Author/Editor		Žvan, Bojana; Zaletel, Marjan
Title		Preprečevanje možganskih ishemičnih dogodkov pri bolnikih s karotidno boleznijo
Translated title		Prevention of ischemic brain events in patients with carotid disease
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. Suppl 2
Publication year		2003
Volume		str. 41-6
Language		slo
Abstract		Atherosclerotic carotid disease is an important cause of ischemic brain events. The first approach in the prevention of stroke is to stabilize or halt the progression of carotid plaques via risk factor modification and medication. The second approach is to eliminate or reduce carotid artery stenosis through carotid endarterectomy or angioplasty with stenting. For patients with symptomatic carotid stenosis of over 70%, the value of carotid endarterectomy has been firmly established on the basis of the results of randomized trials, which showed a perioperative risk lower than 6%. The benefit of endarterectomy in patients with moderate symptomatic carotid stenosis (of 50 to 69%) has also been proved. Asymptomatic carotid stenosis is a clear risk factor for stroke, but the risk is lower than that associated with symptomatic disease. Surgical treatment of asymptomatic carotid stenosis is a source of continuing debate. At present, any decision regarding the use of endarterectomy depends on minimizing the complication rate by having an experienced surgeon (with a complication rate of less than 3%) perform the surgery. In our experience, carotid angioplasty with stenting and the use of periprocedural protection devices can be performed relatively safely with good results. In the conclusion, recommendations are given for the nursing of patients with ischemic brain events due to carotid stenosis.
Summary		Aterosklerotična karotidna bolezen je pomemben vzrok ishemične možganske kapi. V preprečevanju možganske kapi skušamo z vplivanjem na dejavnike tveganja in z uporabo zdravil stabilizirati karotidne aterosklerotične lehe in zmanjšati stopnjo zožitve karotidne arterije. Hkrati pa s posegi kot sta trombendarterektomija in karotidno angioplastiko z vstavitvijo žilne opornice zmanjšamo ali odpravimo zožitve. Študije so pokazale koristnost trombendarterektomije pri bolnikih s karotidno zožitvijo, večjo kot 70%, če je le perioperacijsko tveganje manjše kot 6%. Manjši, vendar pomemben učinek trombendarterektomije, so ugotovili pri bolnikih s karotidno zožitvijo med 50 in 69%. Pri asimptomatski karotidni zožitvi, večji od 60 %, so pokazali pomembno učinkovitost trombendarterektomije, vendar manjšo kot pri simptomatski karotidni zožitvi, večji kot 70%. Perioperacijsko tveganje za možgansko kap mora biti pri asimptomatskih bolnikih manjše kot 3%. Naše in tuje izkušnje kažejo, da je karotidna angioplastika z vstavitvijo žilne opornice in uporabo možganske zaščite relativno varna metoda. V zaključku prispevka podajamo priporočila za zdravljenje karotidne bolezni.
Descriptors		CEREBRAL ISCHEMIA CAROTID ARTERY DISEASES ATHEROSCLEROSIS CAROTID STENOSIS ENDARTERECTOMY, CAROTID ANGIOPLASTY CEREBROVASCULAR DISORDERS CEREBRAL ISCHEMIA, TRANSIENT