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1.
Ann Vasc Surg ; 106: 297-311, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38825067

RESUMO

BACKGROUND: Recent randomized controlled trials (RCTs) have demonstrated similar outcomes in terms of ischemic stroke incidence after carotid endarterectomy (CEA) or carotid artery stenting (CAS) in asymptomatic carotid disease, while CEA seems to be the first option for symptomatic carotid disease. The aim of this meta-analysis is to assess the incidence of silent cerebral microembolization detected by magnetic resonance imaging (MRI) following these procedures. METHODS: A systematic search was conducted using PubMed, Scopus, and Cochrane databases, including comparative studies involving symptomatic or asymptomatic patients undergoing either CEA or CAS and reporting on new cerebral ischemic lesions in postoperative MRI. The primary outcome was the newly detected cerebral ischemic lesions. Pooled effect estimates for all outcomes were calculated using the random-effects model. Prespecified random effects metaregression and subgroup analysis were conducted to examine the impact of moderator variables on the presence of new cerebral ischemic lesions. RESULTS: 25 studies reporting on a total of 1827 CEA and 1500 CAS interventions fulfilled the eligibility criteria. The incidence of new cerebral ischemic lesions was significantly lower after CEA compared to CAS, regardless of the time of MRI assessment (first 24 hours; OR: 0.33, 95% CI: 0.17-0.64, P < 0.001), (the first 72 hours, OR: 0.25, 95% CI 0.18-0.36, P < 0.001), (generally within a week after the operation; OR: 0.24, 95% CI: 0.17-0.34, P < 0.001). Also, the rate of stroke (OR: 0.38, 95% CI: 0.23-0.63, P < 0.001) and the presence of contralateral new cerebral ischemic lesions (OR: 0.16, 95% CI 0.08-0.32, P < 0.001) were less frequent after CEA. Subgroup analysis based on the study design and the use of embolic protection device during CAS showed consistently lower rates of new lesions after CEA. CONCLUSIONS: CEA demonstrates significant lower rates of new silent cerebral microembolization, as detected by MRI in postoperative period compared with CAS.


Assuntos
Endarterectomia das Carótidas , Procedimentos Endovasculares , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Stents , Humanos , Endarterectomia das Carótidas/efeitos adversos , Resultado do Tratamento , Fatores de Risco , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Fatores de Tempo , Idoso , Feminino , Masculino , Isquemia Encefálica/etiologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/prevenção & controle , Incidência , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Estenose das Carótidas/cirurgia , Pessoa de Meia-Idade , Medição de Risco , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/terapia , Embolia Intracraniana/etiologia , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Doenças Assintomáticas
2.
J Clin Neurosci ; 89: 271-278, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119280

RESUMO

Coronavirus Disease 19 (COVID-19) pandemic affects the worldwide healthcare system and our understanding of this disease grows rapidly. Although COVID-19 is a mainly respiratory disease, neurological manifestations are not uncommon. The aim of this review is to report on the etiology, clinical profile, location, and outcome of patients with intracerebral hemorrhage (ICH) and COVID-19. This review includes 36 studies examining ICH in the clinical presentation of COVID-19. Overall, 217 cases with intracranial hemorrhage, of which 188 ICHs, were reported. Generally, a low incidence of both primary and secondary ICH was found in 8 studies [106 (0.25%) out of 43,137 hospitalized patients with COVID-19]. Available data showed a median age of 58 years (range: 52-68) and male sex 64%, regarding 36 and 102 patients respectively. Furthermore, 75% of the patients were on prior anticoagulation treatment, 52% had a history of arterial hypertension, and 61% were admitted in intensive care unit. Location of ICH in deep structures/basal ganglia was ascertained in only 7 cases making arterial hypertension an improbable etiopathogenetic mechanism. Mortality was calculated at 52.7%. Disease related pathophysiologic mechanisms support the hypothesis that SARS-CoV2 can cause ICH, however typical ICH risk factors such as anticoagulation treatment, or admission to ICU should also be considered as probable causes. Physicians should strongly suspect the possibility of ICH in individuals with severe COVID-19 admitted to ICU and treated with anticoagulants. It is not clear whether ICH is related directly to COVID-19 or reflects expected comorbidity and/or complications observed in severely ill patients.


Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Adulto , Idoso , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/fisiologia , Hemorragia Cerebral/tratamento farmacológico , Hospitalização/tendências , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , SARS-CoV-2 , Tratamento Farmacológico da COVID-19
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