Brain angioplasty may prevent strokes.

For thousands of heart-disease patients, angioplasty has obviated the need for surgery. In this technique, surgeons thread a catheter tipped with a tiny inflatable balloon through an artery until it reaches a blockage. They gently inflate the balloon to widen the opening and restore blood flow to heart muscle.

This procedure also works on arterial blockages in the brain, scientists report in the May STROKE.

Researchers at Stanford University Medical Center tried the procedure on 23 patients at high risk of stroke. In these people, blood flow through at least one major brain artery had slowed substantially. Ten had already had strokes, and symptoms of all were worsening as drugs failed to relieve the condition. The arterial blockages had forced some to curtail their activities greatly and even rendered some bedridden.

All the patients underwent angioplasty in a brain artery except one who had a blockage that doctors couldn't safely treat. This patient died soon afterward. Another patient died during surgery.

Most of the other 21 patients have done well, considering their poor prognoses at the start of the experiment, says study coauthor Michael P. Marks, a neuroradiologist at Stanford. They continued on medication, and during a follow-up period averaging 3 years, only two patients in this group had strokes. One of those was due to a blockage in a brain vessel other than the one that underwent angioplasty.

These results translate to an annual stroke rate of only 3.2 percent, significantly less than the 7.8 to 10.7 percent rate typical of patients with such blockages. The actual gains from angioplasty might be even greater, says Marks, considering that unlike most such patients, these had not been responding to drug therapy. The study's success rate indicates that the procedure is a potential weapon against stroke, Marks says.

The researchers have now followed some of their patients for as long as 6 years after the angioplasties. "Many of the patients were really helped," Marks says.

To more fully ascertain the treatment's benefits, Marks is calling for a larger study to compare stroke-risk patients receiving only medication with those getting medication plus angioplasty.