Bölgesel anestezi ile karotis endarterektomisi: 71 vakanın dökümü

This method offers several advantages including monitorization of the cerebral ischemia during surgery, usage of selective shunting, decreased need for intensive care and shorter hospitalization time.

📌 3 Key Takeaways

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Objective & Hypothesis:AIM: The aim of carotid endarterectomy (CEA) is the successful removal of the atherosclerotic plaque and meticulous anatomical and physiological reconstruction of the carotid artery without any perioperative complications.

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Key Findings & Data:MATERIAL and METHODS: A total of 71 consecutive patients were planned to undergo carotid endarterectomy under regional anesthesia between 2000 and 2006.

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Conclusion & Impact:This method offers several advantages including monitorization of the cerebral ischemia during surgery, usage of selective shunting, decreased need for intensive care and shorter hospitalization time.

🔬Design:Review & Systematic Survey

📍Scope:2000 Verileri

⚙️Variables:İleriye dönük çalışma · Geriyedönük çalışma · Ölüm oranı

Abstract

AIM: The aim of carotid endarterectomy (CEA) is the successful removal of the atherosclerotic plaque and meticulous anatomical and physiological reconstruction of the carotid artery without any perioperative complications. Endarterectomy can also be carried out with regional anesthesia, which allows monitoring of the neurological status. This study reviews patients who underwent CEA with regional anesthesia. MATERIAL and METHODS: A total of 71 consecutive patients were planned to undergo carotid endarterectomy under regional anesthesia between 2000 and 2006. All of these patients, assessed by our neurovascular team, were recruited prospectively and the data was analyzed retrospectively. RESULTS: The study group consisted of 23 women and 48 men with a mean age of 62 (range 37-79). 67 patients (94,4%) had symptomatic, and 4 (5,6%) had asymptomatic (5.6%) carotid stenosis. Six patients (8.45%) were intolerant to carotid clamping (8,45%). The stroke morbidity rate was 1.4% and the mortality rate was 1.4%. The mean hospitalization time was 2.07 (range 1-10) days. CONCLUSION: Carotid endarterectomy performed under regional anesthesia can be a safe method which may lead to better neurological outcome. This method offers several advantages including monitorization of the cerebral ischemia during surgery, usage of selective shunting, decreased need for intensive care and shorter hospitalization time.

Özet

AMAÇ: Karotis endarterektomide amaç, herhangi bir komplikasyon olmadan aterosklerotik plağın dikkatlice çıkarılarak patent arter karotisin yeniden tamiridir. Bölgesel anestezi nörolojik monitorizasyona olanak sağlaması nedeniyle tercih edilen yöntemlerden birisidir. Bu çalışmanın amacı, bölgesel anestezi ile karotis endarterektomi uygulanan olgularımızın retrospektif olarak gözden geçirilerek klinik sonuçlarımızın incelenmesidir. YÖNTEM ve GEREÇ: 2000 – 2006 tarihleri arasında 71 olgu bölgesel anestezi ile karotis endarterektomi operasyonuna alınmıştır. Hastaların bilgileri prospektif olarak kaydedilmiştir. Tüm olgular nörovasküler ekip tarafından ameliyat öncesinde ve sonrasında takip edilmiştir. Bütün prospektif data retrospektif olarak analiz edilmiştir. BULGULAR: Olgularımızın 23'ü kadın, 48'i erkekti ve ortalama yaşları 62 (37-79) bulundu. 67 hasta semptomatik (%94,4), 4 hasta asemptomatikdi (%5.6). Altı (%8,45) hasta karotis kapatılmasını tolere etmedi. Mortalite %1,4 morbidite %1,4 olarak belirlendi. Hastanede kalma süreleri ortalama 2,07 (1-10) gündü. SONUÇ: Uyanık hastada bölgesel anestezi ile karotis endarterektomisi güvenli bir yöntemdir. Ameliyat sırasında oluşabilecek serebral iskeminin monitorizasyonu, seçici şant uygulanabilmesi, yoğun bakım ihtiyacının olmaması ve hastanede kalış sürelerinin kısa olması da bu tekniğe ayrı avantajlar sağlamaktadır.

Keywords

İleriye dönük çalışma Geriyedönük çalışma Ölüm oranı Yatış süresi Cinsiyet dağılımı Endarterektomi karotis Hastalık oranı Yaş dağılımı Anestezi blok Prospective Studies Retrospective Studies Mortality Length of Stay Sex Distribution Endarterectomy Carotid Morbidity Age Distribution Anesthesia Conduction

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Cite This Article

KARASU, A., KUŞÇU, Y. D., BAKAÇ, G., OFLUOĞLU, E., AKKOYUN, N., YALÇINER, B., DAYAN, C., BAHAR, S., KIRIŞ, T., ÜYE, M., TOPLAMOĞLU, H. (2009). Bölgesel anestezi ile karotis endarterektomisi: 71 vakanın dökümü. Turkish Neurosurgery, Cilt: 19 - Sayı: 1, 21–28. https://ajindex.com/articles/417873

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References (1)

Barnett HJ. The inappropriate use of carotid endarterectomy. CMAJ 4171(5):455-459, 2004 2. Barnett HJM, Meldrum HE, Eliasziw M: North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. The appropriate use of carotid endarterectomy. CMAJ 66(9):1169-1179, 2002 3. Benavente O, Moher D, Pham B: Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421-1429, 1995 4. Benjamin ME, Silva MB Jr, Watt C, Mc Caffrey MT, BurfordFoggs A, Flinn WR: Awake patient monitoring to determine the need for shunting during carotid endarterectomy. Surgery 114:673-681, 1993 5. Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, Caplan LR, Kresowik TF, Matchar DB, Toole JF, Easton JD, Adams HP Jr, Brass LM, Hobson RW 2nd, Brott TG, Sternau L: Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. Feb 10, 97(5):501-509, 1998 6. Bond R, Rerkasem K, Counsell C, Salinas R, Naylor R, Warlow CP, Rotwell PM: Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2: 2002 CD000190 7. Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, Cote R, Hess D, Saver J, Spence JD, Stern B, Wilterdink J: Carotid endarterectomy-an evidence-based review: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 65: 794–801, 2005 8. Colpan ME, Attar A, Sekerci Z, Tuna H, Egemen N: Chlamydia pneumoniae infection related atherosclerotic clinical variables on carotid stenosis. J Clin Neurosci. 11(4):389-394, 2004 9. Coward LJ, Featherstone; RL, Brown MM: Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst. Rev 2: 2004 CD 000515 10. European Carotid Surgery Trialists’ Collaborative Group: Randomised trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351:1379-1387, 1998 11. Findlay JM, Marchak BE, Pelz DM, Feasby TE: Carotid endarterectomy: A review. Can J. Neurol. Sci. 31:22-36, 2004 12. Fiorani P: General anaesthesia versus cervical block and perioperative complications in carotid artery surgery. Eur J Vasc Endovasc Surg 13:37-42, 1997 13. Forssell C,