Öz
Amaç
Çalışmanın amacı kontralateral internal karotis arter oklüzyonu (KKO) olan ve ciddi ipsilateral karotis arter stenozu bulunan hastalarda karotis arter stentleme (KAS) işleminin uygulanabilirliğini, güvenliğini ve etkinliğini değerlendirmek; bu sonuçları kontralateral karotis arter oklüzyonu olmayan eşleştirilmiş kontrol grubu ile karşılaştırmaktır.
Yöntem
Nisan 2020 ile Temmuz 2024 tarihleri arasında KAS uygulanan 247 hasta ile retrospektif bir çalışma yapıldı. Bu hastalardan KKO’ya sahip 21 hasta, yaş ve cinsiyet açısından 1:1 oranında eşleştirilmiş kontrol grubu ile karşılaştırıldı. Prosedürel başarı, periprosedürel komplikasyonlar ve kısa-orta dönem takip sonuçları (medyan takip süresi: 24 ay) analiz edildi.
Bulgular
Hastaların tamamında teknik başarı sağlandı. Periprosedürel komplikasyonlar her iki grupta da ikişer hastada gözlendi. Takip süresi boyunca KKO grubunda 3 hasta, kontrol grubunda ise 2 hasta hayatını kaybetti; her iki grupta da birer hastada miyokard enfarktüsü ölüm nedeni olarak belirlendi. Takip süresi boyunca hiçbir hastada yeni iskemik serebrovasküler olay saptanmadı.
Sonuç
KAS, ciddi karotis stenozu ve KKO’su olan hastalar için uygulanabilir ve etkili bir tedavi seçeneğidir. Bu hasta grubundaki sonuçlar, kontralateral oklüzyonu olmayan hastalarla karşılaştırılabilir düzeydedir.
Anahtar Kelimeler: Anahtar kelimeler: Anjiyoplasti, karotis stenozu, serebrovasküler inme
Kaynakça
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209.
Sacco RL, Ellenberg JH, Mohr JP, Tatemichi TK, Hier DB, Price TR, et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol. 1989;25(4):382-390.
Ricotta JJ 2nd, Upchurch GR Jr, Landis GS, Kenwood CT, Siami FS, Tsilimparis N, et al. The influence of contralateral occlusion on results of carotid interventions from the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;60(4):958-64; discussion 64-5.
Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke. 1999;30(9):1751-1758.
Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the asymptomatic carotid atherosclerosis study. JAMA. 1995;273(18):1421-1428.
Kizilkilic EK, Akan YN, Atbas B, Karagöz SH, Korkmazer B, Arslan S, et al. Results of carotid stenting in patients with contralateral internal carotid artery occlusion: a retrospective single-center analysis and 22 years of experience. Neuroradiology. 2025;67:393-401.
Capoccia L, Sbarigia E, Rizzo AR, Pranteda C, Menna D, Sirignano P, et al. Contralateral occlusion increases the risk of neurological complications associated with carotid endarterectomy. Int J Vasc Med. 2015;2015:942146.
White CJ, Avula SB, Mintz RT, Iskander A, Chervu A, Feldman RL, et al. Carotid artery revascularization with distal protection in high-surgical-risk patients in routine clinical practice: rationale and design of the CABANA safety surveillance program. Catheter Cardiovasc Interv. 2012;79(1):167-173.
Oka F, Ishihara H, Kato S, Higashi M, Suzuki M. Cerebral hemodynamic benefits after contralateral carotid artery stenting in patients with internal carotid artery occlusion. AJNR Am J Neuroradiol. 2013;34(3):616-621.
Kakkos SK, Kakisis I, Tsolakis IA, Geroulakos G. Endarterectomy achieves lower stroke and death rates compared with stenting in patients with asymptomatic carotid stenosis. J Vasc Surg. 2017;66(2):607-617.
Kokkinidis DG, Chaitidis N, Giannopoulos S, Texakalidis P, Haider MN, Aronow HD, et al. Presence of contralateral carotid occlusion is associated with increased periprocedural stroke risk following CEA but not CAS: A meta-analysis and meta-regression analysis of 43 studies and 96,658 patients. J Endovasc Ther. 2020;27(2):334-344.
Salem MM, Alturki AY, Fusco MR, Thomas AJ, Carter BS, Chen CC, et al. Carotid artery stenting vs. carotid endarterectomy in the management of carotid artery stenosis: Lessons learned from randomized controlled trials. Surg Neurol Int. 2018;9:85.
AbuRahma AF, Metz MJ, Robinson PA. Natural history of > or =60% asymptomatic carotid stenosis in patients with contralateral carotid occlusion. Ann Surg. 2003;238(4):551-561; discussion 61-2.
Cheng XQ, Tian JM, Zuo CJ, Liu J, Zhang Q, Lu GM. Quantitative perfusion computed tomography measurements of cerebral hemodynamics: correlation with digital subtraction angiography identified primary and secondary cerebral collaterals in internal carotid artery occlusive disease. Eur J Radiol. 2012;81(6):1224-1230.
Dinculescu V, Ritter AC, dos Santos MP, Mohan RM, Schwarz BA, Lesiuk HJ, et al. Factors determining periprocedural and long-term complications of high risk carotid artery stenting. Can J Neurol Sci. 2015;42(1):48-54.
Hong JH, Kang J, Yeo MJ, Kim BJ, Jang MU, Bae HJ, et al. The 10-year trend of periprocedural complication following carotid artery stenting; single center experience. Cardiovasc Intervent Radiol. 2015;38(2):280-287.
Huibers AE, Westerink J, de Vries EE, Hoskam A, den Ruijter HM, Moll FL, et al. Editor's choice - cerebral hyperperfusion syndrome after carotid artery stenting: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2018;56(3):322-333.
Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery. 2003;53(5):1053-1058; discussion 8-60.
Mercado N, Cohen DJ, Spertus JA, Chan PS, House J, Kennedy K, et al. Carotid artery stenting of a contralateral occlusion and in-hospital outcomes: results from the CARE (carotid artery revascularization and endarterectomy) registry. JACC Cardiovasc Interv. 2013;6(1):59-64.
Krawisz AK, Rosenfield K, White CJ, Jaff MR, Campbell J, Kennedy K, et al. Clinical impact of contralateral carotid occlusion in patients undergoing carotid artery revascularization. J Am Coll Cardiol. 2021;77(7):835-844.
Lago A, Parkhutik V, Tembl JI, Aparici F, Mainar E, Alcalá C, et al. Long-term outcome in patients with carotid artery stenting and contralateral carotid occlusion: a single neurovascular center prospective analysis. Neuroradiology. 2012;54(9):965-972.
Keldahl ML, Park MS, Garcia-Toca M, Wang CH, Kibbe MR, Rodriguez HE, et al. Does a contralateral carotid occlusion adversely impact carotid artery stenting outcomes? Ann Vasc Surg. 2012;26(1):40-45.
