INTRODUÇÃO: O tratamento endovascular da doença aterosclerótica carotídea vem evoluindo continuamente, embora possam ocorrer complicações embólicas ou isquêmicas, mesmo com o uso dos sistemas de proteção cerebral. Este estudo teve como objetivo avaliar os resultados de uma série inicial de pacientes que utilizaram o sistema de reversão de fluxo durante angioplastia carotídea. MÉTODOS: Estudo prospectivo, não-randomizado, não-controlado, realizado em um único centro. Foram incluídos pacientes assintomáticos com lesão > 70% ou sintomáticos com lesão > 50% em artéria carótida interna. Foi utilizado o sistema de reversão de fluxo, com pré-dilatação em casos selecionados e uso de stents de células abertas em todos os casos. Avaliou-se a ocorrência de acidentes vasculares encefálicos (AVEs) maiores e menores, ataques isquêmicos transitórios (AITs), infarto agudo do miocárdio (IAM) e óbito até 30 dias pós-procedimento. RESULTADOS: Entre setembro de 2010 e fevereiro de 2011 foram realizadas angioplastias carotídeas em 17 pacientes, a maioria do sexo masculino (70,6%), com média de idade de 66,7 ± 8 anos, sendo 17,6% diabéticos. Cerca de metade dos pacientes era sintomática, 5 pacientes tinham história de AVE prévio (29,4%) e 3, de AIT (17,7%) prévio. Sucesso técnico foi obtido em 100% dos casos. Houve um caso de óbito (5,9%), 24 horas após o procedimento, em paciente de alto risco cirúrgico tratado na fase evolutiva de IAM por apresentar AITs de repetição. Não ocorreram casos de AVE maior ou menor ou AIT durante o período de acompanhamento. CONCLUSÕES: Neste estudo, o sistema de reversão de fluxo mostrou ser eficiente e seguro em pacientes submetidos a angioplastia carotídea.

BACKGROUND: The endovascular treatment of carotid atherosclerotic disease has continuously evolved, although ischemic or embolic complications may occur even with the use of cerebral protection systems. This study was aimed at evaluating the perioperative results of an initial series of patients using the flow reversal system during carotid angioplasty. METHODS: This was a prospective, non-randomized, non-controlled, single-center study. Asymptomatic patients with lesions > 70% or symptomatic patients with lesions > 50% in the internal carotid artery were included. The flow reversal system was used with pre-dilation in selected cases and open-cell stents were used in all cases. We evaluated the occurrence of major and minor strokes, transient ischemic attacks (TIAs), acute myocardial infarction (AMI) and death within 30 days after the procedure. RESULTS: Between September 2010 and February 2011 carotid angioplasty was performed in 17 patients, most of them male (70.6%), with mean age of 66.7 ± 8 years, of which 17.6% were diabetic. Approximately half of the patients were symptomatic, 5 patients had a prior history of stroke (29.4%) and 3 had TIA (17.7%). Technical success was achieved in 100% of the patients. There was one death (5.9%), 24 hours after the procedure in a high surgical risk patient treated in the evolution phase of an AMI due to repetitive TIAs. There were no cases of major or minor strokes or TIAs during the follow-up. CONCLUSIONS: In our study, the flow reversal system proved to be effective and safe in patients undergoing carotid angioplasty.

The objective of this study was to evaluate the impact of dengue virus infection on liver function by measuring aminotransferase in blood samples from patients serologically diagnosed by according to two MAC-ELISA protocols. Degrees of liver damage were classified according to aminotransferase levels: grade A - normal enzyme levels; grade B - increased levels of at least one of the enzymes; grade C - increased, with at least one of the enzymes being at levels higher than three times the upper reference values; grade D - acute hepatitis, with aminotransferase levels at least ten times their normal values. Of the 169 serologically confirmed cases of dengue at the dengue referral center in Campos dos Goytacazes in the state of Rio de Janeiro, Brazil, 65.1% had abnormal aminotransferase levels: 81 cases being classified as grade B, 25 as grade C and 3 as grade D. A further 34.9% of cases had normal enzyme levels and were classified as grade A. Liver damage is a common complication of dengue infection and aminotransferase levels are a valuable marker for monitoring these cases.