Palacios RJM, Bazzoni RA, Torres HM, Comparán NA et al

Language: Spanish
References: 31
Page: 5-13
PDF size: 152.90 Kb.

ABSTRACT

Objective: The cerebral vascular accident is the 3rd cause of death and first in permanent inability in the industrialized countries. In this small study we demonstrate the security, effectiveness so much initial as long term of the Carotid Stenting (SC) in patient of high risk. Methods: Of Feb 98 to Jun 03 we treated 46 pts (51 lesions) with carotid stenosis (F:17, M 29), 5 pts with bilateral stenosis, an half age of 67.3 + 8.9 years, 55% payees of arterial Hypertension, 42% Diabetics, 48% smoke +, and 86.9% of ischemic cardiopathy; 24% with previous myocardial infarction (MI), a Fraction of expulsion of LV 46.2 + 16%; 84% was symptomatic and 21% had antecedents of previous Stroke with minimum neurological sequels, in 43% of the group(20 pts) we carry out a combined revascularization. Result: The stenosis average before CS was of 79.6 + 9.8% and later 6.36 + 6.27%, the Diameter minimum luminar was incremented of 1.52 + 0.5 at 6.04 + 1.47 mm, in the last 32 pts (69.5%) we use filter of protection carotidea being obtained macroscopic material in 26 of them (81%). The success angiography and Clinical of the procedure it was obtained in 100 and 98% respectively Complications: Two events neurological noipsilateral, one resolved without sequels to the 7 days, the other one culminates in secondary cerebral hemorrhage to crisis hipertensiva and anticoagulation excess with partial recovery to the 60 days, 1 pts present renal insufficiency, we didn’t obtain neurological ipsilaterales complications or deaths periprocedures. To a current follow-up of 21.7 + 19.55 (r = 1-63 months) 2 pts died one to 6 months and another to 3.5 years search-procedure in both cases documented by MI; 34 pts (74%) they were evaluated in the clinical Doppler being reported restenosis in 4 pts, being only demonstrated by angiography quantitative restenosis in 1 pts (2%), in none of the 44 alive pts with current follow-up in external consultation have presented events neurological ipsilaterales, all continue with antiplatelet treatment and a very strict control of factors of Risk. Conclusion: The benefit in these patients was also demonstrated in the SAPPHIRE trial that included of high risk pts and the final points of death/Stroke/MI to 30 days in pts randomized to CS vs Endarterectomy was (5.8% vs 12.6% p = 0.047 respectively). there is not doubt that the angioplasty with CS with endoprotection is a safe and effective procedure, of minimum risk even in considered of high risk pts, with long term certain benefits.

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