Endarterectomía carotídea, resultados a mediano y largo plazo / Carotid endarterectomy, medium to long-term results

Resumen Introducción: Entre el 50% al 80% de los pacientes con un ictus, presentan lesión de la arteria carótida común o interna, de estos un 15% a 30% quedan con discapacidad severa, y el 20% requiere de institucionalización. Objetivo: Analizar las variables epidemiológicas involucradas en la estenosis carotídea y los resultados a mediano-largo plazo de la endarterectomía carotídea. Materiales y Método: Estudio observacional, descriptivo y retrospectivo, donde se analizan 103 endarterectomías carotídeas sucesivas, realizadas en 97 pacientes, en un período de 12 años (2007 a 2018), en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo masculino 64,9%, edad promedio 70,2 años, sintomáticos 65,9%, presentación clínica más frecuente el ataque isquémico transitorio (48,4%), morbilidad global inmediata del procedimiento 20,3%, AVE perioperarorio 3,9% (ninguno discapacitante), disfunción de nervios periféricos 5,8%, mortalidad operatoria 70% y cuando se efectúa en un plazo menor a 2 semanas del evento isquémico. Conclusión: La endarterectomía carotídea sigue siendo el procedimiento quirúrgico de elección para tratar la estenosis carotídea severa; realizada en centros con experiencia, es un procedimiento seguro y eficaz en la prevención del infarto cerebral.

Introduction: Between 50 and 80% of patients with a stroke, have lesions of the common or internal carotid artery, of these 15 to 30% are severely disabled, and 20% require institutionalization. Aim: To analyze the epidemiological variables involved in carotid stenosis, and the medium to long-term results of carotid endarterectomy. Materials and Method: Observational, descriptive and retrospective study, analyzed 103 successive carotid endarterectomies procedures in 97 patients, in a period of 12 years (2007 to 2018), in the Surgery Department of the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Male sex 64.9%, average age 70.2 years, symptomatic 65.9%, most frequent clinical presentation, transient ischemic attack (48.4%), immediate global morbidity of the procedure 20.3%, peri-operative AVE 3.9% (none disabling), peripheral nerve dysfunction 5.8%, operative mortality 70%, and when performed within a period less than 2 weeks of the ischemic event. Conclusion: Carotid endarterectomy remains the surgical procedure of choice, to treat severe carotid stenosis, performed in experienced centers, it is a safe and effective procedure in the prevention of cerebral ischemia.

Short-term efficacy of percutaneous vascular forming and stenting in patients with severe stenosis combined with cerebral infarction / 中华神经医学杂志

Objective To explore the clinical efficacy of percutaneous vascular forming and stenting in patients with severe stenosis combined with cerebral infarction.Methods The clinical data of 74 patients with severe carotid stenosis combined with cerebral infarction,admitted to our hospital from January 2011 to January 2014,were analyzed;and according to the treatment methods,all patients were divided into operation group (percutaneous angioplasty and stenting,n=37) and non-operation group (conventional therapy,n=37).Follow-up was performed one,3 and 6 months after discharge,and the prognoses of these patients were evaluated with NIHSS and mini-mental state examination (MMSE).Results Before treatment,the rate of carotid artery stenosis,NIHSS scores and MMSE scores in the two groups showed no significant differences (P＞0.05).After treatment,stenosis rate of the operation group ([32.35±4.15]％) was significantly lower than that in the non-operation group ([72.32±7.72]％,P＜0.05).One month after treatment,the MMSE scores in the operation group (22.24±2.74) were significantly higher than those in the non-operation group (20.29±3.15,P＜0.05).Three months after treatment,the NIHSS scores in the operation group (7.05±1.35) were significantly lower than those in the non-operation group (8.89±1.76,P＜0.05).Conclusion Percutaneous vascular forming and stenting can help to achieve favorable outcome in patients with severe stenosis combined with cerebral infarction,which achieves better effect than conventional therapy.

Long term effect of stent implantation in patients with severe carotid stenosis / 实用医学杂志

Objective To investigate the long term effect of stent implantation for severe carotid stenosis. Methods The clinical data of 66 patients with severe carotid artery stenosis who were hospitalized from January 2009 to December 2015 were retrospectively reviewed.40 patients underwent carotid artery stenosis stent implanta-tion(as study group)and 26 patients were treated with conventional drug theraphy(as control group).All patient were followed up for 36 months.and the quality of life of the patients was evaluated by SF-36 and the incidence of cerebrovascular events was recorded by following up.Results The quality of life score of the study group were sig-nificantly higher than those of the control group at 3 months,12 months,24 months and 36 months after operation (P<0.05);the incidence of cerebrovascular events after 12 months,24 months and 36 months in the study group was lower than in the control group,and the difference was significant(P<0.05).Conclusions There is obvious long-term effect of carotid artery stenting in the treatment of severe carotid stenosis,in which the quality of life can be effectively improved and the incidence of cerebrovascular events can be reduced in patients with carotid stenosis.