Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000100005
Jornal Vascular Brasileiro
Original Article

Tratamento endovascular da doença obstrutiva carotídea em pacientes de alto risco: resultados imediatos

Endovascular treatment of carotid obstructive disease in high risk patients: immediate results

Ricardo Augusto Carvalho Lujan; Leonardo Aguiar Lucas; Andréa de Fátima Gracio; Armando de Carvalho Lobato

http://dx.doi.org/10.1590/S1677-54492006000100005 J Vasc Bras, vol.5, n1, p.23-29, 2006
PDF
Downloads: 1
Views: 1360

Resumo

OBJETIVO: Tratamento endovascular - angioplastia carotídea com stent (ACS) - tem se mostrado como opção atual no tratamento da estenose da artéria carótida em pacientes considerados de alto risco para endarterectomia de carótida (ECA). Este trabalho reporta a experiência do Instituto de Cirurgia Vascular e Endovascular (ICVE) de São Paulo nos casos de ACS em pacientes de alto risco. MATERIAL E MÉTODO: Foi realizado um estudo retrospectivo descritivo baseado na análise dos prontuários de 113 pacientes (84 homens e 29 mulheres) submetidos a 130 procedimentos de ACS pelo ICVE, no período de março de 2000 a junho de 2004. A idade média dos pacientes foi de 74 anos (variando de 51 a 86 anos). Os pacientes assintomáticos (55%) apresentavam estenose > 75%, enquanto nos sintomáticos (45%) as lesões encontradas foram > 70%. Foi indicado ACS nos seguintes pacientes: alto risco para ECA (45%), reestenose pós-ECA (15%), estenose carotídea severa bilateral (14%), oclusão da carótida contralateral (12%), bifurcação alta (no nível ou acima da segunda vértebra cervical) (6%), estenose pós-radioterapia (5%) e pescoço hostil (3%). As lesões encontradas localizavam-se na bifurcação carotídea (46%), carótida interna (32%), origem da artéria carótida comum (9%), tronco braquiocefálico (8%) e artéria carótida comum (5%). RESULTADO: Foi observado um total de sete eventos neurológicos (cinco casos de acidente vascular encefálico e dois pacientes que apresentaram ataque isquêmico transitório). A taxa de óbito foi de 0%. A taxa total de complicações (acidente vascular encefálico, acidente isquêmico transitório, óbito) foi de 5,3%. CONCLUSÃO: ACS demonstrou ser um procedimento com baixa taxa de complicações, sendo uma opção segura e eficaz nos pacientes de alto risco para ECA.

Palavras-chave

Artéria carótida, estenose, angioplastia, alto risco cirúrgico

Abstract

OBJECTIVE: Endovascular treatment - carotid artery stenting (CAS) - has been recommended as the current option in the treatment of carotid artery disease in high risk patients for carotid endarterectomy surgery (CEA). This study reports our experience at Instituto de Cirurgia Vascular e Endovascular de São Paulo with regard to CAS in high risk patients. MATERIAL AND METHOD: A retrospective descriptive study was performed based on the analysis of 113 medical charts of patients (84 males and 29 females) submitted to 130 CAS from March 2000 to June 2004. Mean age was 74 years (range, 51-86 years). Asymptomatic patients (55%) presented stenosis > 75%, whereas in symptomatic patients (45%) stenosis was > 70%. Indication for CAS included: high risk for CEA (45%), recurrent stenosis post-CEA (15%), contralateral internal carotid artery stenosis (14%), contralateral carotid occlusion (12%), high cervical bifurcation (6%), post-radiation stenosis (5%), anatomically limited access (3%). The lesions were located at: carotid bifurcation (46%), internal carotid artery (32%), common carotid artery origin (9%), brachiocephalic trunk (8%), and common carotid artery (5%). RESULT: Seven neurological events were observed (five cases of cerebral vascular accident and two patients who had a transitory ischemic attack). Death rate was 0%. Overall complication rate (cerebral vascular accident, transitory ischemic attack, death) was 5.3%. CONCLUSION: CAS has proved to be a procedure with a low complication rate. Therefore, it is a safe and efficient option in high risk patients for CEA.

Keywords

Carotid artery, stenosis, angioplasty, high surgical risk

References

Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445-53.

MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis European Carotid Surgery Trialists' Collaborative Group. Lancet. 1991;337:1235-43.

Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273:1421-8.

Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from Framingham Study. Stroke. 1991;22:312-8.

Moore WS, Barnett HJ, Beebe HG. Guidelines for carotid endarterectomy: A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. Stroke. 1995;26:188-201.

Crouse JR, Toole JF, McKinney WM. Risk factors for extracranial carotid artery atherosclerosis. Stroke. 1987;18:990-6.

O'Leary DH, Anderson KM, Wolf PA, Evans JC, Poehlman HW. Cholesterol and carotid atherosclerosis in older persons: the Framingham Study. Ann Epidemiol. 1992;2:147-53.

Antiplatelet Trialists Collaboration. BMJ. 1994;308:81-106.

Fields WS, Lemak NA, Frankowski RF, Hardy RJ. Controlled trial of aspirin in cerebral ischemia. Stroke. 1977;8:301-14.

Ouriel K, Hertzer NR, Beven EG. Preprocedural risk stratification: identifying an appropriate population for carotid stenting. J Vasc Surg. 2001;33:728-32.

Hobson RW, Weiss DG, Fields WS. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group N Engl J Med. 1993;328:221-7.

Veith FJ, Amor M, Ohki T. Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg. 2001;33(^s2):S111-6.

Wennberg DE, Lucas FL, Birkmeyer JD, Bredenberg CE, Fisher ES. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA. 1998;279:1278-81.

Tardini DM, Yoshida WB. Brain injury due to ischemia and reperfusion in carotid endarterectomy surgery. Rev Port Cir Cardiotorac Vasc. 2003;10:133-40.

Diethrich EB. Indications for carotid artery stenting: a preview of the potential derived from early clinical experience. J Endovasc Surg. 1996;3:132-9.

Ouriel K, Yadav J, Green RM. Standards of practice: carotid angioplasty and stenting. J Vasc Surg. 2004;39:916-7.

Wholey MH, Wholey M, Mathias K. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv. 2000;50:160-7.

Yadav JS, Wholey MH, Kuntz RE. Protected carotid-artery stenting versus endarterectomy in high risk patients. N Engl J Med. 2004;351:1493-501.

Illig KA, Zhang R, Tanski W, Benesch C, Sternbach Y, Green RM. Is the rationale for carotid angioplasty and stenting in patients excluded from NASCET/ACAS or eligible for ARCHeR justified?. J Vasc Surg. 2003;37:575-81.

Jordan WD Jr., Alcocer F, Wirthlin DJ. High-risk carotid endarterectomy: challenges for carotid stent protocols. J Vasc Surg. 2002;35:16-21.

Mozes G, Sullivan TM, Torres-Russotto DR. Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting. J Vasc Surg. 2004;39:958-65.

New G, Roubin GS, Iyer SS. Safety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy: a multicenter study. J Endovasc Ther. 2000:345-52.

Hobson RW, Goldstein JE, Jamil Z. Carotid restenosis: operative and endovascular management. J Vasc Surg. 1999;29:228-35.

Henry M, Amor M, Masson I. Angioplasty and stenting of the extracranial carotid arteries. J Endovasc Surg.. 1998;5:293-304.

Merlo M, Conforti M, Apostolou D, Carignano G. Surgical and endovascular treatment of stenosis of the innominate artery. Minerva Cardioangiol. 1999;47:49-54.

Sullivan TM, Gray BH, Bacharach JM. Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients. J Vasc Surg. 1998;28:1059-65.

Order BM, Gass C, Liess C, Heller M, Muller-Hulsbeck S. Comparison of 4 cerebral protection filters for carotid angioplasty: an in vitro experiment focusing on carotid anatomy. J Endovasc Ther. 2004;11:211-8.

Rapp JH, Pan XM, Sharp FR. Atheroemboli to the brain: size threshold for causing acute neuronal cell death. J Vasc Surg. 2000;32:68-76.

Ohki T, Marin ML, Lyon RT. Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. J Vasc Surg. 1998;27:463-71.

Reimers B, Corvaja N, Moshiri S. Cerebral protection with filter devices during carotid artery stenting. Circulation. 2001;104:12-5.

Jordan WD Jr, Voellinger DC, Doblar DD, Plyushcheva NP, Fisher WS, McDowell HA. Microemboli detect by transcranial Doppler monitoring in patients during carotid angioplasty versus carotid endarterectomy. Cardiovasc Surg. 1999;7:33-8.

Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized study. Lancet. 2001;357:1729-37.

Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003;34:1936-41.

Castriota F, Cremonesi A, Manetti R. Impact of cerebral protection devices on early outcome of carotid stenting. J Endovasc Ther. 2002;9:786-92.

Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: initial experience in 110 patients. J Vasc Surg. 1996;3:42-62.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dea48170e88258c142afa9e jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections