Karotis Arter Hastalığında Lezyon Ciddiyeti ve Klinik Özellikler Arasındaki İlişki

Year 2025, Volume: 22 Issue: 3, 551 - 556

Feyzullah Beşli , Fatih Güngören , Halil Fedai

https://doi.org/10.35440/hutfd.1751671

Abstract

Amaç: Karotis arter hastalığı, akut iskemik inmenin en önde gelen nedenlerindendir. Karotis arter hastalığı, koroner arter hastalığı ile yakından ilişkili olup, aterosklerozis patofizyolojisinde yer alan; yaş, erkek cinsiyet, diabetes mellitus, hipertansiyon, hiperlipidemi ve sigara içiciliği başlıca risk faktörleridir. Çalışmamızda karotis anjiyografi ile karotis arter hastalığı ciddiyeti değerlendirilen hasta grubunda saptanan, lezyon ciddi-yeti ve hastaların sahip olduğu klinik ve laboratuvar özelliklerinin değerlendirilmesi amaçlamıştır.
Materyal ve Metod: Bu çalışmaya kliniğimizde karotis anjiyografisi yapılan 208 hasta alındı. Anjiyografik olarak yapılan ölçümlerde karotis arterlerde %50 ve üzerinde darlık saptanan hastalar kritik karotis arter lezyonlu grup, grup 1-n=122 ve %50’nin altında darlık saptanan hastalar ise non-kritik karotis arter lezyonlu grup, grup 2- n=86 olarak ayrıldı.
Bulgular: İki grup arasında cinsiyet, vücut kitle indeksi, hipertansiyon, hiperlipidemi, sigara içiciliği ve temel laboratuvar parametreleri açısından farklılık saptanmadı. Grup 1 hastalarında lezyon derecesi %90 (80-95) iken grup 2 de ise %30 (18.75- 40.0) olarak saptandı. Grup 1 hastalarında, serebrovasküler olay öyküsü anlamlı olarak daha yüksek saptandı (%66.4’e karşın %51.2). Grup 2’ye göre yaş, diabetes mellitus ve koro-ner arter hastalığı öyküsü sıklığı grup 1 de anlamlı derecede yüksek saptandı. Yapılan lojistik regresyon analizinde kritik karotis arter hastalığı grubunda en yüksek etkide bulunan durumun ileri yaş olduğu görüldü (Odds oranı: 1.071 [1.032-1.111], p<0.001).
Sonuç: Çalışmamızda, karotis arter anjiyografisinde kritik karotis arter lezyonu varlığı %58.7 olarak saptanmış olup, diabetes mellitus ve koroner arter hastalığı öyküsünün ciddi lezyon ile yakından ilişkili olduğu ve en yüksek etkide bulunan durumun ise ileri yaş olduğu görülmüştür.

Keywords

Karotis Arter Hastalığı , Yaş , Diabetes Mellitus , Koroner Arter Hastalığı

Ethical Statement

Çalışma için yerel etik kurul onayı Harran Üniversitesi etik kurulundan alındı.

Thanks

Çalışmamızda etik kurallar ve litaratüre katkı sağlayacak şekilde derginizin bilimsel içeriğine uygun bir şekilde yazılmaya çalışılmıştır. Saygılarımızla

The Relationship between Lesion Severity and Clinical Features in Carotid Artery Disease

Abstract

Background: Carotid artery disease is one of the leading causes of acute ischemic stroke. It is closely associ-ated with coronary artery disease. Atherosclerosis risk factors including age, male gender, diabetes melli-tus, hypertension, hyperlipidemia, and smoking are also the most important factors for carotid artery dis-ease. Our study aimed to evaluate the link between carotid artery lesion severity by carotid angiography and their clinical and laboratory characteristics.
Materials and Methods: This study included 208 patients underwent carotid angiography in our clinic. According to angiographic evaluation, study population were divided into two groups as follows: the pa-tients 50% or more were the critical carotid artery lesion group (group 1, n=122), and those with stenosis of less than 50% were non-critical carotid artery lesion group (group, n=86)
Results: There was no statistically significant difference between the two groups in terms of gender, body mass index, hypertension, hyperlipidemia, smoking status, and laboratory parameters. The lesion degree was 90% (80-95) in group 1 patients while 30% (18.75- 40.0) in group 2. The history of cerebrovascular event was significantly higher in group 1 patients (66.4% vs. 51.2%). The frequency of age, diabetes melli-tus, and coronary artery disease was significantly higher in group 1 compared to group 2. Logistic regression analysis showed that advanced age had the highest effect on the critical carotid artery disease (Odds ratio 1.071 [1.032-1.111], p<0.001).
Conclusions: The prevalence of critical carotid artery lesions was found to be 58.7 in carotid artery angi-ography. The study showed that diabetes mellitus and coronary artery disease history were closely related to critical carotid artery lesions. However, advanced age has the highest independent effect on critical carotid artery lesions.

Keywords

Carotid Artery Disease , Age , Diabetes Mellitus , Coronary Artery Disease

References

• 1. Bushnell C, Kernan WN, Sharrief AZ, Chaturvedi S, Cole JW, Cornwell WK 3rd, et al. 2024 Guideline for the Primary Pre-vention of Stroke: A Guideline From the American Heart Asso-ciation/American Stroke Association. Stroke. 2024; 55(12):e344-e424.
• 2. Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, et al. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018; 55(1):3-81.
• 3. Dossabhoy S, Arya S. Epidemiology of atherosclerotic carotid artery disease. Semin Vasc Surg. 2021; 34(1):3-9
• 4. Prasad K. Pathophysiology and Medical Treatment of Carotid Artery Stenosis. Int J Angiol. 2015; 24(3):158-72.
• 5. Zhang Y, Bai Y, Xie J, Wang J, He L, Huang M, et al. Carotid plaque components and other carotid artery features associat-ed with risk of stroke: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2022; 31(12):106857.
• 6. AbuRahma AF, Avgerinos ED, Chang RW, Darling RC 3rd, Duncan AA, Forbes TL, et al. Society for Vascular Surgery clinical prac-tice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg. 2022; 75(1S):4S-22S.
• 7. Woo SY, Joh JH, Han SA, Park HC. Prevalence and risk factors for atherosclerotic carotid stenosis and plaque: A population-based screening study. Medicine (Baltimore). 2017; 96(4):e5999.
• 8. Phan TG, Beare RJ, Jolley D, Das G, Ren M, Wong K, et al. Carot-id artery anatomy and geometry as risk factors for carotid ath-erosclerotic disease. Stroke 2012; 43:1596-601.
• 9. Karahan-özcan R, Özmen S. Comparison of risk factors that play a role in extra-cranial carotid artery atherosclerosis. CMJ. De-cember 2019; 41(4):726-33.
• 10. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al. Guideline for the prevention, de-tection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiolo-gy/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol 2018;71:e127-248.
• 11. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018; 41(Suppl 1):S13-S27.
• 12. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circula-tion. 2019; 139(10):e56–528.
• 13. Barrett KM, Brott TG. Stroke caused by extracranial disease. Circ Res. 2017; 120(3):496–501.
• 14. Mechtouff L, Rascle L, Crespy V, Canet-Soulas E, Nighoghossian N, Millon A. A narrative review of the pathophysiology of is-chemic stroke in carotid plaques: a distinction versus a com-promise between hemodynamic and embolic mechanism. Ann Transl Med. 2021; 9(14):1208.
• 15. Besli F, Gungoren F, Kocaturk O, Tanriverdi Z, Tascanov MB. The impact of post-dilatation on periprocedural outcomes during carotid artery stenting: A single-center experience. Atheroscle-rosis. 2019; 290:74-9.
• 16. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339:1415-25.
• 17. Saxena A, Ng EYK, Lim ST. Imaging modalities to diagnose carot-id artery stenosis: progress and prospect. Biomed Eng Online. 2019; 28:18(1):66.
• 18. Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al; ESC Scientific Document Group. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024; 29;45(36):3538-700.
• 19. Brevetti G, Sirico G, Giugliano G, Lanero S, De Maio JI, Luciano R, et al. Prevalence of hypoechoic carotid plaques in coronary artery disease: relationship with coexistent peripheral arterial disease and leukocyte number. Vasc Med. 2009; 14(1):13-9.
• 20. Van Dam-Nolen DHK, van Egmond NCM, Koudstaal PJ, van der Lugt A, Bos D. Sex Differences in Carotid Atherosclerosis: A Sys-tematic Review and Meta-Analysis. Stroke. 2023; 54(2):315-26.
• 21. De Weerd M, Greving JP, de Jong AW, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke. 2009; 40(4):1105-13.
• 22. Dhawan SS, Avati Nanjundappa RP, Branch JR, Taylor WR, Quyyumi AA, Jo H, et al. Shear stress and plaque development. Expert Rev Cardiovasc Ther 2010; 8:545-56.
• 23. Del Brutto VJ, Gornik HL, Rundek T. Why are we still debating criteria for carotid artery stenosis? Ann Transl Med. 2020; 8(19):1270.
• 24. Vranic H, Hadzimehmedagic A, Haxibeqiri-Karabdic I, Mujacic E, Djedovic M. Critical Carotid Artery Stenosis in Coronary and Non-Coronary Patients - Frequency of Risk Factors. Med Arch. 2017; 71(2):110-14.
• 25. Mughal MM, Khan MK, DeMarco JK, Majid A, Shamoun F, Abela GS. Symptomatic and asymptomatic carotid artery plaque. Ex-pert Rev Cardiovasc Ther. 2011; 9(10):1315-30.
• 26. Ranjan R, Adhikary D, Das D, Adhikary AB. Prevalence and Risk Factors Analysis of Carotid Stenosis Among Ischaemic Heart Dis-eases Patient in Bangladesh: A Cross-Sectional Study. Int J Gen Med. 2022; 15:3325-31.
• 27. Shchehlov DV, Svyrydiuk OY, Vyval MB, Sydorenko OF, Nosenko NM, Gudym MS. Simultaneous bilateral angioplasty and stenting for carotid stenosis—A single center experience. J Med Life. 2022;15:252–257.