|
Angioplasty
The diagrams
above clearly show the need for angioplasty and also its long term effectiveness
after successful treatment. Percutaneous Transluminal Angioplasty (PTA)
involves a minor procedure, normally carried out under local anaesthetic,
in which a catheter is inserted into the femoral artery in the groin and
then guided using an X-ray monitor to the stenosis in the carotid artery
. A balloon (thus the term "balloon angioplasty") which is mounted
on the end of the catheter is then inflated to approximately 5mm diameter
to dilate the artery. A protection filter is often added to catch any
atheroma that is not flattened as these could cause a stenosis and so
stroke/TIA further up the artery. This mechanism is shown below:
When considering
whether to perform a surgical operation to remove the atheroma, or angioplasty
the following considerations are taken into account:
|
Factors for angioplasty:
- Local
anaesthesia
- MI
or PE very rare
- Avoids
neck incision
- Short
hospital Stay
|
Factors
against surgery:
- Risks
of General anaesthesia
- Risk
of MI and PE
- Incision
in the neck (haematoma, cranial nerve palsy, permenant scar)
- Expensive
|
|
Factors
against angioplasty:
- Risks
of embolisation
- Restenosis
- Implanted
metal
|
Factors
for surgery:
- Brain
protected
- Tried
& Tested
- Long
Term Effiacy
|
The table
below shows the risk of stroke associated with angioplasty in series treated
in the 1990's
|
n
|
Stroke
or death within 30 days (%)
|
| Kachel et
al 1991 |
37
|
0
|
| Munari et
al 1992 |
44
|
9.1
|
| Mathias 1994 |
166
|
2.4
|
| Brown et al
1995 |
50
|
6.0
|
| Eckert et
al 1996 |
61
|
4.9
|
| Gil-Peralta
1996 |
82
|
4.9
|
| Kachel 1996 |
74
|
3.1
|
| Theron et
al 1996 |
43
|
5.0
|
Click for Stenting Page
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