Mehmet Ruhi ONUR, Timur SİNDEL, Saim YILMAZ, Ersin LÜLECİ

Karotis Arter Stenozlarında Endovasküler Tedavi Etkinliğinin Değerlendirilmesi

Giriş: Aterosklerotik karotis arter stenozunda karotis artere stent yerleştirilmesi karotis endarterektomisine alternatif olan bir tedavi yöntemidir. Bu çalışmada endovasküler tedavi uygulanan hastalarda stent açıklığının renkli Doppler Ultrasonografi (RDUS) ile değerlendirilerek tedavinin etkinliğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde 2001 Kasım-2005 Ocak arasında emboli koruyucu filtre kullanılarak karotis arter stenozlarına yönelik karotis arter stent tedavisi yapılan 36 olgu RDUS ile değerlendirildi. Otuzaltı olguya takılan toplam 42 stentin RDUS ile değerlendirilmesinde stent içinde restenoz varlığı araştırıldı. Bulgular: Olgulara uygulanan endovasküler tedavide %100 teknik başarı oranı sağlandı. Endovasküler tedavi uygulanan ve toplam 42 stent takılan 36 olgunun takibinde sadece 1 hastada (%2.3) RDUS incelemede stent içerisinde anlamlı restenozu (%70) düşündüren hız artısı saptandı (sistolik hız/diastolik hız: 175/29 cm/sn, ICA sistolik hız/CCA sistolik hız>4). Bunun dışında 2 hastada RDUS incelemesinde anlamlı darlığa yol açmayan intimal hiperplazi izlendi. Sonuç: Karotis stenozlarına yönelik uyguladığımız endovasküler tedavide stentlerin açık kalım oranı ve işleme bağlı komplikasyon oranı literatürde yapılan çalışmalarla uyumludur. Emboli koruyucu filtre kullanımı karotis stenozlarının endovasküler tedavisinde serebrovasküler olay riskini azaltır. ©2007, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler:

Karotis, Stenoz, Stent

Evaluation of Endovascular Treatment Efficacy in Carotid Artery Stenosis

Objectives: Carotid artery stenting is an alternative therapeutic approach to carotid endarterectomy in the treatment of atherosclerotic carotid artery stenosis. In this study we evaluated the results of endovascular treatment in our clinic and investigated the restenosis in stents that corresponds to effectiveness of treatment. Material and Method: We evaluated 36 patients with 42 carotid artery stents treated in our clinic between November 2001 and January 2005. We used Doppler ultrasonography in order to search restenosis in the stents. Results: Technical success rate at the endovascular treatment was 100%. Significant restenosis (70%) in totally 42 stents was shown in only 1 patient (2.3%) with increased velocity rates (systolic/diastolic velocities: 175/29 cm/sn). In addition intimal hyperplasia was shown on 2 patients. Conclusion: The results of our endovascular treatment for carotid artery stenosis regarding restenosis ratio of stents and complications of treatment are compatible with literature. ©2007, Fırat Üniversity, Medical Faculty

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Roubin GS, New G, Iyer SS, et al. Immediate and late clinical outcomes of carotid artery stenting in symptomatic and asymptomatic carotid stenosis: a 5-year prospective analysis. Circulation 2001; 103: 532-537.
Wholey MH, Wholey M, Mathias K, et al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 2000; 50: 160-167.
Shawl F, Kadro W, Domanski MJ, et al. Safety and efficacy of elective carotid artery stenting in high-risk patients. J Am Coll Cardiol 2000; 35: 1721-1728.
Vitek JJ, Mubarak NA, Iyer SS, Roubin GS. Carotid artery stent placement with distal balloon protection: technical considerations. Am J Neuroradiol 2005; 26: 854-861.
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Eng J Med 1991; 325: 445-453.
Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Eng J Med 1998; 339: 1415-1425.
Brown R. R, Rogers J, Bland J.M, et al. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 2001; 357: 1729-1737.
Melliere D. Chirurgie carotidienne: bilan et problemes actuels. J Mal Vasc 1993; 18: 176-185.
Heyman A, Wilkinson WE, Heyden S, et al. Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Eng J Med 1980; 302: 838841.
Willing SJ, Patel NH. Endarterectomy, carotid stenting and stroke prevention. Semin Intervent Radiol 2002; 313-320.
Kızıkkılıç O, Yıldırım T, Giray S, et al. Endovascular treatment of extracranial ınternal carotid artery stenosis. J Neurol Sci [Turk] 2005; 22: 21-28.
Phatouros CC, Higashida R, Malek A, et al. Carotid artery stent placement for atheroschlerotic disease: Rationale, technique, and current status. Radiology 2000; 217: 26-41.
European Carotid Surgery Trialist’s Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70 – 99%) or with mild (0-29%) carotid stenosis. Lancet 1991; 337: 1235-1243.
Endarterectomy for asymptomatic carotid artery stenosis: Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273: 1421-1428.
Allum CA, Lacina T, Watkinson AF. Metallic stent-Individual designs and characteristics. Semin Intervent Radiol 2001; 18: 191-204.
Mathur A, Roubin GS, Iyer SS, et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998; 97:12391245.
Piepgras DG, Morgan MK, Sundt TM, et al. Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 1988; 68: 532-536.
Solomon RA, Loftus CM, Quest DO, Correll JW. Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy. J Neurosurg 1986; 64: 29-34.
Geary RL, Nikkari ST, Wagner WD, et al. Wound healing: a paradigm for lumen narrowing after arterial reconstruction. J Vasc Surg 1998; 27: 96-106.
Schllinger M, Exner M, Mlekusch W, et al. Acute-phase response after stent implantation in the carotid artery: association with 6month in-stent restenosis. Radiology 2003; 227: 516-521.
Denny FD. Prediction of restenosis after carotid artery stent implantation. Radiology 2003; 227: 316-318.
Barr JD, Connors JJ, Sacks D, et al. Quality improvement guidelines for the performance of cervical carotid angioplasty and stent placement. Am J Neuroradiol 2003; 24: 2020-2034.
Willfort Ehringer A, Ahmadi R, Gschwandtner ME, et al. Single center experience with carotid stent restenosis. J Endovasc Ther 2002; 9: 299-307.
Bergeron P, Bafort AC, Pietri PA, et al. Long term results of carotid angioplasty and stenting. In: Carotid Artery Angioplasty and Stenting. A Multidisciplinary approach. Torino: Edizioni Minerva Medica 2002; 246-253.
Biller J, Feinberg WM, Castaldo JE. Guidelines for carotid Endarterectomy: a statement for healthcare professionals from a specific writing group of the Stroke Council, American Heart Association. Stroke 1998; 29: 554-562.