Diagnostics of stenotic and occlusive changes of carotid arteries

Moždani udar je u razvijenim zemljama prvi uzrok invalidnosti i drugi uzrok smrti. Najnovije europske statistike o kardiovaskularnim bolestima navode da od kardiovaskularnih bolesti umire godišnje 4,3 milijuna ljudi u Europi. Nešto manje od polovine smrti uzrokovano je ishemičnom bolesti srca, a oko trećine CVB-om.31 Uzroci moždanog udara su u oko 30% slučajeva emboli koji potječu iz srca, u 25% slučajeva ateroskleroza velikih cerebralnih arterija (85% su zbog karotidne aterosklerotičke bolesti), u oko 20% slučajeva okluzije malih moždanih arterija (lakunarni infarkti), u 20% slučajeva uzroci su višestruki ili neodređeni, a u oko 5% slučajeva radi o neaterosklerotičkim vaskulopatijama, hiperkoagulabilnim stanjima i hematološkim bolestima. Moždani udar je, dakle, vrlo značajan uzrok smrtnosti, a aterosklerotička stenotičko-obliterativna bolest karotidnih arterija je uzrok moždanog infarkta u oko 20-25% bolesnika. Brojne su dijagnostičke metode razvijene za kvalitetno verificiranje karotidne patologije zbog njene velike važnosti u etiologiji moždanog infarkta.32 Doplerski pregled karotidnih arterija je dominantna neinvazivna slikovna metoda u dijagnostici karotidne patologije i u praksi se vrlo često indicira. Ultrazvuk je izvrsna metoda za rano otkrivanje, kvantifikaciju i karakterizaciju aterosklerotičnih promjena. Iako se dopler u početku smatralo metodom samo dijagnostičkog probira (screening) koja treba smanjiti broj nepotrebnih angiografija, danas je to i metoda postoperativnog praćenja uspješnosti samog kirurškog zahvata.4 No, danas na raspolaganju stoje i brojne druge dijagnostičke metode poput CT-angiografije i MR-angiografije kao i digitalne suptrakcijske angiografije, koja se dugo smatrala metodom zlatnog standarda u dijagnostici i stupnjevanju stenoza ACI i drugih promjena. Između ostalog, medikamentno liječenje te kirurški postupci poput karotidne endarterektomije (CEA) i endovaskularnog liječenja (CAS, CBA) su uvelike pridonijeli uspješnosti rješavanja stenotičko obliterativnih promjena karotidnih arterija.In developed countries, stroke is the primary cause of invalidity and the second cause of mortality. The newest European statistics of cardiovascular disease presumes that in one year 4,3 million people will die of cardiovascular disease. Little less of 50% of deaths is caused by ischemic heart disease, and one third of deaths is caused by CVD. Stroke is in 30% of cases caused by emboli emerging from the heart, in 25% of cases by atherosclerosis of large cerebral arteries (85% are due to carotid atherosclerotic disease), in about 20% of cases by occlusions of small cerebral arteries (lacunar infarct), in 20% of cases by multiple or unspecified causes, and in about 5% of cases by vasculopathies, hypercoagulable conditions and hematological diseases. Stroke is, therefore, a very significant cause of mortality, and stenotic-obliterative disease of carotid arteries is the cause of stroke in about 20-25% of patients. Numerous diagnostic methods were developed for efficient verification of carotid pathology due to its great importance in the etiology of stroke. Doppler examination of carotid arteries is a dominant non-invasive imaging method in the diagnosis of carotid pathology and is often indicated in practice. Ultrasound is an excellent method for early discovery, quantification and classification of atherosclerotic changes. Although Doppler was initially considered merely a method of diagnostic screening which was supposed to reduce the number of unnecessary angiographies, today it is a method of post-operative monitoring of success of the very surgical procedure. However, there are also other diagnostic procedures available today, such as CT-angiography, MR-angiography and digital subtraction angiography, which has long been considered a gold standard method for diagnosing and grading ACI stenosis and other changes. In addition to that, pharmacological treatment and surgical procedures like carotid endarterectomy (CEA) and endovascular treatment (CAS-carotid artery stenting, CBA-carotid balloon angioplasty) have substantially contributed to the success rate of treating stenotic-obliterative changes in carotid arteries