Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital

Brooks, William H.; McClure, Rick; Jones, Michael R.; Coleman, Timothy C.; Breathitt, Linda

doi:10.1016/s0735-1097(01)01595-9

Cited by 349 publications

(246 citation statements)

References 45 publications

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“…Em contraste a esses dois estudos, um estudo realizado em um único centro nos EUA randomizou 104 pacientes com estenose sintomá-tica > 70%, e não houve AVC tanto no grupo cirúrgico quanto no endovascular, ocorrendo um óbito na endarterectomia e nenhum no grupo do stent 8 .…”

Section: Discussionunclassified

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

Tinoco¹,

Silva

Luquini³

et al. 2006

J. vasc. bras.

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257 ResumoObjetivo: 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 chaves: Carótida, endarterectomia, angioplastia. AbstractObjective: 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 IntroduçãoO acidente vascular cerebral (AVC) isquêmico é a causa mais comum de déficit neurológico na população idosa, e a doença cerebral de origem extracraniana é responsável por aproximadamente 20-30% dos casos. A aterosclerose obliterante é o principal fator etiológico dessas lesões.A endarterectomia carotídea (EC), ao longo do tempo, apresenta-se como o principal método terapêu-tico no tratamento e prevenção desses acidentes encefá-

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Section: Discussionunclassified

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

Tinoco¹,

Silva

Luquini³

et al. 2006

J. vasc. bras.

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“…However, so far there has been no evidence of CAS superiority over CEA. [6][7][8][9][10][11][12][13] In Brazil, practice of carotid surgery has more than 40 years, and a survey has been published about indications and about who would indicate that procedure: neurologists, cardiologists or vascular surgeons.…”

Section: Introductionmentioning

confidence: 99%

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Bonamigo

Lucas

2007

J. vasc. bras.

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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.

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“…29 A small single-institution study randomized over 100 patients with symptomatic carotid stenosis to CAS or CEA and found equivalent and very low rates of complications in either arm. 30 A follow-up randomized trial of over 80 asymptomatic patients demonstrated similarly equivalent very low rates of complications in either arm. 31 The largest study so far (CAVATAS) 32 consisted mainly of carotid balloon angioplasty (74%) with a small number of implanted stents and randomized over 500 patients to CEA or endovascular therapy.…”

Section: Early Randomized Studiesmentioning

confidence: 91%

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

Fayad

2007

Stroke

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Abstract-Atherosclerotic carotid stenosis has been recognized for the past several decades as being responsible for a significant portion of ischemic stroke, particularly the major and disabling ones. This category of stroke distinguished itself as being one of the first ones to have an effective preventive treatment in carotid endarterectomy. It took over 4 decades before major randomized, controlled trials were completed in North America and Europe to provide enough definitive information about its effectiveness, risks, limitations, and categories of patients that most benefit from it. Just like any invasive surgery, endarterectomy is being challenged by minimally invasive stenting, which has already made major technologic leaps and rapid clinical inroads. Stenting has started by tackling patient populations like surgical high-risk patients who were largely avoided in the endarterectomy trials and demonstrated equivalence to it in such populations. The broader applicability of the technique, however, has not been yet adequately investigated. The results so far are greatly reassuring and encouraging to enroll patients in the ongoing randomized trials that will hopefully provide more definitive answers to this issue. Key Words: angioplasty and stenting Ⅲ asymptomatic carotid stenosis Ⅲ carotid endarterectomy Ⅲ carotid stenosis Ⅲ prevention T he first comprehensive description of the relationship between occlusive carotid artery disease and ischemic brain symptoms in 1955 1 by Fisher triggered a momentum in furthering clinical descriptive, experimental, diagnostic, and therapeutic efforts that continue to transform our understanding and management of carotid disease. It took over 40 years for carotid endarterectomy (CEA) to demonstrate its effectiveness and limitations through major randomized trials. Despite these advances and efforts, there remains a lot of uncertainties about many aspects of risks, prognosis, and treatment of carotid stenosis in certain populations and circumstances. Similar to any new technology, the introduction of carotid artery stenting (CAS) as a potential alternative to CEA brought new challenges, questions, and issues. I review the clinical evidence and its limitations including CEA trials and comparisons to published and presented clinical information about CAS. Carotid AtherosclerosisCarotid atherosclerotic disease is a continuum of stages spanning the spectrum from intima-media thickening, to asymptomatic carotid plaque, and to symptomatic carotid disease. Various factors and triggers determine the transformation and evolution from one stage to another. Increasing degrees of atherosclerosis develop in the carotid arteries with older age. The Framingham Heart Study 2 suggests that by the age of 50, less than 1% of the population have carotid stenosis of 50% or greater, but by the age of 75, 9% to 7% of the population will develop a 50% or greater stenosis. Carotid intima-media thickness as measured by ultrasound is rapidly becoming a surrogate marker for systemic atherosclerosis and c...

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Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital

Cited by 349 publications

References 45 publications

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

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

Análise crítica das indicações e resultados do tratamento cirúrgico da doença carotídea

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

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