Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular Laboratory. Medical history, clinical findings and atherosclerosis risk factors were compared with data on 33patients with satisfactory postoperative finding. Student\u27s t-test was used on data comparison (P<0.05). In 31 of 33 patients, ICA occlusion was recorded on the first postoperative examination, 3 months after carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common carotid artery and ICA was found (4 right, 4 left). One patient ICA developed occlusion during the first and third postoperative year each. Clinically, three patients presented with ischemic symptoms (one stroke and two transitory ischemic attacks (TIA)). The following risk factors were present in the group with postoperative ICA occlusion: hypertension in 18, smoking in 10, hyperlipidemia in 8, diabetes mellitus in 9, history of stroke in 13, TIA in 3, heart attack in 4 and coronary disease in 3 patients; the respective figures in the control group were as follows: 25, 11, 16, 7, 7, 3, 4 and 3. There was no significant between-group difference in the presence of risk factors. Study results suggested that postoperative ICA occlusion was not caused by atherosclerosis risk factors but by perioperative complications.Poslijeoperacijska okluzija unutarnje karotidne arterije je rijetka komplikacija s nedovoljno poznatim rizičnim čimbenicima. Cilj ove studije bio je analizirati čimbenike rizika ateroskleroze i simptome ishemije kod bolesnika s okluzijom karotidne arterije nakon karotidne endarterektomije. Tijekom godine dana je u Cerebrovaskularnom laboratoriju pregledano 33 bolesnika s poslijeoperacijskom okluzijom unutarnje karotidne arterije. Uzeti su anamnestički podaci, analizirana je klinička slika, te čimbenici rizika ateroskleroze. Podaci su uspoređeni s podacima 33 bolesnika sa zadovoljavajućim poslijeoperacijskim nalazom. Podaci su uspoređeni Studentovim t-testom. U 31 od 33 bolesnika okluzija je ustanovljena tijekom prvog pregleda 3 mjeseca nakon karotidne endarterektomije, u troje bolesnika uz pojavu ishemijske simptomatologije. U 8 bolesnika zabilježena je poslijeoperacijska okluzija cijelog karotidnog stabla. U jednog je bolesnika okluzija nastala tijekom prve godine praćenja. dok je u jednog nastupila nakon tri godine. Čimbenici rizika ateroskleroze u skupini s poslijeoperacijskom okluzijom su bili: hipertenzija u 18, pušenje u 10, hiperlipidemija u 8, dijabetes melitus u 9, preboljeli moždani udar u 13, preboljela TIA u 3, infarkt miokarda u 4, angina pektoris u 3 bolesnika, dok su u skupini sa zadovoljavajućim poslijeoperacijskim nalazom to bili: hipertenzija u 25, pušenje u 11, hiperlipidemija u 16, dijabetes melitus u 7, preboljeli moždani udar u 7, preboljela TIA u 3, infarkt miokarda u 4, angina pektoris u 3 bolesnika. Nije bilo značajne razlike u prisutnim čimbenicima rizika. Dakle, rana poslijeoperacijska okluzija karotidne arterije najvjerojatnije nije uzrokovana uobičajenim čimbenicima rizika ateroskleroze, nego periproceduralnim komplikacijama
