Vascular surgical society of great britain and ireland: results of the carotid and vertebral artery transluminal angioplasty study

Abstract

BACKGROUND: Trials have demonstrated the benefit of surgery for severe carotid stenosis, but there is still significant morbidity from the operation. Percutaneous transluminal angioplasty (PTA) avoids general anaesthesia and trauma from a neck incision, but has not yet gained acceptance for carotid stenosis because of concern about the risks. The Carotid And Vertebral Artery Transluminal Angioplasty Study was established to investigate the risks and benefits of cerebrovascular PTA. METHODS: Twenty-four centres in Europe, Australia, Canada and the USA collaborated to randomize 504 patients (mean age 67 years; 69 per cent men) with carotid stenosis to surgery (n = 253) or angioplasty (n = 251) between 1992 and 1997. RESULTS: Some 90 per cent of the patients were recently symptomatic. PTA was carried out using balloon catheters with the adjunctive use of stents in 26 per cent. Mean carotid stenosis by the common carotid method was 87 per cent. Safety analysis by intention to treat showed no difference in the primary outcome measure of disabling stroke or death within 30 days of treatment (surgery, 6 per cent; PTA, 6 per cent). Cranial nerve injury and myocardial ischaemia were only reported at the time of treatment in the surgical group. Long-term survival curves showed no difference in ipsilateral stroke during follow-up. CONCLUSION: Carotid surgery and angioplasty are equivalent in safety and efficacy, but angioplasty has advantages with respect to nerve injury and cardiac complications.