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Karotis Endarterektomi Sonrası Klinik Sonuçlar ve Orta Dönem Mortalite: Tek Merkez Çalışması

Yıl 2023, Cilt: 33 Sayı: 5, 614 - 618, 25.10.2023
https://doi.org/10.54005/geneltip.1330055

Öz

Amaç: Bu tek merkezli çalışma, çeşitli endikasyonlar için karotis endarterektomi (CEA) uygulanan hastalarda klinik sonuçları ve orta dönem mortaliteyi araştırmayı amaçlamıştır.
Gereç ve Yöntemler: Çalışma, kurumumuzda CEA uygulanan 109 hastayı içermektedir. Demografik özellikler, cerrahi endikasyonlar, operasyon teknikleri ve erken postoperatif komplikasyonlar kaydedilmiştir. Ortalama 23.3 ± 17.2 aylık takip verileri elde edilmiş ve mortalite nedenleri ve nörolojik sonuçlar analiz edilmiştir.
Bulgular: Hastaların ortalama yaşı 66.53 ± 8.00 yıldır ve 73 erkek ile 36 kadın bulunmaktadır. CEA endikasyonları, hastaların %21.1'inde geçici iskemik atak (TIA) ve %26.6'sında iskemik inme öyküsüdür. Genel olarak, hastaların %86.2'sinde ipsilateral karotis darlığı %70 veya daha fazladır. Hastaların çoğuna (%89.9) genel anestezi altında ameliyat uygulanmış olup, en yaygın kullanılan cerrahi teknik geleneksel karotis endarterektomidir (%78.0). Longitudinal karotis arteriyotomisinin en sık kullanılan rekonstrüksiyon yöntemi Dacron yama plastisidir (%56.0). Erken takip döneminde düşük hastane mortalitesi (%0.9) ve sınırlı postoperatif komplikasyonlar tespit edilmiştir (%3.7 TIA, %1.8 büyük nörolojik komplikasyonlar ve %1.8 küçük nörolojik komplikasyonlar). Takip döneminde, mutlak sağkalım oranı %87.0 olarak belirlenmiştir.
Sonuç: Çalışmamız, CEA sonrası olumlu erken sonuçları ve kabul edilebilir uzun dönem mortalite oranlarını göstermektedir. Ancak, bu sonuçları desteklemek ve CEA'nın uzun dönem faydalarını daha iyi anlamak için daha büyük ve çok merkezli çalışmalara ihtiyaç vardır.

Kaynakça

  • GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 May;18(5):439–58.
  • Topcuoglu MA, Ozdemir AO. Acute stroke management in Turkey: Current situation and future projection. European Stroke Journal. 2023 Jan 1;8(1_suppl):16–20.
  • Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D, et al. Carotid Artery Stenosis as a Cause of Stroke. Neuroepidemiology. 2012 Oct 11;40(1):36–41.
  • Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023 Jan;65(1):7–111.
  • Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, et al. Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney International. 2021 Oct 1;100(4):753–79.
  • European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis [Internet]. [cited 2023 Jul 17]. Available from: https://journals.sagepub.com/doi/epub/10.1177/23969873211012121
  • Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Jang MU, Park MS, et al. White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke. Neurology. 2019 Aug 6;93(6):e578–89.
  • Wang Y, Xu J, Zhao X, Wang D, Wang C, Liu L, et al. Association of Hypertension With Stroke Recurrence Depends on Ischemic Stroke Subtype. Stroke. 2013 May;44(5):1232–7.
  • Hata J, Tanizaki Y, Kiyohara Y, Kato I, Kubo M, Tanaka K, et al. Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study. Journal of Neurology, Neurosurgery & Psychiatry. 2005 Mar 1;76(3):368–72.
  • GALA Trial Collaborative Group: General anaesthesia... - Google Akademik [Internet]. [cited 2023 Jul 16]. Available from: https://scholar.google.com/scholar_lookup?title=General%20anaesthesia%20versus%20local%20anaesthesia%20for%20carotid%20surgery%20(GALA)%3A%20a%20multicentre%2C%20randomised%20controlled%20trial&author=G.A.L.A.%20Trial%20Collaborative&publication_year=2008&pages=2132-2142
  • Mracek J, Kletecka J, Holeckova I, Dostal J, Mrackova J, Mork J, et al. Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy. J Neurol Surg A Cent Eur Neurosurg. 2019 Sep;80(5):341–4.
  • Chongruksut W, Vaniyapong T, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database of Systematic Reviews [Internet]. 2014 [cited 2023 Jul 16];(6). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000190.pub3/abstract
  • Wiske C, Arhuidese I, Malas M, Patterson R. Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. Journal of Vascular Surgery. 2018 Aug 1;68(2):416–25.
  • Lazarides MK, Christaina E, Argyriou C, Georgakarakos E, Tripsianis G, Georgiadis GS. Editor’s Choice – Network Meta-Analysis of Carotid Endarterectomy Closure Techniques. European Journal of Vascular and Endovascular Surgery. 2021 Feb 1;61(2):181–90.
  • Rerkasem K, Rothwell PM. Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure and Different Types of Patch Materials During Carotid Endarterectomy. Asian Journal of Surgery. 2011 Jan 1;34(1):32–40.
  • Paraskevas KI, Robertson V, Saratzis AN, Naylor AR. Editor’s Choice – An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational Studies. European Journal of Vascular and Endovascular Surgery. 2018 Apr 1;55(4):465–73.
  • Wadén K, Hultgren R, Kotopouli MI, Gillgren P, Roy J, Hedin U, et al. Long Term Mortality Rate in Patients Treated with Carotid Endarterectomy. European Journal of Vascular and Endovascular Surgery. 2023 Jun 1;65(6):778–86.
  • Mannheim D, Weller B, Vahadim E, Karmeli R. Carotid endarterectomy with a polyurethane patch versus primary closure: A prospective randomized study. Journal of Vascular Surgery. 2005 Mar 1;41(3):403–7.

Clinical Outcomes and Midterm Mortality After Carotid Endarterectomy: A Single Center Study

Yıl 2023, Cilt: 33 Sayı: 5, 614 - 618, 25.10.2023
https://doi.org/10.54005/geneltip.1330055

Öz

Background/Aims: This single-center study aimed to investigate the clinical outcomes and midterm mortality in patients who underwent carotid endarterectomy (CEA) for various indications.
Methods: The study included 109 patients who underwent CEA at our institution. Demographic characteristics, indications for surgery, operative techniques, and early postoperative complications were recorded. Follow-up data were obtained for a mean period of 23.3 ± 17.2 months, and mortality causes, and neurological outcomes were analysed.
Results: The mean age of the patients was 66.53 ± 8.00 years, with 73 men and 36 women. Indications for CEA included transient ischemic attack (TIA) in 21.1% and a history of ischemic stroke in 26.6% of patients. Overall, 86.2% had ipsilateral carotid stenosis of 70% or more. Most patients (89.9%) were operated under general anesthesia, and the conventional carotid endarterectomy technique was most employed (78.0%). The most frequent reconstruction method for the longitudinal carotid arteriotomy was Dacron patch plasty (56.0%). Early follow-up revealed low hospital mortality (0.9%) and limited postoperative complications (3.7% TIA, 1.8% major neurological complications, and 1.8% minor neurological complications). During the follow-up period, absolute survival was 87.0%.
Conclusions: Our study demonstrates favourable early outcomes and acceptable long-term mortality rates following CEA. However, larger, and multicentre studies are warranted to further validate these results and enhance our understanding of CEA's long-term benefits

Kaynakça

  • GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 May;18(5):439–58.
  • Topcuoglu MA, Ozdemir AO. Acute stroke management in Turkey: Current situation and future projection. European Stroke Journal. 2023 Jan 1;8(1_suppl):16–20.
  • Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D, et al. Carotid Artery Stenosis as a Cause of Stroke. Neuroepidemiology. 2012 Oct 11;40(1):36–41.
  • Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023 Jan;65(1):7–111.
  • Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, et al. Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney International. 2021 Oct 1;100(4):753–79.
  • European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis [Internet]. [cited 2023 Jul 17]. Available from: https://journals.sagepub.com/doi/epub/10.1177/23969873211012121
  • Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Jang MU, Park MS, et al. White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke. Neurology. 2019 Aug 6;93(6):e578–89.
  • Wang Y, Xu J, Zhao X, Wang D, Wang C, Liu L, et al. Association of Hypertension With Stroke Recurrence Depends on Ischemic Stroke Subtype. Stroke. 2013 May;44(5):1232–7.
  • Hata J, Tanizaki Y, Kiyohara Y, Kato I, Kubo M, Tanaka K, et al. Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study. Journal of Neurology, Neurosurgery & Psychiatry. 2005 Mar 1;76(3):368–72.
  • GALA Trial Collaborative Group: General anaesthesia... - Google Akademik [Internet]. [cited 2023 Jul 16]. Available from: https://scholar.google.com/scholar_lookup?title=General%20anaesthesia%20versus%20local%20anaesthesia%20for%20carotid%20surgery%20(GALA)%3A%20a%20multicentre%2C%20randomised%20controlled%20trial&author=G.A.L.A.%20Trial%20Collaborative&publication_year=2008&pages=2132-2142
  • Mracek J, Kletecka J, Holeckova I, Dostal J, Mrackova J, Mork J, et al. Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy. J Neurol Surg A Cent Eur Neurosurg. 2019 Sep;80(5):341–4.
  • Chongruksut W, Vaniyapong T, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database of Systematic Reviews [Internet]. 2014 [cited 2023 Jul 16];(6). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000190.pub3/abstract
  • Wiske C, Arhuidese I, Malas M, Patterson R. Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. Journal of Vascular Surgery. 2018 Aug 1;68(2):416–25.
  • Lazarides MK, Christaina E, Argyriou C, Georgakarakos E, Tripsianis G, Georgiadis GS. Editor’s Choice – Network Meta-Analysis of Carotid Endarterectomy Closure Techniques. European Journal of Vascular and Endovascular Surgery. 2021 Feb 1;61(2):181–90.
  • Rerkasem K, Rothwell PM. Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure and Different Types of Patch Materials During Carotid Endarterectomy. Asian Journal of Surgery. 2011 Jan 1;34(1):32–40.
  • Paraskevas KI, Robertson V, Saratzis AN, Naylor AR. Editor’s Choice – An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational Studies. European Journal of Vascular and Endovascular Surgery. 2018 Apr 1;55(4):465–73.
  • Wadén K, Hultgren R, Kotopouli MI, Gillgren P, Roy J, Hedin U, et al. Long Term Mortality Rate in Patients Treated with Carotid Endarterectomy. European Journal of Vascular and Endovascular Surgery. 2023 Jun 1;65(6):778–86.
  • Mannheim D, Weller B, Vahadim E, Karmeli R. Carotid endarterectomy with a polyurethane patch versus primary closure: A prospective randomized study. Journal of Vascular Surgery. 2005 Mar 1;41(3):403–7.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm Original Article
Yazarlar

Emre Yasar 0000-0003-2599-6521

Muhammed Bayram 0000-0001-6980-3950

Erken Görünüm Tarihi 23 Ekim 2023
Yayımlanma Tarihi 25 Ekim 2023
Gönderilme Tarihi 19 Temmuz 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 33 Sayı: 5

Kaynak Göster

Vancouver Yasar E, Bayram M. Clinical Outcomes and Midterm Mortality After Carotid Endarterectomy: A Single Center Study. Genel Tıp Derg. 2023;33(5):614-8.