Ekstrakranial Karotis Arter Hastalığına Uygulanan Endarterektomi Kısa Dönem Sonuçları

Abstract

Amaç: Yakın zamanda yayınlanan karotis arter darlığı tedavisindeki çalışmalar eski sonuçlarla çelişmektedir. Bazı uzmanlar, bu bulguların asemptomatik hastalarda karotis revaskülarizasyona (karotis endarterektomi veya karotis stentleme) konservatif yaklaşımı desteklediğini ifade etmektedir. Bu çalışmanın amacı karotis endarterektomi sonuçlarının preoperatif semptom durumuna dayalı olarak incelenmesidir.

Gereç ve Yöntemler: Bu retrospektif çalışmaya Ağustos 2008 ve Ağustos 2015 tarihleri arasında internal karotis arter darlığına karotis endarterektomi uygulanan hastalar dahil edilmiştir. Hastalar preoperative semptomlarına göre iki gruba ayrıldı. Asemptomatik grup preoperatif nörolojik semptomu bulunmayan 41 hasta içermekte ve semptomatik grup preoperatif nörolojik semptomu (vertigo, amorozis fugax, geçici iskemik atak ve iskemik inme) olan 62 hasta içermekte idi. Postoperatif dönemde tüm hastalara kılavuzların önerisine uygun olarak standart tedavi uygulandı.

Bulgular: Bu çalışmaya 103 hasta dahil edildi. Hastaların ortalama yaşı 68,20±9,79 (aralık, 41-86) yıl ve 27 (%26,2)’si kadın idi. Gruplar arasında, risk grubu dışında demografik özellikler açısından istatiksel anlamlı farklılık yoktu; asemptomatik grupta yüksek riskli olarak gruplanan hasta daha fazlaydı (p=0,001). Asemptomatik grupta, semptomatik grup ile karşılaştırıldığında postoperatif mortalite istatistiksel olarak anlamlı şekilde daha fazla görüldü (p=0,028). Preoperatif değişkenlerinin hiç biri postoperatif inme ile ilişkili değildi. Semptomatik grupta, postoperatif inme preoperatif geçici iskemik atak ve majör inme olan hastalarda görüldü.

Sonuç: Asemptomatik karotis arter hastalığında cerrahi tedavinin zamanlaması hastanın kardiak risk faktörlerine göre yapılmalıdır.

Keywords

• Karotis arter darlığı
• endarterektomi
• inme

Short Term Outcomes of Endarterectomy to Asymptomatic Extracranial Carotid Artery Disease

Abstract

Aim: Recently published papers regarding the treatment of carotid artery stenosis are in contradiction with previous trials. Some experts have argued that this evidence supports a conservative approach to carotid revascularization (carotid endarterectomy or carotid stenting) in asymptomatic patients. The objective of this study is to evaluate outcomes of carotid endarterectomy based on preoperative symptom status.

Material and Methods: This retrospective study included patients underwent carotid endarterectomy to internal carotid artery between August 2008 and August 2015. Patients were divided into two groups according to preoperative symptoms. Asymptomatic group consisted of 41 patients with no preoperative neurological symptoms, and symptomatic group of 62 patients with preoperative neurological symptoms (vertigo, amaurosis fugax, transient ischemic attack and ischemic stroke). Postoperatively, all patients received standard therapy in line with the recommendation of the guidelines.

Results: One hundred and three patients were enrolled in this study. The mean age of patients was 68.20±9.79 (range, 41-86) years, and 27 (26.2%) of them were female. There were no statistically significant difference in terms of demographic characteristics between the groups except risk groups; asymptomatic group had more high risk grouped patients (p=0.001). Asymptomatic group was associated with statistically significantly more postoperative mortality compared with symptomatic group (p=0.028). None of the preoperative variables were related to postoperative stroke. In symptomatic group, postoperative stroke was seen in the patients who had preoperative transient ischemic attack and major stroke.

Conclusion: Time of surgical treatment in asymptomatic carotid artery disease should be planned according to patients’ cardiac risk factors.

Keywords

• Carotid artery stenosis
• Endarterectomy
• Stroke

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