Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492010000300017
Jornal Vascular Brasileiro
Case Report

Angioplastia carotídea com reversão do fluxo em octogenários: relato de caso

Carotid angioplasty with flow reversion in octogenarians: a case report

Bernardo Massière; Arno von Ristow; Rafael Dias Vieira; José Mussa Cury; Marcus Gress; Alberto Vescovi; Carlos Peixoto; Marcos Areas Marques

http://dx.doi.org/10.1590/S1677-54492010000300017 J Vasc Bras, vol.9, n3, p.186-189, 2010
PDF Português
PDF English
Downloads: 0
Views: 1298

Resumo

Pacientes octogenários submetidos à angioplastia carotídea apresentam maior incidência de eventos neurológicos quando comparados a grupos de pacientes mais jovens e a grupos da mesma faixa etária submetidos à endarterectomia carotídea. A maior taxa de complicações pode ser explicada por fatores anatômicos e anatomopatológicos que aumentam a dificuldade técnica e o risco de ateroembolismo do procedimento endovascular. O procedimento foi realizado no centro cirúrgico, com o paciente em decúbito dorsal e sob anestesia geral. Realizamos acesso cirúrgico transverso limitado, na base do pescoço à direita, com dissecção, identificação e reparo da artéria carótida comum e veia jugular interna. Foram administradas 10.000 U de heparina e puncionada a carótida comum pela técnica de Seldinger com introdução de bainha 8F em sentido cranial. Na sequência, foi puncionada a veia jugular interna com instalação de bainha 8F em sentido caudal. Em seguida, ambas as bainhas foram conectadas, utilizando-se um segmento de equipo de soro. A carótida comum foi fechada por cadarço duplo de silicone e o fluxo retrógrado pela carótida interna foi estabelecido. Subsequentemente, foi introduzido fio guia 0.014 x 190 cm com cruzamento da lesão, realizando-se angioplastia com balão 5 x 20 mm e em seguida stent (Wallstent® 7 x 50 - Boston Scientific) foi introduzido, posicionado e liberado. A angioplastia carotídea com reversão de fluxo, por via transcervical, constitui estratégia de proteção cerebral custo-eficiente e com menor potencial emboligênico em pacientes octogenários com anatomia desfavorável.

Palavras-chave

Doenças das artérias carótidas, angioplastia, embolia intracraniana

Abstract

Octogenarian patients submitted to carotid angioplasty present higher incidence of neurological events when compared to younger patients and to patients in this same age submitted to carotid endarterectomy. The higher complication rate could be related to anatomic and anatomopathological factors that increase technical difficulties and atheroembolic risk associated with the endovascular procedure. At the operating room, the patient was in dorsal decubitus position and submitted to general anesthesia. Limited transversal surgical access was carried out on the right neck base, with dissection, identification and restoration of the common carotid artery and internal jugular vein. A 8F sheath was implanted cranially oriented into the common carotid by Seldinger technique after endovenous injection of 10.000 UI of heparin. Another 8F sheath was implanted into the internal jugular vein in caudal orientation. Both sheath were connected by the use of infusion set segment. The common carotid artery was clamped with a silastic double lace, establishing reversion of blood flow in the internal carotid artery. The lesion was crossed by 0.014 x 190 cm wire and the carotid angioplasty was performed employing a 5 x 20 mm ballon and a stent (Wallstent® 7 x 50 - Boston Scientific) was introduced, positioned and released. Carotid angioplasty with transcervical flow reversal is a cost effective brain protection strategy, associated to low embolic potential in octagenarian patients with unfavorable anatomy.

Keywords

Carotid artery diseases, angioplasty, intracranial embolism

References

Kastrup A, Schulz JB, Raygrotzki S, Gröschel K, Ernemann U. Comparison of angioplasty and stenting with cerebral protection versus endarterectomy for treatment of internal carotid artery stenosis in elderly patients. J Vasc Surg. 2004;40:945-51.

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.

Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg. 2007;45:875-80.

Kastrup A, Gröschel K, Schnaudigel S, Nägele T, Schmidt F, Ernemann U. Target lesion ulceration and arch calcification are associated with increased incidence of carotid stenting-associated ischemic lesions in octogenarians. J Vasc Surg. 2008;47:88-95.

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

Eckstein HH, Ringleb P, Allenberg JR. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893-902.

Ristow AV, Pedron C. Cirurgia da carótida. Programa de Atualização em Cirurgia (PROACI) do Colégio Brasileiro de Cirurgiões. 2006:9-50.

Rapp JH, Zhu L, Hollenbeck K, Sarkar R. Distal filtration versus flow reversal: An ex vivo assessment of the choices for carotid embolic protection. J Vasc Surg. 2009;49:1181-8.

Ristow AV. O vai-e-vem no tratamento da doença carotídea. J Vasc Bras. 2007;6:303-6.

Parodi JC, Ferreira LM, Sicard G, La Mura R, Fernandez S. Cerebral protection during carotid stenting using flow reversal. J Vasc Surg. 2005;41:416-22.

Coppi G, Moratto R, Silingardi . PRIAMUS--proximal flow blockage cerebral protection during carotid stenting: results from a multicenter Italian registry. J Cardiovasc Surg (Torino). 2005;46:219-27.

Criado E, Doblas M, Fontcuberta J, Orgaz A, Flores A. Transcervical carotid artery angioplasty and stenting with carotid flow reversal: surgical technique. Ann Vasc Surg. 2004;18:257-61.

Ohki T, Roubin GS, Veith FJ, Iyer SS, Brady E. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis. J Vasc Surg. 1999;30:1034-44.

Alvarez B, Ribo M, Maeso J, Quintana M, Alvarez-Sabin J, Matas M. Transcervical carotid stenting with flow reversal is safe in octogenarians: a preliminary safety study. J Vasc Surg. 2008;47:96-100.

Criado E, Fontcuberta J, Orgaz A, Flores A, Doblas M. Transcervical carotid stenting with carotid artery flow reversal: 3-year follow-up of 103 stents. J Vasc Surg. 2007;46:864-9.

Matas M, Alvarez B, Ribo M, Molina C, Maeso J, Alvarez-Sabin J. Transcervical carotid stenting with flow reversal protection: experience in high-risk patients. J Vasc Surg. 2007;46:49-54.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dded4650e882501587279a1 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections