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Carotid Angioplasty and Stenting
in High-Risk Patients

Cano, M.N.; Kambara, A.; Costa Jr., J.R.;
Cano, S.J.F.; Perez, A.R.R.

Instituto Dante Pazzanese de Cardiología, São Paulo, Brasil

SUMMARY
Objectives: Examine our experience in carotid stetting in high risk patients for endarterctomy submitted to percutaneous treatment.
Material and Method: Some groups of patients have an increased risk for carotid surgery, old age >70; previous endarterectomy, concomitant coronary and carotid disease, cervical tumor and/or radiotherapy and those with previous stroke. These patients (p) could benefit from percutaneous procedure.
Between August of 1996 and April of 2001, 86 patients were treated, 43p (50%) considered of high risk for endarterectomy. They were retrospectively analyzed and grouped according to sex gender, clinical presentation, number and kind of stents placed, number of carotid artery treated and immediate complications.
Results: From the 43 high risk patients, 25 (58%) were male; 31p over 70 years old, 5p had previous stroke, 3p coronary artery by-pass graft (CABG), 3p combined stroke and CABG, and 5p had controlateral occlusion. There were 3p with cervical tumor - 2p treated with radiotherapy. A total of 46 stents were used to treat 43 patients-02 patients had right and left carotids treated and another one used 02 stents in the left carotid artery. Wallstent were used in 37 procedures (80%); SMART in 3 arteries, Palmaz, Memotherm and Symphony 2 each. Among the immediate complications we had 2 minor strokes (5,3%); 1 major stroke, followed by death 14 days later (2,6%).
Conclusions: Even though we did not use neurological protection in this series we had a low rate of complications (3p. 7,9%) mainly if we consider that this was a high risk group of patients.

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INTRODUCTION
   Patients with increased risk for carotid endarterectomy are:

- Elderly > 70y
- Previous endarterectomy
- Concomitant Coronary and carotid disease
- Cervical tumor / radiotherapy
- Previous stroke

   They could benefit from percutaneous procedure (Angioplasty - Stenting) less invasive.

OBJECTIVES
   Evaluate our experience in carotid stinting in high-risk patients for endarterectomy submitted to percutaneus treatment: angioplasty and stetting.

MATERIAL AND METHODS

· CAROTID STENTING - From August 1996 to April 2001 (Figure 1)
· GENDER (Figure 2)
· 35 p > 70 years old

8 p previous stroke
6 p both carotids affected
3 p Concomitant CABG (Coronary Artery By pass Graft)
4 p Previous carotid endarterectomy
3 p Cervical tumor / Radiotherapy

RESULTS
   Characteristics of the Lesion (Figure 3)

   Kinds of Stent Used (Figure 4)

COMPLICATIONS
2 p Minor stroke
1 p Major Stroke - Died 14 days later
Death
1P 58y
   Previous Stroke. He had a new Stroke in controlateral cerebral territory to the carotid treated. The Stent was open with good flow.

CONCLUSIONS
   Even though this group of patients was of high-risk for endarterectomy, they had a low rate of complications (considering serious concomitant morbidity) with percutaneus treatment.

   The authors conclude that carotid stetting is a secure therapeutic option in high risk patients.
   Figure 5, Figure 6, Figure 7

Figure 5

Figure 6

Figure 7

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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