RESUMO
Carotid angioplasty and stenting (CAS) has been touted as a reasonable alternative to carotid endarterectomy (CEA) for high-risk surgical candidates. Several published CAS series, primarily from academic centers, show immediate results approaching those of CEA. However, very little is known about long-term results with CAS, particularly in the community hospital setting. Therefore, we retrospectively reviewed our CAS experience. From February 1999 to July 2003, 44 consecutive patients underwent placement of 46 stents. The mean patient age was 73 years, and 57 per cent were men. Most patients were asymptomatic (74%). High-risk categories included prior CEA (71%), other anatomic risks (13%), and/or significant medical comorbidities (16%). Technical success was achieved in all 46 cases. At 30 days, there were no deaths and one stroke, giving a combined stroke/mortality of 2 per cent. Clinical follow-up was obtained on all 44 patients at a mean follow-up of 42 months. Duplex scans performed on 44 stents (96%), at a mean follow-up of 40 months, demonstrated four 60 per cent to 79 per cent recurrent stenoses. CAS in a community hospital can have a 30-day stroke/mortality equivalent to CEA. The procedure is durable, with no critical (80%-99%) carotid restenoses and no stroke or transient ischemic attacks referable to a stented carotid artery in long-term follow-up.
Assuntos
Angioplastia/métodos , Estenose das Carótidas/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Endarterectomia das Carótidas , Estudos de Viabilidade , Feminino , Seguimentos , Hospitais Comunitários , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
Renal artery occlusion after blunt trauma is a rare occurrence, and the optimal treatment for this condition has not been established. To our knowledge, endovascular repair for blunt renal artery occlusion in a solitary kidney has not been described in the literature. This case report describes a 42-year-old woman with a solitary left kidney presenting with total occlusion of the left renal artery after a significant crush injury. She was successfully treated by percutaneous placement of an endovascular stent. Postprocedure, the patient developed acute renal failure requiring temporary dialysis. At follow-up 4 months later, the patient has normal urinary output and a normal creatinine.