Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000400011
Jornal Vascular Brasileiro
Review Article

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

Critical analysis of indications and outcomes of surgical treatment for carotid disease

Telmo P. Bonamigo; Márcio L. Lucas

Downloads: 0
Views: 1184

Resumo

O tratamento da doença carotídea tem ganhado enfoque nos últimos anos, principalmente com o advento da técnica endovascular, que defende o emprego da angioplastia e stent de carótida (CAS), principalmente em pacientes considerados de "alto risco" para a endarterectomia carotídea (ECA). Através da revisão bibliográfica, analisamos os resultados do tratamento da lesão carotídea em ambas as técnicas, realizando comentários embasados na experiência pessoal e nos dados da literatura, sobretudo nos pacientes de alto risco. Até o presente momento, não há evidência e justificativa para o emprego da CAS em larga escala nos pacientes com doença carotídea, inclusive nas situações de alto risco, tais como nos octogenários. No entanto, acreditamos que a CAS possa ser um coadjuvante no tratamento de pequeno número de pacientes com lesão carotídea (até 4% dos casos), como na presença de pescoço hostil, radioterapia prévia e alguns casos de estenose carotídea alta. Quando realizada com os cuidados técnicos necessários, a ECA ainda continua a melhor opção terapêutica aos doentes com lesão carotídea.

Palavras-chave

Endarterectomia carotídea, angioplastia carotídea com stent

Abstract

Treatment of carotid disease has been in focus over the past years, especially with the advent of the endovascular technique, which supports use of carotid angioplasty and stenting (CAS) in "high-risk" patients for carotid endarterectomy (CAE). We analyzed current outcomes of the treatment for carotid disease using both techniques. Furthermore, we performed some comments based on data from the literature, particularly in high-risk patients. We conclude that, up to the present moment, there is no evidence and justification for large use of CAS in patients with carotid disease, even in high-risk patients, such as in octogenarians. However, we believe that CAS could be useful in the treatment of a small number of patients with carotid disease (less than 4%), such as those with hostile neck, previous cervical radiation and in some cases of high carotid stenosis. When performed using the required technical skills, CAE is still the best choice for patients with carotid disease.

Keywords

Carotid endarterectomy, carotid angioplasty/stenting

References

Carrea R, Molins M, Murphy G. Surgical treatment of spontaneous thrombosis of the internal carotid artery in the neck: Carotid-carotideal anastomosis. Report of a case. Acta Neurol Latinoamer. 1955;1:71-8.

DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency: Nineteen-year follow-up. JAMA. 1975;233:1083-5.

Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;267:994-6.

Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med. 1991;325:445-53.

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

Naylor AR, Bolia A, Abbott RJ. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg. 1998;28:326-34.

Alberts MJ. Results of a multicenter prospective randomized trial of carotid artery stenting versus carotid endarterectomy. Stroke. 2001;32:325.

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

Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol. 2001;38:1589-95.

Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery. 2004;54:318-24.

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

Endarterectomy versus stenting in patients with severe symptomatic stenosis. N Engl J Med. 2006;355:1660-71.

Ringleb PA, Allenberg J. 30 days results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. The SPACE Collaborative Group. Lancet. 2006;368:1239-47.

Bonamigo TP, Nienchenski A, Copal A. Cirurgia carotídea no Brasil no ano de 1989: Relato de estudo cooperativo. Rev Angiol Cir Vasc. 1992;1:146-52.

Karakhanian W. Estenose de carótida: por que defendo o tratamento endovascular. J Vasc Bras. 2006;5:174-6.

Pereira AH. Angioplastia da carótida versus endarterectomia: o velho e o novo. J Vasc Bras. 2006;5:169-73.

Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-8.

Halliday A, Manfield A, Masso J. The MRC Asymptomatic Carotid Surgery Trial (ACST): Prevention of disabling and fatal strokes by succesful carotid endarterectomy in patients without recent neurologic symptons: randomised controlled trial. Lancet. 2004;363:1491-502.

Rothwell PM, Eliasziw M, Gutnikov AS. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107-16.

Mayberg MR, Wilson SE, Yatsu F. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis: Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA. 1991;266:3289-94.

Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363:915-24.

Hsia DC, Moscoe LM, Krushat WM. Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985-1996 Update. Stroke. 1998;29:346-50.

Naylor AR. An update of the randomized trials of interventions for symptomatic and asymptomatic carotid artery disease. J Vasc Endovasc Surg. 2006;13:111-20.

Vollmar J, Laubach K, Gruss JD. The technique of thrombendarterectomy (spiral ring disobliteration). Bruns Beitr Klin Chir. 1969;217:678-90.

Hassen-Khodja R, Sala F, Declemy S, Lagrange J-L, Bouillane P-J, Batt M. Surgical management of atherosclerotic carotid artery stenosis after cervical radiation therapy. Ann Vasc Surg. 2000;14:608-11.

Kashyap VS, Moore WS, Quinones-Baldrich WJ. Carotid artery repair for radiation-associated atherosclerosis is a safe and durable procedure. J Vasc Surg. 1999;29:90-6.

Ballotta E, Thiene G, Baracchini C. Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: a prospective randomized clinical study. J Vasc Surg. 2005;42:838-46.

Grego F, Lepidi S, Cognolato D, Frigatti P, Morelli I, Deriu GP. Rationale of the surgical treatment of carotid kinking. J Cardiovasc Surg (Torino). 2003;44:79-85.

Hans SS, Shah S, Hans B. Carotid endarterectomy for high plaques. Am J Surg. 1989;157:431-4.

Frim DM, Padwa B, Buckley D, Crowell RM, Ogilvy CS. Mandibular subluxation as an adjunct to exposure of the distal internal carotid artery in endarterectomy surgery: Technical note. J Neurosurg. 1995;83:926-8.

Simonian GT, Pappas PJ, Padberg FT Jr. Mandibular subluxation for distal internal carotid exposure: technical considerations. J Vasc Surg. 1999;30:1116-20.

Roubin GS, New G, Iyer SS. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis. Circulation. 2001;103:532-7.

Chastain HD 2nd, Gomez CR, Iyer S. Influence of age upon complications of carotid artery stenting: UAB Neurovascular Angioplasty Team. J Endovasc Surg. 1999;6:217-22.

Stanziale SF, Marone LK, Boules TN. Carotid artery stenting in octogenarians is associated with increased adverse outcomes. J Vasc Surg. 2006;43:297-304.

Hobson RW 2nd, Howard VJ, Roubin GS. Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40:1106-11.

Perler BA, Williams GM. Carotid endarterectomy in the very elderly: is it worthwhile?. Surgery. 1994;116:479-83.

Van Damme H, Lacroix H, Desiron Q, Nevelsteen A, Limet R, Suy R. Carotid surgery in octogenarians: is it worthwhile?. Acta Chir Belg. 1996;96:71-7.

O"Hara PJ, Hertzer NR, Mascha EJ, Beven EG, Krajewski LP, Sullivan TM. Carotid endarterectomy in octogenarians: early results and late outcome. J Vasc Surg. 1998;27:860-9.

Rockman CB, Jacobowitz GR, Adelman MA. The Benefits of carotid endarterectomy in the octogenarian: a challenge to the results of carotid angioplasty and stenting. Ann Vasc Surg. 2003;17:9-14.

Mackey WC, O"Donell TF Jr, Callow AD. Carotid endarterectomy contralateral to an occluded carotid artery: perioperative risk and late results. J Vasc Surg. 1990;11:778-83.

Mattos MA, Barkmeier LD, Hodgson KJ, Ramsey DE, Sumner DS. Internal carotid artery occlusion: operative risks and long term stroke after contralateral carotid endarterectomy. Surgery. 1992;112:670-9.

Meyer FB, Fode NC, Marsh WR, Piepgras DG. Carotid endarterectomy in patients with contralateral carotid occlusion. Mayo Clin Proc. 1993;68:337-42.

Deriu GP, Franceschi L, Milite D. Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results. Ann Vasc Surg. 1994;8:337-42.

Coyle KA, Smith RB 3rd, Salam AA, Dodson TF, Chaikof EL, Lumsden AB. Carotid endareterectomy in patients with contralaeral carotid occlusion: review of a 10-year experience. Cardiovasc Surg. 1996;4:71-5.

Samson RH, Showalter DP, Yunis JP. Routine carotid endareterectomy without a shunt, even in presence of a contralateral occlusion. Cardiovasc Surg. 1998;6:475-84.

Pulli R, Dorigo W, Barbanti E. Carotid endarterectomy with contralateral carotid artery occlusion: is this a higher risk subgroup?. Eur J Vasc Endovasc Surg. 2002;24:63-8.

Rockman C, Su W, Lamparello PJ. A reassessment of carotid endarterectomy in the face of contralateral occlusion: surgical results in symptomatic and asymptomatic patients. J Vasc Surg. 2002;36:668-73.

Bonamigo TP, Weber EL, Lucas ML, Bianco C, Cardozo MA. Carotid endarterectomy in patients with contralateral occlusion: a 10-year experience. J Vasc Bras. 2004;3:197-205.

Grego F, Antonello M, Lepidi S. Is contralateral carotid artery occlusion a risk factor for carotid endarterectomy?. Ann Vasc Surg. 2005;19:882-9.

Chiariello L, Tomai F, Zeitani J, Versaci F. Simultaneous hybrid revascularization by carotid stenting and coronary artery bypass grafting. Ann Thorac Surg. 2006;81:1883-5.

Lucas ML, Bonamigo TP, Weber EL, Lucchese F. Combined carotid endarterectomy and coronary artery bypass grafting: Analysis of the results. Arq Bras Cardiol. 2005;85:412-20.

Naylor R, Cuffe RL, Rothwell PM, Loftus IM, Bell PR. A systematic review of outcome following synchronous carotid and coronary artery bypass: influence of surgical and patients variables. Eur J Vasc Endovasc Surg. 2003;26:230-41.

Rizzo RJ, Whittemore AD, Couper GS. Combined carotid and coronary revascularization: the preferred approach to the severe vasculopath. Ann Thorac Surg. 1992;54:1099-08.

Kolh PH, Comte L, Tchana-Sato V. Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and results. Eur Heart J. 2006;27:49-56.

Byrne J, Darling RC 3rd, Roddy SP. Combined carotid endarterectomy and coronary artery bypass grafting in patients with asymptomatic high-grade stenoses: an analysis of 758 procedures. J Vasc Surg. 2006;44:67-72.

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

Sundt TM Jr., Ebersold MJ, Sharbrough FW, Piepgras DG, Marsh WR, Messick JM Jr. The risk-benefit ratio of intraoperative shunting during carotid endarterectomy: Relevancy to operative and postoperative results and complications. Ann Surg. 1986;203:196-204.

Riles TS. Surgical management of internal carotid artery stenosis: preventing complications. Can J Surg. 1994;37:124-7.

Hertzer NR, O"Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg. 1997;26:1-10.

Gasparis AP, Ricotta L, Cuadra SA. High-risk carotid endarterectomy: fact or fiction. J Vasc Surg. 2003;37:40-6.

Reed AB, Gaccione P, Belkin M. Preoperative risk factors for carotid endarterectomy: defining the patient at high-risk. J Vasc Surg. 2003;37:1191-9.

Pulli R, Dorigo W, Barbanti E. Does the high-risk patient for carotid endarterectomy really exist?. Am J Surg. 2005;189:714-9.

Ecker RD, Pichelmann MA, Meissner I, Meyer FB. Durability of Carotid Endarterectomy. Stroke. 2003;34:2941-4.

Becquemin J-P. Endovascular treatment of carotid disease. Comprehensive vascular and endovascular surgery. 2004.

Biasi GM, Froio A, Deleo G, Lavitrano M. Indication for carotid endarterectomy versus carotid stenting for the prevention of brain embolization from carotid artery plaques: in search of consensus. J Endovasc Ther. 2006;13:578-91.

Carotid revascularization using endarterectomy or stenting systems (CaRESS) phase I clinical trial: 1-year results. J Vasc Surg. 2005;42:213-9.

Gray WA, Hopkins LN, Yadav S. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258-69.

Jaeger HJ, Mathias KD, Hauth E. Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery. AJNR Am J Neuroradiol. 2002;23:200-7.

Schluter M, Tubler T, Steffens JC. Focal ischemia of the brain after neuroprotected carotid artery stenting. J Am Coll Cardiol. 2003;42:1007-13.

Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215-22.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddeba850e8825947f7279a1 jvb Articles

J Vasc Bras

Share this page
Page Sections