Palacios RJM, Galván GE, Ficker LB, Jiménez TO, Díaz LGE, Baena SE, Acuña MVH, De la Cruz OR, Ramírez SC, Medellín MB

Language: Spanish
References: 29
Page: 10-16
PDF size: 227.56 Kb.

ABSTRACT

Carotid angioplasty with stent (CAS) represents a less invasive alternative to carotid endarterectomy (CEA) for treatment of carotid occlusive disease. Objective: To analyze the morbidity and mortality to 30 days and 6 months after CAS, we report our results and complications in 206 Pts (231 lesions) treated in the Hemodynamics Department UMAE 34 IMSS, with an average age of 67.46 ± 8.37 years, 40 Pts (19.4%) › 75 years, 66% were symptomatic, 75 pts (36%) with cerebral vascular accident (CVA) before, 169 pts (82%) were carriers of ischemic heart disease, closed-cell stent (Carotid Wall Stent, Boston Sc) was used in 86%, in 213 lesions (92.2%) used cerebral protection filters, recovering atheromatous material in 132 lesions (61.9%). Femoral access was the most used and only in 3 cases we use the radial access (Arch Bovine), pharmacological management in all the time of surgery was 300 mg loading clopidogrel and aspirin 325 VO, Heparin IV 70 u/kg, temporary pacemaker in patients with ostial lesion was used, neuroprotection was not used, neurology evaluation as well as carotid Doppler was performed on all Pts before the study and at the end of the same well as a Doppler at 6 and 12 month follow-up; clinical and angiographic success (stenosis ‹ 30%, without increased cerebral vascular accident, death, surgery or MI) was reached in 99.5% and 95.4% respectively. Complications: There were 4 deaths related to the procedure 1.9% (2 Cardiovascular and 2 Neurological), 5 major neurological events (2.16%) and 3 minor neurological events 1.3%, no myocardial infarction (MI), 5 Pts had bradycardia and hypotension meriting vasoconstrictors for 72 h without further complications in 104 pts (50.4%) apart from the CAS conducted a successful coronary angioplasty in both procedures: The current monitoring of 26.5 ± 23.2 (r = 3 to 84 months) 5 Pts showed restenosis by vascular Doppler angiography documented only in 3 Pts (1.3%) of them, be submitted to ATP; 2 of them without complications, 3 patients had a stroke (1 Major ipsilateral and 2 minor stroke contralateral), 31 Pts underwent myocardial revascularization surgery (MRS) 19 of them between 4 to 30 days of CAS and 12 between day 31 and 60 days, mortality occurred in 5 Pts (16.1%) pos MRS all of them a cardiac event, 5 Pts died over the follow-up two by MI, 2 more due to infections and the remaining unknown Pt. Conclusion: Currently, CAS is an alternative to surgery in patients with critical or symptomatic carotid artery disease, so also in Pts who have a comorbidity or unfavorable anatomy compared to conventional CEA.

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