Publication: Análisis comparativo de morbimortalidad y supervivencia a 12 años del tratamiento de la estenosis carotidea mediante endarterectomía, stent transfemoral y stent transcervical en 481 pacientes. Análisis de coste efectividad
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2016-07-14
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Universidad Complutense de Madrid
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Abstract
Los avances en la era endovascular han causado una revolución en el abordaje de la estenosis carotidea. La irrupción del abordaje transfemoral y transcervical ha hecho que la comunidad científica nos replanteemos las indicaciones terapeúticas en pacientes con estenosis carotidea sintomática o asintomática. Aunque los resultados del abordaje transfemoral mejoraron con la introducción de los sistemas de neuroprotección, un abundante número de estudios randomizados han sido dirigidos para comparar stent transfemoral frente a la endarterectomia. Endarterectomia frente a angioplastia en pacientes con estenosis severa sintomatica(EVA-3S), angioplastia con stent y neuroprotección frente a endarterectomia (SPACE), Angioplastia carotidea y vertebral (CAVATAS), revascularización carotidea mediante stent versus endarterectomia (CREST) estudio internacional carotideo (ICSS) todos fallaron en demostrar una ventaja global del stent transfemoral frente a la endarterectomia. El abordaje transcervical surge por tanto como opción segura de tratamiento, con buenos resultados clínicos iniciales, eliminando así algunas de las complicaciones del acceso transfemoral. Existe hasta la fecha una falta de estudios comparativos de morbimortalidad entre las tres opciones terapeúticas. Además, dado el elevado número de pacientes candidatos a ellos, es necesario una análisis de resultados y supervivencia de los mismos, asi como un análisis de costes relativos y coste-efectividad que podría tener importantes implicaciones en las políticas de salud y en las guias de tratamiento...
Advances in the endovascular era have caused a revolution in the approach of carotid stenosis. The emergence of transfemoral and transcervical approach has made us the scientific community rethink the therapeutic indications in patients with symptomatic or asymptomatic carotid stenosis. Although the results of transfemoral improved with the introduction of neuroprotection systems, a large number of randomized studies have been conducted to compare transfemoral stent versus endarterectomy. Endarterectomy versus angioplasty in patients with symptomatic severe stenosis (EVA-3S), angioplasty with stent and neuroprotection against endarterectomy (SPACE), carotid and vertebral Angioplasty (CAVATAS), carotid revascularization with stenting versus endarterectomy (CREST) international study carotid (ICSS ) all failed to demonstrate an overall advantage of transfemoral stent versus endarterectomy. The transcervical approach thus emerges as a safe treatment option with good initial clinical results, thus eliminating some of the complications of transfemoral access. To date there is a lack of comparative studies of morbidity and mortality among the three treatment options. Moreover, given the large number of candidates for them, you need one survival analysis results thereof, as well as an analysis of relative costs and cost-effectiveness that could have important implications for health policy and Guides treatment...
Advances in the endovascular era have caused a revolution in the approach of carotid stenosis. The emergence of transfemoral and transcervical approach has made us the scientific community rethink the therapeutic indications in patients with symptomatic or asymptomatic carotid stenosis. Although the results of transfemoral improved with the introduction of neuroprotection systems, a large number of randomized studies have been conducted to compare transfemoral stent versus endarterectomy. Endarterectomy versus angioplasty in patients with symptomatic severe stenosis (EVA-3S), angioplasty with stent and neuroprotection against endarterectomy (SPACE), carotid and vertebral Angioplasty (CAVATAS), carotid revascularization with stenting versus endarterectomy (CREST) international study carotid (ICSS ) all failed to demonstrate an overall advantage of transfemoral stent versus endarterectomy. The transcervical approach thus emerges as a safe treatment option with good initial clinical results, thus eliminating some of the complications of transfemoral access. To date there is a lack of comparative studies of morbidity and mortality among the three treatment options. Moreover, given the large number of candidates for them, you need one survival analysis results thereof, as well as an analysis of relative costs and cost-effectiveness that could have important implications for health policy and Guides treatment...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía I, leída el 30/10/2015