Learning curve during percutaneous treatment of carotid lesions

Marcelo O. Bettinotti, Carlos Sztejfman, Ramón Gómez Márquez, Alejandro Goldsmith, Fernando Chiminella, Matías Sztejfman, José Luis Rojas, Marisa Lezcano, Jorge Hiriart

Abstract


Background

Percutaneous transluminal angioplasty (PTA) of the carotid artery with stent implantation is an effective procedure for the prevention of ischemic stroke but its periprocedural morbimortality is still subject to debate.

Objective

The aim of this study is to report the results of a prospective series of patients treated with PTA.

Methods

This is a descriptive, observational, prospective study using the database of three Hemodynamic centers in Buenos Aires, which included all patients submitted to PTA from January 1998 to December 2010. The results of PTA performed by the same operator were analyzed.

Results

Mean age was 69 years, 58% of the patients were men, 58.8% were smokers, 52% had dyslipidemia, 79.1% were hypertensive, and 28% had diabetes. Prior history of acute myocardial infarction and coronary surgery was present in 19.4 and 11.6% of the patients, respectively. From 1998 to 2004 (initial stage, n=54) 72% of symptomatic patients had indication of revascularization, which was performed without cerebral protection in all cases. During the most recent stage (2004-2010, n=171), only 17.5% of the patients were symptomatic and revascularization was performed systematically with cerebral protection. Similar angiographic success was obtained in both stages (initial 96% vs. recent 97%), whereas clinical success rate was greater in the recent phase (96.1% vs. 87%, p=0.016). There were no cardiac complications. The rate of death or intrahospital stroke was 4%, 4.3% (3/70) in symptomatic and 3.2% (5/155) in asymptomatic patients; moreover, this rate was higher in the initial than in the recent phase (11.1% [6/54] vs. 1.7% [2/171], p=0.0028).

Conclusions

PTA represents an acceptably safe therapeutic alternative to surgical revascularization, providing the procedure is performed by experienced operators.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar