Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Bonamigo, Telmo Pedro; Lucas, Márcio Luı́s

doi:10.1590/s1677-54492007000400011

Cited by 12 publications

(14 citation statements)

References 65 publications

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“…5 We agree with their statement because of the reasons mentioned above. Comparing all data, endarterectomy is certainly still the best treatment for most patients, but we maintain our belief that the endovascular treatment of the carotid arteries is an evolving method that already has many indications, many of them with better outcomes than CE.…”

Section: Indicationsmentioning

confidence: 55%

“…Among the many indications of carotid stenosis listed in the article by Bonamigo & Lucas, 5 we agree that treatment of carotid stenosis can be indicated for asymptomatic individuals with stenosis of 70% or more, with good life expectancy, and in those with stenosis of 60% or more, with contralateral occlusion, provided that complication rates regarding morbidity and mortality in the group are below 3%. 8 Our practice is also to perform simultaneous treatment of asymptomatic stenosis with obstruction degree above 69% in patients with indication of myocardial revascularization.…”

Section: Indicationsmentioning

confidence: 86%

“…We recommend reading the references listed in the article by Bonamigo & Lucas, 5 which are complementary to this editorial.…”

Section: Indicationsmentioning

confidence: 99%

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O vai-e-vem no tratamento da doença carotídea

Ristow

2007

J. vasc. bras.

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Section: Indicationsmentioning

confidence: 55%

Section: Indicationsmentioning

confidence: 86%

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O vai-e-vem no tratamento da doença carotídea

Ristow

2007

J. vasc. bras.

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“…Apesar dos diversos estudos randomizados publicados, até o momento, não existem argumentos com nível um de evidência a favor ou contra a ACS em relação à ECA na doença carotídea obstrutiva extracraniana sintomática ou assintomática, incluindo na REC 18 . Bettendorf et al 7 relataram em seu trabalho que ACS é um método seguro e efetivo para tratar pacientes com REC e pode se tornar o tratamento de escolha.…”

Section: Discussionunclassified

Tratamento endovascular da reestenose carotídea: resultados em curto prazo

Lujan¹,

Lucas²,

Gracio³

et al. 2011

J. vasc. bras.

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ResumoContexto: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. Objetivos: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS) no tratamento da reestenose carotídea (REC) no intraoperatório e no pós-operatório recente (<30 dias). Métodos: Análise retrospectiva dos pacientes portadores de reestenose carotídea submetidos à angioplastia com stent no período de março 2000 a junho de 2004. Resultados: Foram analisados 19 pacientes com reestenose carotídea. Quatorze pacientes (74%) eram do sexo masculino, com média de idade de 74 anos. Quinze (79%) eram assintomáticos com estenose >80%, enquanto quatro (21%) eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias). Conclusão: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazo.Palavras-chave: Doenças das artérias carótidas; angioplastia com balão; estenose das carótidas. AbstractContext: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. Objective: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting -CAS) for the treatment of carotid artery restenosis, in the intraoperative and early (<30 days) postoperative period. Methods: Retrospective analysis of patients with carotid artery restenosis who have undergone stenting angioplasty from March 2000 to June 2004. Results: Nineteen patients with carotid artery restenosis were analyzed. Fourteen (74%) patients were male, with a mean age of 74 years. Fifteen (79%) patients were asymptomatic, with stenosis >80%, whereas 4 (21%) were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days). Conclusion: Endovascular treatment of carotid artery restenosis seems to be a feasible and safe approach in the short term.

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“…1 De acordo com dados epidemiológicos, cerca de cem mil pessoas por ano poderiam se beneficiar profilaticamente do tratamento de suas lesões carotídeas, evitando-se as sequelas de um AVE, mas somente a minoria é privilegiada. 2,3 O tratamento endovascular da doença aterosclerótica carotídea vem evoluindo continuamente com o advento de novos stents e novos mecanismos de proteção cerebral. A maior limitação para angioplastia carotídea é o risco potencial de eventos neurológicos catastróficos associados ao procedimento.…”

Section: Descritoresunclassified

Experiência inicial com o sistema de reversão de fluxo em pacientes submetidos a angioplastia carotídea

Metzger

Moreira

Izukawa

et al. 2011

Rev. Bras. Cardiol. Invasiva

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Background:The endovascular treatment of carotid atherosclerotic disease has continuously evolved, although ischemic or embolic complications may occur even with the use of cerebral protection systems. This study was aimed at evaluating the perioperative results of an initial series of patients using the flow reversal system during carotid angioplasty. Methods: This was a prospective, non-randomized, non-controlled, singlecenter study. Asymptomatic patients with lesions > 70% or symptomatic patients with lesions > 50% in the internal carotid artery were included. The flow reversal system was used with pre-dilation in selected cases and open-cell stents were used in all cases. We evaluated the occurrence of major and minor strokes, transient ischemic attacks (TIAs), acute myocardial infarction (AMI) and death within 30 days after the procedure. Results: Between September 2010 and February 2011 carotid angioplasty was performed in 17 patients, most of them male (70.6%), with mean age of 66.7 + 8 years, of which 17.6% were diabetic. Approximately half of the patients were symptomatic, 5 patients had a prior history of stroke (29.4%) and 3 had TIA (17.7%). Technical success was achieved in 100% of the patients. There was one death (5.9%), 24 hours after the procedure in a high surgical risk patient treated in the evolution phase of an AMI due to repetitive TIAs. There were no cases of major or minor strokes or TIAs during the follow-up. Conclusions: In our study, the flow reversal system proved to be effective and safe in patients undergoing carotid angioplasty.

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Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Cited by 12 publications

References 65 publications

O vai-e-vem no tratamento da doença carotídea

O vai-e-vem no tratamento da doença carotídea

Tratamento endovascular da reestenose carotídea: resultados em curto prazo

Experiência inicial com o sistema de reversão de fluxo em pacientes submetidos a angioplastia carotídea

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