Elective Stenting of the Extracranial Carotid Arteries

Yadav, Jay S.; Roubin, Gary S.; Iyer, Sriram S.; Vitek, Jiri J.; King, Peter H.; Jordan, William D.; Fisher, Winfield S.

doi:10.1161/01.cir.95.2.376

Cited by 633 publications

(325 citation statements)

References 13 publications

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“…Mais recentemente, os trabalhos mostram taxas que variam de 1 a 7,5%, nos pacientes sem comorbidades, podendo chegar até a 18% nos pacientes com coronariopatia prévia 4,5,[16][17][18] .…”

Section: Discussionunclassified

“…Porém deve-se lembrar que os pacientes com comorbidades, tais como diabetes, infarto de miocárdio prévio, hipertensão arterial sistêmica (HAS), entre várias outras, foram excluídos destes estudos, apesar da alta incidência de associação entre estas doenças e a doença ateromatosa da caró-tida, tornando limitada a reprodutibilidade desses resultados [5][6][7]20,21 . É importante ressaltar que, até pouco tempo atrás, os pacientes encaminhados a angioplastia eram aqueles com algum tipo de contraindicação a cirurgia, com alto risco de complicações 10,14,17,19,20 , ou previamente submetidos à endarterectomia carotídea.…”

Section: Discussionunclassified

“…Alguns autores caracterizam a reestenose apenas quando ocorre redução luminar maior que 50% 16,17 . Dos nossos pacientes com seguimento por Doppler ou angiografia -24 pacientes correspondendo a 29 artérias -ocorreu re-estenose em 2, o que leva a incidência de re-estenose a 6,7%.…”

Section: Discussionunclassified

“…Já na endarterectomia carotídea, além das taxas de embolia, devemos considerar outras complicações decorrentes da cirurgia, tais como, lesão de nervo craniano, infecção de ferida, hematoma de parede e outras complicações cardiovasculares, com incidên-cia variando de 7,6% a 27% 5,17 .…”

Section: Discussionunclassified

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Técnica de proteção cerebral na angioplastia e "stent" de carótida: um procedimento eficaz contra embolia

Piske

Ferreira

Campos

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -Objetivo: Descrever a técnica de proteção cerebral usada na angioplastia com colocação de "stent" para tratamento de lesões estenóticas da bifurcação carotídea, mostrando sua eficiência em evitar a embolia durante o procedimento. Métodos: Quarenta e dois pacientes (47 artérias) foram tratados com a técnica de proteção cerebral que consistiu na oclusão temporária da carótida interna acima da estenose, fazendo-se aspiração e injeção de solução de glicose a 5% na carótida interna após a colocação de "stent" e angioplastia, para remover eventuais fragmentos da placa. Resultados: A angioplastia foi eficiente em todos os casos. Não ocorreu embolia nos pacientes deste estudo nos quais se utilizou a técnica de proteção cerebral na sua versão completa. Embolia ocorreu em um paciente, durante pré-dilatação da estenose, antes de se usar a técnica de proteção cerebral. Conclusão: A técnica de proteção cerebral foi eficiente em evitar a embolia nos procedimentos realizados. Esses dados concordam com os da literatura e o uso desta técnica amplia as indicações da angioplastia carotídea.PALAVRAS-CHAVE: carótida, estenose, doença ateromatosa, angioplastia, "stent", proteção cerebral, embolia cerebral, acidente vascular cerebral.The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against The cerebral protection technique in angioplasty plus stenting of carotid: an effective procedure against cerebral embolism cerebral embolism cerebral embolism cerebral embolism cerebral embolism ABSTRACT -Objective: To describe the cerebral protection technique used in the angioplasty and stenting to treat stenotic lesions of carotid artery bifurcation, showing its efficiency in avoiding cerebral emboli during the procedure. Method: Forty two patients (47 arteries) were treated with the cerebral protection technique, which consists in the temporary occlusion of the internal carotid artery, above the stenotic lesion, performing the aspiration and flushing of glucose solution into the internal carotid artery after the delivery of the stent and the angioplasty, to remove any atherosclerotic plaque's fragments. Results: The angioplasty was efficient in all cases. There were no cerebral emboli in the patients in whom the complete cerebral protection technique was used, showing its efficiency . Distal embolism occurred in one patient, during pre angioplasty and before the use of cerebral protection. Conclusion: The cerebral protection technique was efficient to avoid cerebral emboli in the procedures performed. This data is in agreement with the literature and the use of this technique increases the indications of carotid angioplasty.KEY WORDS: carotid, stenoses, atherosclerotic disease...

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“…Mais recentemente, os trabalhos mostram taxas que variam de 1 a 7,5%, nos pacientes sem comorbidades, podendo chegar até a 18% nos pacientes com coronariopatia prévia 4,5,[16][17][18] .…”

Section: Discussionunclassified

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Técnica de proteção cerebral na angioplastia e "stent" de carótida: um procedimento eficaz contra embolia

Piske

Ferreira

Campos

et al. 2003

Arq. Neuro-Psiquiatr.

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“…Significant information about safety and feasibility of stenting was derived from large case series with periprocedural stroke and mortality and patency not too dissimilar from CEA trials. 25 An international survey by Wholley et al, 26,27 from major centers perform-ing CAS, reported 12 392 procedures performed in 11243 patients and suggested an acceptable periprocedural stroke and mortality of 4.75% that falls somewhere between NASCET and ACAS rates. The validity of these results is hampered by the uncontrolled nature of the data and potential verification and reporting bias of complications.…”

Section: Carotid Artery Stentingmentioning

confidence: 99%

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 Stenting for Patients With Coexisting Carotid and Coronary Disease

Xavier

2008

Arch Neurol

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Elective Stenting of the Extracranial Carotid Arteries

Abstract: In a high-risk group of patients, percutaneous carotid angioplasty and stenting are feasible and can be performed with low restenosis and repeat intervention rates.

Cited by 633 publications

References 13 publications

Técnica de proteção cerebral na angioplastia e "stent" de carótida: um procedimento eficaz contra embolia

Técnica de proteção cerebral na angioplastia e "stent" de carótida: um procedimento eficaz contra embolia

Endarterectomy and Stenting for Asymptomatic Carotid Stenosis

Carotid Stenting for Patients With Coexisting Carotid and Coronary Disease

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