Endarterectomía carotídea en pacientes con enfermedad cerebrovascular isquémica

espanolINTRODUCCION. La identificacion de los pacientes portadores de enfermedad carotidea, sintomatica o no, y con riesgo de padecer un Ictus, proporcionara a los cirujanos vasculares la oportunidad de realizar una intervencion quirurgica profilactica, la endarterectomia carotidea para su prevencion; la cual es superior al mejor tratamiento medico. OBJETIVOS. Evaluar los resultados de la endarterectomia carotidea en pacientes con enfermedad cerebrovascular isquemica; conocer la distribucion de sus formas clinicas segun sexo; los porcentajes de estenosis entre pacientes sintomaticos y asintomaticos; y determinar los tipos y caracteristicas de dicho proceder quirurgico. SUJETOS Y METODOS. La muestra estuvo compuesta por 61 pacientes, con una edad promedio de 65,7 anos; 21 mujeres (34,4%) y 40 hombres (65,5%), portadores de enfermedad cerebro vascular extra-craneal. Se extrajo de las historias clinicas las siguientes variables: interrogatorio e historia de la enfermedad; examen fisico, clinico y vascular; ultrasonido vascular carotideo, previo y posterior al acto quirurgico, ecocardiograma; RX de torax; electrocardiograma; analitica sanguinea y estudios angiograficos. RESULTADOS. Se encontro que el 81,97% de los pacientes eran sintomaticos con una proporcion similar para hombres (82,5%) y mujeres (80,95%). Se constato que el accidente trombotico isquemico fue la forma clinica que predomino con un 44,26%, seguida por la disfuncion cerebral cronica (24,59%), el stroke (11,47%) y el soplo en la base del cuello (3,28%), con una aparicion similar en hombres y mujeres (42,5% vs 42,86 %). Se pudo observar una elevada frecuencia de pacientes sintomaticos (N=50, 81,97%) y de ellos el 62,3% (N=38) presentaron una estenosis carotidea entre el 70% y 99%. En la mayoria de los casos se empleo la endarterectomia con cierre directo (N=57, 93,4%). El tiempo promedio de clampeo fue de 27,3 min. CONCLUSIONES. La endarterectomia carotidea es el metodo de excelencia en el tratamiento de la estenosis carotidea. EnglishINTRODUCTION. Surgery is highly beneficial in patients with a symptomatic stenosis of 70% or greater. The identification of the patient whit carotid lesion and the benefit is unknown in asymptomatic patients. Surgery has also been shown to reduce the risk of stroke, carotid endarterectomy for their prevention; it is the best of medical treatment. OBJECTIVE. Evaluate the carotid endarterectomy in patient with cerebrovascular ischemic illness; know the distribution according to sex and ways clinical; the stenosis, percentages of stenosis among patient symptomatic and asymptomatic; and to determine the characteristic and types surgical proceed. METHODS. The sample was integrated by 61 patients; 21 women (34,4%) and 40 men (65,5%), with an age average of 65,7 year-old; payees of extra brain - cranial vascular of illness. The variables of it was extracted clinical histories of those the following ones: history of and of interrogation of the illness; physical examine, and of vascular clinical; vascular ultrasound, and surgical carotid of act of to the later one of previous, echocardiogram; RX of the thorax; EKG; angiographic of studies, and sanguine analytic complement. RESULTS. 81,97 % of high rail of it was found that of proportion women of and of men (82,5%) of for similar of one of cheat of symptomatic of they were of patient of those (80,95%). The % of an of cheat of it prevailed 44,26% that of form clinic of it was of ischemic thrombotic accident of high rail of it was verified that, chronicle of the cerebral dysfunction of for of followed (24,59%), neck of super of base of blow of high rail of and suddenly of (11,47%) high (3,28%) rail, appearance women of and of men of in similar of one of cheat (42,5% versus 42,86%). One could observe a high frequency of and of symptomatic (n=50; 81,97%) of patient of carotid stenosis of one of they presented of 62,3% (n=38) high rail 62,30 of them it enters and of rail high between 70% and 99%. In most of the direct one of closing of cheat of endarterectomy of employment of you of cases of those (n=57; 93,4%). Average of time of high rail of it was of clamper of 27,3 minutes. CONCLUSION. Carotid endarterectomy remains the standard revascularization technique for the prevention of ischemic stroke resulting from severe carotid stenosis.