Symptomatic carotid stenosis. The endovascular of surgical treatment

被引:0
作者
Leseche, Guy [1 ]
机构
[1] Hop Bichat Claude Bernard, AP HP, Serv Chirurg Vasc Thorac Transplantat Pulm, F-75018 Paris, France
来源
SANG THROMBOSE VAISSEAUX | 2010年 / 22卷 / 08期
关键词
carotid endarteriectomy; controled studies; stenting; SILENT BRAIN INFARCTS; ENDARTERECTOMY; ANGIOPLASTY; RISK;
D O I
10.1684/stv.2010.0515
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Symptomatic carotid stenosis. The endovascular of surgical treatment The carotid stenting is often considered, without real scientific evidence, as a valuable alternate technique of revascularization and endarteriectomy. Three randomized clinical trials compared the surgical endarteriectomy with endovascular stenting in patients with symptomatic tight atheromatous carotid stenosis. The EVA3-S trial has been stopped, after inclusion of 527 patients, in reason of an excess of strokes or deaths at day 30 in the arm endovascular stenting vs. the surgical one. In the SPACE trial, the rate of stroke or death at day 30 was 7,7% in the arm "endovascular stenting" vs. 6,5% in the surgical arm (statistically non inferior). Results from both studies evidenced that the endovascular treatment did not have the same level of safety than the surgical one. Moreover, preliminary results of the ICSS trial evidenced, after carotid stenting, a percentage of stroke or death of 8,5% in the group "stent" and of 4,7% in the group "endarteriectomy" (p = 0,001). Meta-analyzes of these three trials confirmed the significant superiority of surgery and showed an increased relative risk of stroke, death and myocardial infarction in patients randomized in the "endovascular treatment" arm. In these three clinical trials, the endovascular treatment did not reach the level of safety required by the experts (stroke and death 6%). The only evidenced superiority of the stenting procedure was related to the lower surgical risk of hematomas and of lesions of cranial nerves. Thus, there is no doubt that the endarteriectomy is, and must remain today, the preferred technique of revascularization in patients having a symptomatic tight atheromatous carotid stenosis. Further studies are needed to evaluate the risk of subclinical cerebral infarction and, finally, the global morbid-mortality and the cost of surgery following the failure of the surgical and the endarteriectomy techniques in addition to the occurrence of death and stroke.
引用
收藏
页码:409 / 414
页数:6
相关论文
共 24 条
  • [1] Bonati LH, 2010, LANCET NEUROL, V9, P353, DOI 10.1016/S1474-4422(10)70057-0
  • [2] Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial
    Bonati, Leo H.
    Ederle, Joerg
    McCabe, Dominick J. H.
    Dobson, Joanna
    Featherstone, Roland L.
    Gaines, Peter A.
    Beard, Jonathan D.
    Venables, Graham S.
    Markus, Hugh S.
    Clifton, Andrew
    Sandercock, Peter
    Brown, Martin M.
    [J]. LANCET NEUROLOGY, 2009, 8 (10) : 908 - 917
  • [3] Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis
    Brott, Thomas G.
    Hobson, Robert W., II
    Howard, George
    Roubin, Gary S.
    Clark, Wayne M.
    Brooks, William
    Mackey, Ariane
    Hill, Michael D.
    Leimgruber, Pierre P.
    Sheffet, Alice J.
    Howard, Virginia J.
    Moore, Wesley S.
    Voeks, Jenifer H.
    Hopkins, L. Nelson
    Cutlip, Donald E.
    Cohen, David J.
    Popma, Jeffrey J.
    Ferguson, Robert D.
    Cohen, Stanley N.
    Blackshear, Joseph L.
    Silver, Frank L.
    Mohr, J. P.
    Lal, Brajesh K.
    Meschia, James F.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (01) : 11 - 23
  • [4] Brown MM, 2001, LANCET, V357, P1729
  • [5] Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial (vol 7, pg 893, 2008)
    Eckstein, H-H
    Ringleb, P.
    Allenberg, J-R
    [J]. LANCET NEUROLOGY, 2009, 8 (02) : 135 - 135
  • [6] Percutaneous transluminal angioplasty and stenting for carotid stenosis: a Cochrane review
    Ederle, Joerg
    Featherstone, Roland L.
    Brown, Martin M.
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2010, 81 (05) : 477 - 478
  • [7] Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
    Ederle, Joerg
    Dobson, Joanna
    Featherstone, Roland L.
    Bonati, Leo H.
    van der Worp, H. Bart
    de Borst, Gert J.
    Lo, T. Hauw
    Gaines, Peter
    Dorman, Paul J.
    Macdonald, Sumaira
    Lyrer, Philippe A.
    Hendriks, Johanna M.
    McCollum, Charles
    Nederkoorn, Paul J.
    Brown, Martin M.
    Algra, A.
    Bamford, J.
    Beard, J.
    Bland, M.
    Bradbury, A. W.
    Brown, M. M.
    Clifton, A.
    Gaines, P.
    Hacke, W.
    Halliday, A.
    Malik, I.
    Mas, J. L.
    McGuire, A. J.
    Sidhu, P.
    Venables, G.
    Bradbury, A.
    Brown, M. M.
    Clifton, A.
    Gaines, P.
    Collins, R.
    Molynewc, A.
    Naylor, R.
    Warlow, C.
    Ferro, J. M.
    Thomas, D.
    Bonati, L. H.
    Coward, L.
    Dobson, J.
    Ederle, J.
    Featherstone, R. F.
    Tindall, H.
    McCabe, D. J. H.
    Wallis, A.
    Brooks, M.
    Chambers, B.
    [J]. LANCET, 2010, 375 (9719) : 985 - 997
  • [8] Ernst JMPG, 2003, J ENDOVASC THER, V10, P702
  • [9] The CAPTURE registry: Predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting
    Gray, William A.
    Yadav, Jay S.
    Verta, Patrick
    Scicli, Andrea
    Fairman, Ronald
    Wholey, Mark
    Hopkins, L. Nelson
    Atkinson, Richard
    Raabe, Rod
    Barnwell, Stanley
    Green, Richard
    [J]. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2007, 70 (07) : 1025 - 1033
  • [10] Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase
    Hobson, RW
    Howard, VJ
    Roubin, GS
    Brott, TG
    Ferguson, RD
    Popma, JJ
    Graham, DL
    Howard, G
    [J]. JOURNAL OF VASCULAR SURGERY, 2004, 40 (06) : 1106 - 1110