Portal de Periódicos da CAPES

Carotid artery stenting in patients with high neurologic risks

1999; Elsevier BV; Volume: 83; Issue: 9 Linguagem: Inglês

10.1016/s0002-9149(99)00110-1

1879-1913

Nadim Al‐Mubarak, Gary S. Roubin, Camilo R. Gomez, Ming W. Liu, John B. Terry, Sriram S. Iyer, Jiri J. Vitek,

Oropharyngeal Anatomy and Pathologies

The value of carotid endarterectomy (CEA) in reducing the risk of stroke in selected patients with severe internal carotid artery stenoses and ipsilateral symptoms is well established. 1 North American Symptomatic Carotid Endarterectomy Trial CollaboratorsBeneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N Engl J Med. 1991; 325: 445-453 Crossref PubMed Scopus (7823) Google Scholar , 2 European Carotid Surgery Trialists' Collaborative GroupMRC European Carotid Surgery Trial Interim results for patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet. 1991; 337: 1235-1243 Abstract PubMed Scopus (3117) Google Scholar Its benefit, however, is partly dependent on preoperative risk and is eliminated when the combined major stroke and death rates are ≥6%, which are the rates reported in the major randomized trials. 1 North American Symptomatic Carotid Endarterectomy Trial CollaboratorsBeneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N Engl J Med. 1991; 325: 445-453 Crossref PubMed Scopus (7823) Google Scholar , 2 European Carotid Surgery Trialists' Collaborative GroupMRC European Carotid Surgery Trial Interim results for patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet. 1991; 337: 1235-1243 Abstract PubMed Scopus (3117) Google Scholar , 3 Matchar D.B. Pauker S.G. Edarterectomy in carotid artery disease a decision analysis. JAMA. 1987; 258: 793-798 Crossref PubMed Scopus (65) Google Scholar , 4 Committee on Health Care IssuesDoes carotid endarterectomy decrease stroke and death in patients with transient ischemic attacks?. Ann Neurol. 1987; 22: 72-76 Crossref PubMed Scopus (39) Google Scholar A system of grouping patients according to medical, neurologic, and angiographic risk factors, known as the Mayo Clinic CEA risk classification, was devised by Sundt et al 5 Sundt Jr, T.M. Sandok B.A. Whisnant J.P. Carotid endarterectomycomplications and pre-operative assessment of riskMay Clin Proc. 1975; 50: 301-306 PubMed Google Scholar to assess CEA preoperative risk. This system has proven to be of great value and its ability to predict the surgical outcomes has been previously reported. 5 Sundt Jr, T.M. Sandok B.A. Whisnant J.P. Carotid endarterectomycomplications and pre-operative assessment of riskMay Clin Proc. 1975; 50: 301-306 PubMed Google Scholar , 6 Sundt Jr, T.M. Meyer F.B. Fode N.C. Ebersold N.J. Marsh W.R. Risk factors and operative results. in: Meyer F.B. Sundt's Occlusive Cerebrovascular Disease. 2d ed. W.B. Saunders Co, Philadelphia1994: 241-247 Google Scholar , 7 Sieber F.E. Toung T.J. Diringer M.N. Wang Long D.M. Preoperative risks predict neurological outcome of carotid endarterectomy related stroke. Neurosurgery. 1992; 30: 847-854 Crossref PubMed Scopus (30) Google Scholar , 8 McCrory D.C. Goldstein L.B. Samsa G.P. Oddone E.Z. Landsman P.B. Moore W.S. Matchar D. Predicting complications of carotid endarterectomy. Stroke. 1993; 24: 1285-1291 Crossref PubMed Scopus (199) Google Scholar The combined major stroke and death among Mayo class IV patients (i.e., patients at high neurologic risk) undergoing CEA has been reported to be 6.8% to 14% in different series. 6 Sundt Jr, T.M. Meyer F.B. Fode N.C. Ebersold N.J. Marsh W.R. Risk factors and operative results. in: Meyer F.B. Sundt's Occlusive Cerebrovascular Disease. 2d ed. W.B. Saunders Co, Philadelphia1994: 241-247 Google Scholar , 7 Sieber F.E. Toung T.J. Diringer M.N. Wang Long D.M. Preoperative risks predict neurological outcome of carotid endarterectomy related stroke. Neurosurgery. 1992; 30: 847-854 Crossref PubMed Scopus (30) Google Scholar , 8 McCrory D.C. Goldstein L.B. Samsa G.P. Oddone E.Z. Landsman P.B. Moore W.S. Matchar D. Predicting complications of carotid endarterectomy. Stroke. 1993; 24: 1285-1291 Crossref PubMed Scopus (199) Google Scholar Carotid artery stenting has recently evolved as a viable alternative to CEA and may have its greatest benefit in patients with high preoperative risk. 9 Roubin G.S. Yadov S. Iyer S.S. Vitek J.J. Carotid stent-supported angioplasty: a neurovascular approach to prevent stroke. Am J Cardiol (Supp 3A). 1996; 78: 8-12 Abstract Full Text Full Text PDF PubMed Scopus (271) Google Scholar , 10 Yadav J.S. Roubin G.S. Iyer S.S. Vitek J.J. King P. Jordan W.D. Fisher W.S. Elective stenting of extra-cranial carotid arteries. Circulation. 1997; 95: 376-381 Crossref PubMed Scopus (638) Google Scholar , 11 Diethrich E.B. Lopez L.G. Rodriguez-Lopez J.A. Techniques and results of subclavian, innominate and carotid occlusive disease treatment using balloon angioplasty and stents. J Endovasc Surg. 1995; 2: 114 Google Scholar , 12 Kachel R. Endert G. Bashe S. Percutaneous transluminal angioplasty of carotid, innominate and vertebral artery stenosis. Cardiovasc Interv Rad. 1994; : 17-28 PubMed Google Scholar , 13 Mathias K. Stent placement in arteriosclerotic disease of the internal carotid artery. J Int Cardiol. 1997; 10: 469-477 Crossref Scopus (17) Google Scholar The aim of this study is to determine the immediate and late outcome of carotid artery stenting in patients with high neurologic risk (Mayo class IV).