Karotis stentlemede yaş ve peroperatif morbidite İlişkisi

Amaç: Karotid arter stenozu ileri yaş olgularda görülen bir hastalıktır. Karotid stenozu tedavisinde uygulanan karotis stentlemede peroperatif morbidite ve mortalitenin yaşa bağlı arttığı belirtilmektedir. Gereç ve Yöntem: Bu çalışmada Ankara Numune Eğitim ve Araştırma Hastanesinde 2017 Ocak ve 2018 Ağustos tarihleri arasında karotis stentleme yapılan 106 olgu analiz edilmiş olup yaş ve risk faktörleri ile peroperatif morbidite ve mortalite ilişkisi araştırılmıştır. Bulgular: 106 olgunun analiz edildiği bu çalışmada 55 yaş altı görülen olgularda 2 olguda görülen hipotansiyon dışında herhangi bir morbidite gözlenmemiştir. 75 yaş ve üzeri olgularda ise hipotansiyon görülmemiş olup 55 yaş altı gruba göre daha fazla morbidite mevcuttur. 55-65 yaş arası yer alan grupta ise 1 olguda afazi, 1 olguda sol homonim hemianopsi, 1 mortalite olmuştur. 65-75 yaş arası grupta ise 2 olguda kısmi parezi, 1 olguda disfazi gözlenmiş ve 1 olguda postoperatif eksitus olmuştur. 75 yaş üzeri grupta ise 1 olguda silik hemiparezi, 1 olguda kranial sinir parezisi ve gözlerde deviasyon görülmüş olup postoperatif dönemde nöbet görülen 1 olgu ise eksitus olmuştur. Yaş artışı ile birlikte peroperatif morbidite ve mortalite oranlarında artış olduğu oransal olarak görülse de anlamlı bir istatistiksel sonuç elde edilememektedir. Hipotansiyonun ise yaşla birlikte azaldığı görülmektedir. Sonuç: 55 yaş altı karotis stentlemede risk minimal olup hipotansiyon oransal olarak fazla görülmekte, 75 yaş üzeri grupta da hipotansiyon görülmeyip komplikasyonlar artış göstermektedir.

Anahtar Kelimeler:

Yaş, karotid arter stentleme, peroperatif morbidite

The association between age and peroperative morbidity in carotid stenting cases

Aim: Carotid artery stenosis is a geriatric population disease. It was considered that advanced age is related to increased peroperative morbidity and mortality during carotid stenting. Material and Methods:The study population includes 106 patients who were treated with carotid stenting at Ankara Numune Education and Research Hospital between January 2017 and August 2018 The aim of the study is to find the correlation between age and perioperative morbidity and mortality rates. Results: The group of patients below 55 years of age didn’t develop any morbidity except marked hypotension in 2 patients. Patients aged over 75 did not develop any hypotension and morbidity in this group is relatively high compared to patients below 55 years of age. Age group between 55 and 65 developed 1 aphasia, 1 homonymous hemianopia and 1 mortality. There were 1 dyspasia, 2 hemiparesis and 1 mortality in patients between 65 and 75 years of age. Morbidity over 75 years of age included 1 hemiparesis, 1 cranial nerve paresis and 1 mortality. No correlation was found between age groups except patients below 55 years of age. An increased morbidity and mortality rate was noted with advanced age though a statistical correlation can not be applied. Hypotension was noted to decrease with advanced age. Conclusion: The risk of carotid stenting below 55 years of age is minimal except hypotension risk however perioperative morbidity and mortality is more pronounced with advanced age without any hypotension.

Keywords:

carotid artery stenting, Age, perioperative morbidity,

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1. Wendorff C, Wendorff H, Kuehnl A, Tsantilas P, Kallmayer M, Eckstein HH, Pelisek J. Impact of sex and age on carotid plaque instability in asymptomatic patients-results from the Munich Vascular Biobank. Vasa 2016; 45: 411-16.
2. Ballotta E, Toniato A, Da Roit A, Lorenzetti R, Piatto G, Baracchini C. Carotid endarterectomy for asymptomatic carotid stenosis in the very elderly. J Vasc Surg 2015; 61: 382-88.
3. Mo D, Wang B, Ma N, Gao F, Miao Z. Comparative outcomes of carotid artery stenting for asymptomatic and symptomatic carotid artery stenosis: a single-center prospective study. J Neurointerv Surg 2016; 8: 126-29.
4. Rosenfield K, Matsumura JS, Chaturvedi S et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med 2016; 374: 1011-20.
5. Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg 2007; 45: 875-80.
6. Lin SC, Trocciola SM, Rhee J et al. Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting. Ann Vasc Surg 2005; 19: 798-804.
7. Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public health reports 2009; 124: 471-74.
8. Nam HJ, Heo SH, Kim BJ, San Lee J, Youn HC, Lee JS, Kwon SU, Bushnell CD, Chang DI. Long-Term Outcome After Carotid Endarterectomy in Patients with Ischemic Heart Disease. World Neurosurg 2018; 110: 806-14.
9. Antoniou GA, Georgiadis GS, Georgakarakos EI, Antoniou SA, Bessias N, Smyth JV, Murray D, Lazarides MK. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg 2013; 148: 1140-52.
10. Nanto M, Goto Y, Yamamoto H, Tanigawa S, Takado M, Ogawa T, Nakahara Y. Periprocedural Outcomes of Carotid Artery Stenting in Elderly Patients. J Stroke Cerebrovasc Dis 2018; 27: 103-7.
11. Roubin GS, Iyer S, Halkin A, Vitek J, Brennan C. Realizing the potential of carotid artery stenting: Proposed paradigms for patient selection and procedural technique. Circulation 2006; 113: 2021-30.
12. Antoniou GA, Georgiadis GS, Georgakarakos E, Antoniou SA, Bessias N, Smyth JV, Murray D, Lazarides MK. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surg 2013; 148: 1140-52.
13. Qureshi AI, Chaudhry SA, Qureshi MH, Suri MF. Rates and predictors of 5-year survival in a national cohort of asymptomatic elderly patients undergoing carotid revascularization. Neurosurgery 2015; 76: 34-41.
14. Ledwoch J, Staubach S, Segerer M, Strohm H, Mudra H. Carotid artery stenting in clinical practice depending on patient age. Catheter Cardiovasc Interv 2017; 90: 451-60.
15. Lin CM, Chang YJ, Liu CK, Yu CS, Lu HH. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting. Clin Interv Aging 2016; 11: 985-95.
16. Rubio G, Karwowski JK, DeAmorim H, Goldstein LJ, Bornak A. Predicting Factors Associated with Postoperative Hypotension following Carotid Artery Stenting. Ann Vasc Surg 2018 pii: S0890-5096(18)30571-5.
17. Gökçal E, Niftaliyev E, Deniz Ç, Ergelen M, Güzel V, Göktekin Ö, Asil T. Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences. Acta Neurochir 2017; 159: 2081-87.
18. Cirbian J, Echaniz G, Gené A, Silva L, Fernández-Valenzuela V, de Nadal M. Incidence and timing of hypotension after transcervical carotid artery stenting: correlation with postoperative complications. Catheter Cardiovasc Interv 2014; 84: 1013-18.
19. Nanto M1, Goto Y, Yamamoto H, Tanigawa S, Takeuchi H, Nakahara Y, Tenjin H, Takado M. Complications and Predictors of Hypotension Requiring Vasopressor after Carotid Artery Stenting. Neurol Med Chir 2017; 57: 115-21.