Servikal internal karotid arterin tıkanıklığı veya stenozu nedeniyle akut iskemik inmeli hastalarda acil karotid arter stentlemesi: Tek merkez deneyimi

Öz

Özet Amaç: Acil karotid arter stentleme (KAS) tedavilerinin sonuçlarını bir araya getirerek bu tedavi yönteminin seçilmiş hasta popülasyonundaki etkinliğini ve güvenliğini kapsamlı bir şekilde değerlendirmektir. Metod: 1 Ocak 2020 – 31 Temmuz 2024 tarihleri arasında girişimsel radyoloji ünitemizde KAS yapılmış 230 hasta retrospektif olarak değerlendirildi. İlk başvurusunda hemodinamik instabilite ve Ulusal Sağlık İnme Ölçeği (NIH Skoru – NIHSS) yüksekliği (>4), takibinde geçici iskemik atak (GİA) sıklığında artış, akut enfarktta takipte klinik durumda kötüleşme, Glaskow koma skoru (GKS)’de ve bilinçte gerileme, diseksiyona bağlı akımın belirgin engellendiği ve tandem oklüzyonu olup balona direnç gözlenmesi nedeniyle acil KAS yapılan 35 hasta çalışmaya dahil edildi. İşlem komplikasyonları, teknik ve klinik başarı, modifiye rankin skoru (mRs) ve mortalite oranları kaydedildi. Bulgular: Çalışmaya dahil edilen toplam 35 hastanın %57.2 (n=20)’i erkek olup tüm hastaların yaş ortalaması 67.5 ±9.4 yıl idi. Hastaların %77.1 (n=27)’inde komorbidite mevcut olup en sık görülenleri hipertansiyon (n=21, %60) idi. Lezyonların %57.2’si (n=20) sağ karotis arterde yerleşimli olup, darlık derecesine göre yapılan hasta dağılımında en sık %70-90 aralığında (n=21, %60) darlık mevcuttu. Akımı engelleyen disseksiyon nedeniyle 5 (%14.2) hastaya işlem yapıldı. Predilatasyon uygulanan 20 (%57.1) hasta ve postdilatasyon uygulanan 25 (%77.1) hasta ve distal emboli koruyucu filtre kullanılan 20 (%57.1) hasta vardı. İşlemde 7 (%20) hastada vazospazm gelişti. Persistan hipotansiyon olan 1 (%2.8) hasta ve hiperperfüzyon kanaması olan 3 (%8.6) hasta vardı. 48 saatten uzun süren yoğunbakım yatışı olan 2 (%5.7) hasta vardı. 3. aydaki klinik başarısı olan (mRS≤ 2) 32 (%91.4) hasta vardı. Mortalite bir (%2.8) hastada myokard enfarktüsüne sekonder gelişti. Sonuç: Semptomatik ciddi karotid arter stenozu olan hastalarda acil KAS’ın kabul edilebilir erken dönem güvenlik ve etkinlik sonuçları sunmaktadır. Mevcut çalışma acil KAS'ın seçilmiş hasta popülasyonunda etkili bir tedavi seçeneği olabileceğini ortaya koymaktadır. Ancak, bu alanda daha fazla prospektif, randomize kontrollü ve çok merkezli çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

• Karotid arter stenozu
• acil stentleme
• inme
• endovasküler tedavi
• komplikasyonlar
• klinik sonuçlar

Emergency Carotid Artery Stenting in Acute Ischemic Stroke Due to Cervical Internal Carotid Artery Occlusion or Stenosis: A Single-Center Experience

Öz

Objective: This study aims to comprehensively evaluate the effectiveness and safety of emergency carotid artery stenting (CAS) in a selected patient population by consolidating the outcomes of CAS procedures. Methods: A total of 230 patients who underwent CAS at our interventional radiology unit between January 1, 2020, and July 31, 2024, were retrospectively evaluated. Among these, 35 patients who received emergency CAS due to hemodynamic instability and high National Institutes of Health Stroke Scale (NIHSS) scores (>4) at initial admission; increased frequency of transient ischemic attacks (TIA) during follow-up; clinical deterioration in acute infarction; decline in Glasgow Coma Scale (GCS) scores and consciousness; significantly impaired flow due to dissection; or balloon resistance in tandem occlusion were included in the study. Procedural complications, technical and clinical success, modified Rankin Scale (mRS) scores, and mortality rates were recorded. Results: Of the 35 patients included, 57.2% (n=20) were male, with a mean age of 67.5 ± 9.4 years. Comorbidities were present in 77.1% (n=27) of the patients, with hypertension being the most common (n=21, 60%). Lesions were located in the right carotid artery in 57.2% (n=20) of cases, and the most frequent degree of stenosis was between 70–90% (n=21, 60%). CAS was performed in 5 patients (14.2%) due to flow-limiting dissection. Predilatation and postdilatation were performed in 20 (57.1%) and 25 (77.1%) patients, respectively, and distal embolic protection filters were used in 20 (57.1%) patients. Procedural vasospasm occurred in 7 patients (20%). Persistent hypotension was observed in 1 patient (2.8%), and hyperperfusion-related hemorrhage occurred in 3 patients (8.6%). Two patients (5.7%) required intensive care unit (ICU) stay longer than 48 hours. At 3 months, 32 patients (91.4%) demonstrated favorable clinical outcomes (mRS ≤ 2). Mortality occurred in one patient (2.8%) due to myocardial infarction. Conclusion: Emergency CAS offers acceptable early safety and efficacy outcomes in patients with symptomatic high-grade carotid artery stenosis. The findings suggest that emergency CAS may be a viable therapeutic option in selected patients. However, further prospective, randomized controlled, multicenter studies are warranted to validate these results.

Anahtar Kelimeler

• Carotid artery stenosis
• emergency stenting
• stroke
• endovascular treatment
• complications
• clinical outcome

Kaynakça

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