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Year : 2001, Volume : 10, Issue : 3

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SURGICAL PRINCIPLES OF CAROTID ARTERY STEN OSIS: KOŞUYOLU EXPERIENCE

Mustafa Güler, Nilgün Ulusoy Bozbuğa, Kaan Kırali, Ercan Eren, Mehmet Erdem Toker, Cüneyt Keleş, Mehmet Balkanay, Gökhan İpek, Esat Akıncı, Ömer Işık, Cevat Yakut

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Abstract

Carotid endarterectomy is stili the most common procedure that is performed lor cerebrovascular ischemia due to at­ herosclerosis.

At Koşuyo lu Heart and Research Hospital Department of Cardiovascular Surgery, between February 1985 to Febru­ ary 2000, carotid endarterectomy (CEA) procedure was applied in 67 patients. The patients population included 61 men (91%) and 6 women (9%), with a mean age of 63.4±2.6 years (ranged !rom 46 to 74). Additional to the carotid stenosis, 56 cases (84%) had hypertension, 22 cases (33%) diabetes mel!itus and 18 cases (27%) myocardial infarc­tion.

44 patients were symtomatic (66%) versus 23 asymtomatic patients (34%). in 12 of the cases (18%) cerebrovascu­ lar accidents were revealed beforehand. in our series, 49 cases (73%) were demonstrated unilateral and 18 cases (27%) were demonstrated bileteral stenosis of carotid artery. 28 cases had (42%) had isolated and 39 cases (58%) had combined carotid lesions with coronary artery disease required CABG.

Out of 28 cases with isolated carotid lesion, 8 were underwent CEA with primary closure while 20 were underwent CEA with patch closure (17 otologeus saphenous patch, 3 PTFE patch). Out of the 39 cases, combined CEA and CABG operations were performed to one-stage procedure in 30 patients, and two-stage procedure in the others. in one case, CABG + CEA with patching + replacement of ascending aort were performed in the same operation sta­ ge. in combined operation group of patients, CEA was closed primarly in 9 cases, patching (17 otologeous sapheno­ us patch, 3 Dacron patch) was done in 30 cases.

The early mortality rate was 3% in 2 cases. Cerebrovascular morbidity was recorded in 5 cases (7.5%) (tefi hemipa­ resis in 2, right hemiparesis in 2, decerebation in 1) and cardiac morbidity was recorded in 5 cases (7.5%) (perioperative MI in 3, reexploration far mediastinal bleeding). Recurrent stenosis was occured in 5 patients (7.5%) in late-term follow-up. There were one cerebrovascular reoperation (1.5%), and two cardiac reoperations (3%). Lale mortality rate was 6% in 4 cases. The mean follow-up time was 5.3±1.7 years (range, 6 months ta 12 years), 312.7 patient-year.

Keywords : Carotid endarterectomy; carotid artery stenosis; combined procedures o( carotid and coronary artery

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