| Popis: |
Vascular brain diseases are known to be the second cause of death worldwide, and the third cause of death in the developed countries. Approximately 20 % of the cases with stroke are due to carotid artery atherosclerosis. The treatment of patients with carotid atherosclerosis consists of an effective medical treatment together with neuroradiologic interventions ( stending) or surgery ( endarterectomy). In our university hospital from 2003 till now, symptomatic or asymptomatic patients with carotid artery atherosclerosis have been assessed by a multidisciplinary committee in which the instructors from the departments of neurology, cardiovascular surgery and interventional radiology take part and the treatment or preventive procedures for these patients have been assigned accordingly. Between June 2003 and September 2007, 139 patients referred mostly from the neurology department have been assessed by this committee in our hospital. In this article, the experiences from the demographic features, treatment decisions and outcomes of these patients are discussed. Of the 139 patients assessed by the committee, 37 patients have been decided to be followed only by a medical treatment, 97 patients have been decided to have an interventional treatment, and 5 patients have undergone endarterectomy. Among 97 patients decided to have an interventional treatment, 3 had an intracranial stending. In the remaining 94 patients who had an extracranial stending, 8 had subclavian and 86 had carotid artery stending. After carotid stent procedure, in 2 cases a major and in 8 cases a minor neurological complication have developed. Finally, carotid stending is a procedure with acceptable complication ratio and an alternative treatment to endarterectomy in experienced centers. Each center should have a treatment suggestion depending on its facilities and experiences, making a common decision together with patients by suggesting each alternative. Ideally this decision should be made by a committee in which a neurologist, an interventional radiologist and a cardiovascular surgeon take part, as in our center. More importantly, symptomatic patients require either interventional treatment or endarterectomy apart from medical treatment alone. The patients should be protected from a second stroke by an optimal medical treatment in addition to these procedures. |
