Com a tendência do diagnóstico não-invasivo como método de imagem isolado na indicação cirúrgica da estenose carotídea, é fundamental a confiança do cirurgião no ecografista. Este também deve auditar seus resultados regularmente, comparando-os com outros métodos de imagem como a angioressonância, a angiotomografia e, principalmente, com a arteriografia.

No HCPA indicamos a endarterectomia de carótida nas estenoses acima de 70% independente do paciente ser sintomático ou assintomático, levando em consideração o grau de estenose em relação ao diâmetro da artéria carótida interna distal (critérios do NASCET).46

A American Heart Association, em reunião do comité executivo no ano de 1998, definiu suas metas para os próximos dez anos: reduzir a doença coronariana, o AVC e os fatores de riscos em 25%. Os planos incluem uma vigilância dos sintomas e o aumento no acesso dos pacientes com IAM, AVC e risco de morte súbita ao atendimento de emergência.47 Esta deve ser também a nossa luta. O reduzido número de endarterectomias de carótida no nosso meio tem privado muitos paciente dos benefícios da cirurgia. Este é o nosso pensamento.

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