Tratamento endovascular com stent coberto de aneurisma carotídeo associado a arterite rádica

 

Emanuel Dias*, Gonçalo Alves** Leonor Vasconcelos***, J. Aragão de Morais****, J. Albuquerque e Castro*****, L. Mota Capitão ******

Hospital de Santa Marta,EPE Serviço de Angiologia e Cirurgia Vascular (Director: Dr.L. Mota Capitão)

* 50Ano do Internato Médico de Angiologia e Cirurgia Vascular

** 30Ano do Internato Médico de Angiologia Cirurgia Vascular

***Assistente Hospitalar de Angiologia e Cirurgia Vascular

****Assist Hospitalar Grad. de Angiologia e Cirurgia Vascular

***** Chefe de Serviço de Angiologia e Cirurgia Vascular

 

|RESUMO|

Introdução: O uso de radioterapia no tratamento de neoplasias pode causar inflamação e fibrose nas artérias adjacentes e levar a estenose com significado clínico ou, raramente, à formação de aneurismas. A arterite carotídea associada à radioterapia tem surgido como critério anatómico de alto risco para a endarterectomia carotídea (CEA), sendo a arterioplastia e stenting carotídeo (CAS) encarado como uma alternativa terapêutica atrativa, apesar da falta de dados acerca dos resultados a longo prazo nesta indicação.

Caso clínico: Homem de 70 anos, com antecedentes de neoplasia da laringe em 1998, sujeito a laringectomia radical e a radioterapia adjuvante. Admitido electivamente para tratamento de estenose da artéria carótida primitiva (ACC) direita superior a 70%, medida em velocimetria de Eco-doppler, e de pequeno aneurisma do bulbo carotídeo ipsilateral. Apresentava história de acidente isquémico transitório 3 meses antes. O doente foi sujeito a colocação de stent coberto Viabahn® por via percutânea femoral direita na presença de dispositivo de protecção cerebral FilterWire EZ™, cobrindo as artérias carótidas comum e interna direitas no intuito de tratar a estenose da ACC e a dilatação aneurismática do bulbo carotídeo. O seguimento aos 6 meses não mostrou intercorrências.

Conclusão: A utilização de um stent coberto para tratamento deste caso de arterite carotídea associada à radiação mostrou-se uma opção simples, eficaz e sem o risco das complicações associadas à cirurgia convencional.

Palavras-chave: arterite rádica, endoprótese, tratamento endovascular

 

Endovascular treatment with a covert-stent of radiation-associated carotid aneurysm

|ABSTRACT|

Introduction: Clinically significant arterial stenosis and aneurysm may result from inflamation and fibrosis induced by radiotherapy directed to an adjacent tumour. Carotid artery arterioplasty and stenting (CAS) have revealed as valid alternatives to carotid endarteriectomy (CEA) in patients with high risk such as patients with carotid arteritis secondary to radiotherapy. However, long-term follow-up are sparse.

Clinical Case: A 70 year-old male, with a larynx carcinoma diagnosed in 1998, submitted to a radical laryngectomy and adjuvant radiotherapy, with a Transient Ischaemic Attack 3 months before, was admitted to our department with a stenosis superior to 70% of the active common carotid artery (CCA) diagnosed by Ecodoppler. Also, the ipsilateral Bulbus was aneurysmatic.

A Viabahn® covert-stent was deployed by right transfemoral access under cerebral protection, covering the CCA and the internal carotid artery, correcting the stenosis and also the aneurysm. Follow-up at 6 months has not shown any adverse events.

Conclusion: Covert stenting of the carotid artery is a simple, efficient and simple option for the treatment of carotid arteritis secondary to radiotherapy and without the risks associated to conventional surgery.

Key words: radiation arteritis, stentgrafts, endovascular treatment

 

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