Análisis comparativo de morbimortalidad y supervivencia a 12 años del tratamiento de la estenosis carotidea mediante endarterectomía, stent transfemoral y stent transcervical en 481 pacientesanálisis coste-efectividad

Resumo

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...