Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492011000100008
Jornal Vascular Brasileiro
Artigo de Revisão

Carotid artery surgery: back to the future

Cirurgia de artéria carótida: de volta para o futuro

Marc Bosiers; Gustavo Henrique Dumont Kleinsorge; Deloose Koen; Túlio Pinho Navarro

http://dx.doi.org/10.1590/S1677-54492011000100008 J Vasc Bras, vol.10, n1, p.44-49, 2011
PDF
SciELO
Downloads: 0
Views: 1233

Abstract

In this study we performed 548 carotid revascularizations between 2006 and 2008 at the Department of Vascular Surgery of the A.Z. Sint-Blasius, Dendermonde, Belgium - a high-volume experienced center for carotid artery stenting (CAS). In 2006, our 30-day complication rates were 3.21 and 1.51% for symptomatic and asymptomatic patients, respectively. At that time, CAS represented approximately 86% of all cases we performed. However, the publication of the results of EVA-3S and SPACE studies drove us to reconsider our treatment allocation algorithm. In 2007 and 2008, CAS procedures only accounted for 43% of all carotid procedures, which was a result of strict patient selection with comorbidities and high-risk lesions assessment, especially in symptomatic patients. Our current 30-day stroke/death rates are 1.24% for symptomatic patients and 0.53% for asymptomatic ones, which reflects that correct patient selection is the key to maintain CAS as a valuable alternative to carotid endarterectomy.

Keywords

Endarterectomy, endarterectomy, carotid, angioplasty, carotid stenosis, patient selection

Resumo

Neste estudo, realizamos 548 revascularizações carotídeas entre 2006 e 2008 no Departamento de Cirurgia Vascular do A.Z. Sint-Blasius, Dendermonde, Bélgica - um centro de grande porte com experiência em angioplastia com stent de carótida (CAS, do inglês carotid artery stenting). Em 2006, nossas taxas de complicação em 30 dias foram de 3,21 e 1,51% para pacientes sintomáticos e assintomáticos, respectivamente. Àquela época, a CAS representava aproximadamente 86% de todos os casos realizados; entretanto, a publicação dos resultados dos estudos EVA-3S e SPACE nos levaram a reconsiderar nosso algoritmo de tratamento. Em 2007 e 2008, os procedimentos de CAS representaram apenas 43% de todos os procedimentos carotídeos, o que foi resultado da seleção rigorosa de pacientes com avaliação de comorbidades e das lesões de alto risco, especialmente em pacientes sintomáticos. Nossas taxas atuais de AVE/óbito em 30 dias são de 1,24% para pacientes sintomáticos e de 0,53% para assintomáticos, refletindo que a seleção correta de pacientes é a chave para manter a CAS como uma alternativa válida à endarterectomia carotídea.

Palavras-chave

Endarterectomia, endarterectomia das carótidas, angioplastia, estenose das carótidas, seleção de pacientes

Referências

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

Struly KJ, Hurwitt ES, Blankenberg HW. Thromboendarterectomy for thrombosis of the internal carotid artery in the neck. J Neurosurg. 1953;10:474-82.

DeBakey ME. Carotid endarterectomy revisited. J Endovasc Surg. 1996;3(4).

Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators: Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-501.

Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I clinical trial: 1-year results. J Vasc Surg. 2005;42:213-9.

Bosiers M, Peeters P, Deloose K. Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry). J Cardiovasc Surg (Torino). 2005;46:241-7.

Bergeron P, Roux M, Khanoyan P, Douillez V, Bras J, Gay J. Long-term results of carotid stenting are competitive with surgery. J Vasc Surg. 2005;41:213-21.

Wholey MH, Wholey M, Bergeron K. Current global status of carotid artery stent placement. Cathet Cardiovasc Diagn. 1998;44:1-6.

Ahmadi R, Willford A, Lang W. Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome. J Endovasc Ther. 2001;8:539-46.

Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, Larrue V, Lièvre M, Leys D, Bonneville JF, Watelet J, Pruvo JP, Albucher JF, Viguier A, Piquet P, Garnier P, Viader F, Touzé E, Giroud M, Hosseini H, Pillet JC, Favrole P, Neau JP, Ducrocq X. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660-71.

Ringleb PA, Allenberg J, Brückmann H, Eckstein HH, Fraedrich G. 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.

Bonamigo TP, Lucas ML. Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea: revisão. J Vasc Bras. 2007;6:366-77.

Tinoco ECA, Silva LF, Luquini BB, Campanha R, Nascimento M, Horta L. Estudo prospectivo comparativo entre a endarterectomia e a angioplastia com stent e proteção cerebral no tratamento das lesões ateroscleróticas carotídeas: resultados em 30 dias. J Vasc Bras. 2006;5:257-62.

Hobson RW 2nd, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, Graham DL, Howard G, CREST Investigators. 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.

Macdonald S, Lee R, Williams R, Stansby G. Towards safer carotid artery stenting: a scoring system for anatomic suitability. Stroke. 2009;40:1698-703.

Topakian R, Strasak A, Sonnberger M. Timing of stenting of symptomatic carotid stenosis is predictive of 30-day outcome. Eur J Neurol. 2007;14:672-8.

Bosiers M, Deloose K, Verbist J, Peeters P. What practical factors guide the choice of stent and protection device during carotid angioplasty?. Eur J Vasc Endovasc Surg. 2008;35:637-43.

Biasi G, Froio A, Diethrich E. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study.. Circulation. 2004;10:756-62.

Cremonesi A, Setacci C, Manetti R. Carotid angioplasty and stenting: lesion related treatment strategies. EuroIntervention. 2005;1:289-95.

Hart JP, Peeters P, Verbist J, Deloose K, Bosiers M. Do device characteristics impact outcome in carotid artery stenting?. J Vasc Surg. 2006;44:725-30.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfcaf10e88251b064ce1d6 jvb Articles
Links & Downloads
1677-7301 (Eletrônico)
J Vasc Bras ©2024 Todos os direitos reservados.

J Vasc Bras

Share this page
Page Sections