Serdar DEMİR, Alev KILIÇGEDİK, Büşra GÜVENDİ ŞENGÖR, Süleyman Çağan EFE, Gönenç KOCABAY, Mehmet Vefik YAZICIOĞLU, Cevat KIRMA

Karotis Arter Darlığı Olan Hastalarda Karotis Artere Stent Yerleştirilmesi Sonrası Uzun Dönem Majör Serebrovasküler ve Kardiyovasküler Olay Gelişimin Belirleyicileri

Giriş: Karotis arter darlığı olan hastalarda bazı komorbid durumların uzun dönem morbidite ve mortalite üzerine etkisi olabileceği varsayımı ile yola çıkarak çalışma tasarlanmıştır. Çalışmada karotis arter darlığı olan hastalarda karotis artere stent (KAS) yerleştirilmesi sonrası uzun dönem serebrovasküler ve kardiyovasküler olay gelişiminin belirleyicilerinin tespit edilmesi amaçlanmıştır. Hastalar ve Yöntem: Çalışmamıza Kartal Koşuyolu Eğitim ve Araştırma Hastanesinde Ocak 2010-Ekim 2012 tarihleri arasında KAS yerleştirilmesi işlemi yapılan 212 ardışık hasta retrospektif olarak tespit edilerek alındı. Semptomatik hastalarda %60’ın üzerindeki, asemptomatik hastalarda ise %80’in üzerindeki ekstrakraniyal karotis arter darlığına karotid arter stentleme işlemi uygulandı. Son altı ay içerisinde aynı taraf serebral ve oküler minör ya da majör iskemik olay semptom varlığı olarak kaydedildi. Bulgular: Çalışma grubunun ortalama yaşı 67.4 ± 7.9 yıl olarak hesaplandı ve 150 (%74.5) hasta erkekti. Takip süresince 18 hastada miyokart enfarktüsü, 18 hastada majör inme, 23 (%9.9) hastada ise geçici iskemik atak gelişmiştir. Yirmi bir hastada ise serebral veya kardiyovasküler ölüm izlenmiştir. Tüm kardiyovasküler ve serebral istenmeyen olaylar (MACCE) ise 64 (%30.2) hastada izlenmiştir. Multivaryate analiz ile yaş (OR: 1.09 %95 GA: 1.02-1.17, p= 0.05), kalp yetersizliği (OR: 3.78, %95 GA: 1.48-9.62, p= 0.005), kreatinin (OR: 3.54, %95 GA: 1.16-10.82, p= 0.026) ve nötrofil-lenfosit oranının (OR: 2.88, %95 GA: 1.90-4.36, p< 0.0001) MACCE’nin bağımsız belirleyicileri olduğu saptanmıştır. Sonuç: KAS işlemi yapılan hastalarda kısa dönem riskleri belirlemede lezyonla ilişkili faktörler ön plandayken, var olan komorbid durumlar ise uzun dönem olayları göstermede daha belirleyici olabilir. Yaş, kalp yetersizliği, kreatinin ve nötrofil/lenfosit oranı, MACCE ile ilişkili en önemli risk faktörleri olarak saptandı.

Long-term Pedictors of Composite of Major Adverse Cardiovascular and Cerebrovascular Events in Carotid Artery Stenosis Patients After Stenting

Introduction: We hypothesized that long-term morbidity and mortality can be identified by the presence of comorbidities in patients with carotid artery stenosis. In our study we aimed to investigate the relationship between clinical characteristics, laboratory findings and long-term prognosis in carotid artery stenosis patients after stenting. Patients and Methods: We retrospectively enrolled 212 patients whom underwent carotid artery stenting (CAS) between January 2010 and December 2012 at Kartal Kosuyolu Training and Research Hospital. CAS was performed in symptomatic patients with > 60% stenosis and in asymptomatic patients with > 80% stenosis of extracranial carotid artery. Symptoms were defined by an ipsilateral cerebral or ocular minor or major ischemic event within the past 6 months. Results: Mean age of study population was 67.4 ± 7.9 years and 158 patients (74.5%) were male. In the follow-up period 18 patients had MI, 18 patients had major stroke, 23 patients had transient ischemic attack. Twenty-one patients (9.9%) died from cerebral-cardiovascular causes. All MACCE was found in 64 patients (30.2%). Multivariate analysis revealed that age (OR: 1.09, 95% CI: 1.02-1.17, p= 0.05), heart failure (OR: 3.78, 95% CI: 1.48-9.62, p= 0.005), creatinine (OR: 3.54, 95% CI: 1.16-10.82, p= 0.026) and neutrophil-lymphocyte ratio (OR: 2.88, 95% CI: 1.90-4.36, p< 0.0001) were independent predictors of the MACCE. Conclusion: Although, the short-term risk of patients undergoing CAS dominated by lesion-related factors, pre-existing comorbidities may be even more important for the long-term event. Age, heart failure, creatinine and neutrophil-lymphocyte ratio were found as the most important risk factors of MACCE.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi