Current management of carotid artery stenosis. what does the evidence show us?
Objective. Surgery of carotid artery stenosis as treatment for acute cerebral vascular accident was most used in the 1980s. This surgical procedure is one of the few to have been ‘examined’ to demonstrate its usefulness by means of a series of prospective multicentric trials, carried out between 1980 and 1990. This paper aims to show the results of these trials and give useful advice for current management of these patients. Development. We describe the most important studies carried out to date, both in the group of patients with symptomatic and those with asymptomatic carotid artery stenosis. We emphasize the impor[1]tance of achieving low morbi-mortality, both in the surgical procedure and in diagnosis. We describe the advantages and disadvantages of non-invasive methods of diagnosis, alternatives to cerebral angiography, and discuss current indications for carotid artery surgery in symptomatic and asymptomatic groups. Conclusions. The most important cooperative studies (ECST and NASCET) have shown the validity of surgical in combination with medical treatment, as opposed to medical treatment alone, in order to avoid further neurological incidents in patients with symptomatic carotid stenosis. The only cooperative study which has shown the superiority of surgical treatment, as compared with medical treatment, in a group of asymptomatic patients was ACAS (particularly in male patients)
Desarrollo Se describen los estudios más importantes realizados hasta el momento, tanto en el grupo de pacientes con estenosis carotídea sintomática, como en los de asintomática. Se hace hincapié en la importancia de obtener una baja morbi-mortalidad, tanto en el procedimiento quirúrgico como en el diagnóstico. Se describen las ventajas y los inconvenientes de los métodos de diagnóstico no invasivos, alternativos a la angiografía cerebral, y se apuntan las indicaciones actuales de la cirugía carotídea en el grupo de pacientes sintomáticos y en el de los asintomáticos.
Conclusiones Los estudios cooperativos más importantes (ECST y NASCET) han demostrado la validez del tratamiento quirúrgico en combinación con el tratamiento médico, frente al tratamiento médico en solitario, a la hora de evitar nuevos eventos neurológicos en pacientes con estenosis carotídea sintomática. El único estudio cooperativo que ha mostrado la superioridad del tratamiento quirúrgico frente al médico, en el grupo de pacientes asintomáticos, ha sido el ACAS, y de manera particular en el grupo de pacientes pertenecientes al sexo masculino
