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Karotis Arter Stentlemesi Uygulanan Hastaların Özellikleri ve Hastane İçi Klinik Sonuçları: Tek merkez deneyimi

Year 2021, , 737 - 742, 27.12.2021
https://doi.org/10.31832/smj.913188

Abstract

Amaç: Çalışmamızın amacı, hastanemizde uygulanan karotis arter stentleme (KAS) prosedürlerini ve hastane içi sonuçları değerlendirmektir.
Gereç ve Yöntemler: Ocak 2019 ile Aralık 2019 arasında KAS uygulanan 86 hasta retrospektif olarak incelendi.
Bulgular: Bu hastalardan 46'sının (% 53,5) son 6 ay içinde geçici iskemik atak veya inme öyküsü mevcuttu. Hastaların ortalama yaşı semptomatik grupta, asemptomatik gruba göre anlamlı olarak daha düşüktü (65,5 ± 10,7 vs 70,2 ± 6,8, p = 0,019). Predilatasyon 79 hastaya (% 91,9) yapılmıştı. Yedi hastada (% 8.1) yetersiz açılmaya bağlı olarak postdilatasyon gerektiği görüldü. Sadece 4 hastada işlem sırasında hem predilatasyon hem de postdilatasyon yapılmıştı. Hastaların çoğunda (84 hasta,% 97,7) distal embolik koruma cihazı kullanıldı. Sadece iki hastada (% 2.3) proksimal emboli koruma cihazı kullanıldı. Teknik başarı oranı% 98,8 (85/86) idi. Hastane içi ölüm ve kalıcı inme hiçbir hastada görülmedi. İki hastada geçici iskemik atak görüldü.
Sonuç: KAS, deneyimli merkezlerde düşük komplikasyon oranları ile karotis arter darlığında güvenli ve etkili bir tedavi yöntemidir. KAS, özellikle cerrahi riski yüksek hastalarda karotis endarterektomiye alternatif bir tedavidir.

References

  • 1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133(4):e38-360.
  • 2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018;49(3):e46-e110.
  • 3. Cremonesi A, Castriota F, Secco GG, Macdonald S, Roffi M. Carotid artery stenting: an update. Eur Heart J 2015; 36: 13-21.
  • 4. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Eur Heart J 2018;39:763−816.
  • 5. Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, et al; ICSS-MRI study group. New ischaemic brain lesions on MRI after stenting or endarterectomy for sympto matic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010;9:353−62.
  • 6. Kuliha M, Roubec M, Procházka V, Jonszta T, Hrbáč T, Havelka J, et al. Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting. Br J Surg 2015;102:194−201.
  • 7. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30: 1751-8.
  • 8. Karaduman BD, Ayhan H, Keleş T, Bozkurt E. Efficacy and safety of carotid artery stenting: Experience of a single center. Turk Kardiyol Dern Ars. 2020 Oct;48(7):646-655.
  • 9. Eckstein HH, Reiff T, Ringleb P, Jansen O, Mansmann U, Hacke W; SPACE 2 Investigators. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. Eur J Vasc Endovasc Surg 2016;51:761−5.
  • 10. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al; EVA-3S investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008;7:885−92.
  • 11. Roh HG, Byun HS, Ryoo JW, Na DG, Moon WJ, Lee BB, et al. Prospective analysis of cerebral infarction after carotid endarterectomy and carotid artery stent placement by using diffusion weighted imaging. AJNR Am J Neuroradiol 2005;26:376–84.
  • 12. Maleux G, Demaerel P, Verbeken E, S Daenens, F Heye, A Van Sonhoven, et al. Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device. AJNR Am J Neuroradiol 2006;27:1830–3.
  • 13. Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 2012;59:1383–9.
  • 14. Schmidt A, Diederich KW, Scheinert S, Bräunlich S, Olenburger T, Biamino G, et al. Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 2004;44:1966−9.

Characteristics and In-Hospital Clinical Outcomes of the Patients Undergoing Carotid Artery Stenting: A single center experience

Year 2021, , 737 - 742, 27.12.2021
https://doi.org/10.31832/smj.913188

Abstract

Objective: The aim of our study was to evaluate carotid artery stenting (CAS) procedures and in-hospital outcomes performed in our instutition.
Materials and Methods: A total of 86 patients who underwent CAS between January 2019 and December 2019 were analyzed retrospectively.
Results: Among these patients, 46 of the patients (53.5%) were symptomatic because of a history of transient ischemic attack (TIA) or stroke in the preceding 6 months, and the remain of the patients were asymptomatic (40 patients, 46.5%). The mean age of the patients was significantly lower in symptomatic group compared to asymptomatic group (65.5±10.7 vs 70.2±6.8, p=0.019). Predilatation was performed in 79 patients (91.9%). In 7 patients (8.1%) postdilatation was required due to insufficient opening. Only in 4 patient, both predilatation and postdilatation was performed during the procedure. In most of the patients (84 patients, 97.7%) distal embolic protection device (EPD) were used. Only in two patients (2.3%) proximal EPD were used. Technical success rate was 98.8% (85/86). In-hospital death and disabling stroke was not observed in any patients. TIA was observed in two patients.
Conclusion: CAS is safe and effective treatment method in carotid artery stenosis with low complication rates in experienced centers. CAS is alternative treatment to carotid endarterectomy (CEA) especially in patients with high surgical risk.

References

  • 1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133(4):e38-360.
  • 2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018;49(3):e46-e110.
  • 3. Cremonesi A, Castriota F, Secco GG, Macdonald S, Roffi M. Carotid artery stenting: an update. Eur Heart J 2015; 36: 13-21.
  • 4. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Eur Heart J 2018;39:763−816.
  • 5. Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, et al; ICSS-MRI study group. New ischaemic brain lesions on MRI after stenting or endarterectomy for sympto matic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010;9:353−62.
  • 6. Kuliha M, Roubec M, Procházka V, Jonszta T, Hrbáč T, Havelka J, et al. Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting. Br J Surg 2015;102:194−201.
  • 7. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30: 1751-8.
  • 8. Karaduman BD, Ayhan H, Keleş T, Bozkurt E. Efficacy and safety of carotid artery stenting: Experience of a single center. Turk Kardiyol Dern Ars. 2020 Oct;48(7):646-655.
  • 9. Eckstein HH, Reiff T, Ringleb P, Jansen O, Mansmann U, Hacke W; SPACE 2 Investigators. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. Eur J Vasc Endovasc Surg 2016;51:761−5.
  • 10. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al; EVA-3S investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008;7:885−92.
  • 11. Roh HG, Byun HS, Ryoo JW, Na DG, Moon WJ, Lee BB, et al. Prospective analysis of cerebral infarction after carotid endarterectomy and carotid artery stent placement by using diffusion weighted imaging. AJNR Am J Neuroradiol 2005;26:376–84.
  • 12. Maleux G, Demaerel P, Verbeken E, S Daenens, F Heye, A Van Sonhoven, et al. Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device. AJNR Am J Neuroradiol 2006;27:1830–3.
  • 13. Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 2012;59:1383–9.
  • 14. Schmidt A, Diederich KW, Scheinert S, Bräunlich S, Olenburger T, Biamino G, et al. Effect of two different neuroprotection systems on microembolization during carotid artery stenting. J Am Coll Cardiol 2004;44:1966−9.
There are 14 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

İbrahim Kocayiğit 0000-0001-8295-9837

Yusuf Can 0000-0002-4535-7367

Harun Kılıç 0000-0002-1358-5015

Publication Date December 27, 2021
Submission Date April 11, 2021
Published in Issue Year 2021

Cite

AMA Kocayiğit İ, Can Y, Kılıç H. Characteristics and In-Hospital Clinical Outcomes of the Patients Undergoing Carotid Artery Stenting: A single center experience. Sakarya Tıp Dergisi. December 2021;11(4):737-742. doi:10.31832/smj.913188

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