Carotid Endarterectomy

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Carotid endarterectomy

.Zelikovsky A

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ANATOMY

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CAROTID ARTERY STENOSIS

Symptomatic

Neurological event in 5years - 35%

Surgery < 70% stenosis

Asymptomatic

Neurological event in 5 years - 11%

Surgery < 70%

?? stenosis

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Evaluation of carotid & vertebral artery

•Duplex

•CT – Angio

•MRA•Angiography

•CT

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Duplex

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CT angio

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MRA

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ANGIOGRAPHY

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CT

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TREATMENT

•Conservative – Antiaggregative

• Surgery CEA

• (PTA + Sent (with protctic device

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Conservative treatment

• ASPIRIN

•PLAVIX

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SURGERY

•CEA with or without patch

•(By – Pass (anatomic or extra anatomic

•Shunt•Results

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CEA

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CEA + SHUNT

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PTA + STENT

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שונות

•Vertebral arteries stenosis treatment

• Subclavien steal syndrome SSS

•Carotid Stenosis with CABG

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CEA/ CABG ? האם לבצע ניתוח משולב

CEAמעקפים ולאחר זמן : ניתוח בשלבים

– סיכון שלחד צדדיתהצרות אסימפטומטית •לאירוע מוחי11%

הצרות סימפטומטית חד צדדית – סיכון של•לאירוע מוחי35%

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סקר מקרים של מנותחי מעקפים הזקוקיםלהתערבות ניתוחית בעורק התרדמה

לעתים מאד קרובות - ממצא משותף •

O'Donnell et al: מהמטופלים על פי 66% • CABGממנותחי הקרוטיס זקוקים גם ל 37% •

5 נפטרו בטווח של CEAמהחולים שעברו 24% •שנים לאחר אוטם שריר הלב

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מסקנות

חולים עם מחלה משולבת הצרות קרוטידית1.והצרות קורונרית עם סיכון קטן ייהנו מביצוע בשלב

CABGובשלב שני CEAראשון של עורקים3 מחלת , חולים עם תעוקת לב לא יציבה 2.

בשלב ראשון ו CABGקורונריים – רצוי לנתח CEA שלב שני או בצורה משולבת.

במידה ואינם סימפטומטיים או הצרות2 חולים מסוג

הקרוטיס דו צדדית הנם בעלי סיכון גבוה יותר. לאירועים מוחיים ולכן יש לנתחם בו זמנית

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RESULTS

•CEA – operative complication 1%

•Recurrent stenosis – 5% in 2 years

•PTA +stent – 6% - 8% immediate

complication

• Recurrent stenosis – 12% - 20% in 2years

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סיכוםיש לזכור שאירועים מוחיים אינם ברי טיפול פרט

.לתפילה

.כל המאמצים צריכים להיות מיושמים במניעתם

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