SONER ÇİVİ, EMRE DURDAĞ, ÇAĞATAY ANDİÇ, Aslı KARSLI, Halil Ibrahim SUNER, ÖZGÜR KARDEŞ, KADİR TUFAN, Şule AKIN ENES

ELEKTİF ENDOVASKÜLER SEREBRAL ANEVRİZMA TEDAVİSİ SONRASI YOĞUN BAKIM TAKİBİ GEREKLİ MİDİR?

Amaç: Elektif kanamam›fl intrakraniyal anevrizmalar›n (K‹A) tedavisinde endovasküler yöntemler s›kça kullan›lmaktad›r. ‹fllem sonras›nda hastalar›n nerede izlenmesi gerekti¤i ise son y›llarda s›kça tart›fl›lmaktad›r. Elektif K‹A hastalar›n›n takibinde yo¤un bak›m gereklili¤ini araflt›rmak istedik. Yöntem: fiubat-2015 ile Haziran-2018 y›llar› aras›nda Baflkent Üniversitesi Adana Dr. Turgut Noyan Uygulama ve Araflt›rma Merkezi’nde tedavi edilen vakalar›n, demografik bilgileri, anevrizmalar›n yerleflimleri, uygulanan tedaviler, komplikasyonlar, yo¤un bak›mda yat›fl süreleri, toplam hastanede yat›fl süreleri ve mortalite ile morbiditeleri incelendi. Bulgular: Araflt›rma sonunda 116 hastaya endovasküler olarak tedavi uyguland›¤› görüldü. Erkek/Kad›n oran› 39/77 idi. Ortalama yafl 52.87 idi. En s›k tedavi gerektiren K‹A’lar incelendi¤inde, hastalar›n 27’sinin (%23) sol internal karotid arter anevrizmas› (ICA) nedeniyle tedavi edildi¤i görüldü. Altm›fl yedi hastaya (%58) ak›m çevirici stent uyguland›¤› saptand›. On hastada komplikasyon gözlendi, bunlar›n 4’ü ifllem s›ras›nda, 6’s› ifllem sonras›nda görülen komplikasyonlard›. Mortalite veya kal›c› morbidite gözlenmedi. Komplike olmayan vakalarda ortalama yo¤un bak›m yat›fl süreleri 1.23 gün, komplikasyonla sonuçlanan vakalar›n ise ortalama yat›fl süresi ise 7.4 gün olarak saptand›. Sonuç: Son y›llarda yap›lan elektif K‹A’lar›n yo¤un bak›mda takibi ile ilgili tart›flmalar sa¤l›k giderlerini azaltmak üzerine kurulmufltur. Bu hasta grubunun yönetiminde yo¤un bak›m›n önemi çok fazlad›r. Medikolegal konular›n s›kl›kla gündeme geldi¤i günümüzde hastay› ve hekimi korumak ve uygun takip ve tedavi koflullar›n› sa¤lamak ad›na tüm hastalar›n yo¤un bak›m ünitelerinde takibini önermekteyiz.

IS INTENSIVE CARE FOLLOW UP NECESSARY AFTER ELECTIVE ENDOVASCULAR CEREBRAL ANEURYSM TREATMENT

Objective: Endovascular methods are frequently used in the treatment of elective unruptured intracranial aneurysms (CIA). It is frequently discussed in recent years about where patients should be monitored after the procedure. We want to investigate the need for intensive care following endovascular treatment of elective CIA patients. Method: Between February-2015 and June-2018, elective patients with unruptered intracranial aneurysms treated via endovascular method was reviewed in Baskent University. Adana Dr. Turgut Noyan Training and Research Center. Demographic information, location of aneurysms, treatments, complications, duration of stay in intensive care unit, total stay in hospital, mortality and morbidity were analyzed. Results: At the end of the investigation it was seen that 116 patients were treated endovascularly. The Male/Female ratio was 39/77. The mean age was 52.87. When the most frequently treated CIAs were examined, 27 patients (23%) were treated for left internal carotid artery aneurysm (ICA). A total of 67 patients (58%) were found to have a flow-diverter stent. Complications were observed in 10 patients, of which 4 were at the time of operation and 6 complications were after operation. Mortality or permanent morbidity was not observed. The mean intensive care stay was 1.23 days in uncomplicated cases and 7.4 days in complicated cases Conclusion: The recent debates about the follow-up of elective CIAs in intensive care have been based on reducing health care costs. But the intensive follow-ups of these patients in intensive care are very important. Today, when medicolegal issues are frequent, we advise all patients to follow intensive care in order to preserve patients and physicians and to ensure appropriate follow-up and treatment conditions.

PDF

___

Andaluz N, Zuccarello M. Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg 2008; 108: 1163-1169.
Brinjikji W, Kallmes DF, Lanzino G, Cloft HJ. Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments. AJNR Am J Neuroradiol 2012; 33: 1037-1040.
Fiehler J, Ries T. Prevention and treatment of thromboembolism during endovascular aneurysm therapy. Klin Neuroradiol 2009; 19: 73-81.
Kang HS, Han MH, Kwon BJ, et al. Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms? Neurosurgery 2010; 67: 1371-1376.
Cavaliere F, Conti G, Costa R, Masieri S, Antonelli M, Proietti R. Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity. Minerva Anestesiol 2008; 74: 459-468.
Pearse RM, Harrison DA, James P, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006; 10: R81.
Teplick R, Caldera DL, Gilbert JP, Cullen DJ. Benefit of elective intensive care admission after certain operations. Anesth Analg 1983; 62: 572-577.
Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014; 13: 393-404.
Hwang SK, Hwang G, Oh CW, et al. Endovascular treatment for unruptured intracranial aneurysms in elderly patients: single-center report. AJNR Am J Neuroradiol 2011; 32: 1087-1090.
Burrows AM, Rabinstein AA, Cloft HJ, Kallmes DF, Lanzino G. Are routine intensivecare admissions needed after endovascular treatment of unruptured aneurysms? AJNR Am J Neuroradiol 2013; 34: 2199-2201.
Stiefel MF, Park MS, McDougall CG, Albuquerque FC. Endovascular treatment of unruptured intracranial aneurysms in the elderly: analysis of procedure related complications. J Neurointerv Surg 2010; 2: 11-15.
Stetler WR Jr, Griauzde J, Saadeh Y, et al. Is intensive monitoring necessary after coil embolization of unruptured intracranial aneurysms? J Neurointerv Surg 2017; 9: 756-760.
Jabbour P, Koebbe C, Veznedaroglu E, Benitez RP, Rosenwasser R. Stent-assisted coil placement for unruptured cerebral aneurysms. Neurosurg Focus 2004; 17: E10.
Niskanen M, Koivisto T, Rinne J, et al. Complications and postoperative care in patients undergoing treatment for unruptured intracranial aneurysms. J Neurosurg Anesthesiol 2005; 17: 100-105.
Arias EJ, Patel B, Cross DT 3rd, et al. Timing and nature of in-house postoperative events following uncomplicated elective endovascular aneurysm treatment. J Neurosurg 2014; 121: 1063-1070.
Bui JQ, Mendis RL, van Gelder JM, Sheridan MM, wright KM, Jaeger M. Is postoperative intensive care unit admission a prerequisite for elective craniotomy? J Neurosurg 2011; 115: 1236-1241.
Beauregard CL, Friedmann WA. Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol 2003; 60: 483-489.
Zimmerman JE, Junker CD, Becker RB, Draper EA, Wagner DP, Knaus WA. Neurological intensive care admissions: identifying candidates for intermediate care and the services they receive. Neurosurgery 1998; 42: 91-101.
Smith M. Postoperative care after elective endovascular treatment of unruptured intracranial aneurysms: where matters less than what. Anesth Analg 2015; 121: 17-19.
Eisen SH, Hindman BJ, Bayman EO, Dexter F, Hasan DM. Elective endovascular treatment of unruptured intracranial aneurysms: a management case series of patient outcomes after institutional change to admit patients principally to postanesthesia care unit rather than to intensive care. Anesth Analg 2015; 121: 188-197.