java 2019 angioplastia carotídea: controversias que persisten, … · ultimas tecnologías safety...

JAVA 2019Angioplastia Carotídea: controversias

que persisten, últimas tecnologías, desafíos por delante.

Médico Staff. Departamento de Cardiología

Intervencionista

- Fundación Favaloro -

- Buenos Aires - Argentina -

Dr. León Valdivieso.

Conflicto de interés:

MEDTRONIC:

Proctor en intervenciones Periféricas

Controversias que Persisten

CAS vs CEA

Asymptomatic Carotid Artery Stenosis

Ross Naylor. The Surgeon 2015;13:34-43

Controversias que Persisten

CAS vs CEA

Also crucial “was the exceptionally low number of strokes that occurred in both treatment

groups between the time of the procedure and out to 10 years,” Thomas Brott, MD

Ross Naylor. The Surgeon 2015;13:34-43

Controversias que PersistenWhy is the management of asymptomatic carotid

disease so controversial?

Ultimas Tecnologías

Stents Micromallados:

C-Guard Carotid Stent System (InspireMD)

Roadsaver Carotid Artery Stent System (Microvention/Terumo)

Gore Carotid Stent System (Gore)

Paladin Carotid Post-dilation Balloon and IEP System (Contego)

Neuroguard IEP 3-in-1 System (Contego)

Transcarotid Artery Revascularization:

ENROUTE Transcarotid Neuroprotective System (Silk Road

Medical)

Ultimas Tecnologías

Safety and Efficacy of the New Micromesh-Covered Stent C-Guard

in Patients Undergoing Carotid Artery Stenting: Early Experience

From a Single Centre.

Casana R, et al. Eur Jvasc Endovasc Srg 2017;54:681-687

82 patients (73.8 ± 8.5 years, 75% male, 19% symptomatic)

Immediate Technical Success 100%

Stenosis Diameter reduced from 81.4 ± 4.9% to 11.0 ± 3.5%

P-O Technical and Clinical Success 100% in symptomatics and 98.5% in

asymptomatics

30 days F-U No new events

DW-MRI in last 21 patients new ischaemic lesions 23.8% of patients

average lesion volume 0.039 ± 0.025 cm3.

Ultimas Tecnologías

The Gore Carotid Stent System

Ultimas TecnologíasThe Paladin System

Ultimas Tecnologías

The Neuroguard IEP 3-in1 System

40 u filterSE closed cell stent

Post-dilation balloon

The PERFORMANCE I Trial

Ultimas TecnologíasThe ENROUTE System.

Novel transcarotid device yields low stroke rate during

carotid artery stenting: The ROADSTER Trial

99

3.5 2.8 1.70

20

40

60

80

100

120

Tech Succ D/MI/Stroke D/Stroke All Stroke

Kwolwk et al. J Vasc Surg 2015

Desafíos por delante

CREST-2 trial:

Two Parallel Trials, Three Methods of Stroke Prevention(asymptomatic individuals with severe carotid stenosis)

Trial 1 will assess treatment differences between intensive medical management

alone compared with CEA plus intensive medical management.

Trial 2 will assess treatment differences between intensive medical management

alone compared with CAS plus intensive medical management.

RCTs with New Technologies

Conclusiones

Datos a 10 años confirman la equivalencia de CEA y CAS en la

revascularización carotídea.

En pacientes asintomáticos el tratamiento médico ha mejorado

significativamente pero también lo han hecho los procedimientos de

revascularización. Probablemente el CREST-2 nos aclare un poco a

que pacientes asintomáticos hay que intervenir.

Nuevas tecnologías se han desarrollado para disminuir las

complicaciones de CAS, sobre todo el Stroke mayor y menor. Sus

resultados iniciales son promisorios pero deben ser valoradas con

RCTs a gran escala para determinar su rol en el futuro.

Gracias por su atención