Carotid angioplasty in diabetic patients carriers of critical carotid stenosis. Experience in a hospital in Mexico; results and six-month follow-up / Angioplastia carotídea en pacientes diabéticos portadores de estenosis carotídea crítica. Experiencia en un hospital en México; resultados y seguimiento a seis meses
Rev. mex. cardiol
;
29(1): 4-12, Jan.-Mar. 2018. tab, graf
Article
in English
| LILACS
| ID: biblio-1004295
ABSTRACT
Abstract Objective:
To evaluate the impact of diabetic status on outcome of patients undergoing carotid artery stenting (CAS).Background:
Diabetes has been demonstrated to be a strong predictor of adverse outcome in patients undergoing coronary revascularization. Its significance in predicting outcome of patients undergoing carotid interventions has not been ascertained.Methods:
This research is an observational, retrospective, comparative, descriptive study.Results:
279/341 patients/lesions were evaluated for carotid stenosis undergoing stenting. Non-diabetics versus diabetics were compared. Of the diabetic group, 59.5% were men, mostly hypertensive and with hypercholesterolemia. More than 40% of both groups had a prior percutaneous coronary intervention (PCI), 68.2% were asymptomatic and a half was high risk, greater comorbidity in the diabetic group with an EuroSCORE > 3, 46 vs 21.4% p = 0.000. No statistically significant difference was found in terms of major adverse cardiovascular events (MACE) at 30 days and accumulated six months in the non-diabetic group (non-DM) versus the diabetic (DM) nine patients (5.4%) versus eight (4.8%), p = 0.756 OR, 95% CI 0.857 (0.322-2.27) and 14 (8.3%) versus nine (5.3%), p = 0.249 OR, 95% CI 0.604 (0254-1435), respectively. Diabetic patients treated with carotid stent who underwent cardiovascular surgery showed a higher intrahospitalary mortality (4.6 vs 0.6%, p = 0.02). There was a higher rate of restenosis (1.9 vs 0%, p = 0.077) in non-diabetic patients. An increased incidence of TIA (transient ischemic attack) was observed in diabetic patients (8.7 vs 3.6%, p = 0.05).Conclusion:
Diabetics undergoing CAS are more likely to have associated co-morbidities. However despite this handicap, their short term outcome after CAS is similar to that of non diabetics. Endovascular treatment of carotid stenosis may be a good alternative to surgical treatment.(AU)RESUMEN
Resumen Objetivo:
Evaluar el impacto del estado diabético sobre el resultado de los pacientes que se someten a la colocación de stents en la arteria carótida (CAS). Antecedentes Se ha demostrado que la diabetes es un fuerte predictor de resultados adversos en pacientes sometidos a revascularización coronaria. No se ha determinado su importancia para predecir el resultado de los pacientes que se someten a intervenciones carotídeas.Métodos:
Esta investigación es un estudio observacional, retrospectivo, comparativo y descriptivo.Resultados:
Se evaluaron 279/341 pacientes/lesiones para la estenosis carotídea sometida a colocación de stents. Se compararon los no diabéticos versus los diabéticos. Del grupo diabético, 59.5% fueron hombres, la mayoría hipertensos y con hipercolesterolemia. Más del 40% de ambos grupos tuvieron una intervención coronaria percutánea (ICP) previa, el 68.2% fueron asintomáticos y la mitad de ellos de alto riesgo, mayor comorbilidad en el grupo diabético con un EuroSCORE > 3, 46 vs 21.4% p = 0.000. No se encontraron diferencias estadísticamente significativas en cuanto a los eventos cardiovasculares adversos mayores (MACE) a los 30 días y acumulados a los seis meses en el grupo no diabético (no DM) versus diabético (DM) nueve pacientes (5.4%) versus ocho (4.8%), p = 0.756 OR; IC 95% 0.857 (0.322-2.27) y 14 (8.3%) versus nueve (5.3%), p = 0.249 OR; IC 95% 0.604 (0254-1435), respectivamente. Los pacientes diabéticos tratados con endoprótesis carotídea sometidos a cirugía cardiovascular mostraron una mortalidad intrahospitalaria mayor (4.6 vs 0.6%, p = 0.02). Hubo una mayor tasa de reestenosis (1.9 vs 0%, p = 0.077) en pacientes no diabéticos. Se observó una mayor incidencia de AIT (ataque isquémico transitorio) en pacientes diabéticos (8.7 vs 3.6%, p = 0.05).Conclusión:
Los diabéticos que se someten a la CAS son más propensos a tener comorbilidades asociadas. Sin embargo, a pesar de esta desventaja, su resultado a corto plazo después del CAS es similar al de los no diabéticos. El tratamiento endovascular de la estenosis carotídea puede ser una buena alternativa al tratamiento quirúrgico.(AU)
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Carotid Artery, Internal
/
Carotid Stenosis
/
Angioplasty
/
Diabetes Mellitus
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
Country/Region as subject:
Mexico
Language:
English
Journal:
Rev. mex. cardiol
Journal subject:
Cardiology
Year:
2018
Type:
Article
Affiliation country:
Mexico
Institution/Affiliation country:
Mexican Social Security Institute/MX
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