Karotis endarterektomide yama ve şanta gerçekten ihtiyacımız var mı?

Abstract

Amaç: Karotis endarterektomi (KEA) ameliyatının semptomatik ve asemptomatik hastalarda inmeyi önlemedeki etkinliği bilinmektedir. Biz bu çalışmada şant kullanmadan, primer kapama tekniği ile gerçekleştirdiğimiz KEA operasyonlarının uzun dönem sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntemler: Ekim 2013 ile 2019 tarihleri arasında şant kullanmadan primer kapama tekniği ile opere olan 122 hasta bu retrospektif çalışmaya dahil edildi. Doppler ultrasonografi (DUSG) rezidüel ve tekrarlayan darlıkların tespiti için primer görüntüleme yöntemi olarak kullanıldı. Takip süresince hastalar ikinci, altıncı aylarda ve sonrasında yıllık olarak yapıldı. Takiplerde ipsilateral serebrovasküler olaylar ve mortalite kayıtları alındı. Bulgular: Hastaların ortalama yaşı 69,1 ± 7,1 (48-90)’ydi. Median takip süresi 47 (5 - 78) aydı. 1 (0,8%) hastada hastane içi ölüm gerçekleşti. Erken dönemde; 1(0,8%) hastada ipsilateral sekel bırakan ve 1(0,8%) hastada da sekelsiz serebrovasküler olay izlendi. Yine 1(0,8%) hastada geridönüşümlü iskemik nörolojik defisit ve 1(0,8%) hastada kafaiçi kanama görüldü. Geç mortalite gelişen hasta sayısı 4 (3,3%) olarak kayıt edildi. Bunların 2 (1,6%)’si kardiyak nedenli ölümdü. Geç dönemde 3 (2,5%) hastada ipsilateral serebrovasküler hadise gelişti. Bunların 1 (0,8%)’i sekel bırakan, 1 (0,8%)’i sekel bırakmayan inmeydi. 1 (0,8%) hastada da geridönüşümlü iskemik nörolojik deficit görüldü. Geç dönemde DUSG sonuçlarına göre 4 (3,3%) hastada 50%’nin altında, 2 (1,7%) hastada 70%’in üzerinde darlık görüldü. 1 (0,8%) hastada da total oklüzyon meydana saptandı. Sonuç: Primer kapama tekniği ile KEA seçilmiş hastalarda kabul edilebilir erken ve geç dönem komplikasyon, düşük mortalite ve tekrarlayan darlık oranlarıyla uygulanabilir.

Keywords

• karotis endarterektomi

Do we really need patch and shunt for carotid endarterectomy?

Abstract

Aim: The efficacy of carotid endarterectomy (CEA) for stroke prevention in asymptomatic and symptomatic patients is well known. We aimed to share long term follow up results for primary closure technique for CEA without shunting and investigated risk factors for complications in this patient group. Material and Methods: Between September 2013-2019, 122 patients with isolated CEA with primary closure were enrolled in this retrospective study. Dopppler ultrasound (DUSG) scanning was used as the primary imaging tool for the determination of residual and recurrent stenosis. During the follow-up period duplex ultrasonography was performed in the second month, sixth month and annually thereafter. Ipsilateral cerebrovascular events and mortalities were recorded during follow up period. Results: The mean age was 69,1 ± 7,1 (48-90) years. The median follow-up time was 47 (5 to 78) months. Hospital mortality was reported in 1 patient (0,8%). Early postoperative cerebrovascular accident were seen as ipsilateral disabling stroke in 1 patient (0,8%), ipsilateral non-disabling stroke in 1 patient (0,8%), reversible ischemic neurological deficit (RIND) in 1 patient (0,8%) and massive intracranial bleeding in 1 patient (0,8%). Late mortality was reported in 4 (3,3%) patients. 2 (1,6%) were cardiac reasons and 2 (1,6%) were non cardiac reasons. During the follow-up period ipsilateral cerebrovascular accident (CVA) were seen in 3 patients (2,5%) and these were; ipsilateral disabling stroke in 1 patient (0,8%), ipsilateral non-disabling stroke in 1 patient (0,8%), RIND in 1 patient (0,8%).According to the latest duplex scanning during follow up period 4 (3,3%) patients had below 50% restenosis, 2 (1,7%) patients had above 70% restenosis and 1 (0,8%) patient had total occlusion. Conclusion: Primary closure technique for CEA can be used in selected patients with acceptable early and late complication rates, low mortality and low restenosis rate.

Keywords

• carotid endarterectomy,carotid artery disease,carotid artery stenosis

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