Hasan Hüseyin KOZAK, Hasan Hüseyin KIR, Ahmet BUĞRUL, Osman KOÇ

Karotis Arter Darlığı ile Birlikte Sınır Zonu İnfarktı Saptanan Olguların Klinik ve Radyolojik Özellikleri ile Karotis Arter Stentlemesinin Erken Dönem Sonuçları

Amaç: İnternal karotis arter gibi supraaortik büyük arter tıkanıklarında mortalite ve kalıcı özürlülük oranı daha yüksektir. Dolayısıyla karotis arter darlıklarının erken tespiti klinik açıdan önem arzetmektedir. Aterom plağının distale olan akımı kısıtlayacak derecede stenoza neden olması sonucunda karşımıza çıkan “sınır zonu infarktı” ise karotis arter darlıklarında normalden çok daha sık olarak karşımıza çıkarak karotis arter darlığı açısından uyarıcı olabilmektedir. Bu çalışmada, kraniyal görüntülemelerinde sınır zonu infarktı izlenen ve etiyolojisinde karotis arter darlığı saptanarak karotis arter stentleme yapılan olgular incelenmiştir.Yöntemler: Ocak 2017-Temmuz 2019 tarihleri arasında serebrovasküler hastalık tanısı ile takip edilmiş ve karotis arter stentleme yapılmış 120 olgu retrospektif olarak incelenmiş sınır zonu infarktı saptanan 31 olgu çalışmaya dahil edilmiştir.Bulgular: 31 olgunun yaş ortalaması 68,1±9,6 olup 27 si erkek ve 4 ü kadındı. Bu olguların 8 (%25,8) tanesinde sağ, 7 (%22,6) tanesinde sol, 16 (%51,6) tanesinde bilateral karotis arter darlığı mevcuttu. En yüksek oranda eşlik eden komorbiditeler hipertansiyon 28 (%90,3), hiperlipidemi 22 (%71) ve koroner arter hastalığı 18(%58,1) idi. Olguların17 (%54,8)’inde geçici iskemik atak, 24(%77,4)’ünde sigara içme öyküsü mevcuttu. 31 olgu radyolojik olarak değerlendirildiğinde 17 (%54,8) tanesinde internal+eksternal, (%16,1) tanesinde izole internal ve 9 (%29) tanesinde izole eksternal sınır zonu infarktı saptandı. Olgulara iskemik inmeden ortalama 22,3±12,2 gün sonra stentleme yapıldığı saptandı. Karotis arter stentleme sonrası 3 olguda minör inme saptandı. Minör inme sebebi ile bu olguların hastane yatış sürelerinin ortalama 6 gün uzadığı izlendi. Olguların pre-op ortalama modifiye rankin skorları 1.35±0.87iken işlemden 30 gün sonra 1.13±0.99 idi. Tüm olguların birinci ay sonunda yapılan karotis arter doppler ultrasonografi incelemelerinde stent açıklığının tam olarak izlendiği ve restenoz saptanmadığı tespit edildi.Sonuç: Sınır zonu infarktları karotis arter darlıkları açısından uyarıcı bir iskemik inme paternidir. Klinisyenlerin hastalığın tanınması ve tedavisinin yürütülmesi süreçlerinde etkin bir şekilde mücadele edebilmeleri için farkındalıkları arttırılmalıdır. Bu çalışma, sınır zonu infarktı ile gelen karotis arter darlıklı hasta gruplarında endovasküler stentleme yönteminin güvenli olduğuna ve erken dönemli sonuçlarının fonksiyonel sonlanımlar açısından olumlu sonuçlandığına işaret etmektedir.

Clınıcal and Radıologıcal Features of Patıents Wıth Carotıd Artery Stenosıs and Watershed İnfarction and Early Outcomes of Carotıd Artery Stentıng

Objective: Mortality and permanent disability rates are higher in supraaortic large artery occlusions such as the internal carotid artery. Therefore, early detection of carotid artery stenosis is clinically important. As a result of the atheroma plaque causing stenosis to a degree that restricts the flow to the distal, "border zone infarction" is more common than normal in carotid artery stenosis and can be a warning for carotid artery stenosis. In this study, patients who had border zone infarction and carotid artery stenting due to carotid artery stenosis were evaluated. Methods: Between January 2017 and July 2019, 120 patients who were followed up with a diagnosis of cerebrovascular disease and carotid artery stenting were reviewed retrospectively. 31 cases with border zone infarction were included in the study Results: The mean age of 31 cases (27 male, 4 female) was 68,1 ± 9,6. 8 (25.8%) of these cases had right, 7 (22.6%) of them had left, and 16 (51.6%) had bilateral carotid artery stenosis. The most seen comorbid disease were hypertension 28 (90.3%), hyperlipidemia 22 (71%) and coronary artery disease 18 (58.1%). There was a transient ischemic attack in 17 (54.8%) cases, and smoking in 24 (77.4%) cases.When 31 cases were evaluated radiologically, 17 (54.8%) internal + external, 5 (16.1%) isolated internal and 9 (29%) isolated external border zone infarcts were detected. It was determined that stenting was performed on average 22.3 ± 12.2 days after ischemic stroke.Minor stroke was detected in 3 cases after carotid artery stenting. Due to minor stroke, the hospitalization time of these cases was observed to increase 6 days on average. The pre-op mean mRS of the cases was 1.35 ± 0.87, while it was 1.13 ± 0.99 30 days after the procedure. In the carotid artery doppler ultrasonography examinations performed at the end of the first month of all cases, it was determined that the stent patency was fully monitored and no restenosis was detected. Conclusions: Border zone infarcts are a stimulating ischemic stroke pattern for carotid artery stenosis. Awareness of clinicians should be increased so that they can effectively fight the disease recognition and treatment processes. This study indicates that the endovascular stenting method is safe in patients with carotid artery stenosis that comes with border zone infarction, and that early results result positively in terms of functional outcomes.

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