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ISSN 0188-2198 (Impreso)

2014, Número 3

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Rev Mex Cardiol 2014; 25 (3)


Terapia de revascularización percutánea en pacientes portadores de estenosis crítica carotídea-coronaria: resultados en un hospital y a largo plazo

Palacios-Rodríguez JM, Muñiz GA, Bonfil FMA, De la Cruz OR, Cantú RS

Idioma: Español
Referencias bibliográficas: 31
Paginas: 149-157
Archivo PDF: 212.24 Kb.


RESUMEN

Objetivo: Analizar la morbimortalidad a 30 días y 6 meses en pacientes sometidos a una intervención percutánea (IP) por estenosis critíca carotídea (EAC)-coronaria (EACo) en un centro hospitalario de alto volumen, experto en el tratamiento de la enfermedad multivascular. Antecedentes: El tratamiento óptimo de los pacientes con EAC y EACo concomitante sigue siendo controvertido. Ha sido reportada una variedad de estrategias terapéuticas, incluyendo a la cirugía de revascularización coronaria (BACo), sola o en combinación con la revascularización percutánea o quirúrgica de la arteria carótida. Material y métodos: Entre enero de 1998 y junio de 2013 fueron tratados 118 (149 lesiones) pacientes consecutivos con EAC (estenosis carotídea sintomática en el 37.6%) y EACo en forma estadiada o simultánea a IP carotídeo-coronario con stent. El objetivo primario (PP) fue evaluar la incidencia de los eventos cardiacos y cerebro-vasculares mayores (ECVM) (muerte, infarto al miocardio y accidente vascular cerebral mayor) en los 30 días posteriores, tanto al primero como segundo procedimiento. Con un EuroSCORE (ES) promedio de 2.75 ± 1.5. Resultados: A 30 días, la incidencia de PP fue de 4.02%; la muerte global infarto agudo al miocardio (IAM) y accidente vascular cerebral mayor (AVCM) ocurrieron en el 2.01, 1.34 y 0.67% respectivamente; no observamos diferencia en AVC mayor y muerte en el grupo Sx versus Asx, 2.14% versus 2.14%, p = 0.809; ambos grupos, sin embargo, en el infarto fue mayor en Asx versus Sx 4.3% versus 0%, p = 0.053. Se hizo un seguimiento a seis meses de 140 lesiones tratadas; cuatro pacientes se sometieron a revascularización coronaria, uno falleció, tres de ellos presentaron IAM y muerte cardiovascular, 0% de AVC ipsilaterales; 1.4% presentó reestenosis in stent carotídeo tratándose con angioplastia balón (ATP). Conclusiones: En los pacientes con EAC y EACo concomitante, un tratamiento percutáneo combinado se compara muy favorablemente con las experiencias quirúrgicas o híbridos con evidente menor ECVM. Tal estrategia puede ser especialmente más adecuada a pacientes complejos con alto riesgo quirúrgico.


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