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      Resultados del tratamiento endovascular de la patología carotídea en el Hospital San Juan de Dios de Enero 2007 a Febrero 2010 Translated title: Results of endovascular management of carotid disease at San Juan de Dios Hospital from January 2007 to February 2010

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          Abstract

          Justificación y objetivo: Determinar la morbi-mortalidad de los pacientes con enfermedad carotídea tratados por medio de stent en el Hospital San Juan de Dios, Costa Rica; de Enero 2007 a Febrero 2010. Métodos: Se realizó un registro retrospectivo observacional de los pacientes con Enfermedad Carotídea durante 13 meses en nuestro instituto. Basado en la información obtenida de los expedientes clínicos, dos subgrupos fueron identificados: pacientes sintomáticos y asintomáticos. Los factores de riesgo, escala ABCD2, territorio cerebral afectado, medidas de severidad de lesión no-invasiva e invasivas, tamaño de stents y finalmente complicaciones peri-operatorias, fueron investigadas y evaluadas. Resultados: 76 pacientes fueron identificados en nuestra serie, 87% (n=66/76) sintomáticos y 13% (n=10/76) asintomáticos. La Hipertensión Arterial fue el factor de riesgo más frecuente, seguido por el tabaquismo. Se evidenció una sub-estimación de la severidad de la lesión en los ultrasonidos diagnósticos en 24% (n=18/76) de los pacientes. Durante el procedimiento, se documentó predilatación de la lesión en 55% (n=42/76) de los pacientes y los stents más frecuentemente utilizados fueron de 7x30mm y 8x30mm representando un 47% (n=36/76) de los casos. La morbilidad neurológica de los pacientes asintomáticos fue del 0% y en el subgrupo de pacientes sintomáticos fue del 3% (2/66). Conclusión: La terapia endovascular demostró ser una técnica segura y efectiva para la revascularización carotídea. Series más numerosas de pacientes deberían ser investigadas para adquirir mayor significancia estadística.

          Translated abstract

          Background and aim: To determine the morbi-mortality of patients treated with endovascular stenting for Carotid Artery disease at San Juan de Dios Hospital, Costa Rica; from January 2007 to February 2010. Methods: A retrospective observational registry of patients treated with Carotid Artery endovascular stenting was maintained at our institution over 13 months. Based on the information acquired from medical records, two subgroups were identified: symptomatic and asymptomatic. Some aspects were researched and evaluated such as risk factors, ABCD scale, affected cerebral territory, invasive and non-invasive lesion measurements, stent sizing and finally peri-operatory complications. Results: 76 patients were identified in this series, 87% (n=66/76) symptomatic and 13% (n=10/76) asymptomatic. The most frequent risk factor was hypertension, followed by smoking. Underestimation by ultrasound of lesion severity was found in up to 24% (n=18/76) of patients. Predilatation was done in 55% (n=42/76) and most frequent stent sizes identified were 7x30mm or 8x30mm in 47% (n=36/76) of patients. Neurologic morbidity of asymtomatic patients was 0%, and in the symptomatic group was a 3% (2/66) Conclusion: Endovascular therapy demonstrated to be a safe and effective as a revascularization technique; however larger patient series should be investigated for grater statistical significance.

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          Most cited references20

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          Long-term results of carotid stenting versus endarterectomy in high-risk patients.

          We previously reported that, in a randomized trial, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy for the treatment of carotid artery disease at 30 days and at 1 year. We now report the 3-year results. The trial evaluated carotid artery stenting with the use of an emboli-protection device as compared with endarterectomy in 334 patients at increased risk for complications from endarterectomy who had either a symptomatic carotid artery stenosis of at least 50% of the luminal diameter or an asymptomatic stenosis of at least 80%. The prespecified major secondary end point at 3 years was a composite of death, stroke, or myocardial infarction within 30 days after the procedure or death or ipsilateral stroke between 31 days and 1080 days (3 years). At 3 years, data were available for 260 patients (77.8%), including 85.6% of patients in the stenting group and 70.1% of those in the endarterectomy group. The prespecified major secondary end point occurred in 41 patients in the stenting group (cumulative incidence, 24.6%; Kaplan-Meier estimate, 26.2%) and 45 patients in the endarterectomy group (cumulative incidence, 26.9%; Kaplan-Meier estimate, 30.3%) (absolute difference in cumulative incidence for the stenting group, -2.3%; 95% confidence interval, -11.8 to 7.0). There were 15 strokes in each of the two groups, of which 11 in the stenting group and 9 in the endarterectomy group were ipsilateral. In our trial of patients with severe carotid artery stenosis and increased surgical risk, no significant difference could be shown in long-term outcomes between patients who underwent carotid artery stenting with an emboli-protection device and those who underwent endarterectomy. (ClinicalTrials.gov number, NCT00231270 [ClinicalTrials.gov].). Copyright 2008 Massachusetts Medical Society.
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            Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning

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              Detection of carotid stenosis. From NASCET results to clinical practice.

              Results from large multicenter studies have shown that carotid endarterectomy, performed with low perioperative morbidity and mortality, is beneficial for patients with symptomatic carotid stenosis > or = 70% as calculated according to strict angiographic criteria. To apply these results in clinical practice, individual institutions should determine whether locally implemented duplex ultrasonography adequately identifies patients with > or = 70% stenosis and whether the degree of stenosis reported by local angiographers correlates with strict angiographic measurements.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                amc
                Acta Médica Costarricense
                Acta méd. costarric
                Colegio de Médicos y Cirujanos de Costa Rica (San José )
                0001-6012
                March 2012
                : 54
                : 1
                : 45-49
                Affiliations
                [1 ] Hospital San Juan de Dios
                Article
                S0001-60022012000100008
                e5e4facc-695e-493a-a3d8-b09c22d6331d

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=0001-6002&lng=en
                Categories
                Health Care Sciences & Services

                Health & Social care
                Endovascular procedures,Carotid Stenosis,stroke,Procedimientos endovasculares,estenosis carotídea,accidente cerebrovascular

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