Carotid and Vertebral Artery Stenting: REMAT Data (Madre Teresa Registry)
Stroke remains the leading cause of morbidity and mortality in Brazil. Epidemiological data suggest that 10% to 30% of all strokes are due to atherosclerotic carotid artery disease and 8% due to vertebral artery disease. Endovascular treatment of extracranial lesions is an alternative to endarterect...
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| Published in: | Revista brasileira de cardiologia invasiva Vol. 21; no. 2; pp. 152 - 158 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | Portuguese |
| Published: |
2013
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Stroke remains the leading cause of morbidity and mortality in Brazil. Epidemiological data suggest that 10% to 30% of all strokes are due to atherosclerotic carotid artery disease and 8% due to vertebral artery disease. Endovascular treatment of extracranial lesions is an alternative to endarterectomy. We evaluated the results and predictors of adverse events in patients undergoing carotid and vertebral artery stenting.
Asymptomatic patients with lesion > 70% or symptomatic patients with lesions > 50% in carotid arteries and symptomatic patients with lesion > 70% in vertebral arteries were included. We evaluated the primary endpoint, defined as the composite incidence of death (procedural or non-procedural), major stroke, minor stroke or myocardial infarction (MI).
Two hundred and twenty-four interventions with stenting were performed in 199 consecutive patients with a prevalence of males (73.9%), 69.8±9.9years of age and 37.7% were diabetics. Symptomatic patients represented about two thirds of the cases and the most commonly treated lesions were de novo lesions (96.4%). The left (46%) and right (44.6%) internal carotid arteries were the most commonly approached vessels. Composite primary endpoint was observed in 5% of the patients, procedure-related mortality in 1%, non-procedure related mortality in 1%, minor stroke in 1.5% and MI in 1.5%. Patients with a history of coronary artery disease had a 4-fold probability of presenting the primary endpoint [odds ratio (OR) 4.32, 95% confidence interval (CI 95%) 1.09-17.21); P=0.038].
In our study we obtained a high success rate and had a low rate of adverse events, demonstrating the safety and efficacy of percutaneous stent implantation in the carotid and vertebral arteries.
Implante Percutâneo de Stent em Artérias Carótidas e Vertebrais: Dados do REMAT (Registro Madre Teresa)
O acidente vascular encefálico (AVE) é a principal causa de morbidade e mortalidade no Brasil. Entre 10% e 30% dos AVEs estão associados à doença carotídea e 8%, à artéria vertebral. O tratamento endovascular das lesões extracranianas é alternativa à endarterectomia. Analisamos os resultados e avaliamos os preditores de eventos adversos em pacientes submetidos a angioplastia carotídea e vertebral com implante de stents.
Incluídos assintomáticos com lesão > 70% ou sintomáticos com lesão > 50% em artérias carótidas e sintomáticos com lesão > 70% em artérias vertebrais. Avaliamos desfecho primário, definido como a incidência combinada de morte relacionada ou não ao procedimento, AVE maior, AVE menor ou infarto agudo do miocárdio (IAM).
Realizadas 224 intervenções com implante de stents em 199 pacientes consecutivos, com predomínio do sexo masculino (73,9%), idade de 69,8±9,9 anos e 37,7% eram diabéticos. Pacientes sintomáticos representaram cerca de dois terços dos casos e as lesões mais tratadas foram as lesões de novo (96,4%). As artérias carótidas internas esquerda (46%) e direita (44,6%) foram os vasos mais abordados. Desfecho combinado primário ocorreu em 5%, mortalidade relacionada ao procedimento em 1%, mortalidade não-relacionada ao procedimento em 1%, AVE menor em 1,5% e IAM em 1,5%. Pacientes com antecedente de doença arterial coronária mostraram chance de apresentar desfecho primário 4 vezes maior [odds ratio (OR) 4,32, intervalo de confiança de 95% (IC 95%) 1,09-17,21; P=0,038].
Em nosso estudo obtivemos alto índice de sucesso e baixa ocorrência de eventos adversos, que demonstram a segurança e a eficácia do implante percutâneo de stent em artérias carótidas e vertebrais. |
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| ISSN: | 0104-1843 |
| DOI: | 10.1016/S0104-1843(13)50031-2 |