[Early therapeutic intervention: thromboendarterectomy and percutaneous transluminal angioplasty].
Occlusion of the internal carotid artery (ICA) due to atherosclerosis, or more rarely thromboembolism, is a fairly frequent cause of stroke. Spontaneous ICA occlusion is associated with a 40 to 69% incidence of profound neurologic deficit and a 16 to 55% death rate. Management of this entity, however, continues to be controversial, as currently used treatments have not yet been shown to modify morbidity/morbility rate. Acute-phase performance of thromboendarterectomy or percutaneous transluminal angioplasty may play a role in ICA treatment. Emergency revascularization has not generally been considered to benefit stroke patients: clinical improvement is only slight in many cases and the incidence of perioperative complications, particularly brain hemorrhage, is high. Review of the literature, however, demonstrates that adequate restoration of flow is achievable in a subgroup of patients with spontaneously occluded symptomatic ICAs without severe neurological deficit, without decreased level of consciousness and without intracerebral hemorrhage manifest in computed tomography or magnetic resonance images. The outcome of emergency intervention also seems to depend on the duration of symptoms, individual collateral blood flow and the angiographic reflux pattern in the ICA. Given the potential usefulness of these surgical techniques, controlled clinical comparison of operated and non-operated groups seems highly recommendable in spite of the significant difficulties involved.
Gil-Peralta
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Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla.
D000800:Angioplasty, Balloon; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D013923:Thromboembolism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*
Terapéutica intervencionista precoz: tromboendarterectomía y angioplastia transluminal percutánea.