#136
|
||||
|
||||
|
#137
|
|||
|
|||
|
#138
|
|||
|
|||
Carotid stenting benefits outweigh risks among standard-risk surgical patients, FDA advisors say - [Ссылки доступны только зарегистрированным пользователям ]
|
#139
|
|||
|
|||
Новые рекомендации:
2011ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. [Ссылки доступны только зарегистрированным пользователям ] |
#140
|
|||
|
|||
Если не вдаваться в подробности, американцы данным руководством легализовали каротидное стентирование, с чем собственно и поздравляю всех интервентов
|
#141
|
||||
|
||||
А если вдаваться?
|
#142
|
||||
|
||||
|
#143
|
|||
|
|||
Цитата:
Что мы видим в 2011году: стентирование - альтернатива КЭА с таким же классом и уровнем доказательности пользы... Цитата:
|
#144
|
|||
|
|||
Если я правильно понял:
- всех симптомных можем брать со стенозами ВСА более 50% по ангиографии более 70% по неинвазивным данным - можем брать и асимптомных (более 60% по ангиографии) если они не подходят для хирургии - с позвоночными артериями как и раньше ничего не понятно - стентируем подключичные, ОСА и БЦС только если есть ишемия в голове, в руке или маммария планируется на КШ (реверсия кровотока по позвоночной не является самостоятельным показанием). |
#145
|
||||
|
||||
Journal Watch Neurology February 8, 2011
Summary and Comment Endarterectomy vs. Carotid Stenting: A Meta-Analysis Age is an important consideration in choosing between these two procedures. Carotid artery atherosclerosis is a major cause of symptomatic cerebrovascular disease linked to approximately one in six strokes each year. Therefore, stroke researchers continue to seek a better understanding of the role of revascularization procedures in optimizing outcomes among patients with severe carotid artery atherosclerotic disease. The Carotid Stenting Trialists' Collaboration (CSTC) investigators conducted a preplanned analysis of individual patient data from three clinical trials (JW Neurol Feb 6 2007 and JW Cardiol Apr 7 2010) in which a total of 3433 patients with recently symptomatic carotid artery stenosis were randomized to undergo carotid artery stenting (CAS) or carotid endarterectomy (CE). Between randomization and 120 days, the risk for stroke or death was significantly higher in the CAS group than in the CE group (8.9% vs. 5.8%). However, age affected the risk: In patients younger than the median age of 70, the risk for stroke or death was similar between the CAS and the CE groups (5.8% and 5.7%), whereas in patients aged 70, the estimated risk with CAS was double that with CE (12.0% vs. 5.9%). In the first Asymptomatic Carotid Surgery Trial (ACST-1), investigators assessed the 10-year benefits of immediate CE versus deferment of carotid procedures in patients with severe asymptomatic carotid stenosis. Although CE carried some risk for perioperative stroke or death (3% within 30 days), allocation to immediate CE (median delay, 1 month) almost halved the nonperioperative stroke rate over the next 10 years (10.8% vs. 16.9%). Net risk (perioperative events plus strokes) remained significantly in favor of immediate CE — 13.4% versus 17.9% at 10 years — but only those younger than 75 benefited because of a higher rate of all-cause mortality in the older patients. Comment: The significantly higher short-term rate of stroke or death among CSTC participants with recently symptomatic severe carotid disease who received stenting versus endarterectomy is consistent with early outcome data from the published Carotid Revascularization Endarterectomy vs. Stenting Trial (JW Cardiol Jun 4 2010). However, to put these early CSTC data into proper context, longer-term data (including rates of myocardial infarction) are needed. Given these and other data, age should now be a major consideration when evaluating the indication for and type of revascularization in patients with severe carotid artery atherosclerosis. Among patients with symptomatic disease, stenting should probably be avoided in those aged 70, whereas among patients with severe asymptomatic disease, immediate endarterectomy should probably be recommended only fo r those younger than 75 who have more than 10 years of reasonable life expectancy. |
#146
|
|||
|
|||
Цитата:
Относительно ACST-1, выходит, что на данный момент не очень разумно обрекать бессимптомного пациента к каротидной реваскуляризации (неважно каким методом) имея 10 летние данные с абсолютной разницей на выходе в 3.5%, при условии, что пациент имеет 3% риск инсульта/смерти интраоперационно и в ближайшие 30дней после реваскуляризации... |
#147
|
||||
|
||||
Guideline on the Management of Patients With Extracranial Carotid and Vertebral AD
Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease
[Ссылки доступны только зарегистрированным пользователям ] |
#148
|
||||
|
||||
|
#149
|
||||
|
||||
Stroke 2011;42:1015-20
While carotid stenting has grown in popularity, rates of restenosis are more frequent than after carotid endarterectomy. In a study involving just over 500 patients, the rate of restenosis (greater than 50% or occlusion) was significantly higher after angioplasty and stenting (12.5%) than after endarterectomy (5%). No significant differences were seen between the groups for the rates of severe restenosis of greater than 70% or occlusion. More data are needed to determine the relation between restenosis and recurrent stroke over time. |
#150
|
|||
|
|||
На LINNC турки при выполнении каротидного стентирования во всех случаях выполняли аспирацию в проекции зоны постдилятации. Была дискуссия не приведшая ни к чему. Доказательно базы нет. Однако из собственного опыта работы с МоМой и Файбернетом скажу, что почти в 100% случаев в аспирате имеется мелкодисперсный атероматозный детрит (с пятирублевую монету на первый шприц аспирации). После такой картины начинаешь верить в целесообразность аспирации. Кто знает доступный в России девайс для аспирации из сонных артерий при стентировании?
|