Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492011000100002
Jornal Vascular Brasileiro
Original Article

Tratamento endovascular da reestenose carotídea: resultados em curto prazo

Endovascular treatment of carotid artery restenosis: short term results

Ricardo Augusto Carvalho Lujan; Leonardo Aguiar Lucas; Andréia de Fátima Gracio; Giovana Maria Lopes Carvalho; Armando de Carvalho Lobato

Downloads: 0
Views: 42

Resumo

CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS) no tratamento da reestenose carotídea (REC) no intraoperatório e no pós-operatório recente (<30 dias). MÉTODOS: Análise retrospectiva dos pacientes portadores de reestenose carotídea submetidos à angioplastia com stent no período de março 2000 a junho de 2004. RESULTADOS: Foram analisados 19 pacientes com reestenose carotídea. Quatorze pacientes (74%) eram do sexo masculino, com média de idade de 74 anos. Quinze (79%) eram assintomáticos com estenose >80%, enquanto quatro (21%) eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias). CONCLUSÃO: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazo

Palavras-chave

Doenças das artérias carótidas, angioplastia com balão, estenose das carótidas

Abstract

CONTEXT: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. OBJECTIVE: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting - CAS) for the treatment of carotid artery restenosis, in the intraoperative and early (<30 days) postoperative period. METHODS: Retrospective analysis of patients with carotid artery restenosis who have undergone stenting angioplasty from March 2000 to June 2004. RESULTS: Nineteen patients with carotid artery restenosis were analyzed. Fourteen (74%) patients were male, with a mean age of 74 years. Fifteen (79%) patients were asymptomatic, with stenosis >80%, whereas 4 (21%) were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days). CONCLUSION: Endovascular treatment of carotid artery restenosis seems to be a feasible and safe approach in the short term

Keywords

Carotid artery diseases, angioplasty, balloon, carotid stenosis

References

, . Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445-53.

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

Jahromi AS, Cinà CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg. 2005;41:962-72.

Stoney RJ, String ST. Recurrent carotid stenosis. Surgery. 1976;80:705-10.

Cho JS, Pandurangi K, Conrad MF. Safety and durability of redo carotid operation: an 11-year experience. J Vasc Surg. 2004;39:155-61.

Bowser AN, Bandyk DF, Evans A. Outcome of carotid stentassisted angioplasty versus open surgical repair of recurrent carotid stenosis. J Vasc Surg. 2003;38:432-8.

Bettendorf MJ, Mansour MA, Davis AT. Carotid angioplasty and stenting versus redo endarterectomy for recurrent stenosis. Am J Surg. 2007;193:356-9.

Barnett HJ, Taylor DW, Eliasziw M. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;12(339):1415-25.

Young B, Moore WS, Robertson JT. An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study: ACAS Investigators. Asymptomatic Carotid Artheriosclerosis Study. Stroke. 1996;27:2216-24.

de Borst GJ, Ackerstaff RG, de Vries JP. Carotid angioplasty and stenting for postendarterectomy stenosis: long-term follow-up. J Vasc Surg. 2007;45:118-23.

Lal BK, Hobson RW 2nd. Management of carotid restenosis. J Cardiovasc Surg (Torino). 2006;47:153-60.

Hobson RW 2nd, Goldstein JE, Jamil Z. Carotid restenosis: operative and endovascular management. J Vasc Surg. 1999;29:235-8.

Reimers B, Corvaja N, Moshiri S. Cerebral protection with filter devices during carotid artery stenting. Circulation. 2001;104:12-5.

Garami ZF, Bismuth J, Charlton-Ouw KM. Feasibility of simultaneous pre- and postfilter transcranial Doppler monitoring during carotid artery stenting. J Vasc Surg. 2009;49:340-4.

Powell RJ, Alessi C, Nolan B. Comparison of embolization protection device-specific technical difficulties during carotid artery stenting. J Vasc Surg. 2006;44:56-61.

Roffi M, Greutmann M, Schwarz U. Flow impairment during protected carotid artery stenting: impact of filter device design. J Endovasc Ther. 2008;15:103-9.

Chong PL, Salhiyyah K, Dodd PD. The role of carotid endarterectomy in the endovascular era. Eur J Vasc Endovasc Surg. 2005;29:597-600.

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

Veith FJ, Amor M, Ohki T. Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg. 2001;33:S111-6.

Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Ansel G, Strickman NE, Wang H, Cohen SA, Massaro JM, Cutlip DE. SAPPHIRE Investigators: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358:1572-9.

Lujan RAC, Lucas LA, Gracio AF. Tratamento endovascular da doença obstrutiva carotídea em pacientes de alto risco: resultados imediatos. J Vasc Bras. 2006;5:23-29.

Vanhoenacker PK, Decramer I, Bladt O. Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance. BMC Med Imaging. 2008;8.

5ddfc2c60e882593704ce1d5 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections