Evolución natural de la reestenosis tras endarterectomía carotídea / Natural history of restenosis after carotid endarterectomy

RESUMEN

OBJETIVOS: Registrar la incidencia de reestenosis tras endarterectomía carotídea (EDAc), observar su evolución natural e identificar los factores de riesgo para su desarrollo. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte prospectiva de EDAc realizadas en 2006-2011. Registramos: datos clínicos, detalles quirúrgicos, desarrollo de reestenosis moderada (REM) (50-69%), reestenosis severa (RES) (≥ 70%) y oclusión. El seguimiento se realizó con ecodoppler carotídea en los 6, 12, 18 y 24 meses tras la intervención, y después anualmente en caso de REM/RES. Todas las RES se confirmaron con angio-RNM. Ninguna reestenosis se reintervino de forma abierta ni endovascular. Realizamos un análisis descriptivo y utilizamos chi-cuadrado/test de Fisher para la definición de factores de riesgo de RES. RESULTADOS: Incluimos 186 carótidas, 77 (41,4%) sintomáticas, y se utilizó parche (dacron) en 19 (10,2%) casos. El primer año detectamos 20 (10,8%) REM de las cuales 9 (45%) remitieron (a <50%) y una (5%) progresó a RES el 2.° año. Se observaron 12 (6,5%) RES el 1.er año, 4 (33,3%) remitieron (a 50-69%) durante el 2.° año y 3 (25%) más durante el 3.er año. Ninguna RES se ocluyó ni fue sintomática. Se ocluyeron 2 carótidas el primer año (una fue sintomática) y una el segundo año, sin reestenosis ≥ 50% previa. El uso de puntos de Kunlin aumentó el riesgo de desarrollar RES (OR 3,61; IC = 95%: 1,13-11,57; p = 0,023). CONCLUSIONES: La RES tras EDAc mayoritariamente con cierre directo es poco frecuente. La evolución natural de las RES durante el seguimiento es benigna. Los puntos de Kunlin se asocian con el desarrollo de RES

ABSTRACT

OBJECTIVES: To determine the incidence of restenosis after carotid endarterectomy (CEA), as well as to observe its natural history and identify the risk factors for its development. MATERIAL AND METHODS: Retrospective study of a prospective cohort of CEA performed in 2006-2011. The variables recorded were: clinical data, surgical details, incidence of moderate restenosis (MRE) (50-69%), severe restenosis (SRE) (≥ 70%), and occlusion. The patients were followed-up with carotid duplex-scan 6, 12, 18 and 24 months after the procedure, and annually thereafter if MRE/SRE was found. All SRE were confirmed with MRI. No restenosis was surgically or endovascularly repaired. A descriptive analysis was performed, and Chi-squared/Fisher's exact test was used for the definition of SRE risk factors. RESULTS: A total of 186 patients with carotid endarterectomy were included, 77 (41.4%) performed in symptomatic patients, and a patch (dacron) used in 19 (10.2%) cases. During the first year of follow-up 20 (10.8%) MRE were found, with 9 of them (45%) regressed (to <50%) and one (5%) progressed to SRE during the second year. SRE was observed in 12 (6.5%) patients during the first year of follow-up, and 4 (33.3%) regressed (to 50-69%) during the second year, and 3 (25%) more during the third year. No SRE were occluded or became symptomatic. Two carotid arteries became occluded during the first year (one caused a stroke), and one more during the second year, without previous ≥ 50% restenosis. The use of Kunlin stitches increased the risk of developing SRE (OR 3,61; 95%CI: 1.13-11.57; P=.023). CONCLUSIONS: SRE after CEA, mostly with direct suture, is infrequent. The natural history of SRE during follow-up is benign. Kunlin stitches are associated to the development of SRE