{"id":1408,"date":"2023-02-04T14:51:38","date_gmt":"2023-02-04T14:51:38","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=1408"},"modified":"2023-02-24T10:07:13","modified_gmt":"2023-02-24T10:07:13","slug":"2-etiopatogeneza-karotidne-bolesti-2","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=1408","title":{"rendered":"2. ETIOPATOGENEZA KAROTIDNE BOLESTI"},"content":{"rendered":"<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/friz-poglavlja2.jpg\" alt=\"\"><br \/>\n<a href=\"\/index.php?page_id=1408\"><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/2.png\" alt=\"\"><\/a><\/p>\n<h1><a href=\"\/index.php?page_id=1408\"><\/p>\n<h1 class=\"western\" lang=\"bs-BA\">ETIOPATOGENEZA KAROTIDNE BOLESTI<\/h1>\n<p><\/a><\/h1>\n<div>\n<p style=\"text-align: left;\" align=\"LEFT\">There are more things in heaven and earth, than are dreamt of in our philosophy.<br \/><em>W. Shakespeare<\/em><\/p>\n<p style=\"text-align: right;\" align=\"LEFT\">The way to do researche is to attack the facts at the point of greatest astonishment.<br \/><em>Celia Green<\/em><\/p>\n<\/div>\n<div>\n<p>Ateroskleroza je naj\u010de\u0161\u0107i uzrok (70-90%) cerebralne ishemije.<br \/><strong>Ateroskleroza<\/strong> je dinami\u010dan skup degenerativnih i regenerativnih procesa u intimi i mediji arterijskog zida sa njegovim zadebljavanjem, pove\u0107avanjem rigiditeta, stenoziranjem lumena i distalnom ishemijom. To je sistemska, hroni\u010dna, degenerativno-proliferativna bolest koja zahvata velike i srednje arterije.<\/p>\n<\/div>\n<div>\n<p><strong>Karotidna bolest<\/strong> dovodi do cerebralne ishemije:<\/p>\n<ul>\n<li>embologenim potencijalom,<\/li>\n<li>hemodinamskim zna\u010dajem ili kombinacijom oba mehanizma.<\/li>\n<\/ul>\n<\/div>\n<div>\n<p style=\"text-align: right;\" align=\"CENTER\"><em>Embolizacija cerebralnih arterija iz arterioskleroti\u010dnog plaka: <\/em><\/p>\n<p style=\"text-align: right;\" align=\"CENTER\"><em>(a) Agregati trombocita i fibrina se <br \/>formiraju na iregularnoj povr\u0161ini,<\/em><\/p>\n<p style=\"text-align: right;\" align=\"CENTER\"><em>(b) Ulcercijom karotidnog plaka prazni se<br \/>sadr\u017eaj u krvnu struju i <\/em><\/p>\n<p style=\"text-align: right;\" align=\"CENTER\"><em>(c) Prizidni tromb (nestabilni plak) se <br \/>fragmentira\u00a0 emboliziraju\u0107i cerebralnu arteriju.<\/em><\/p>\n<\/div>\n<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2023\/02\/1.jpg\" alt=\"\"><\/p>\n<div>\n<h5><strong>Hemodinamski zna\u010daj\u00a0<\/strong> okluzivne bolesti podrazumeva da je stenoza tolika da kompromituje protok do kriti\u010dnog stepena (ishemija mozga).<br \/>Cerebralna ishemija se razvija u slu\u010daju multiplih ekstenzivih ateroskleroti\u010dnih lezija supraaortalnih arterija, pogotovo u kombinaciji sa sr\u010danim oboljenjima (aritmije, low cardiac output).<\/h5>\n<h5><strong>Emboligeni potencijal<\/strong> karotidnog plaka raste sa pojavom komplikovanih ateroskleroti\u010dnih lezija kao \u0161to su intramuralna hemoragija, egzulceracija i prizidna tromboza. \u201cNestabilni\u201d karotidni plak je izvor distalnih atero-arterijskih embolizacija mozga. Sr\u010dana oboljenja: aritmija a naj\u010de\u0161\u0107e treperenje pretkomora, oboljenja sr\u010danih zalistaka, miksom, infarkt miokarda sa prizidnim trombom, endokarditis, operacija srca sa ekstrakorporalnom cirkulacijom, imaju tako\u0111e visok emboligeni potencijal. Kardioembolizacija je razlog cerebralne ishemije u oko 8 do 9% slu\u010dajeva.<br \/>Hiperkoagulabilna stanja (aktivacija trombocita, povi\u0161en nivo prokoagulantnih faktora, povi\u0161en hematokrit itd.) mogu da se pojave kao precipitiraju\u0107i faktor.<br \/>Obi\u010dno se embolijski i hemodinamski patolo\u0161ki mehanizam kombinuju. Me\u0111utim, ako dominira embolizacija znaci ishemije \u0107e biti uglavnom fokalni. Ako su bitniji hemodinamski poreme\u0107aji simptomatologija je obi\u010dno globalnog tipa.<\/h5>\n<h5><strong>Fokalna ishemija mozga<\/strong> razvija se zbog embolizacije cerebralne arterije. Simptomi zavise od lokalizacije i opsega arterijske okluzije. Na pr.: Amaurosis fugax (AF) ili tranzitorno monookularno slepilo se javlja kao posledica ipsilateralnog karotidnog ulcerisanog plaka. Mikroembolizacija holesterolskim kristalima se dokazuje fundoskopskim nalazom Hollenhorstovih tela\u0161aca.<br \/>Simptomi zavise od mesta embolizacije:<\/h5>\n<ul>\n<li>Karotidni sliv snabdeva hemisfere velikog mozga, me\u0111umozak, bazalne ganglije, o\u010di i lice,<\/li>\n<li>Vertebrobazilarni sliv ishranjuje mo\u017edano stablo, mali mozak, produ\u017eenu mo\u017edinu i okcipitalne lobuse.<\/li>\n<li>Globalna cerebralna ishemija nastaje na bazi op\u0161te redukcije protoka zbog arterijskih stenoza (ili okluzija) uz eventualnu sistemsku hipoperfuziju. Ekstenzivnost ishemi\u010dkih lezija mozga zavisi od: stepena i du\u017eine stenoze, kolateralnog sistema, sistemskog krvnog pritiska itd.<\/li>\n<\/ul>\n<h5><\/h5>\n<\/div>\n<p><!--more--><br \/>\n<!-- {\"type\":\"layout\",\"children\":[{\"type\":\"section\",\"props\":{\"image\":\"\",\"image_position\":\"center-center\",\"padding\":\"small\",\"preserve_color\":true,\"style\":\"secondary\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/friz-poglavlja2.jpg\",\"image_border\":\"rounded\",\"image_box_decoration\":\"shadow\",\"image_svg_color\":\"emphasis\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"layout\":\"1-4,3-4\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/2.png\",\"image_svg_color\":\"emphasis\",\"link\":\"index.php?page_id=1408\",\"margin\":\"default\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"3-4\"},\"children\":[{\"type\":\"headline\",\"props\":{\"content\":\"\n\n<h1 class=\\\"western\\\" lang=\\\"bs-BA\\\">ETIOPATOGENEZA KAROTIDNE BOLESTI<\\\/h1>\",\"link\":\"index.php?page_id=1408\",\"title_color\":\"success\",\"title_decoration\":\"line\",\"title_element\":\"h1\",\"title_font_family\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: left;\\\" align=\\\"LEFT\\\">There are more things in heaven and earth, than are dreamt of in our philosophy.<br \\\/><em>W. Shakespeare<\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: right;\\\" align=\\\"LEFT\\\">The way to do researche is to attack the facts at the point of greatest astonishment.<br \\\/><em>Celia Green<\\\/em><\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"xsmall\",\"preserve_color\":true,\"style\":\"secondary\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-4\"},\"children\":[]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"3-4\"},\"children\":[{\"type\":\"nav\",\"props\":{\"grid\":\"1\",\"grid_divider\":true,\"image_vertical_align\":true,\"nav_style\":\"primary\",\"show_image\":true,\"show_meta\":true},\"children\":[{\"type\":\"nav_item\",\"props\":{\"icon\":\"git-branch\"},\"source\":{\"query\":{\"name\":\"customMenuItems\",\"arguments\":{\"id\":46,\"parent\":\"\",\"heading\":\"\",\"include_heading\":true,\"ids\":[\"3182\",\"3183\",\"3184\",\"3185\",\"3186\",\"3187\"]}},\"props\":{\"type\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"active\":{\"filters\":{\"search\":\"\"},\"name\":\"active\"},\"content\":{\"filters\":{\"search\":\"\"},\"name\":\"title\"},\"link\":{\"filters\":{\"search\":\"\"},\"name\":\"url\"}}}}],\"name\":\"submeni\"}]}],\"props\":{\"layout\":\"1-4,3-4\"}}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding_remove_bottom\":true,\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"\"},\"children\":[{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p>Ateroskleroza je naj\\u010de\\u0161\\u0107i uzrok (70-90%) cerebralne ishemije.<br \\\/><strong>Ateroskleroza<\\\/strong> je dinami\\u010dan skup degenerativnih i regenerativnih procesa u intimi i mediji arterijskog zida sa njegovim zadebljavanjem, pove\\u0107avanjem rigiditeta, stenoziranjem lumena i distalnom ishemijom. To je sistemska, hroni\\u010dna, degenerativno-proliferativna bolest koja zahvata velike i srednje arterije.<\\\/p>\",\"margin\":\"default\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"none\",\"preserve_color\":true,\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"layout\":\"1-3,2-3\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"1-3\"},\"children\":[{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p><strong>Karotidna bolest<\\\/strong> dovodi do cerebralne ishemije:<\\\/p>\\n\n\n<ul>\\n\n\n<li>embologenim potencijalom,<\\\/li>\\n\n\n<li>hemodinamskim zna\\u010dajem ili kombinacijom oba mehanizma.<\\\/li>\\n<\\\/ul>\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<p style=\\\"text-align: right;\\\" align=\\\"CENTER\\\"><em>Embolizacija cerebralnih arterija iz arterioskleroti\\u010dnog plaka: <\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: right;\\\" align=\\\"CENTER\\\"><em>(a) Agregati trombocita i fibrina se <br \\\/>formiraju na iregularnoj povr\\u0161ini,<\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: right;\\\" align=\\\"CENTER\\\"><em>(b) Ulcercijom karotidnog plaka prazni se<br \\\/>sadr\\u017eaj u krvnu struju i <\\\/em><\\\/p>\\n\n\n<p style=\\\"text-align: right;\\\" align=\\\"CENTER\\\"><em>(c) Prizidni tromb (nestabilni plak) se <br \\\/>fragmentira\\u00a0 emboliziraju\\u0107i cerebralnu arteriju.<\\\/em><\\\/p>\",\"margin\":\"default\",\"text_color\":\"success\"}}]},{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"2-3\"},\"children\":[{\"type\":\"image\",\"props\":{\"image\":\"wp-content\\\/uploads\\\/2023\\\/02\\\/1.jpg\",\"image_svg_color\":\"emphasis\",\"image_width\":\"600\",\"margin\":\"default\",\"text_align\":\"center\"}}]}]}]},{\"type\":\"section\",\"props\":{\"image_position\":\"center-center\",\"padding\":\"none\",\"style\":\"default\",\"title_breakpoint\":\"xl\",\"title_position\":\"top-left\",\"title_rotation\":\"left\",\"vertical_align\":\"middle\",\"width\":\"default\"},\"children\":[{\"type\":\"row\",\"props\":{\"divider\":true,\"margin\":\"remove-vertical\",\"match\":true,\"width\":\"expand\"},\"children\":[{\"type\":\"column\",\"props\":{\"image_position\":\"center-center\",\"media_overlay_gradient\":\"\",\"position_sticky_breakpoint\":\"m\",\"width_medium\":\"\"},\"children\":[{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\n\n<h5><strong>Hemodinamski zna\\u010daj\\u00a0<\\\/strong> okluzivne bolesti podrazumeva da je stenoza tolika da kompromituje protok do kriti\\u010dnog stepena (ishemija mozga).<br \\\/>Cerebralna ishemija se razvija u slu\\u010daju multiplih ekstenzivih ateroskleroti\\u010dnih lezija supraaortalnih arterija, pogotovo u kombinaciji sa sr\\u010danim oboljenjima (aritmije, low cardiac output).<\\\/h5>\\n\n\n<h5><strong>Emboligeni potencijal<\\\/strong> karotidnog plaka raste sa pojavom komplikovanih ateroskleroti\\u010dnih lezija kao \\u0161to su intramuralna hemoragija, egzulceracija i prizidna tromboza. \\u201cNestabilni\\u201d karotidni plak je izvor distalnih atero-arterijskih embolizacija mozga. Sr\\u010dana oboljenja: aritmija a naj\\u010de\\u0161\\u0107e treperenje pretkomora, oboljenja sr\\u010danih zalistaka, miksom, infarkt miokarda sa prizidnim trombom, endokarditis, operacija srca sa ekstrakorporalnom cirkulacijom, imaju tako\\u0111e visok emboligeni potencijal. Kardioembolizacija je razlog cerebralne ishemije u oko 8 do 9% slu\\u010dajeva.<br \\\/>Hiperkoagulabilna stanja (aktivacija trombocita, povi\\u0161en nivo prokoagulantnih faktora, povi\\u0161en hematokrit itd.) mogu da se pojave kao precipitiraju\\u0107i faktor.<br \\\/>Obi\\u010dno se embolijski i hemodinamski patolo\\u0161ki mehanizam kombinuju. Me\\u0111utim, ako dominira embolizacija znaci ishemije \\u0107e biti uglavnom fokalni. Ako su bitniji hemodinamski poreme\\u0107aji simptomatologija je obi\\u010dno globalnog tipa.<\\\/h5>\\n\n\n<h5><strong>Fokalna ishemija mozga<\\\/strong> razvija se zbog embolizacije cerebralne arterije. Simptomi zavise od lokalizacije i opsega arterijske okluzije. Na pr.: Amaurosis fugax (AF) ili tranzitorno monookularno slepilo se javlja kao posledica ipsilateralnog karotidnog ulcerisanog plaka. Mikroembolizacija holesterolskim kristalima se dokazuje fundoskopskim nalazom Hollenhorstovih tela\\u0161aca.<br \\\/>Simptomi zavise od mesta embolizacije:<\\\/h5>\\n\n\n<ul>\\n\n\n<li>Karotidni sliv snabdeva hemisfere velikog mozga, me\\u0111umozak, bazalne ganglije, o\\u010di i lice,<\\\/li>\\n\n\n<li>Vertebrobazilarni sliv ishranjuje mo\\u017edano stablo, mali mozak, produ\\u017eenu mo\\u017edinu i okcipitalne lobuse.<\\\/li>\\n\n\n<li>Globalna cerebralna ishemija nastaje na bazi op\\u0161te redukcije protoka zbog arterijskih stenoza (ili okluzija) uz eventualnu sistemsku hipoperfuziju. Ekstenzivnost ishemi\\u010dkih lezija mozga zavisi od: stepena i du\\u017eine stenoze, kolateralnog sistema, sistemskog krvnog pritiska itd.<\\\/li>\\n<\\\/ul>\\n\n\n<h5><\\\/h5>\",\"margin\":\"default\"}},{\"type\":\"text\",\"props\":{\"column_breakpoint\":\"m\",\"content\":\"\",\"margin\":\"default\"}}]}]}]}],\"version\":\"3.0.25\"} --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>ETIOPATOGENEZA KAROTIDNE BOLESTI There are more things in heaven and earth, than are dreamt of in our philosophy.W. Shakespeare The way to do researche is to attack the facts at the point of greatest astonishment.Celia Green Ateroskleroza je naj\u010de\u0161\u0107i uzrok (70-90%) cerebralne ishemije.Ateroskleroza je dinami\u010dan skup degenerativnih i regenerativnih procesa u intimi i mediji arterijskog [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1408","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>2. 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