Bilateral İnternal Karotis Arter Darlıkları: Risk Faktörleri ve Prognozları

Abstract

Amaç: İnternal karotis arter darlığı; iskemik olaylar, geçici/kalıcı görme kaybı ve uzun vadede bellek bozuklukları gibi durumlara yol açabilir. Bu çalışmanın amacı bilateral internal karotis arter darlıklarında (BİKAD) risk faktörleri ile inme, fundus bulguları ve bilişsel bozukluk arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Bu çalışmaya herhangi bir nedenle nöroloji polikliniğine başvuran ve karotis doppler duplex ultrasonography ve/ veya Bilgisayarlı Tomografi Anjiografi ile BİKAD saptananlar alındı. BİKAD için üç grup oluşturuldu: (A) her iki arterde ciddi darlık, (B) bir arterde ciddi, diğerinde orta darlık ve (C) her iki arterde orta darlık varlığı. Serebral iskemik inme öyküsü veya görüntüleme bulgusu olanlar semptomatik, diğerleri asemptomatik olarak kabul edildi. Uyum sağlayabilenlere tecrübeli nöroloji uzmanı tarafından oftalmaskop ile fundus değerlendirmesi ve mini-mental test (MMT) yapıldı. Semptomatik grup endovasküler tedavi alanlar ve iyi medikal tedavi ile takip edilenler olarak da sınıflandırıldı. Bulgular: Çalışmada 86 hasta incelendi. Yetmiş yaş üzerinde ve erkek bireylerde BİKAD görülme oranı daha yüksekti. Bilateral veya tek taraflı ciddi darlığı olan bireylerin inme geçirme riski daha yüksekti. Bilateral ciddi darlık grubunda bilişsel etkilenme, oküler bulgu ve stentleme oranı daha yüksekti. Sonuç: BİKAD hastalarında bilişsel etkilenme, oküler bulgu ve inme geçirme oranları daha yüksektir. Asemptomatik hastaların tanınmasında non-invazif yöntemler olarak fundoskopik muayene ve MMT bulguları dikkate alınmalı, hastalar ileri tetkik ve tedavi için yönlendirilmelidir

Keywords

• Bilateral internal karotis arter darlığı
• bilişsel bozukluk
• fundoskopik muayene
• inme

Bilateral Internal Carotid Artery Stenosis: Risk Factors and Prognosis

Abstract

Aim: Internal carotid artery stenosis may lead to ischemic events, temporary/permanent vision loss, and cognitive impairment. The aim of this study was to evaluate the association between risk factors for bilateral internal carotid artery stenosis (BICAS) and stroke, fundus findings, and cognitive impairment. Material and Methods: Patients who applied to the neurology outpatient clinic for any reason and were diagnosed with BIKAD by carotid doppler duplex ultrasonography and/or Computed Tomography Angiography were included in this study. Three groups were created for BICAS: (A) Severe stenosis in both arteries, (B) Severe stenosis in one artery and moderate stenosis in the other, and (C) Moderate stenosis in both arteries. Patients with a history of cerebral ischemic stroke or imaging findings were grouped as symptomatic, while others were asymptomatic. Those who were able to comply underwent fundus evaluation with an ophthalmoscope and mini-mental state examination (MMSE) by an experienced neurologist. The symptomatic group was also classified as those who received endovascular treatment and those who followed with the best medical treatment. Results: Eighty-six patients were evaluated. BICAS was higher in patients over 70 years and in males. In addition, patients in groups A and B had a higher risk of stroke. Cognitive impairment, ocular findings, and stenting rate were higher in group A. Conclusion: Cognitive impairment, ocular findings and stroke rates are higher in BICAS patients. Funduscopic examination and MMSE findings should be taken into consideration as non-invasive methods in the diagnosis of asymptomatic patients, and patients should be referred for further examination and treatment.

Keywords

• Bilateral carotid artery stenosis
• MMSE
• cognitive impairment
• stroke
• fundoscopic examination

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