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Y a-t-il une place pour l'angioplastie et stenting de la carotide?

Authors: Emmanuel Touzé;

Y a-t-il une place pour l'angioplastie et stenting de la carotide?

Abstract

L’angioplastie stenting de la carotide (ASC) pourrait constituer une alternative a l’endarterectomie carotidienne (EAC). Cependant, les essais randomises montrent que l’ASC pratiquee chez des patients porteurs d’une stenose carotidienne symptomatique, par ailleurs eligibles pour la chirurgie, est associee a un plus mauvais pronostic a court terme. Les patients percus a haut risque chirurgical pourraient constituer des bons candidats a l’ASC. Cependant, il n’y a pas de definition univoque du haut risque chirurgical et l’ASC a ete comparee a l’EAC dans une seule etude randomisee de petite taille. De nombreux registres suggerent que les taux de complications entre ASC et EAC sont comparables. Cependant, lorsque les analyses sont stratifiees en fonction du caractere symptomatique ou non de la stenose, les taux de complications perioperatoires de l’ASC sont superieurs a ceux de l’EAC. Les facteurs de risque de complications perioperatoires de l’EAC semblent differer de ceux de l’ASC. A moyen terme, les deux techniques semblent avoir une efficacite comparable, mais le taux de restenose est plus eleve en cas d’ASC. Ainsi, l’EAC reste le traitement de reference des stenoses carotides pour lesquelles un traitement chirurgical est possible. Il est possible que l’ASC constitue une option interessante chez certains patients, mais il reste beaucoup a faire pour identifier ces patients.

Keywords

Hematology

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    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
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