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Procena indikacija za primenu protektivnog intraluminalnog šanta u karotidnoj hirurgiji

Evaluation of indications for the use of protective intraluminal shunt in carotid surgery

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Disertacija637.pdf (37.82Mb)
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Author
Dragaš, Marko V.
Mentor
Davidović, Lazar
Committee members
Plješa-Ercegovac, Marija
Maksimović, Živan
Radak, Đorđe
Simić, Tatjana
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Abstract
Uvod: Karotidna endarterektomija (CEA) se dokazala kao najbolji metod prevencije šloga kod simptomatskih i asimptomatskih pacijenata sa visokostepenom suženjem ekstrakranijalnog segmenta karotidnih arterija i u poslednje dve decenije postala najčešće izvođena procedura u rekonstruktivnoj vaskularnoj hirurgiji. Uprkos tome, više aspekata ove operacije su i dalje predmet debate, a jedan od najkontroverznijih je primena protektivnog intraluminalnog šanta tokom karotidne endarterektomije. Cilj: Radi provere hipoteze da rutinska primena protektivnog intraluminalnog šanta tokom karotidne endarterektomije u regionalnoj anesteziji pruža zaštitu mozga od ishemijskog i reperfuzionog oštećenja, postavljeni su sledeći ciljevi istraživanja: (1) utvrditi ishod i neposredne rezultate lečenja pacijenata podvrgnutih CEA sa i bez rutinske primene šanta; (2) utvrditi promene koncentracija biohemijskih pokazatelja moždanog oštećenja (neuron specifična enolaza, protein S-100B) u perifernoj krvi pacijenata ...podvrgnutih CEA sa i bez rutinske primene šanta; (3) utvrditi stepen oksidativnog oštećenja lipida i proteina određivanjem biohemijskih pokazatelja lipidne peroksidacije (malondialdehid) i aktivnosti slobodnih radikala (količina karbonilnih grupa, proteinskih tiol grupa i koncentracija nitrotirozina) u krvi ipsilateralne jugularne vene tokom CEA sa i bez rutinske primene šanta i (4) utvrditi promene u aktivnosti ključnih antioksidantnih enzima u perifernoj krvi pacijenata podvrgnutih CEA sa i bez rutinske primene šanta. Metodologija: Prospektivna studija obuhvatila je pacijente podvrgnute karotidnoj endarterektomiji zbog hemodinamski značajne (>70%) stenoze unutrašnje karotidne arterije tokom 2012. godine (01.01. – 31.12.2012.), u Klinici za vaskularnu i endovaskularnu hirurgiju KCS. Od 89 pacijenata operisanih od strane autora tokom perioda istraživanja, 60 je ispunilo kriterijume za uključivanje u studiju, te su metodom slučajnog izbora preoperativno podeljeni u dve grupe od po 30 pacijenata: grupa sa šantom (sCEA) koja je operisana konvencionalnom tehnikom endarterektomije sa rutinskom primenom šanta i grupa bez šanta (eCEA), operisana everzionom tehnikom, bez primene šanta...

Introduction: Carotid endarterectomy (CEA) is well recognized as the best method for stroke prevention in symptomatic and asymptomatic patients with significant carotid stenosis, and in the past two decades has become the most frequently performed procedure in reconstructive vascular surgery. However, several aspects of this procedure are still under debate, and the most controversial is probably the use of protective intraluminal shunt during CEA. Objective: To test the hypothesis that routine shunting during CEA in regional anesthesia protects the brain from ischemia and reperfusion injury, this research focused on following objectives: (1) to determine treatment outcome for CEA performed with and without routine shunting; (2) to evaluate the changes in serum concentrations of biochemical markers of cerebral injury (neuron specific enolase, protein S-100B) in patients undergoing CEA with and without routine shunting; (3) to evaluate the extent of lipid and protein oxidative damage by... determining jugular concentrations of byproducts of lipid peroxidation (malondialdehyde) and free radical activity (carbonyl groups, protein thiol groups and nitrotyrosine) during CEA with and without routine shunting, and (4) to evaluate the changes in activity of key antioxidant enzymes in patients undergoing CEA with and without the routine use of shunt. Methods: This prospective study was conducted on patients treated by the author for significant (>70%) carotid stenosis, during one-year period (01.01.2012.-31.12.2012.), at the Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia. Of 89 patients operated by the author during the trial period, 60 patients met the inclusion criteria, and were preoperatively randomized in two groups with 30 patients each: shunt group (sCEA) operated with conventional endarterectomy technique and routine shunting, and no shunt group (eCEA) undergoing eversion endarterectomy without shunting. Preoperatively, all patients underwent carotid Duplex ultrasonography, brain multidetector computerized tomography, as well as thorough physical and neurological examination...

Faculty:
Универзитет у Београду, Медицински факултет
Date:
13-07-2015
Keywords:
karotidna endarterektomija / carotid endarterectomy / protective intraluminal shunt / ischemia and reperfusion injury / oxidative stress / discrete cerebral injury / protektivni intraluminalni šant / ishemijsko i reperfuziono oštećenje / oksidativni stres / subklinička cerebralna lezija
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_nardus_5011
URI
https://nardus.mpn.gov.rs/handle/123456789/5011
http://eteze.bg.ac.rs/application/showtheses?thesesId=2644
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