stent placement. A recent study by Theron et al. [1996] on 136 patients showed that this new technique eliminated embolic complications during angioplasty itself, but not completely during stent placement which was performed withou
