Embolización transarterial en tumores renales y suprarrenales / Transarterial Embolization in Renal and Adrenal Tumors

Evaluar la seguridad y factibilidad de la embolización transarterial como tratamiento coadyuvante prequirúrgico o paliativo. Entre mayo de 2005 y junio de 2013 se realizaron 32 procedimientos de embolización transarterial por patología renal y suprarrenal (30 carcinomas renales, 2 tumores de glándulas suprarrenales). La eficacia del método fue evaluada según el logro del objetivo que motivó la indicación. Los pacientes se dividieron en 2 grupos: Embolización prequirúrgica en el tratamiento combinado de carcinomas renales y embolización como único tratamiento paliativo en tumores inoperables. Se incluyeron 36 procedimientos en 32 pacientes: 30 con carcinoma renal y 2 con tumores en las glándulas suprarrenales. No se presentaron complicaciones intraprocedimiento. El éxito fue del 100 %. En 28 (87,5 %) pacientes se logró la devascularización del 100 %. En nuestra experiencia, la embolización tumoral fue segura y eficaz. Las indicaciones actuales de la embolización transarterial para tumores son: 1. Prequirúrgica, en el tratamiento combinado de carcinomas renales, con el objetivo de disminuir la morbimortalidad del acto quirúrgico. 2. Como único tratamiento, con objetivo paliativo en tumores inoperables.

Evaluate the safety and feasibility of transarterial embolization as a preoperative adjunct or palliative treatment. Between May 2005 and June 2013, 32 transarterial embolization procedures for renal and adrenal pathology were performed (30 renal carcinoma, 2 tumors of adrenal glands). The efficacy of the procedure was determined based on whether the goal for which it was indicated was achieved or not. Patients were divided into 2 groups: 1) preoperative embolization in the combined treatment of renal carcinomas and 2) embolization as the only palliative treatment in inoperable tumors. 36 procedures in 32 patients were included: 30 patients with renal cell carcinoma and 2 patients with adrenal tumors. No intra-procedural complications. Technical success was 100%. In 28 (87.5%) patients, devascularization of 100% was achieved. In our experience, tumor embolization was safe and effective. Current indications of transarterial embolization for tumors are: 1. Pre-operative in the combined treatment of renal cell carcinomas, with the aim of diminishing the morbid-mortality of surgical procedures. 2. As the only treatment, with palliative aim in inoperable tumors.

Angioplastia "primária" de artéria carótida interna direita em paciente com contraindicação à terapia trombolítica / Primary angioplasty of right internal carotid artery in patients with contraindications to thrombolytic therapy

É relatado o caso de paciente do sexo masculino, de 63 anos de idade, que apresentava história prévia de acidente vascular encefálico isquêmico, com sequela motora e oclusão da artéria carótida interna esquerda. O paciente foi admitido no serviço de emergência com episódio agudo (quatro horas após o início dos sintoma) de novo evento isquêmico cerebrovascular. Apresentava contraindicação absoluta para ser submetida a terapia trombolítica, em decorrência da recente utilização de biópsia hepática. Assim, optou-se pela realização, na fase aguda, de angiografia de artéria carótidas e vetebrais. A lesão culpada foi identificada e procedeu-se ao implante de stent autoexpansível, obtendo-se sucesso angiográfico e melhora clínica substancial. Embora não exista substrato robusto na literatura que suporte a conduta adotada (angioplastia "primária" da artéria carótida intena), essa pareceu ser a melhor estratégia a ser implementada naquele momento.

We report a case of a 63-year-old male patient with a previous history of ischemic stroke, motor sequelae and occlusion of the left internal carotid artery. He was admitted at the emergency room with an acute episode of a new ischemic stroke (4 hours after symptoms onset). The patient had an absolute contraindication for thrombolytic therapy due to a recent liver biopsy. Thus, we decided to perform an emergency angiography of the carotid and vertebral arteries. Culprit lesion was identified and we decided to implant a self-expandable stent, obtaining angiographic success and significant clinical improvement. Although we do not have strong evidence supporting the chosen strategy ("primary" angioplasty of the internal carotid artery), it seemed to be the best one to be used at the time.