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Sede
Social
Colegio Oficial
de Médicos
de Barcelona
Paseo de la Bonanova, 47
08017 Barcelona
Telf.: 93 863 02 38
Fax: 93 863 05 58
secretariaseacv@telefonica.net |
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Lunes, 23 de Enero de 2012
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| Publicación
Española del Mes Nº 16 |
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Son las 01:34:11 horas del 5-2-2012 |
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Archivo PDF
(95 KB)
A Prospective Evaluation of Cerebral Infarction
following Transcervical Carotid Stenting with
Carotid Flow Reversal.
J.I. Leal, A. Orgaz, J. Fontcuberta, A. Flores, M. Doblas, J.M.
Garcia-Benassi,
B. Lane, C. Loh, E. Criado.
Eur J Vasc Endovasc Surg. 2010 Jun;39(6):667.
Vascular Surgery Section, Complejo Hospitalario de Toledo,
Toledo, Spain. mecriado@umich.edu.
Factor de Impacto : 3,007.
Objective
Cerebral embolisation constitutes the main source of complications during
transfemoral carotid artery stenting (CAS) and is associated with a high incidence of
silent brain infarction. The goal of this study is to evaluate the incidence of new
ischaemic cerebral lesions following transcervical CAS with carotid flow reversal for
neuroprotection.
Materials and Methods
Thirty-one consecutive patients underwent transcervical CAS with carotid flow
reversal. A stroke scale and diffusion-weighted magnetic resonance imaging (DWMRI)
were performed within 24 h before and after the procedure. DW-MRI studies
were compared blindly by two independent neuroradiologists. New hyper-intense DW
signals were interpreted as ischaemic infarcts. The progress of all patients was
followed for at least 30 days following intervention.
Results
All procedures were technically successful. Nineteen (61%) patients were symptomatic
Mean carotid flow reversal time was 22 min. There were no major adverse events at 30
days. All patients remained neurologically intact without increase in the stroke scale.
Thirty subjects had paired DW-MRI studies. Post-procedural DW-MRI ischaemic
infarcts were found in four (12.5%) patients, all ipsilateral to the treated hemisphere
and asymptomatic. During follow-up, all stents remained patent and all patients
remained stroke-free.
Conclusions
These data suggest that transcervical carotid stenting with carotid flow reversal carries
a low incidence of new ischaemic infarcts, significantly lower than that reported with
transfemoral CAS. The transcervical approach with carotid flow reversal may improve
the safety of CAS and has the potential to produce results comparable to those of
carotid endarterectomy.
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