Dijagnostički algoritam i endovaskularno liječenje postavljanjem stenta kod stenookluzivne bolesti unutarnje karotidne arterije

master's thesis

• Title (english): Diagnostic algorithm and treatment with carotid artery stenting in steno-occlusive disease of the internal carotid artery
• Author: Ivana Karla Franić
• Mentor: Zdravka Poljaković-Skurić (mentor)
• Committee member: Darija Mahović Lakušić (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Zdravka Poljaković-Skurić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Stenookluzivna bolest karotidnih arterija nastaje kao posljedica generaliziranog aterosklerotskog procesa u ljudskome organizmu. Otprilike 20% svih moždanih udara pripisuje se stenozi karotidnih arterija. Budući da je moždani udar treći po redu uzrok smrti te prvi uzrok invaliditeta u svijetu, jasna je i važnost njegovog uspješnog liječenja. U našem Centru smo proveli retrospektivnu studiju na 120 pacijenata koji su bili podvrgnuti stentiranju unutarnje karotidne atrerije tijekom dvije godine zbog simptomatske stenoze ili asimptomatske, ali hemodinamski značajne stenoze visokog stupnja. Period praćenja pacijenata bilo je minimalno 12 mjeseci poslije zahvata. Cilj našega istraživanja bio je utvrditi učestalost javljanja ranih i kasnih komplikacija zahvata stentiranja. Rane komplikacije, unutar prva 24 sata, povezane su sa samim zahvatom te su iznosile 3,3%. Što se kasnih komplikacija zahvata tiče, bolesnici su praćeni nakon 3, 6 i 12 mjeseci od zahvata, te su svaki puta bili evaluirani klinički i neurosonološki. Pratili smo javljanje kliničkih komplikacija po tipu tranzitorne ishemijske atake i/ili moždanog udara te ultrazvučno određivali prohodnost stenta, odnosno eventualnu progresiju restenoze u postoperativnom razdoblju. Kliničkih komplikacija bilo je također 3,3% i to isključivo u prva tri mjeseca poslije ugradnje stenta. Sve kliničke komplikacije bile su isključivo po tipu tranzitornih ishemijskih ataka. Progresija stenoze na ultrazvučnim nalazima nađena je u do 11% pacijenata, ali nitko od tih pacijenata nije pokazivao kliničke simptome bolesti kao posljedicu progresije stenoze. Sveukupno gledajući, naša studija pokazala je vrlo niske postotke kako ranih, tako i kasnih komplikacija. Svoje dobivene rezultate usporedili smo s podacima iz literature te vidjeli da naši rezultati odgovaraju učestalosti komplikacija stentiranja koji se prijavljuju u drugim međunarodnim studijama. Osim toga naše rezultate usporedili smo sa literaturnim postotcima javljanja komplikacija nakon zahvata trombendarterektomije, gdje također nismo uočili značajnu razliku u javljanju komplikacija. Sve navedeno govori u prilog uspješnosti analizirane metode liječenja stenookluzivnih promjena karotidne arterije. Potrebno je međutim naglasiti i da, kod odabira metode liječenja, najvažniju ulogu igra iskustvo centra koji liječenje provodi. U centru sa pravovaljanim iskustvom, endovaskularno liječenje stenoze karotidne arterije metodom ugradnje stenta sigurna je i vrlo uspješna metoda liječenja.

Abstract (english)

Steno-occlusive disease of the carotid arteries is a consequence of a generalized atherosclerotic process in the human body. Approximately 20% of all strokes are caused by carotid artery stenosis. Since stroke is the third leading cause of death and the first leading cause of disability in the world, the importance of its successful treatment is evident. At our Centre, we conducted a retrospective study on 120 patients who, over the course of two years, underwent stenting of
the internal carotid artery due to symptomatic stenosis or asymptomatic, but hemodynamically significant high-grade stenosis. The follow-up period was a minimum of 12 months after the procedure. The aim of our study was to determine the frequency of occurrence of early and late complications of stenting. Early complications, within the first 24 hours, were related to the procedure itself and amounted to 3.3%. As for late complications of the procedure, the followup was 3, 6 and 12 months after the procedure and the patients were evaluated clinically and neurosonologically each time. We monitored the occurrence of clinical complications such as transient ischemic attack and/or stroke, and with ultrasound we determined the patency of the stent, i.e., the possible progression of restenosis in the postoperative period. There were also 3,3% of clinical complications, exclusively in the first three months after the stent implantation. All clinical complications were in the form of transient ischemic attacks. Progression of stenosis on ultrasound findings was found in up to 11% of patients, but none of these patients showed any clinical symptoms of the disease as a result of stenosis progression. Overall, our study
showed very low rates of both early and late complications. We compared our results with data from the literature and saw that our results correspond to the reported frequency of stenting complications. We compared our results with percentages of complications after thrombendarterectomy, where we did not notice a significant difference in the occurrence of complications as well. All of the above speaks in favour of the success of the analysed method of treatment of the carotid artery steno-occlusive changes. In choosing the method of treatment for carotid stenosis, the most important limiting factor is the experience in performing the procedure of stent implantation of the centre that performs the treatment. In a centre with long and rich experience, endovascular treatment of carotid artery stenosis with stent implantation is a safe and very successful method of treatment.

• Keywords: karotidna arterija; stenookluzivna bolest; stent; moždani udar; liječenje
• Keywords (english): carotid artery; steno-occlusive disease; stent; stroke; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:739502
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-03 10:28:18