Risk-Benefit Assessment of Carotid Revascularization

Abstract

Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes.To review the main studies on carotid revascularization, evaluating the relationship between risks and benefits of this procedure.The data reviewed show that, for a net benefit, carotid intervention should only be performed in cases of a periprocedural risk of less than 6% in symptomatic patients. The medical therapy significantly reduced the revascularization net benefit ratio for stroke prevention in asymptomatic patients. Real life registries indicate that carotid stenting is associated with a greater periprocedural risk. The operator annual procedure volume and patient age has an important influence in the rate of stroke and death after carotid stenting. Symptomatic patients have a higher incidence of death and stroke after the procedure. Revascularization has the greatest benefit in the first weeks of the event.There is a discrepancy in the scientific literature about carotid revascularization and/or clinical treatment, both in primary and secondary prevention of patients with carotid artery injury. The identification of patients who will really benefit is a dynamic process subject to constant review.

Estudo Crítico Epidemiológico Do Tratamento Cirúrgico Da Estenose Carotídea Em Município De Médio Porte No Estado Do Paraná

“…Apesar de diretrizes principais endossarem a intervenção em pacientes assintomáticos desde que o risco periprocedimental seja inferior a 3%, a magnitude restrita da prevenção absoluta de acidentes vasculares cerebrais coloca a intervenção carotídea como um procedimento questionável em uma população assintomática não selecionada 10 .…”

“…Pacientes com isquemia cerebral transitória ou AVE sem déficit grave 1,16 devem ser considerados para tratamento cirúrgico de estenose carotídea em sítio correspondente desde que outra causa etiológica não tenha sido demonstrada [12][13][14][15] . O benefício é inversamente proporcional ao tempo de espera, entre o ictus e o procedimento, a partir da segunda semana 17,18 . Os pacientes desta amostra operados tardiamente apresentaram, no seguimento, incidência significativamente maior de IAM (p= 0,048) e óbito (p= 0,027).…”

Clinical efficacy and safety of statin treatment after carotid artery stenting

“…Taken together, statin pre-treatment was a safe approach to reduce complications and to improve clinical outcomes among patients undergoing CAS. CAS is generally accepted as a substitutive treatment for CEA in patients with carotid artery stenosis, but this method may cause high risk of perioperative complications, stroke and mortality [22]. Statin pre-treatment is a commonly used strategy to reduce perioperative and postoperative complications among patients undergoing CAS.…”