Berk ARAPİ, Deniz GÖKSEDEF, Caner ARSLAN, Kamil Hasan TÜZÜN, Zeki KILIÇ, Kazım BEŞİRLİ

Karotis endarterektomide plak morfolojisi ile ameliyat sonrası mikroemboli-serebrovasküler olay arasındaki ilişki

Amaç: Bu çalışmada rutin karotis şantı kullanılan vearteriyotomileri safen ven yama plastisi ile kapatılan karotisendarterektomi hastalarında yeni iskemi ve ameliyat sırasıinmenin plak morfolojisi ile ilişkisi incelendi.Çalışmaplanı: Çalışmaya %70 ve üzeri karotis darlığı bulunanve izole karotis endarterektomi ameliyatı planlanan 25 hasta(21 erkek, 4 kadın; ort. yaş 69±8.3 yıl; dağılım 47-84 yıl)dahil edildi. Hastaların üçü (%12) asemptomatik, 22si (%88)semptomatik idi. Tüm hastalara ameliyat öncesi ve ameliyatsonrası birinci günde difüzyon manyetik rezonans (MR)görüntüleme uygulandı. Ameliyatlar genel anestezi altındayapıldı. Rutin karotis şantı kullanıldı ve arteriyotomiler safen venyama ile kapatıldı. Endarterektomi materyalleri patolojik olarakincelendi. Ameliyat öncesi ve sonrası difüzyon MR görüntülerikarşılaştırıldı, nörolojik patolojiler ve komplikasyonlar açısındandeğerlendirildi.Bul gu lar: Altı hastada (%24) fibrosis, dokuz hastada (%36)kalsifikasyon, dört hastada (%16) ülserasyon ve altı hastada (%24)tromboz saptandı. Ameliyat öncesi difüzyon MR görüntülemedebeş hastada (%20) aynı tarafta lezyon saptandı. Ameliyatsonrası birinci günde yapılan difüzyon MR görüntülemede beşhastada (%20) yeni iskemik lezyon saptandı. Beş hastada yeniiskemik lezyon saptanmış olsa da ameliyat sonrası nörolojikkomplikasyon yoktu. Yeni iskemik lezyon saptanan hastalarınüçünde kalsifikasyon, birinde ülserasyon ve birinde trombozeplak vardı.Sonuç: Endarterektomi grubumuzda kalsifik plaklar, ameliyatsırası hipotansiyon ve yüksek kolesterol düzeyleri görülmesinerağmen, bunların arasında istatistiksel olarak anlamlı ilişkiyoktu.

Re lationship be tw ee n plaque mo rpho logy and po sto perativ e mic ro embo lus- c erebrov asc ular ev ent on karo tid e ndarte re cto my

Background: This study aims to review the relationship ofnew ischemia and perioperative stroke with plaque morphologyin routine carotid shunt used and saphenous vein patch plastyapplied carotid endarterectomy patients.Methods: The study included 25 patients (21 males, 4 females;mean age 69±8.3 years; range 47 to 84 years) who had 70% andhigher carotid stenosis and were planned to undergo carotidendarterectomy. Of the patients, three (12%) were asymptomaticand 22 (88%) were symptomatic. All patients were administereddiffusion magnetic resonance (MR) imaging perioperatively and atpostoperative first day. Operations were performed under generalanesthesia. Routine carotid shunt was used and arteriotomieswere closed with saphenous ven patch. Endarterectomy materialswere examined pathologically. Preoperative and postoperativediffusion MR images were compared and evaluated for neurologicpathologies and complications.Results: Fibrosis was detected in six patients (24%), calsificationin nine patients (36%), ulceration in four patients (16%), andthrombosis in six patients (24%). Preoperative diffusion MRimaging revealed ipsilateral lesion in five patients (20%).Diffusion MR imaging conducted at postoperative first dayshowed new ischemic lesion in five patients (20%). Althoughnew ischemic lesions were detected in five patients, there was nopostoperative neurologic complication. Of new ischemic lesiondetected patients, three had calsification, one had ulceration, andone had thrombosed plaque.Conclusion: Although calcific plaques, perioperative hypotensionand high cholesterol levels were seen in our endarterectomygroup, there was no statistically significant relationship betweenthem.

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