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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 6 |
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Son las 01:29:11 horas del 5-2-2012 |
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Archivo PDF
(77 KB)
Transcervical carotid stenting with flow reversal
is safe in octogenarians: a preliminary safety study.
Alvarez B, Ribo M, Maeso J, Quintana M, Alvarez-Sabin
J, Matas M.
J Vasc Surg. 2008 Jan;47(1):96-100.
Section of Vascular and Endovascular Surgery,
Hospital Universitario Vall d'Hebron, Universidad Autónoma
de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona,
Spain. 30908bag@comb.es.
Factor de impacto de J Vasc Surg = 3.176 (según
el Journal Citation Report, 2006).
The use of carotid stenting in octogenarian patients is
controversial; some authors consider this population at
high risk for the procedure. Anatomic vascular complexity
may be an important reason for the high reported rates
of periprocedural thromboembolic complications. Transcervical
carotid angioplasty and stenting (TCS) with flow reversal
avoids aortic arch instrumentation. In this study, we
analyzed our experience with TCS in octogenarian patients
and compared the results with those of carotid endarterectomy
(CEA) in the same age group in terms of safety. METHODS:
The study included 81 patients, > or =80 years, a retrospective
cohort of 45 consecutive patients treated with CEA (January
2002 to January 2005), and a prospective cohort of 36
consecutive patients treated with TCS with protective
flow reversal (January 2005 to January 2007). Patients
were considered symptomatic according to the North American
Symptomatic Carotid Endarterectomy Trial (NASCET) criteria.
Stenting indication was established on the SAPPHIRE criteria.
General anesthesia was used in patients undergoing CEA,
and local anesthesia in those receiving TCS. Primary endpoints
were: stroke, death, or acute myocardial infarction within
30 days. Secondary endpoints were peripheral nerve paralysis
and cervical hematoma. Statistical significance for between-group
differences was assessed by Pearson chi(2) or Fisher exact
test, and Student t test. A P value of <.05 was considered
statistically significant. Follow-up was limited to 30
days. RESULTS: Baseline epidemiological characteristics
and revascularization indications were similar between
both groups. Mean age was significantly higher in the
TCS group (83.5 +/- 3.35) than the CEA group (81.7 +/-
1.55) (P = .004). Percentage of symptomatic lesions was
similar: 30.6% in TCS vs 44.4% in CEA (P = .2). Comorbid
conditions (respiratory or cardiac) were more frequent
in TCS group (61.6% vs 26.6%; P = .002). There were no
significant differences between groups for the primary
endpoints: 4.4% (one stroke, one acute myocardial infarction)
for CEA vs 0% for TCS (P = .5). Among CEA patients, there
were two peripheral nerve palsies (4.4%) and one cervical
hematoma (2.2%); there were no such complications with
TCS (P = .5 and P = 1, respectively). In one asymptomatic
TCS patient, Doppler study at 24 hours following the procedure
showed a common carotid artery dissection, which was treated
by a common carotid to internal carotid bypass. CONCLUSIONS:
In this preliminary experience, transcervical carotid
angioplasty and stenting with flow reversal for cerebral
protection was as safe at short term as carotid endarterectomy
in octogenarian patients, who additionally had considerable
comorbidity; thus, it may be possible to extend the indications
for carotid revascularization in this population. Studies
in larger patient series are required to confirm the trends
observed in this study. |
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