Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000400004
Jornal Vascular Brasileiro
Original Article

Estudo prospectivo comparativo entre a endarterectomia e a angioplastia com stent e proteção cerebral no tratamento das lesões ateroscleróticas carotídeas: resultados em 30 dias

Prospective and comparative study between endarterectomy and stent angioplasty with cerebral protection in carotid atherosclerotic lesions: 30-day results

Eugênio Carlos de Almeida Tinoco; Luis Felipe da Silva; Bruno Baião Luquini; Rafael Campanha; Marcelo Nascimento; Luciana Horta

Downloads: 1
Views: 850

Resumo

OBJETIVO: Analisar comparativamente os resultados, em 30 dias, entre a endarterectomia e a angioplastia com stent auto-expansível e filtro de proteção cerebral, avaliando a incidência de acidente vascular cerebral e óbito, bem como o tempo de permanência hospitalar no tratamento das lesões ateroscleróticas da bifurcação carotídea. MÉTODO: Estudo prospectivo, em que foram tratados 80 pacientes, sintomáticos e assintomáticos, com lesões estenóticas maiores que 60 e 70%, respectivamente, da bifurcação carotídea. Os pacientes foram divididos em dois grupos de 40 pacientes, que foram avaliados quanto a sexo, idade, comorbidades associadas e tabagismo. RESULTADOS: A taxa de acidente vascular cerebral e óbito foi de 5,0% em ambas as técnicas. Ocorreu um caso (2,5%) de ataque isquêmico transitório no grupo endovascular e nenhum na endarterectomia. No que se refere ao tempo de internação, o tratamento endovascular apresentou menor tempo em relação à endarterectomia, sendo estatisticamente significativo (P < 0,002). CONCLUSÕES: Nesta série apresentada, a incidência de acidente vascular cerebral e óbito em 30 dias foi de 5% nas duas técnicas utilizadas. Em relação ao tempo de internação, houve um menor tempo de permanência hospitalar a favor da técnica endovascular, com significância estatística (P < 0,002).

Palavras-chave

Carótida, endarterectomia, angioplastia

Abstract

OBJECTIVE: To comparatively analyze the 30-day results between endarterectomy and angioplasty using self-expandable stent and filter protection in the treatment of carotid bifurcation atherosclerotic lesions. The primary endpoint was to analyze stroke and death rate, as well hospitalization time. METHODS: Comparative and prospective study in 80 symptomatic and asymptomatic patients, with carotid bifurcation stenotic lesions greater than 60 and 70%, respectively. The patients were divided into two groups of 40 and assessed according to gender, age, associated comorbid conditions and smoking. RESULTS: The stroke and death rate was 5.0% for both techniques. There was only one case of transient ischemic attack (2.5%) in the endovascular group. Regarding hospitalization time, it was significantly lower in favor of the endovascular technique, with statistical significance (P < 0.002). CONCLUSIONS: This study demonstrated a 5.0% incidence of stroke and death in 30 days considering both techniques. However, the endovascular group presented a statistically significant shorter hospitalization time than the endarterectomy group (P < 0.002).

Keywords

Carotid, endarterectomy, angioplasty

References

Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid 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. Lancet. 1991;337:1235-43.

Endarterectomy for asymptomatic carotid artery stenosis: Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273:1421-8.

Moore WS, Barnett HJ, Beebe HG. Guidelines for carotid endarterectomy: A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Circulation. 1995;91:566-79.

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

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 vs. carotid endarterectomy: a stopped trial. Stroke. 2001;32:325d.

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.

Yadav JS. Carotid stenting in high-risk patients: design and rationale of the SAPPHIRE trial. Cleve Clin J Med.. 2004;71(^s1):S45-6.

Coward LJ, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis (Cochrane Review). Cochrane Libr.. 2006.

Gray WA, Hopkins LN, Yadav S. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg.. 2006;44:258-68.

Mas JL, Chatellier G, Beyssen B. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med.. 2006;355:1660-71.

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.

Carotid revascularization using endarterectomy or stenting systems (CARESS): phase I clinical trial. J Endovasc Ther.. 2003;10:1021-30.

Hobson RW. CREST (Carotid Revascularization Endarterectomy versus Stent Trial): background, design, and current status. Semin Vasc Surg.. 2000;13:139-43.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de95b110e8825a267e31d41 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections