Klinički značaj prediktivnih faktora u nastanku i lečenju karotidne restenoze kod pacijenata nakon everzione endarterektomije
Clinical significance of predictive factors in development and treatment of carotid restenosis in patients after eversion endarterectomy.
Докторанд
Tanasković, SlobodanМентор
Radak, ĐorđeЧланови комисије
Otašević, PetarDavidović, Lazar
Milojević, Predrag
Rančić, Zoran
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: Karotidna endarterektomija je vrlo pouzdana metoda za lečenje simptomatske i
asimptomatske visoko-stepene karotidne stenoze. Karotidna restenoza predstavlja
ponovno suženje karotidne arterije koje nastaje kao rezultat neointimalne hiperplazije u
ranom postoperativnom periodu (unutar 36 meseci) ili rekurentnih aterosklerotskih
lezija u kasnijem toku. Nekoliko studija je pokazalo da je povišena koncentracija Creaktivnog
proteina (CRP) nezavistan prognostički faktor budućih kardioloških
ishemičnih događaja, ali je malo raspoloživih podataka koji govore o povezanosti
karotidne ateroskleroze i serumske koncentracije hs-CRP i drugih proteina akutne faze
inflamacije.
Ciljevi: Cilj naše studije bio je da ispitamo uticaj preoperativno i neposredno post
operativno (48h) povišenih vrednosti sistemskih markera inflamacije („high sensitive“
C-reaktivni protein (hs-CRP), C3 komplement i fibrinogen), njihovih oscilacia i uticaj
na nastanak karotidne restenoze nakon everzione endarterektomije to...kom praćenja.
Takođe smo analizarali uticaj infamatorne komponente i strukture karotidnog plaka na
nastanak karotidne restenoze kao i uticaj svih faktora rizika i drugih udruženih
oboljenja. Poslednji cilj bio je da uporedimo rezultate perkutane angioplastike i
ponovnog hirurškog lečenja pacijenata sa karotidnom restenozom uz evaluaciju
prediktivnih faktora koji mogu imati uticaja na konačni ishod oba modaliteta lečenja.
Materijal i metode: Ispitivanjem obuhvaćeno je 300 pacijenata kojima je na Klinici
za Vaskularnu hirurgiju Instituta za kardiovaskularne bolesti „Dedinje“ učinjena
everziona karotidna endarterektomija od 1.marta do 1. avgusta 2010. godine.
Analizirana je serumska koncentracija „high-sensitive“ C-reaktivnog proteina (hs-
CRP), fibrinogena i C3 komplementa na dan operacije neposredno pre
enadarterektomije, 48 časova nakon endarterektomije, kao i na redovnim kontrolnim
pregledima nakon 1 meseca, 6 meseci, godinu dana i dve godine...
Objective: Carotid endarterectomy is known as very reliable procedure for
symptomatic and asymptomatic carotid stenosis treatment. Carotid restenosis
represents recurrent stenosis that occurs as a result of neointimal hyperplasia in the
early postoperative period (within 36 months) or recurrent atherosclerotic lesions in
the following period. Several studies have shown that increased C-reactive protein
(CRP) values is independent prognostic factor of future cardiological ischemic events,
but there is a few studies that describe connection between CRP serum concentration,
carotid atherosclerosis and other acute inflammatory phasec proteins.
Aims: The aim of our study was to examine influence of increased values of markers
of systemic inflammation (high sensitivity C-reactive protein (hs-CRP), C3
complement and fibrinogen) taken just before and after the surgery, its oscillations
and its mutual impact on carotid restenosis development after eversion
endarterectomy. We have also analyzed ...the impact of inflammatory component and
structure of the carotid plaque on carotid restenosis development as well as influence
of all risk factors and other comorbidities. The last aim was to compare the outcome
of percutaneous angioplasty and “redo” surgical treatment in patients with carotid
restenosis with evaluation of predictive factors influencing the final outcome in both
treatment modalities.
Methodology: In the presented study, 300 patients were included in whom eversion
carotid endarterectomy was performed from 1st march till 1st august 2010. on the
Vascular surgery Clinic, “Dedinje” cardiovascular Institute. We have analyzed serum
concentration of hs-CRP, fibrinogen and C3 complement taken just before the surgery
(06h), 48h after the surgery and on the regular check-ups after 1 month, 6 months, one
year and two years. In then second part of the presented study we have retrospectively
compared the outcomes of endovascular and “redo” surgical treatment of patients
with carotid restenosis in the period from 2002. till 2012...