Influência dos sintomas pré-procedimento na evolução hospitalar e tardia das angioplastias carotídeas com implante de stent e sistemas de proteção cerebral

Abstract

SUMMARY Influence of Symptoms Pre-Procedure in Hospitaland Late Evolution of Carotid Angioplastywith Stent Implantation andCerebral Protection Systems Background: Carotid atherosclerotic disease (CAD) is res-ponsible for 40% of strokes. Despite percutaneous carotidintervention (PCI) is an alternative to endarterectomy,there is little data available comparing the PCI in asymp-tomatic vs. symptomatic patients. The purpose of this analysiswas to evaluate this issue in a consecutive group of cases. Methods: 262 PCIs were conducted on 230 consecutivepatients, 61 (26.5%) in asymptomatic vs. 169 (73.5%) insymptomatic patients. Quantitative carotid angiography(QCA) was performed before and after the procedure andthe clinical follow-up obtained in-hospital and at 6 and 12months. Results: The demographic characteristics weresimilar between groups; 31% were diabetics. Primary successwas obtained in all cases, with no major complications inboth groups. QCA analysis revealed a higher diameterstenosis in asymptomatics (83.4% ± 7.6% vs. 74.9% ± 12.5%;p < 0.01), but symptomatic patients had longer lesions(18.3% ± 5.7% vs. 21.7% ± 7.4%; p < 0.01). At 30 daysthere was no difference in the incidence of major (1.8%vs. 2.0%; p = 0.45) or minor strokes (0 vs. 1.4%; p = 0.19)for both groups. Between 1 and 12 months there havebeen no additional strokes. A late target vessel revascu-larization was observed in symptomatic patients but noneurologic deaths in both groups.