AI Summary & Key Takeaways
AI InsightThe mean follow-up time was 5.3±1.7 years (range, 6 months to 12 years), 312.7 patient-year.
📌 3 Key Takeaways
Abstract
Carotid endarterectomy is stili the most common procedure that is performed for cerebrovascular ischemia due to atherosclerosis. At Koşuyolu Heart and Research Hospital Department of Cardiovascular Surgery, betvveen February 1985 to Febru-ary 2000, carotid endarterectomy (CEA) procedure was applied in 67 patients. The patients population included 61 men (91%) and 6 women (9%), with a mean age of 63.4±2.6 years (ranged from 46 to 74). Additional to the carotid stenosis, 56cases(84%) had hypertension, 22cases (33%) diabetes mellitus and 18 cases (27%) myocardial infarction. 44 patients were symtomatic (66%) versus 23 asymtomatic patients (34%). in 12 of the cases (18%) cerebrovascular accidents were revealed beforehand. in our series, 49 cases (73%) were demonstrated ünilaterai and 18 cases (27%) were demonstrated bileteral stenosis of carotid artery. 28 cases had (42%) had isolated and 39 cases (58%) had combined carotid lesions with coronary artery disease required CABG. Out of 28 cases with isolated carotid lesion, 8 were undervvent CEA with primary closure while 20 were underwent CEA with patch closure (17 otologeus saphenous patch, 3 PTFE patch). Out of the 39 cases, combined CEA and CABG operations were performed to one-stage procedure in 30 patients, and two-stage procedure in the others. in öne case, CABG + CEA with patching + replacement of ascending aort were performed in the same operation stage. in combined operation group of patients, CEA was closed primarly in 9 cases, patching (17 otologeous sapheno-us patch, 3 Dacron patch) was done in 30 cases. The early mortality rate was 3% in 2 cases. Cerebrovascular morbidity was recorded in 5 cases (7.5%) (left hemipa-resis in 2, right hemiparesis in 2, decerebation in 1) and cardiac morbidity was recorded in 5 cases (7.5%)(perioperative MI in 3, reexploration for mediastinal bleeding). Recurrent stenosis was occured in 5 patients (7.5%) in late-term follow-up. There.were öne cerebrovascular reoperation (1.5%), and two cardiac reoperations (3%). Late morlality rate was 6% in 4 cases. The mean follow-up time was 5.3±1.7 years (range, 6 months to 12 years), 312.7 patient-year.
Özet
Karotis endarterektomisi ateroskleroz nedeniyle gelişen serebrovasküler yetmezliğin tedavisi için en sık uygulanan cerrahi girişim olarak halen önemini korumaktadır. Kliniğimizde Şubat 1985-Şubat 2000 tarihleri arasında 67 olguya karotis endarterektomi (KEA) girişiminde bulunuldu. Hastaların 61'nin erkek (%91), 6'sının kadın (%9) ve yaş ortalamalarının 63.4±2.6 (46-74) yıl olduğu belirlendi. 56 olguda eşlik eden (%84) hipertansiyon, 22 olguda (%33) diabetes mellitus, 18 olguda (%27) geçirilmiş myokard infarktüsü saptandı. 44 olgu (%66) semptomatik, 23 olgu (%34) asemptomatikti. 12 vakada (%18) geçirilmiş serebrovasküler olay mevcuttu. Serimizde karotis stenozu 49 olguda ise (%73) ünilaterai, 18 olguda (%27) bilateral idi. 28 olguda (%42) izole karotis arter lezyonu mevcut iken 39 olguda (%58) karotis arter lezyonuna ek koroner arter hastalığı (operasyon indikasyonu olan koroner arter hastalığı) vardı. izole karotis arter stenoz grubunda 8 hastaya sadece KEA yapılırken, 20 hastaya KEA ile birlikte patchplasty (17 safen yama, 3 PTFE yama) uygulandı. 39 hastaya KEA ile birlikte koroner bypass (CABG) uygulandı. CABG ve KEA 30 olguda eşzamanlı yapılmış, 6 olguda önce KEA, daha sonra CABG girişimi yapılmış, Solguda ise CABG girişimi KEA öncesinde yapılmıştır. Bir vakamızda da aynı seansta CABG + KEA patchplasti + asendan aorta replasmanı uygulanmıştır. Kombine cerrahi girişim uygulanan hastalardan 9 olguda KEA primer olarak kapatılırken 30 olguda KEA patchplasti (27 safen yama, 3 Dakron yama) yapılarak kapatılmıştır. Erken mortalite 2 olguda %3. ortaya çıkmıştır. Serebrovasküler morbidite 5 olguda (%7.5) (2 olguda sağ hemiparazi, 2 olguda sol hemiparazi, 1 olguda deserebrasyon), kardiyak morbidite 5 olguda (%7.5) (3 olguda perioperatif Mİ, 2 olguda mediastinal kanama nedeniyle reeksplorasyon) olarak saptanmıştır. Postoperatif uzun dönem takiplerinde 5 hastada (%7.5) restenoz saptandı. Serebrovasküler reoperasyon oranı %1.5 (1 olguda), kardiyak reoperasyon %3 (2 olguda) bulunmuştur. Geç mortalite 4 olguda %6 oranında gelişmiştir. Ortalama izlem süresi 5.3±1.7 yıl (6 ay-12 yıl), 312.7 hasta yılıdır.