JAVA 2019Angioplastia Carotídea: controversias
que persisten, últimas tecnologías, desafíos por delante.
Médico Staff. Departamento de Cardiología
Intervencionista
- Fundación Favaloro -
- Buenos Aires - Argentina -
Dr. León Valdivieso.
Conflicto de interés:
MEDTRONIC:
Proctor en intervenciones Periféricas
Controversias que Persisten
CAS vs CEA
Asymptomatic Carotid Artery Stenosis
Ross Naylor. The Surgeon 2015;13:34-43
Controversias que Persisten
CAS vs CEA
Also crucial “was the exceptionally low number of strokes that occurred in both treatment
groups between the time of the procedure and out to 10 years,” Thomas Brott, MD
Ross Naylor. The Surgeon 2015;13:34-43
Controversias que PersistenWhy is the management of asymptomatic carotid
disease so controversial?
Ultimas Tecnologías
Stents Micromallados:
C-Guard Carotid Stent System (InspireMD)
Roadsaver Carotid Artery Stent System (Microvention/Terumo)
Gore Carotid Stent System (Gore)
Paladin Carotid Post-dilation Balloon and IEP System (Contego)
Neuroguard IEP 3-in-1 System (Contego)
Transcarotid Artery Revascularization:
ENROUTE Transcarotid Neuroprotective System (Silk Road
Medical)
Ultimas Tecnologías
Safety and Efficacy of the New Micromesh-Covered Stent C-Guard
in Patients Undergoing Carotid Artery Stenting: Early Experience
From a Single Centre.
Casana R, et al. Eur Jvasc Endovasc Srg 2017;54:681-687
82 patients (73.8 ± 8.5 years, 75% male, 19% symptomatic)
Immediate Technical Success 100%
Stenosis Diameter reduced from 81.4 ± 4.9% to 11.0 ± 3.5%
P-O Technical and Clinical Success 100% in symptomatics and 98.5% in
asymptomatics
30 days F-U No new events
DW-MRI in last 21 patients new ischaemic lesions 23.8% of patients
average lesion volume 0.039 ± 0.025 cm3.
Ultimas Tecnologías
The Gore Carotid Stent System
Ultimas TecnologíasThe Paladin System
Ultimas Tecnologías
The Neuroguard IEP 3-in1 System
40 u filterSE closed cell stent
Post-dilation balloon
The PERFORMANCE I Trial
Ultimas TecnologíasThe ENROUTE System.
Novel transcarotid device yields low stroke rate during
carotid artery stenting: The ROADSTER Trial
99
3.5 2.8 1.70
20
40
60
80
100
120
Tech Succ D/MI/Stroke D/Stroke All Stroke
Kwolwk et al. J Vasc Surg 2015
Desafíos por delante
CREST-2 trial:
Two Parallel Trials, Three Methods of Stroke Prevention(asymptomatic individuals with severe carotid stenosis)
Trial 1 will assess treatment differences between intensive medical management
alone compared with CEA plus intensive medical management.
Trial 2 will assess treatment differences between intensive medical management
alone compared with CAS plus intensive medical management.
RCTs with New Technologies
Conclusiones
Datos a 10 años confirman la equivalencia de CEA y CAS en la
revascularización carotídea.
En pacientes asintomáticos el tratamiento médico ha mejorado
significativamente pero también lo han hecho los procedimientos de
revascularización. Probablemente el CREST-2 nos aclare un poco a
que pacientes asintomáticos hay que intervenir.
Nuevas tecnologías se han desarrollado para disminuir las
complicaciones de CAS, sobre todo el Stroke mayor y menor. Sus
resultados iniciales son promisorios pero deben ser valoradas con
RCTs a gran escala para determinar su rol en el futuro.
Gracias por su atención