My wife had a mini-stroke. Can she have an angioplasty to open the narrowed brain artery?

DEAR DOCTOR K:

My wife had a mini-stroke. The doctor said she has a narrowed artery in her brain. Can’t the doctor open it up with angioplasty, as he would if she had a narrowed heart artery?

DEAR READER:

“Mini-stroke” is another name for a transient ischemic attack, or TIA. A TIA causes stroke symptoms — such as sudden weakness on one side of the body, blurred vision or difficulty speaking — that last 10 minutes or more, but less than 24 hours. A TIA is a warning sign of an impending stroke. Four to 10 percent of people who have a TIA will go on to have a full-blown stroke.

Both mini-strokes and full-fledged strokes are usually caused by narrowed arteries in the brain. The underlying cause is the same as it is for artery blockages in the heart. It’s atherosclerosis — fatty deposits that enlarge and become plaques. If a plaque ruptures, a clot may grow to obstruct the artery. Or, a blood clot may form elsewhere in the body, travel to the brain, then lodge in a part of the artery that is narrowed by plaque.

Balloon angioplasty has a successful track record in opening arteries in the heart. In this procedure, a catheter with a deflated balloon at the tip is threaded into the narrowed artery. The balloon then inflates to open up the blockage. Often, a wire mesh stent is left behind to keep the artery open.

It seems natural to think that this procedure would also be an option to open blocked arteries inside the brain. But, to date, studies comparing angioplasty to medicines for narrowed arteries in the brain have been disappointing.

A study recently published in the Journal of the American Medical Association once again compared the two treatments. The study included more than 100 people with narrowed arteries in the brain, who had suffered symptoms such as a TIA. The people were assigned at random to be treated with angioplasty and stent or with just medicines. The doctors conducting the study hoped that people treated with angioplasty would have better outcomes.

Here were the outcomes in the angioplasty group (listed first) and the medicines-only group (listed second): brain hemorrhage in the first 30 days (24 percent vs. 9 percent); stroke or TIA in the first year (36 percent vs. 15 percent); increased disability score (24 percent vs. 11 percent).

With the best of intentions, the doctors were trying to do something for their patients, something that seemed likely to help them. Instead, they were doing something to their patients that ended up hurting them. The study was promptly stopped.

So forget about angioplasty. Instead, your wife should focus on other strategies that may help prevent another TIA or stroke. For example:

  • Keep blood pressure in the normal range (less than 140/90).
  • Keep cholesterol levels healthy.
  • Maintain a normal weight.
  • Don’t smoke.
  • Stay physically active and exercise at least 30 minutes per day.

Your wife’s doctor may also prescribe blood-thinning drugs, which can help prevent blood clots. In addition, cholesterol-lowering statin drugs may help prevent strokes, even in people with normal cholesterol levels.