Tek Tarafı Total, Bilateral Internal Karotis Arter Stenozu Olan Hastaya Yaklaşım
Özet
Kontrlateral karotis oklüzyonu (CCO), oklüzyon derecesinden bağımsız olarak karotis arter hastalığının yönetiminde klinik kararları doğrudan etkileyen önemli bir anatomik ve fizyopatolojik durumdur. CCO varlığı çoğu zaman yaygın aterosklerotik damar hastalığının bir göstergesi olarak değerlendirilmekle birlikte, bir tarafı total oklüde olan ve karşı tarafta revaskülarizasyon planlanan hastalarda bu durumun doğal seyri ve prognoza etkisi konusunda literatürde görüş birliği bulunmamaktadır. Bazı çalışmalar, özellikle karotis endarterektomisi (CEA) sonrasında CCO varlığının perioperatif nörolojik ve kardiyovasküler komplikasyon riskini artırabileceğini bildirmiştir. Buna karşın, seçilmiş hasta gruplarında CEA’nın güvenle uygulanabileceğini ve komplikasyon oranlarının CCO olmayan hastalarla benzer olabileceğini gösteren veriler de mevcuttur. Öte yandan, tıkalı bir damarın aktif tromboembolik kaynak oluşturmaması nedeniyle ipsilateral inme veya mortalite riskini artırmayabileceği ileri sürülmüştür. SAPPHIRE çalışması, CCO’yu CEA için yüksek risk kriteri olarak tanımlamış ve karotis arter stentlemesi (CAS) sonrası daha iyi sonuçlar elde edildiğini öne sürmüştür. Güncel kanıtlar ışığında CCO, tek başına mutlak bir kontrendikasyon olmaktan ziyade, hasta özellikleri, eşlik eden komorbiditeler ve merkez deneyimiyle birlikte değerlendirilmesi gereken çok boyutlu bir klinik değişken olarak ele alınmalıdır.
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