WWW.NEUROLOGIAURUGUAY.ORG
Inicio arrow III Congreso Trabajos Científicos presentados arrow RESÚMENES DE LAS CONFERENCIAS arrow When to operate in carotid artery disease?
lunes, 21 de abril de 2014
 
 
Menú principal
Inicio
Historia
Que es la SNU?
Autoridades
Biblioteca
Sitios de Interés
Políticas de privacidad
Contacto
Noticias/Especialidades
Ataque Cerebrovascular
Des.Prof.Med.Continuo
II Congreso - Trabajos Cientìficos presentados
III Congreso Trabajos Científicos presentados
Revista Archivos del Instituto de Neurologia del Uruguay
Guías Clínicas Neurológicas
IV Congreso de Neurología. Trabajos Presentados
De interés

Image

Image

Image

Image

Image

                                                                                                                                                                                                                  

Image
 
When to operate in carotid artery disease? PDF Imprimir E-Mail
jueves, 24 de enero de 2008

Título: When to operate in carotid artery disease? Carotid endarterectomy (CEA) vs carotid angioplasty/stenting (CAS)

Autor: Jose Biller, M,.D, FACP, FAAN, FAHA
Professor and Chairman
Department of Neurology
Loyola University Chicago
Stritch School of Medicine
Maywood, IL. USA

Resumen:

Stroke is often caused by atherosclerotic lesions of the carotid artery bifurcation. Approximately 15% of ischemic strokes are caused by extracranial internal carotid artery (ICA) stenosis. Carotid atherosclerosis develops in areas of flow vessel-wall shear stress, most commonly the carotid artery bulb. In addition to the degree of carotid artery stenosis, plaque structure has been postulated as a critical factor in defining stroke risk.

 

Results form landmark prospective studies comparing best medical therapy with carotid endarterectomy (CEA) provide compelling evidence of the benefit of CEA performed by experienced surgeons in improving the chance of stroke-free survival in high-risk symptomatic patients. Timely surgical intervention in selected patients with  hemispheric transient ischemic attacks (TIAs), amaurosis fugax, or completed non-disabling carotid artery territory ischemic strokes within the previous six months, and with 70% - 99% diameter reducing carotid  artery stenosis, can significantly reduce the risk for recurrent cerebral ischemia or death. With low surgical risk, CEA also provides modest benefit in symptomatic patients with ICA stenosis of 50% - 69%, especially among men with hemispheric ischemia who are not-diabetic. There is no evidence that CEA provides any benefit over medical therapy if the stenosis is less than 50%.

 

Controversy still surrounds the selection of  asymptomatic patients (60% - 99% stenosis) for CEA. Based on combined data from the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial Collaborators (ACST), the 5-year risk of stroke in these asymptomatic patients randomized to best medical therapy was around 12%, falling to approximately 6% with CEA. This corresponds to an absolute risk reduction (ARR) of 1% per year, or 5.4% - 5.9% at 5 years.

 

Carotid angioplasty and stenting (CAS) has recently emerged as a less invasive and popular alternative to carotid endarterectomy (CEA) for the treatment of patients with symptomatic or asymptomatic carotid artery disease (CAD). Preliminary data suggest that these two interventions may have comparable efficacy. However, CAS is currently reserved for "high-surgical risk" patients. However, whether CAS proves to be safer or shares "equipoise" with CEA remains a highly controversial subject. 

 

 
< Anterior   Siguiente >
 
Top! Top!