Bilateral İnternal Karotis Arter Darlıkları: Risk Faktörleri ve Prognozları

Yıl 2025, Cilt: 9 Sayı: 2, 265 - 273, 31.08.2025

Işıl Kalyoncu Aslan , Leyla Ramazanoglu , Beyza Karagöz , Kağan Canyurt , Eren Gözke

Öz

Amaç: İnternal karotis arter darlığı; iskemik olaylar, geçici/kalıcı görme kaybı ve uzun vadede bellek bozuklukları gibi durumlara yol açabilir.
Bu çalışmanın amacı bilateral internal karotis arter darlıklarında (BİKAD) risk faktörleri ile inme, fundus bulguları ve bilişsel bozukluk
arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntemler: Bu çalışmaya herhangi bir nedenle nöroloji polikliniğine başvuran ve karotis doppler duplex ultrasonography ve/
veya Bilgisayarlı Tomografi Anjiografi ile BİKAD saptananlar alındı. BİKAD için üç grup oluşturuldu: (A) her iki arterde ciddi darlık, (B) bir
arterde ciddi, diğerinde orta darlık ve (C) her iki arterde orta darlık varlığı. Serebral iskemik inme öyküsü veya görüntüleme bulgusu olanlar
semptomatik, diğerleri asemptomatik olarak kabul edildi. Uyum sağlayabilenlere tecrübeli nöroloji uzmanı tarafından oftalmaskop ile fundus
değerlendirmesi ve mini-mental test (MMT) yapıldı. Semptomatik grup endovasküler tedavi alanlar ve iyi medikal tedavi ile takip edilenler
olarak da sınıflandırıldı.
Bulgular: Çalışmada 86 hasta incelendi. Yetmiş yaş üzerinde ve erkek bireylerde BİKAD görülme oranı daha yüksekti. Bilateral veya
tek taraflı ciddi darlığı olan bireylerin inme geçirme riski daha yüksekti. Bilateral ciddi darlık grubunda bilişsel etkilenme, oküler bulgu ve
stentleme oranı daha yüksekti.
Sonuç: BİKAD hastalarında bilişsel etkilenme, oküler bulgu ve inme geçirme oranları daha yüksektir. Asemptomatik hastaların tanınmasında
non-invazif yöntemler olarak fundoskopik muayene ve MMT bulguları dikkate alınmalı, hastalar ileri tetkik ve tedavi için yönlendirilmelidir

Anahtar Kelimeler

Bilateral internal karotis arter darlığı , bilişsel bozukluk , fundoskopik muayene , inme

Bilateral Internal Carotid Artery Stenosis: Risk Factors and Prognosis

Öz

Aim: Internal carotid artery stenosis may lead to ischemic events, temporary/permanent vision loss, and cognitive impairment. The aim of
this study was to evaluate the association between risk factors for bilateral internal carotid artery stenosis (BICAS) and stroke, fundus findings,
and cognitive impairment.
Material and Methods: Patients who applied to the neurology outpatient clinic for any reason and were diagnosed with BIKAD by carotid
doppler duplex ultrasonography and/or Computed Tomography Angiography were included in this study. Three groups were created for BICAS: (A) Severe stenosis in both arteries, (B) Severe stenosis in one artery and moderate stenosis in the other, and (C) Moderate stenosis
in both arteries. Patients with a history of cerebral ischemic stroke or imaging findings were grouped as symptomatic, while others were
asymptomatic. Those who were able to comply underwent fundus evaluation with an ophthalmoscope and mini-mental state examination
(MMSE) by an experienced neurologist. The symptomatic group was also classified as those who received endovascular treatment and
those who followed with the best medical treatment.
Results: Eighty-six patients were evaluated. BICAS was higher in patients over 70 years and in males. In addition, patients in groups A and
B had a higher risk of stroke. Cognitive impairment, ocular findings, and stenting rate were higher in group A.
Conclusion: Cognitive impairment, ocular findings and stroke rates are higher in BICAS patients. Funduscopic examination and MMSE
findings should be taken into consideration as non-invasive methods in the diagnosis of asymptomatic patients, and patients should be
referred for further examination and treatment.

Anahtar Kelimeler

Bilateral carotid artery stenosis , MMSE , cognitive impairment , stroke , fundoscopic examination

Kaynakça

• 1. Naylor R, Rantner B, Darling RC 3rd, Eckstein HH, Giannoukas A, Koelemay MJW, Lindström D, Schermerhorn M, Stone DH. 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 ;65(1):7-111. doi: 10.1016/j.ejvs.2022.04.011. Epub 2022 .
• 2. Arasu R, Arasu A, Muller J. Carotid artery stenosis: An approach to its diagnosis and management. Aust J Gen Pract. 2021 ;50(11):821-825. doi: 10.31128/AJGP-10-20-5664.
• 3. Benjamin EJ, V; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018 Mar 20;137(12):e67-e492. doi: 10.1161/CIR.0000000000000558. Epub 2018 Jan 31. Erratum in: Circulation. 2018;137(12):e493. doi: 10.1161/ CIR.0000000000000573.
• 4. Golledge J, Greenhalgh RM, Davies AH. The symptomatic carotid plaque. Stroke. 2000 ;31(3):774-81. doi: 10.1161/01. str.31.3.774.
• 5. Nicolaides AN, Kakkos SK, Griffin M, Sabetai M, Dhanjil S, Tegos T, Thomas DJ, Giannoukas A, Geroulakos G, Georgiou N, Francis S, Ioannidou E, Doré CJ; Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg. 2005;30(3):275-84. doi: 10.1016/j. ejvs.2005.04.031.
• 6. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004 May 8;363(9420):1491-502. doi: 10.1016/S0140- 6736(04)16146-1. Erratum in: Lancet. 2004 ;364(9432):416.
• 7. Gaudino M, Rahouma M, Di Mauro M, Yanagawa B, Abouarab A, Demetres M, Di Franco A, Arisha MJ, Ibrahim DA, Baudo M, Girardi LN, Fremes S. Early Versus Delayed Stroke After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019 ;8(13):e012447. doi: 10.1161/ JAHA.119.012447
• 8. D’Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM. Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg. 1996;62(6):1714-23. doi: 10.1016/s0003- 4975(96)00885-5.
• 9. Beros AL, Sluyter JD, Scragg R. Association of arterial stiffness and eye disease: a systematic review and meta-analysis. BMJ Open Ophthalmol. 2025;10(1):e001980. doi: 10.1136/bmjophth- 2024-001980.
• 10. Cavallari M, Stamile C, Umeton R, Calimeri F, Orzi F. Novel Method for Automated Analysis of Retinal Images: Results in Subjects with Hypertensive Retinopathy and CADASIL. Biomed Res Int. 2015;2015:752957. doi: 10.1155/2015/752957.
• 11. Mendrinos E, Machinis TG, Pournaras CJ. Ocular ischemic syndrome. Surv Ophthalmol. 2010;55(1):2-34. doi: 10.1016/j. survophthal.2009.02.024.
• 12. Dugan JD Jr, Green WR. Ophthalmologic manifestations of carotid occlusive disease. Eye (Lond). 1991;5 ( Pt 2):226-38. doi: 10.1038/eye.1991.38.
• 13. Jonas JB, Wang N, Yang D, Ritch R, Panda-Jonas S. Facts and myths of cerebrospinal fluid pressure for the physiology of the eye. Prog Retin Eye Res. 2015;46:67-83. doi: 10.1016/j. preteyeres.2015.01.002.
• 14. Kohta M, Oshiro Y, Yamaguchi Y, Ikeuchi Y, Fujita A, Hosoda K, Tanaka K, Mizobuchi S, Kohmura E, Sasayama T. Effects of carotid revascularization on cognitive function and brain functional connectivity in carotid stenosis patients with cognitive impairment: a pilot study. J Neurosurg. 2023;139(4):1010-1017. doi: 10.3171/2023.1.JNS222804.
• 15. Hachinski V. The 2005 Thomas Willis Lecture: stroke and vascular cognitive impairment: a transdisciplinary, translational and transactional approach. Stroke. 2007;38(4):1396. doi: 10.1161/01.STR.0000260101.08944.e9.
• 16. Yue W, Wang A, Liang H, Hu F, Zhang Y, Deng M, Li T, Hu X, Ye Z, Shen Y, Ji Y. Association between Carotid Intima-Media Thickness and Cognitive Impairment in a Chinese Stroke Population: A Cross-sectional Study. Sci Rep. 2016 ;6:19556. doi: 10.1038/srep19556.
• 17. Consoli A, Pasi M, Pantoni L. Vascular mild cognitive impairment: concept, definition, and directions for future studies. Aging Clin Exp Res. 2012;(2):113-6. doi: 10.1007/BF03325158.
• 18. Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D, Khatri P, Ferioli S, Adeoye O, Broderick JP, Kleindorfer D. Carotid artery stenosis as a cause of stroke. Neuroepidemiology. 2013;40(1):36-41. doi: 10.1159/000341410.
• 19. den Brok MG, Kuhrij LS, Roozenbeek B, van der Lugt A, Hilkens PH, Dippel DW, Nederkoorn PJ. Prevalence and risk factors of symptomatic carotid stenosis in patients with recent transient ischaemic attack or ischaemic stroke in the Netherlands. Eur Stroke J. 2020 (3):271-277. doi: 10.1177/2396987320932065.
• 20. Sani AF, Widjiati W, Sugianto P, Hamdan M, Swatan JP. Bilateral asymptomatic common carotid artery stenosis: Mouse model for stroke research. Open Vet J. 2022;12(4):463-468. doi: 10.5455/OVJ.2022.v12.i4.7.
• 21. Wanamaker KM, Moraca RJ, Nitzberg D, Magovern GJ Jr. Contemporary incidence and risk factors for carotid artery disease in patients referred for coronary artery bypass surgery. J Cardiothorac Surg. 2012;7:78. doi: 10.1186/1749-8090-7-78.
• 22. Rijbroek A, Wisselink W, Vriens EM, Barkhof F, Lammertsma AA, Rauwerda JA. Asymptomatic carotid artery stenosis: past, present and future. How to improve patient selection? Eur Neurol. 2006;56(3):139-54. doi: 10.1159/000096178.
• 23. Wang T, Mei B, Zhang J. Atherosclerotic carotid stenosis and cognitive function. Clin Neurol Neurosurg. 2016 Jul;146:64-70. doi: 10.1016/j.clineuro.2016.03.027.
• 24. Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci. 2009;283(1-2):36-40. doi: 10.1016/j.jns.2009.02.307.
• 25. Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, Blackwelder WC, Lam DFH, Sikdar S, Lal BK. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg. 2020 ;71(6):1930-1937. doi: 10.1016/j.jvs.2019.09.020.
• 26. Popovic IM, Lovrencic-Huzjan A, Simundic AM, Popovic A, Seric V, Demarin V. Cognitive performance in asymptomatic patients with advanced carotid disease. Cogn Behav Neurol. 2011(3):145-51. doi: 10.1097/WNN.0b013e3182313020.
• 27. Liao D, Wong TY, Klein R, Jones D, Hubbard L, Sharrett AR. Relationship between carotid artery stiffness and retinal arteriolar narrowing in healthy middle-aged persons. Stroke. 2004 ;35(4):837-42. doi: 10.1161/01.STR.0000120310.43457.AD.
• 28. Vasavada AM, Singh P, Firdaus A, Meenashi Sundaram D, Patel M, Singh G, Palanisamy L, Ansari SA, Thummala S, Pandya H. Carotid Endarterectomy Versus Stenting for the Treatment of Patients With Carotid Artery Stenosis: An Updated Systematic Review and Meta-Analysis. Cureus. 2023 16;15(2):e35070. doi: 10.7759/cureus.35070.
• 29. Arslanturk O, Keskin E. Timing of carotid revascularization after acute ischemic stroke: A retrospective comparison of endarterectomy and stenting. Med Science. 2025;14(1):141-7.
• 30. Arslanturk O, Gel MS, Keskin E. Impact of pre-stenting antiplatelet therapy regimens on clinical outcomes following carotid artery stenting: a retrospective analysis. Eur Res J. March 2025;11(2):135-142. doi:10.18621/eurj.1604476.