Contrapondo o artigo: a endarterectomia carotídea é a melhor opção para os pacientes com doença carotídea

Abstract

The Leicester study is a study with only 17 patients, and no conclusion can be drawn from its results .The Cavatas 2 study demonstrated identical results for carotid stenting and endarterectomy. As regards the mortality results in the ECST 3 , the possible reasons presented have to do with differences in the populations studied. In the group of patients treated with carotid stenting, all the deaths were due to CVA, whereas in the group of patients treated with endarterectomy, four deaths were due to CVA and three were due to surgical complications after the procedure. It is understood that the causes of these deaths were attributed to complications relating to the treatment strategy and not to a statistical stratagem as the authors assert 4 . In fact restenosis was greater in those patients treated with carotid stenting, but >70% of the patients were treated only with the balloon, and when they were submitted to carotid stenting, restenosis was close to zero, as demonstrated in the SAPPHIRE study 5 .In the Lexiton I and II studies, the results were similar between the group of patients treated with carotid stenting and the other group treated with endarterectomy, which revealed that the percutaneous technique had not been superseded by endarterectomy 6 . The Sapphire study 5 was important in the analysis of the FDA (Food and Drugs Administration), the North American agency that regulates the pharmaceutical, food and medical device industries in the USA, for the approval of carotid stenting in high risk patients. The principle of non-inferiority is established in statistics and employed in several cardiology studies, and it's not unworthy of use. We point out to the author that the fact that patients are asymptomatic does not mean that they're free of high risk.A recent meta-analysis that analyzed a total of 1,269 patients demonstrated that in 30 days the incidence of CVA and death after carotid stenting was 8.1% (51 out of 632 patients; mean from 0.0 to 12.1%) and 6.3% after endarterectomy (40 out of 637 patients; mean from 0.0% to 9.9%), and the difference between both treatments was not statistically significant 7 . The mortality in this meta-analysis was different in the ACST and Medicare studies in the USA, because the populations have different risk levels. In cardiology, the elevation of CKMB is a predictor of more adverse clinical progress in the medium to long term. The author of the paper infers the presence of commercial influences in the results of the study. I would like to warn readers against the danger of such a statement, as it poses doubts as to the seriousness of researchers and medical journals published later. The funding of studies by the industry is relatively common in evidence-based cardiology; however, we have believed in the honesty of researchers and medical journals, because if it were not so, all the information contained in such journals would have to be challenged.The Space 8 study was unable to demonstrate the noninferiority of carotid stenting in relation to endarterectomy, but i...