Two-Stage Revascularization Treatment of Symptomatic Bilateral Severe Internal Carotid Artery Stenosis-Consecutive Application of Carotid Artery Stenting and Carotid Endarterectomy in Same Patient

Öz

Since carotid artery atherosclerosis is the main physiopathological mechanism underlying stroke; treatment strategy is focused on resolving carotid artery stenosis. Today, carotid artery endarterectomy and carotid artery stenting are applied as treatment options in carotid artery diseases. With the decision of Cardiovascular Surgery, Cardiology and Neurology joint council, two-stage revascularization procedure was decided to be performed in a 61-year-old male patient who had transient ischemic attack two weeks ago and had stenosis over 90% in both two internal carotid arteries. Because of high mortality risk due to carotid artery endarterectomy, carotid artery stenting was primarily performed in symptomatic left internal carotid artery. Mo.Ma® was preferred as the embolic protection device. Four weeks after stent implantation to left internal carotid artery, carotid endarterectomy was performed in right internal carotid artery by applying ultrasound-guided deep and superficial cervical plexus blockade. No permanent neurological damage was occurred during both two procedures. No new neurologic deficit was observed in postoperative 1st and 6th month controls. We treated bilateral internal carotid artery stenosis effectively and safely by performing two-stage revascularization treatment in our high operative risk case that had bilateral severe internal carotid artery stenosis.

Anahtar Kelimeler

• Internal carotid artery stenosis, carotid circulation transient ischemic attack; carotid endarterectomy; stents

Semptomatik İki Taraflı Ciddi İç Karotis Atardamarı Darlığında İki Aşamalı Revaskülarizasyon Tedavisi-Karotis Atardamar Stentleme ve Karotis Endarterektominin Aynı Hastada Ardışık Uygulaması

Öz

Karotis arterinin aterosklerozu, inmenin temelindeki asıl fizyopatolojik mekanizmayı oluşturduğundan tedavi stratejisi karotis atardamar darlığını gidermeye odaklanmıştır. Günümüzde karotis endarterektomi ve karotis atardamar stentlemesi, karotis atardamar hastalıklarında tedavi seçenekleri olarak uygulanmaktadır. İki hafta önce geçici iskemik atak geçiren ve her iki iç karotis atardamarında %90'nın üzerinde darlık saptanan 61 yaşındaki erkek hastaya Kalp Damar Cerrahisi, Kardiyoloji ve Nöroloji ortak konseyi sonucu iki aşamalı revaskülarizasyon işlemi uygulanmasına karar verildi. Karotis endarterektomiye bağlı mortalite riskinin yüksek olarak değerlendirilmesi üzerine öncelikli olarak semptomatik sol iç karotis atardamarına karotis atardamar stentlemesi uygulandı. Emboli koruma cihazı olarak proksimal blokaj sistemi (Mo.Ma®) tercih edildi. Sol iç karotis atardamarına stent yerleştirilmesinden 4 hafta sonra sağ iç karotis atardamarına ultrason eşliğinde derin ve yüzeyel servikal ağ blokajı uygulanarak karotis endarterektomi operasyonu yapıldı. Her iki işlem esnasında kalıcı nörolojik hasar oluşmadı. Operasyon sonrası 1. ve 6. ay kontrollerinde de hastada yeni nörolojik hasar izlenmedi. Biz operasyon riski yüksek iki taraflı ciddi iç karotis atardamar darlığı olan olgumuzda iki aşamalı revaskülarizasyon tedavisi uygulayarak etkin ve güvenli bir şekilde iki taraflı iç karotis atardamar darlıklarının tedavisini gerçekleştirdik.

Anahtar Kelimeler

• İç karotid arter darlığı, karotid dolaşımı geçici iskemik atak; karotid endarterektomi; stentler

Kaynakça

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