Jornal Vascular Brasileiro
https://www.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

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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

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