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Vol. 54. Núm. 4.
Páginas 326-332 (Enero 2002)
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Vol. 54. Núm. 4.
Páginas 326-332 (Enero 2002)
DOI: 10.1016/S0003-3170(02)74759-7
Acceso a texto completo
Reestenosis carotídea tras endarterectomía: factores pronósticos
The stenosis recurrence after carotid endarter ectomy: pronostic factors
Re-estenose carotídea após endarterectomia: factores prognósticos
Visitas
...
J. Royo-Serrando
Autor para correspondencia
jroyo@hg.vhebron.es

correspondence: Servicio de Angiologia, Cirugía Vascular y Endovascular. Hospital General i Universitari Valld'Hebron. Pg. Vall d'Hebron, 119129. E-08035 Barcelona.
, J.M. Escribano-Ferrer, J. Juan-Samsó, B. Álvarez-García, V. Fernández-Valenzuela, M. Matas-Docampo
Servicio de Angiologia, Cirugía Vascular y Endovascular. Hospital General i Universitari Valld'Hebron. Barcelona, España.
Información del artículo
Resumen
Bibliografía
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Estadísticas
Summary
Objective

To determine the echo-Doppler effectiveness in the diagnosis of premature restenoses carotidpost-endarterectomy, emphasizing its echographic characteristics. To determine the preoperative factors: sex, symptomatology and arteriosclerosis risk factors (arterial hipertension, smoking habit, diabetes and dislipemia) and preoperative that influence its emergence.

Patients and methods

Between January 1997 and December 1998, 152 carotid endarterectomies were carriedout in 147 patients. The group was composed of 128 men and 19 women. In 75 cases, the patients didn't show any symptomatology. On the contrary, in 77 cases, the surgical procedure was carried out on systematic stenosis (39 transient ischemic attack, 20 stroke, 12 amaurosis fugax, and on 6 cases resulting from non focal neurological symptomatology). The stenoses degree was in 148 cases higher than 70%, with 4 cases being set between 50-70%. All the patients underwent an echographic control every 6 months, determining both the restenoses degree and their characteristics.

Results

We came up with 17 restenosis which means 11,2% from the operated carotids. The statistic study of the preoperative factors showed a significant difference (p< 0,005) in the sex of the patients, thus 26,3% from the operated women showed restenosis signs compared to 9% from the men. Among the preoperative factors, it was observeda greater restenosis incidence (p< 0,005) in the endarterectomies joined without patch, 38,1% compared to 5,1% where apatch was used. Among the patients who had a bypass implanted, it was observed a stenosis recurrence of 28,5%. Because of the short number of cases, this datum does not have any statistical relevance (2 from 7).

Conclusions

We have encountered 11,2% restenosis in our series. The female gener and the direct suture of the TEAs are the only factors related with the stenosis recurrence.

Key words:
Carotid stenosis
Endarterectomy
Internal carotid artery
Patch
Restenosis
Shunt
Resumen
Objetivo

Determinar la eficacia del eco-Doppler en el diagnóstico de las reestenosis precoces postendarterectomía carotídea, y hacer hincapié en las características ecográficas de las mismas. Determinar los factores preoperatorios: sexo, clinica y factores de riesgo de arteriosclerosis (hipertensión arterial, tabaquismo, diabetes y dislipemia) y peroperatorios que influyen en su aparición.

Pacientes y métodos

Entre enero de 1997y diciembre de 1998 se llevaron a cabo 152 tromboendarterectomías (TEA) carotideas en 147 pacientes. El grupo loformaban 128 hombres y 19 mujeres. En 75 casos los pacientes no mostraron clinica alguna; por el contrario, en 77 casos la intervención se llevó a cabo en estenosis sintomáticas (39 ataque isquémico transitorio, 20 accidente cerebrovascular, 12 amaurosis fugazy seis casos por clinica neurológica no focal). El grado de estenosis fue: 148 casos con estenosis superiores al 70%, por cuatro casos con estenosis situadas entre el 50-70%. A todos los pacientes se les realizó un control ecográfico cada 6 meses, y se determinó el grado de reestenosis, asi como las características de las mismas.

Resultados

Se descubrieron 17reestenosis, lo que supone un 11,2% de las carótidas intervenidas. El estudio estadistico de los factores preoperatorios mostró diferencia significativa (p< 0,005) en elsexo de los pacientes; asi, el 26,3% de las mujeres intervenidas mostraron signos de reestenosis, por un 9% de los varones. De los factores peroperatorios, se objetivó una mayor incidencia de reestenosis (p> 0,005) en las endarte-rectomias cerradas sinparche, 38,1% por un 5,1% en las que se utilizó el parche. En los pacientes que se interpuso una derivación se observó una recurrencia de estenosis del orden del 28,5%, dato sin relevancia estadistica, por el escaso número de casos (dos de siete).

Conclusiones

En nuestra serie hemos descubierto un 11,2% de reestenosis. El sexo femeninoy el cierre directo de las TEA son los únicos factores relacionados con la recurrencia de las estenosis.

Palabras clave:
Arteria carótida interna
Endarterectomía
Endoprótesis
Estenosis carotídea
Parche
Reestenosis
Resumo
Objectivo

Determinara eficácia do eco-Doppler no diagnóstico das re-estenoses precocespós-endarterectomia carotídea e insistir nas características ecográficas das mesmas. Determinar os factores pré-operatórios: sexo, sintomatologia e factores de risco da arteriosclerose (hipertensão arterial, tabagismo, diabetes e dislipidemia) e pré-operatórios que influenciam o seu aparecimento.

Doentes e métodos

Entre Janeiro de 1997 e Dezembro de 1998, efectuaram-se 152trom-boendarterectomias (TEA) carotideas em 147 doentes. O grupo era formado por 128 homens e 19 mulheres. Em 75 casos os doentes nao mostraram qualquer sintoma; pelo contrario, em 7casos a intervenção foi realizada em estenoses sintomáticas (39 acidente isquémico transitório, 20 acidente cérebro-vascular, 12 amaurose fugaz e seis casospor clinica neurológica não focal). O grau de estenose foi: 148 casos com estenoses superiores a 70%, em relação a quatro casos com estenoses situadas entre 50-70%. Todos os doentes foram submetidos a um controlo ecográfico cada 6 meses, e determinou-se o grau de re-estenose, assim como as caracteristicas das mesmas.

Resultados

Descobriram-se 17 re-estenoses, o que supõe 11,2% das carótidas submetidas a intervenção. O estudo estatistico dos factores pré-operatórios mostrou diferença significativa (p>0,005) no sexo dos doentes; assim, 26,3% das mulheres operadas mostraram sinais de re-estenose, em relação a 9% dos homens. Dos factores pré-operatórios, objectivou-se uma maior incidência de re-estenoses (p<0,005) nas endarterectomias fechadas sem patch, 38,1% contra 5,1% nas com patch Nos doentes que se submeteram a bypass, observou-se uma recorrência de estenoses da ordem de 28,5%, dado sem relevancia estatística, pelo escasso número de casos (dois de sete).

Conclusões

Na nossa série, descobrimos 11,2% de re-estenoses. O sexo feminino e o encerramento directo das TEA são os únicos factores relacionados com a recorrência da estenose.

Palavras chave:
Artéria carótida interna
Endarterectomia
Estenose carotídea
Patch
Re-estenose
Shunt
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