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Kontrollü Arteryel Hipertansiyon Altında, Geri Kanama Kontrolü İle Şant Kullanılmadan Yapılan Karotis Endarterektomi; Tek Bir Merkezin Deneyimleri

Carotid Endarterectomy With Checking Back Bleeding Under Controlled Hypertension Without Use of Shunting: Experience of A Single Center

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2011

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Keywords (Original Language):

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Abstract (2. Language): 
This study reflects our experience with controlled arterial hypertension and normocapnia and controlling back bleeding in a cohort of patients who underwent carotid endarterectomy (CEA) without shunting. We reviewed retrospectively 116 consecutive CEA performed in 112 patients with controlled arterial hypertension and normocapnia under general anesthesia. CEA’s were performed after assessment of pressure and color with evaluation of back-bleeding. The mean age of the patients was 64.2 ± 8.6 (47-83). The male/female ratio was 79/37 and the mean cross-clamp time was 25.63±5.1 (15-55) minutes. Thirty patients had bilateral carotid lesions with more than %70 stenosis. Fourteen patients were asymptomatic (12%), and 102 had symptoms (88%). All of the CEA’s were performed without intraluminal shunting. In 93 patients the arteriotomy was closed primarily (80%), in 23 patients closed with patch (20%). Neurological complication occurred within 30 days in 2 patients (1.7%). One stroke and one amaurozis fugax occurred. There was no mortality in the study population. We think that this study provides opinion for avoiding unnecessary shunting. Without shunting, maintaining a controlled hypertensive state and normocapnia and checking back bleeding from ICA enables us to perform surgery with low mortality and morbidity rates.
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Abstract (Original Language): 
Bu çalışma, şantsız karotis endarterektomi yapılan hasta grubunda kontrollü arteryel hipertansiyon, normokapni ve geri kanama kontrolü hakkındaki tecrübemizi yansıtmaktadır. Genel anestezi, normokapni ve kontrollü hipertansiyon altında 112 hastada yapılmış 116 ardışık karotis endarterektomi (KEA) verileri retrospektif olarak incelendi. Karotis endarterektomi geri kanama, basınç ve renk değerlendirilmesi sonrası gerçekleştirildi. Hastaların ortalama yaşı 64.2 ± 8.6 (47-83), Erkek/kadın oranı 79/37 ve ortalama kros-klemp zamanı 25.63±5.1 (15- 55) dakika idi. Otuz hastada %70’in üzerinde bilateral karotis darlığı mevcuttu. On dört hasta asemptomatik (%12) ve 102 hasta (%88) semptomatik idi. Karotis endarterektomilerin tamamı intraluminal şant kullanılmadan uygulandı. 93 hastada(%80) arteriotomi primer, 23 hastada (%20) yama ile kapatıldı 30 günlük hastane içi nörolojik komplikasyonlar iki hastada (%1.7) gelişti. Bunlar; bir hastada inme ve bir hastada amarozis fugaks gelişti. Çalışma grubunda ölüm görülmedi. Bu çalışmanın gereksiz şant uygulamasından sakınmak için bir görüş sağladığını düşünmekteyiz. Şant uygulamadan kontrollü hipertansiyon, normokapni ve internal karotis arterden (İCA) geri kanama kontrolü ile karotis endarterektomi düşük morbitide ve mortalite oranlarıyla cerrahi yapabilmemizi sağlamaktadır.
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REFERENCES

References: 

1. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG,
Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett
DL, Thorpe KE, Meldrum HE, Spence JD. Benefit of carotid
endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998; 339: 1415-25.
2. Executive commitee for the asymtopatic carotid atherosclerosis
study. Endarterectomy for asymtomatic carotid stenosis. JAMA
1995; 273: 1421-8.
3. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et
al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological
symptoms: randomised controlled trial. Lancet. 2004;
363:1491-1502.
4. Rothwell P, Eliasziw M, Gutnikov SA et al. Analysis of pooled
data from the randomised controlled trials of endarterectomy
for symptomatic carotid stenosis. Lancet 2003; 361: 107–15.
5. Markovic DM, Davidovic LB, Cvetkovic DD, Maksimovic ZV,
Markovic DZ, Jadranin DB. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J Cardiovasc Surg (Torino). 2008 49:619-25.
6. Melgar MA, Mariwalla N, Madhusudan H, Weinand M. Carotid endarterectomy without shunt: the role of cerebral metabolic protection. Neurol Res 2005; 8: 850-6.
7. Samson RH, Showalter, Yunis JP. Routine carotid endarterectomy without a shunt, even in the presence of a contralateral
occlusion. Cardiovasc Surg 1998; 6: 475-84.
8. North American Sypmtomatic Carotid Endarterectomy Trial
(NASCET) Collaborators: Benificial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445-53.
9. Aburahma AF. Patch closure improves results with carotid
endarterectomy. Semin Vasc Surg. 2004; 17: 243-52.
10. Bond R, Rerkasem K, Counsell C, Salinas R, Naylor R, Warlow CP, Rothwell PM. Routine or selective carotid artery
shunting for carotid endarterectomy (and different methods of
monitoring in selective shunting). Cochrane Database Syst Rev
2002; (2): CD000190.
11. Causes of perioperative stroke after carotid endarterectomy:
special considerations in symptomatic patients. Ann Vasc Surg.
2001; 15: 19-24.
12. Grame F. Woodworth, Matthew J. McGirt. Selective versus
routine intraoperative shunting during carotid endarterectomy:
A Multivariate outcome analysis. Neurosurgery 2007; 61:
1170-77.
13. Palombo D, Lucertini G, Mambrini, Zettin M. Subtle cerebral
damage after shunting vs non shunting during carotid endarterectomy. Eur J Vasc Endovasc Surg 2007; 34: 546-51.
14. Lee TS, Hines GL, Feurman M. Significant corelation between
cerebral oximetry and carotid stump pressure during carotid endarterectomy. Ann Vasc Surg 2008; 22: 58-62.
15. Schneider PA, Ringelstein EB, Rossman ME, Dilley RB, Sobel
DF, Otis SM,et al Importance of cerebral collateral pathways
during carotid endarterectomy. Stroke 1988; 19: 1328-34.
16. Aleksic M, Heckenkamp, Gawenda M, Reichert V, Brunkwall J.
Evaluation of changes of systemic blood pressure and shunt incidence in CEA. Eur J Vasc Endovasc Surg 2007; 34: 540-45.
17. Stejskal L, Kramar F, Ostry S, Benes V, Mohapl M, Limberk B.
Experience of 500 cases of neurophysiological monitoring in
carotid endarterectomy. Acta Neurochirugica 2007;149: 681-89
18. Rockman CB, Su W, Lamparello PJ et al. A reassessment of
carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic patients. J Vasc Surg 2002; 36: 668-673.
19. Da Silva AF, McCollum P, Szymanska T. Prospective study of
carotid endarterectomy and contralateral carotid occlusion. Br J
Surg 1996; 83: 1370-72.
20. Coyle KA, Smith III RB, Salam AA, Dodson TF, Chaikof EL,
Lumsden AB. Carotid endarterectomy in patients with contralateral carotid occlusion: review of a 10 year-experience. Cardiovasc Surg 1996; 4: 71-75.
21. Frawley JE, Hicks RG, Gray LJ, Niesche JW. Carotid endarterectomy without a shunt for symptomatic lesions associated with
contralateral severe stenosis or occlusion. J Vasc Surg 1996; 23:
421-7.
22. Litooy FN, Halstuk KS, Mamdani M, et al. Factors influencing
morbidity of carotid endarterectomy without a shunt. American
Surgery 1981; 50: 350-3.
23. Barnston NM, Strong AJ, Symon L. Extracelluler potassium
activity, evoked potential and tissue blood flow: relationship
during progressive ischemia in baboon cerebral cortex. J Neurol
Sci 1977; 32: 305-21.
24. Gewertz BL, McCaffrey MT. Intraoperative monitoring during
carotid endarterectomy. Curr Probl Surg 1987; 24: 475-532.
25. Moritz A, Koci G, Barbara S, Hölzenbein T, Nasel C, Grubhofer G, Dworschak M. Contralateral stroke during carotid endarterectomy due to abnormalities in the circle of Wills. Wien
Klin Wochenschr 2007; 22: 669-73.
26. Moseley JI, Laurent JP, Molinari GF. Barbiturate attenuation of
clinical course and pathologic lesions in primate stroke model.
Neurology 1975; 25: 870-4.
27. Botes K, Le Roux DA, Van Marle J. Cerebral monitoring
during carotid endarterectomy-a comparison between electroencephalography, transcranial cerebral oximetry and carotid
stump pressure. S Afr J Surg 2007; 45: 43-6.

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