medigraphic.com

2014, Number 2

<< Back Next >>

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

Medical treatment of the carotid disease

Barnés DJA

Language: Spanish
References: 27
Page:
PDF size: 48.50 Kb.


ABSTRACT

Introduction: the carotid endarterectomy is a surgical procedure under multiple scientific debates and controversies.
Objectives: To update knowledge on the surgical treatment of the carotid stenosis.
Methods: Cochrane, Medline, Embase, Hinari and BVS databases were reviewed by using the keywords carotid stenosis and surgical treatment. The results of the main research studies and randomized clinical assays published in the 2009-2013 period were examined.
Information synthesis: carotid revascularization is indicated in patients with symptoms and stenosis over 60%. In asymptomatic patients, with low surgical risk and over 5 year life expectancy, the medical treatment seems to be best choice. Those patients with severe neurological disability resulting from stroke are not eligible for this surgical treatment. When comparing endarterectomy with the stent angioplasty, the greater benefits went to the former, although both surgical procedures complement one another and are not opponents. In the patients aged over 70 years, it is better to use endarterectomy; however, the stent angioplasty achieved the best results when using cerebral protection devices in patients having unfavourable neck anatomy. The surgical intervention two weeks after the acute stroke seems to be more convenient. In those patients with complete occlusion of the chronic internal carotid, surgery is not prescribed.
Conclusions: the carotid endarterectomy shows the best results, although the stent angioplasty is being gradually introduced. Both methods are valid and complement one another.


REFERENCES

  1. Fisher CM. Occlusion of the internal carotid artery. Arch Neurol Psychiatry. 1951;65:346-77.

  2. Sposato LA, Klein FR. Enfermedad carotídea aterosclerótica extracraneal. Neurol Arg. 2011;3:26-53.

  3. Gil A. Enfermedad carotídea de origen aterotrombótico: hacia un consenso en la prevención. Neurología. 2004;19:193-212.

  4. Buergo Zuaznábar MA. Programa Nacional de Prevención y Control de la Enfermedad Cerebrovascular. Rev Cubana Invest Bioméd 2001 [citado 3 Abr 2013];(4):247-8. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_pdf&pid=S0864 - 03002001000400002&lng=es&nrm=iso&tlng=es

  5. Consenso de Estenosis Carotídea. Sociedad Argentina de Cardiología. Sociedad Neurológica Argentina. Rev Argentina Cardiol. 2006 [citado 21 de marzo 2014];74 (2). Disponible en: http://www.sac.org.ar/files/files/74-2-14.pdf

  6. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72.

  7. Shinton R, Beevers G. Meta-analysis of relation between cigarette and stroke. BJM. 1989;298:789-94.

  8. Jeerakathil T, Johnson JA, Simpson SH, Majumdar SR. Short-term risk for stroke is doubled in persons with newly treated type 2 diabetes compared with persons without diabetes. A population-based cohort study. Stroke. 2007;38:1739-43.

  9. Horenstein RB, Smith DE, Mosca L. Cholesterol predicts stroke mortality in the Women´s Pooling Project. Stroke. 2002;33:1863-8.

  10. Lip GYH, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol. 2007;6:981-93.

  11. Lee C, Folsom A, Blair S. Physical activity and stroke risk: a meta-analysis. Stroke. 2003,34:2475-81.

  12. Fortuño JR, Perendreu J, Falco J, Canovas D, Branera J. Estenosis carotídea: cómo se diagnóstica y se trata adecuadamente. Radiología. 2006;48(3):119-36.

  13. The Homocysteine Studies Collaboration: Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA. 2002;288:2015-22.

  14. Sposato LA, Riccio PM, Klein FR. Diagnóstico y tratamiento de la enfermedad carotídea aterosclerótica extracraneal asintomática. Medicina (Buenos Aires). 2011;71:561-5.

  15. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849-60.

  16. Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Meldrum HE, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 2000;342:1693-700.

  17. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363:1491- 502.

  18. Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549-59.

  19. Sillesen H, Amarenco P, Hennerici MG, Callahan A, Goldstein LB, Zivin J, et al. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008;39:3297-302.

  20. Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J, et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010;376:1074-84.

  21. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have non-valvular atrial fibrillation. Ann Intern Med. 2007;146:857-67.

  22. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients Antithrombotic Trialist´Collaboration. Brith Med J. 2002;324:71-86.

  23. Amarenco P, LabreucheJ, Lavallée PH, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke. 2004;35:2902-9.

  24. Heart Protection Study Collaborative Group: Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20 536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363:757-67.

  25. Sillesen H, Amarenco P, Hennerici MG, Callahan A, Goldstein LB, Zivin J, et al. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008;39:3297-302.

  26. Zanchetti A, Bond MG, Hennig M, Neiss A, Mancia G, Dal Palu C, et al. Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized,double-blind, long-term trial. Circulation. 2002;106:24227.

  27. Zanchetti A, Crepaldi G, Bond MG, Gallus G, Veglia F, Mancia G, et al. Different effects of antihypertensive regimens based on fosinopril or hydrochlorothiazide with or without lipid lowering by pravastatin on progression of asymptomatic carotid atherosclerosis: principal results of PHYLLIS: a randomized double-blind trial. Stroke. 2004;35:280712.




2020     |     www.medigraphic.com