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Risk-Benefit Assessment of Carotid Revascularization

Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes. To review the mai...

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Autores principales: de Oliveira, Pedro Piccaro, Vieira, José Luiz da Costa, Guimarães, Raphael Boesche, Almeida, Eduardo Dytz, Savaris, Simone Louise, Portal, Vera Lucia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cardiologia - SBC 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199518/
https://www.ncbi.nlm.nih.gov/pubmed/30365684
http://dx.doi.org/10.5935/abc.20180208
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author de Oliveira, Pedro Piccaro
Vieira, José Luiz da Costa
Guimarães, Raphael Boesche
Almeida, Eduardo Dytz
Savaris, Simone Louise
Portal, Vera Lucia
author_facet de Oliveira, Pedro Piccaro
Vieira, José Luiz da Costa
Guimarães, Raphael Boesche
Almeida, Eduardo Dytz
Savaris, Simone Louise
Portal, Vera Lucia
author_sort de Oliveira, Pedro Piccaro
collection PubMed
description Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes. To review the main studies on carotid revascularization, evaluating the relationship between risks and benefits of this procedure. The data reviewed show that, for a net benefit, carotid intervention should only be performed in cases of a periprocedural risk of less than 6% in symptomatic patients. The medical therapy significantly reduced the revascularization net benefit ratio for stroke prevention in asymptomatic patients. Real life registries indicate that carotid stenting is associated with a greater periprocedural risk. The operator annual procedure volume and patient age has an important influence in the rate of stroke and death after carotid stenting. Symptomatic patients have a higher incidence of death and stroke after the procedure. Revascularization has the greatest benefit in the first weeks of the event. There is a discrepancy in the scientific literature about carotid revascularization and/or clinical treatment, both in primary and secondary prevention of patients with carotid artery injury. The identification of patients who will really benefit is a dynamic process subject to constant review.
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spelling pubmed-61995182018-10-29 Risk-Benefit Assessment of Carotid Revascularization de Oliveira, Pedro Piccaro Vieira, José Luiz da Costa Guimarães, Raphael Boesche Almeida, Eduardo Dytz Savaris, Simone Louise Portal, Vera Lucia Arq Bras Cardiol Review Article Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes. To review the main studies on carotid revascularization, evaluating the relationship between risks and benefits of this procedure. The data reviewed show that, for a net benefit, carotid intervention should only be performed in cases of a periprocedural risk of less than 6% in symptomatic patients. The medical therapy significantly reduced the revascularization net benefit ratio for stroke prevention in asymptomatic patients. Real life registries indicate that carotid stenting is associated with a greater periprocedural risk. The operator annual procedure volume and patient age has an important influence in the rate of stroke and death after carotid stenting. Symptomatic patients have a higher incidence of death and stroke after the procedure. Revascularization has the greatest benefit in the first weeks of the event. There is a discrepancy in the scientific literature about carotid revascularization and/or clinical treatment, both in primary and secondary prevention of patients with carotid artery injury. The identification of patients who will really benefit is a dynamic process subject to constant review. Sociedade Brasileira de Cardiologia - SBC 2018-10 /pmc/articles/PMC6199518/ /pubmed/30365684 http://dx.doi.org/10.5935/abc.20180208 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
de Oliveira, Pedro Piccaro
Vieira, José Luiz da Costa
Guimarães, Raphael Boesche
Almeida, Eduardo Dytz
Savaris, Simone Louise
Portal, Vera Lucia
Risk-Benefit Assessment of Carotid Revascularization
title Risk-Benefit Assessment of Carotid Revascularization
title_full Risk-Benefit Assessment of Carotid Revascularization
title_fullStr Risk-Benefit Assessment of Carotid Revascularization
title_full_unstemmed Risk-Benefit Assessment of Carotid Revascularization
title_short Risk-Benefit Assessment of Carotid Revascularization
title_sort risk-benefit assessment of carotid revascularization
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199518/
https://www.ncbi.nlm.nih.gov/pubmed/30365684
http://dx.doi.org/10.5935/abc.20180208
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