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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 3 |
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Son las 01:31:22 horas del 5-2-2012 |
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Archivo PDF
(75 KB)
Transcervical carotid stenting with flow reversal
protection: experience in high-risk patients.
Matas M, Alvarez B, Ribo M, Molina C, Maeso J,
Alvarez-Sabin J.
J Vasc Surg 2007 Jul;46(1):49-54.
Section of Vascular and Endovascular Surgery,
Hospital Universitario Vall d'Hebron, Universidad Autónoma
de Barcelona, Paseo Vall d'Hebron 119-129, 08035 Barcelona,
Spain.
Factor de impacto de J Vasc Surg = 3.173 (según
el Journal Citation Report, 2005).
BACKGROUND: Carotid angioplasty and stenting
(CAS) with cerebral embolic protection is a safe alternative
to carotid endarterectomy in high-risk patients. Among
the various systems proposed for cerebral protection,
transcervical CAS avoids crossing the lesion without protection
and eliminates the complications associated with transfemoral
access. This study analyzes our experience and the results
obtained with a transcervical stenting technique for carotid
revascularization.
METHODS: From January 2005 to June 2006,
62 CAS were performed in our center in high-risk patients
with >70% stenosis (38.7% had a previous neurologic
event and 61.3% were asymptomatic). The indications for
CAS were severe heart disease (45.1%), severe pulmonary
disease (6.4%), paralysis of the contralateral laryngeal
nerve (6.4%), recurrent stenosis (3.2%), and high carotid
lesion (1.6%). Twenty-one patients were >80 years old.
A complete neurologic examination was performed by a stroke
neurologist in all patients before and after stenting.
The protection system used was carotid flow reversal by
transcervical access. Transcranial Doppler monitoring
was done during the procedure in 35 patients. We analyzed
technical success, the presence of high-intensity transient
signals during the procedure, neurologic morbidity and
mortality at 30 days and 6 months, and stent patency at
6 months (range, 1 to 18 months). Technical success was
96.8%. Perioperative high-intensity transient signals
were observed in two patients (5.7%). In the immediate
postoperative period, one patient had a transient ischemic
attack of the anterior cerebral artery and another had
a stroke, with contralateral hemiplegia. At 48 hours after
discharge, a third patient returned to the hospital with
a severe cerebral hemorrhage that required surgical drainage;
hence, neurologic morbidity was 4.9%. There were no deaths
at 6 months. Among the total, 98.4% of the stents remained
patent, two showed restenosis of 50% to 70%, and one restenosis
of >70%. No patients presented a neurologic event during
the follow-up.
CONCLUSIONS: Transcervical carotid artery
stenting with flow reversal cerebral protection is a relatively
simple, safe technique that avoids instrumentation of
the aortic arch and crossing the target lesion without
protection. It is less expensive than techniques requiring
a filter device and provides excellent outcome with an
acceptable incidence of complications. |
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