http://www.nytimes.com/2002/11/20/health/20HEAR.html
Device May Make Angioplasty Safer Than Surgery By LAWRENCE K. ALTMAN CHICAGO, Nov. 19 � An experimental filter makes the artery-clearing procedure called angioplasty safer than standard surgery for preventing tens of thousands of strokes caused by clogged arteries in the neck, a new study suggests. For decades, doctors have performed the surgery � carotid endarterectomy � with the aim of cutting open the affected arteries to remove fatty deposits before they can lead to a stroke. In part because the deposits can dislodge during surgery to cause a stroke and in part because the operation leaves a long scar, many doctors have looked to angioplasty instead. But angioplasty � in which a wire is inserted into an artery in the thigh and threaded through other arteries to reach the blocked area in the neck � can also cause the particles to dislodge. In the new study, reported at the annual meeting of the American Heart Association here today, a tiny filter was used to trap the particles. It helped cut the incidence of strokes and other serious complications after 30 days by half, as compared with patients who underwent the standard operation without the filter. If the new findings hold up in further testing, use of the filter may make angioplasty a preferred procedure among many of the estimated 200,000 Americans who undergo carotid artery surgery each year, said Dr. Jay S. Yadav of the Cleveland Clinic, who led the study. Particles that break away from the buildup of fatty deposits in the carotids are a leading cause of the 730,000 strokes that occur in this country each year. "It's a watershed event," Dr. Yadav said, adding that it was the first time a less invasive procedure had been shown superior to surgery in cardiovascular disease. Dr. Donald La Van of the University of Pennsylvania, who was not involved in the study, said it would indeed be a watershed event if the carotid arteries remained open over a longer period of time. Information on how the patients did after one year will be reported next spring, Dr. Yadav said. In the study, involving 307 patients at 29 hospitals in the United States, 9 of the 156 angioplasty patients who received the filters, or 5.8 percent, died or had a nonfatal stroke or heart attack within 30 days, compared with 19 of 151, or 12.6 percent, who had surgery. The study was financed by Cordis, a subsidiary of Johnson & Johnson, which makes the experimental filter device, called the AngioGuard. The AngioGuard is like an umbrella. Doctors guide it along the wire from the thigh artery to the carotid artery and open it at the desired site. There it takes the shape of a basket that catches dislodged particles. After inflating a balloon to open the clogged artery � just as doctors do in angioplasty to open up blocked arteries in the heart � doctors insert a tiny metal tube called a stent to help keep the artery open. The carotid stent is made of flexible nickel and titanium so it can change shape as the artery pulses. After a neurologist examines the patient, the doctors collapse the filter and carefully remove it. Translucent whitish particles are found in about 80 percent of the filters, and the particles usually cover about half the filter surface, Dr. Yadav said. But in 5 percent to 10 percent of patients, the filter becomes so clogged that it slows blood flow to the brain. When that happens, doctors have to speed up the procedure to prevent brain damage, Dr. Yadav said. The researchers have not been able to determine which patients are most likely to be included in the 5-to-10-percent group. Because new fatty deposits and tissue can form on the stents and then block a repaired artery, researchers have reported significant progress in reducing the frequency of such complications by coating the tubes with various drugs. But Dr. Yadav said the role of coated stents in carotid angioplasty was not known. __________________________________________________ Do you Yahoo!? Yahoo! Web Hosting - Let the expert host your site http://webhosting.yahoo.com
