EARLY CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS – OUR EXPERIENCE

U ovoj je studiji analiziran učinak endarterektomije unutarnje karotidne arterije (ACI) u bolesnika unutar tri tjedna od razvoja neurološke simptomatologije s obzirom na učestalost i vrstu neželjenih događaja u poslijeoperacijskom tijeku. U studiju su uključeni bolesnici sa simptomatskom stenozom visokog stupnja ACI, koji su preboljeli ishemijski moždani udar (IMU) ili tranzitornu ishemijsku ataku (TIA). Kod svih je bolesnika učinjena uzdužna karotidna endarterektomija u općoj anesteziji s uporabom intraluminalnog shunt-a. Praćenje bolesnika se odnosi na razdoblje između siječnja 2008. i listopada 2012. godine kada je operirano ukupno 69 simptomatskih bolesnika s visokim stupnjem stenoze ACI (70-99 %). Kontrolni ultrazvuk karotidnih arterija (CD) rađen je sedmi poslijeoperacijski dan te nakon jednog, tri, šest i dvanaest mjeseci, a nakon toga jednom godišnje. Od ukupnog broja operiranih (n = 69), 27 (39 %) bolesnika bilo je sa svježe preboljelim IMU-om koji su operirani unutar tri tjedna od razvoja neurološke simptomatologije, a najranije četrnaest dana nakon razvoja inzulta i 42 (61 %) bolesnika sa simptomima TIA-e, a koji su operirani neposredno nakon završetka prijeoperacijske obrade. Od poslijeoperacijskih neželjenih događaja došlo je do razvoja IMU-a u 2 (2,63 %) bolesnika i 2 odgođene restenoze (2,63 %) endarterektomirane unutarnje karotidne arterije koje su zahtijevale endovaskularno liječenje. Zaključujemo da provođenje rane endarterektomije u klinički odabranih bolesnika s visokim stupnjem stenoze ACI, shodno našim rezultatima i rezultatima drugih studija, ne nosi veći rizik od kasne endarterektomije, a zasigurno snižava postotak recidiva IMU i TIA-a, koji su najčešći u ranom razdoblju razvoja neurološke simptomatologije.Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin’s sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61%) patients had TIA symptoms with verified significant ACI stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid end- arterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely