In addition to angioplasty, coronary bypass surgery is another common treatment for restoring blood flow to the heart. However, bypass surgery is impractical for treating narrowed vessels that feed blood to the brain

In angioplasty, a tiny balloon-tipped catheter is threaded through a blood vessel. When the catheter reaches the area of blockage, the balloon is inflated, compressing atherosclerotic plaque, or fatty build-up, against the vessel lining and opening a wider channel for blood flow.

Although angioplasty has a high technical success rate, it still carries risks. In the stroke study, one patient died of a ruptured blood vessel at the time of the procedure, and another patient had a blood clot near the site of the original blockage an hour after undergoing the procedure. That clot was successfully dissolved with medication.

During about three years of follow-up, two individuals in the study who were treated with angioplasty had strokes in the area of the blockage and three had strokes in other areas of the brain. All patients received continued medical therapy after the procedure. After three years, the patients had an annual stroke rate of 3.2 percent in the area of the blockage and an overall annual stroke rate of 4.8 percent.

"It is difficult to know precisely how these stroke rates would compare to rates of stroke among individuals treated with medication (such as warfarin and aspirin) alone," Marks says. Some limited data available from other studies indicates an annual stroke rate of 7.8 percent to 10.7 percent when individuals are treated with medication alone. "Based on these data, it appears that angioplasty has significantly reduced the stroke rate.

"This study indicates a need for additional studies comparing the usefulness of angioplasty versus medication alone," Marks says. "At this point there is no other proven therapy to treat this proble
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Contact: Carole Bullock
caroleb@heart.org
214-706-1279
American Heart Association
6-May-1999