RESUMO
We performed an observational study on 137 patients undergoing carotid endarterectomy (CEA). Patients on statins were less likely to have had symptoms in the 4 weeks before CEA (p = 0.0049) and were less likely to have spontaneous cerebral embolization detected by transcranial Doppler (p = 0.0459). Carotid plaques retrieved at CEA from patients taking statins revealed significantly lower concentrations of matrix metalloproteinase-1 (p = 0.0176), matrix metalloproteinase-9 (p = 0.0018), and interleukin-6 (p = 0.0005).
Assuntos
Arteriosclerose/tratamento farmacológico , Arteriosclerose/enzimologia , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/enzimologia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/diagnóstico por imagem , Arteriosclerose/patologia , Arteriosclerose/cirurgia , Atorvastatina , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Ácidos Graxos Monoinsaturados/administração & dosagem , Feminino , Fluvastatina , Ácidos Heptanoicos/administração & dosagem , Humanos , Indóis/administração & dosagem , Interleucinas/metabolismo , Masculino , Metaloproteinases da Matriz/metabolismo , Pessoa de Meia-Idade , Pravastatina/administração & dosagem , Pirróis/administração & dosagem , Sinvastatina/administração & dosagem , Inibidores Teciduais de Metaloproteinases/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , UltrassonografiaRESUMO
PURPOSE: To assess the role of percutaneous transluminal angioplasty (PTA) to treat critical limb ischemia (CLI) and to relate the changing experience with endovascular treatment of this condition in a major vascular unit. METHODS: A prospective study was performed involving 110 consecutive patients (57 women; mean age 76 years, range 57-99) undergoing balloon angioplasty for critical limb ischemia in 133 limbs. Outcome at 1 year was examined by case note review or questionnaire to determine survival, amputation-free survival, limb salvage, and CLI recurrence. RESULTS: Technical success was achieved in 105 (79%) of 133 limbs; the overall complication rate was 20% (3.8% major, 16.2% minor). The median follow-up was 15 months (minimum 12). The 12-month limb salvage rate by life-table analysis was 88%. Patients with an initially successful angioplasty had an extremely good outcome (95% 1-year limb salvage). In contrast, the 28 patients with failed angioplasty fared very poorly; a major amputation was required in 10, and death occurred in another 9, leaving only 9 survivors with limbs intact at 1 year. CONCLUSIONS: The results of this study justify the continuing use of PTA as first-line treatment for critical limb ischemia.
