İskemik serebrovasküler patolojilerde cerrahi embolektomi veya by-pass cerrahisi ilk tedavi seçeneği olabilir mi?

Yıl 2023, , 585 - 590, 27.10.2023

Hakan Çakın , Tolga Gediz

https://doi.org/10.47582/jompac.1352325

Öz

Amaç: İntraserebral damar tıkanıklıklarında tıbbi trombolitik tedaviler, endovasküler girişimler ve cerrahi işlemler dahil olmak üzere köklü tedavi yöntemleri kullanılmaktadır.
Yöntemler: Bu çalışmada, cerrahi rekanalizasyon tekniklerine odaklanıldı ve bunlar altı vaka aracılığıyla ortaya kondu. Hastanemizde acil koşullarda tromboembolik olay yaşayan iki hastaya geç dönem tromboembolektomi uygulandı. Diğer iki hasta, acil şartlarda değil, ertesi hafta by-pass ameliyatıyla tedavi altına alındı. Son iki hasta ise klinik semptomlu kronik iskemik intraserebral süreçler nedeniyle rekanalizasyon cerrahisi ile reperfüzyon uygulanan hasta grubundaydı.
Bulgular: İlk hasta, diğer tedavi yaklaşımlarına yanıt vermeyen internal karotid arter (İKA) total enfarktüsü nedeniyle ameliyat edildi. Benzer şekilde kalp nakli sonrası emboli atan ikinci hastada da trombolitik tedavilerin başarısız olması sonucu ana arterlerden kaynaklanan küçük aterom plaklarının düzelmemesi nedeniyle ameliyat edilmesi gerekti. Her iki durumda da başarılı rekanalizasyon prosedürleri sağlandı.
İvedi koşullarda ameliyata alınan hastalar içerisinde biri, travma sonrası internal karotis arter yetmezliği, bir diğeri vasküler hastalık sonrası sol serebral hemisferin beslenmesinin bozulması, ve son iki hasta da anevrizma kaynaklı trombüs sebebiyle ana vasküler arterlerin tıkanması sebebiyle opere edildi.
Sonuç: Bulgularımız, seçilmiş vakalarda akut inmenin tedavisinde cerrahi müdahalenin birincil tedavi seçeneği olarak düşünülebileceğini göstermektedir. Seçilmiş hastalarda hızlı ve ilk seçenek olarak cerrahi tedavi yüz güldürücüdür. Bu yaklaşım, farklı intraserebral damar tıkanıklığı senaryolarında en uygun yaklaşımı belirlemek için daha kapsamlı araştırmalara ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler

intrakranial by-pass, nöroşirurji, rekanalizasyon cerrahisi, inme

Can surgical embolectomy or by-pass surgery be the first treatment option in ischemic cerebrovascular pathologies?

Öz

Background: Well-established treatment methods have been utilized for intracerebral vascular occlusion, including medical thrombolytic treatments, endovascular interventions, and surgical procedures.
Methods: This study focused on surgical recanalization techniques, illustrating them through six patients. In emergency scenarios at our hospital, late-term thromboembolectomy was performed on two patients who had experienced thromboembolic events.The other two patients were treated not in emergency conditions, but with by-pass surgery in the following week.Last two patients were in the group of patients who had reperfusion with recanalization surgery due to chronic ischemic intracerebral processes with clinical symptoms.
Results: One of the patient underwent emergency surgery for total infarction of the internal carotid artery (ICA), which remained unresponsive to other therapeutic approaches. Similarly, the second patient, who had undergone heart transplantation, required surgery due to unyielding small atheroma plaques originating from the main arteries after failed thrombolytic treatments. Successful recanalization procedures were achieved in both cases. Among the other patients who underwent semi-emergency surgery, one patient with internal carotid artery insufficiency after a traumatic process, another patient with left hemisphere vascular insufficiency after vascular disease, and another two patients who had vascular insufficiency due to occlusion of the main vascular structure by an aneurysm thrombus were operated on.
Conclusions: Our findings suggest that surgical intervention could be considered as the primary treatment option in selected cases for managing acute stroke or vascular insufficiency. In selected patients, rapid and first-line surgical treatment is satisfactory. This approach aligns with the need for more comprehensive investigations to determine the optimal approach in different scenarios of intracerebral vascular occlusion.

Anahtar Kelimeler

Intracranial by-pass, neurosurgery, recanalisation surgery, stroke

Kaynakça

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