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2014, Number 2

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

Surgical treatment of the carotid stenosis

Hernández SA

Language: Spanish
References: 41
Page:
PDF size: 208.14 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.


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