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2014, Número 2

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Revista Cubana de Angiología y Cirugía Vascular 2014; 15 (2)


Tratamiento quirúrgico de la estenosis carotídea

Hernández SA

Idioma: Español
Referencias bibliográficas: 41
Paginas:
Archivo PDF: 208.14 Kb.


RESUMEN

Introducción: la endarterectomía de las carótidas es un proceder quirúrgico sometido a múltiples debates y controversias científicas.
Objetivos: actualizar los conocimientos acerca del tratamiento quirúrgico de la estenosis carotídea.
Métodos: se revisaron las siguientes bases de datos: la Cochrane, Medline, Embase, Hinari, BVS, con las palabras claves: estenosis carotídea y tratamiento quirúrgico. Se analizaron los resultados de las principales investigaciones y ensayos clínicos aleatorizados publicados entre 2009-2013.
Síntesis de la información: la revascularización carotídea está indicada en pacientes con sintomatología y una estenosis mayor del 60 %. En pacientes asintomáticos, con riesgo quirúrgico bajo y una expectativa de vida mayor de cinco años, parece ser mejor el tratamiento médico. Los pacientes con severa discapacidad neurológica, como secuela de un ictus, no son tributarios a este tratamiento quirúrgico. La comparación de la endarterectomía con la angioplastia-stent, demostró mayor beneficio de la primera, aunque ambos procederes se complementan y no compiten. En los pacientes mayores de 70 años el uso de la endarterectomía es mejor, sin embargo, la angioplastia-stent registró mejores resultados si se usan dispositivos de protección cerebral en enfermos con anatomía desfavorable del cuello. Parece ser más conveniente realizar la intervención después de dos semanas del evento cerebrovascular agudo. En los pacientes con oclusión completa de la carótida interna, de forma crónica, no está indicada la cirugía.
Conclusiones: la endarterectomía carotídea es la de mejores resultados, aunque la angioplastia-stent va incorporándose lentamente, ambas son válidas y se complementan.


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