{"id":2695,"date":"2023-02-09T19:39:11","date_gmt":"2023-02-09T19:39:11","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=2695"},"modified":"2023-02-24T12:26:12","modified_gmt":"2023-02-24T12:26:12","slug":"7-medikamentozna-terapija-karotidne-bolesti","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=2695","title":{"rendered":"7. MEDIKAMENTOZNA TERAPIJA KAROTIDNE BOLESTI"},"content":{"rendered":"

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<\/p>\n

MEDIKAMENTOZNA TERAPIJA KAROTIDNE BOLESTI<\/h1>\n

<\/a><\/h1>\n

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Ironically, a major goal for vascular surgeons is to make themselves superflous, by ways of preventing or medically treating atherosclerosis. We are coming to an era where all people could be regarded as either patients or prospective patients.<\/em><\/p>\n

A.J. Kroese<\/em><\/p>\n<\/div>\n

\n

Insistiranje na modifikaciji \u017eivotnih navika, statinska i antiagregaciona terapija, sa adekvatnom kontrolom krvnog pritiska (naro\u010dito u dijabeti\u010dara), nesumnjivo \u0107e usporiti razvoj ateroskleroze.<\/p>\n

    \n
  • Ako<\/b> <\/b>revaskularizacija<\/b> <\/b>hirur\u0161kim<\/b> <\/b>metodama<\/b> <\/b>nije<\/b> <\/b>potrebna<\/b> <\/b>ili<\/b> <\/b>nije<\/b> <\/b>mogu\u0107a<\/b> <\/b>pacijenta treba le\u010diti konzervativnim metodama (uklanjanje faktora rizika i medikamentozno le\u010denje).<\/li>\n
  • Ako<\/b> <\/b>je<\/b> <\/b>ura\u0111ena<\/b> <\/b>revaskularizacija<\/b> <\/b>mozga<\/b> <\/b>treba dalje konzervativnim merama spra\u010davati progresiju osnovne bolesti i pojavu kasnih komplikacija (restenoza rekonstruisanog segmenta).<\/li>\n<\/ul>\n

    Multidisciplinarni<\/b> <\/b>programi<\/b> <\/b>prevencije<\/b> <\/b>trebalo bi da budu strate\u0161ki prioritet prvog reda u zdravstvenom planiranju. Neophodna je multidisciplinarna strategija internista, neurologa i vaskularnih hirurga na otkrivanju, evaluaciji, le\u010denju i edukaciji populacije koja je optere\u0107ena rizikom.Treba razlikovati primarnu i sekundarnu prevenciju.<\/p>\n

      \n
    • Primarna<\/b> <\/b>prevencija<\/b> <\/b>ishemi\u010dkog<\/b> <\/b>insulta<\/b> <\/b>podrazumeva identifikaciju, otklanjanje i le\u010denje faktora rizika u op\u0161toj populaciji pre pojave simptoma cerebralne ishemije.<\/li>\n
    • Sekundarna<\/b> <\/b> <\/b>prevencija<\/b> <\/b> <\/b>ishemi\u010dkog<\/b> <\/b> <\/b>insulta<\/b> <\/b> <\/b>otklanja (ili smanjuje) naknadni rizik od mo\u017edanog udara u bolesnika koji su ga ve\u0107 imali, ili imaju tranzitorne ishemi\u010dke atake.<\/li>\n<\/ul>\n

      Me\u0111unarodne preporuke<\/strong> za operativno le\u010denje karotidne bolesti zasnivaju se na rezultatima brojnih klini\u010dkih istra\u017eivanja u prethodnih dvadeset godina. Tada je koncept konzervativne terapije zna\u010dio samo apsolutni prekid pu\u0161enja i terapiju aspirinom. Dve najzna\u010dajnije studije o korisnim dejstvima karotidne endarterektomije u pacijenata sa simptomatskom bole\u0161\u0107u (North<\/i> <\/i>American<\/i> <\/i>Symptomatic<\/i> <\/i>Carotid<\/i> <\/i>Endarterectomy<\/i> <\/i>Trial<\/i> <\/i>– NASCET i European<\/i> <\/i>Carotid<\/i> <\/i>Surgery<\/i> <\/i>Trial<\/i> <\/i>– ECST) vr\u0161ene su tokom osamdesetih godina pro\u0161log veka. <\/span><\/sup>Takodje, istra\u017eivanje asimptomatske karotidne bolesti sprovo\u0111eno je tokom devedesetih godina i po\u010detkom ovog veka (Asymptomatic<\/i> <\/i>Carotid<\/i> <\/i>Surgery<\/i> <\/i>Trial<\/i> <\/i>– ACST i Asymptomatic<\/i> <\/i>Carotid<\/i> <\/i>Atherosclerosis <\/i>Study<\/i> <\/i>-ACAS).<\/p>\n

      Inovacije<\/b> <\/b>na<\/b> <\/b>polju<\/b> <\/b>medikamentne<\/b> <\/b>terapije<\/b>, pojava statina i antitrombocitnih lekova, unapre\u0111enje antihipertenzivne terapije), sa razvojem svesti o zna\u010daju modifikacije \u017eivotnih navika pru\u017eaju nove mogu\u0107nosti u le\u010denju pacijenata sa karotidnom stenozom.<\/p>\n

      Pojava statina je svakako najzna\u010dajniji farmakolo\u0161ki napredak na polju kontrole kardiovaskularnih faktora rizika.<\/p>\n

      Statinska terapija nije postojala u vremesprovo\u0111enja<\/span> <\/span>velikih<\/span> <\/span>studija<\/span> <\/span>(NASCET,<\/span> <\/span>ECST,<\/span> ACAS),<\/span> <\/span>a<\/span> <\/span>u<\/span> <\/span>poslednjoj<\/span> <\/span>i<\/span> <\/span>nedavno<\/span> <\/span>objavljenoj<\/span> <\/span>ACST<\/span> <\/span>studiji,<\/span> <\/span>svega<\/span> <\/span>30%<\/span> <\/span>randomizovanih<\/span> <\/span>pacijenata<\/span> <\/span>je<\/span> <\/span>bilo<\/span> <\/span>na<\/span> <\/span>terapiji<\/span> <\/span>statinom.<\/span> <\/span>Danas<\/span> <\/span>je<\/span> <\/span>u<\/span> <\/span>upotrebi<\/span> <\/span>i<\/span> <\/span>nekoliko<\/span> <\/span>novih<\/span> <\/span>antitrombocitinih<\/span> <\/span>lekova,<\/span> <\/span>a<\/span> <\/span>upotrebom<\/span> <\/span>dvojne<\/span> <\/span>antiagregacione<\/span> <\/span>terapije<\/span> <\/span>posti\u017ee<\/span> <\/span>se<\/span> <\/span>poja\u010dano<\/span> <\/span>speci<\/span>fi<\/span>\u010dno<\/span> <\/span>dejstvo.<\/span> <\/span><\/p>\n

      Pojavom<\/span> <\/span>clopidogrela,<\/span> <\/span>obezbe\u0111ene<\/span> <\/span>su<\/span> <\/span>nove<\/span> <\/span>terapijske<\/span> <\/span>alternative<\/span> <\/span>za<\/span> <\/span>oko<\/span> <\/span>10%<\/span> <\/span>pacijenata<\/span> <\/span>sa<\/span> <\/span>intolerancijom<\/span> <\/span>ili<\/span> <\/span>rezistencijom<\/span> <\/span>na<\/span> <\/span>aspirin.<\/span><\/p>\n

      Rano<\/b><\/span> <\/b><\/span>zapo\u010dinjanje<\/b><\/span> <\/b><\/span>medikamentne<\/b><\/span> <\/b><\/span>terapije.<\/b><\/span> <\/b><\/span>Maksimalni<\/span> <\/span>bene<\/span>fi<\/span>t<\/span> <\/span>od<\/span> <\/span>karotidne<\/span> <\/span>rekonstrukcijeposti\u017eeseuprvedvenedeljeodpojaveprvihsimptomaTIA.<\/span>5<\/span><\/sup> <\/span><\/sup>Me\u0111utim,<\/span> <\/span>mali<\/span> <\/span>broj<\/span> <\/span>istra\u017eiva\u010da<\/span> <\/span>se<\/span> <\/span>pitao<\/span> <\/span>da<\/span> <\/span>li<\/span> <\/span>se<\/span> <\/span>i<\/span> <\/span>ranim<\/span> <\/span>zapo\u010dinjanjem<\/span> <\/span>medikamentne<\/span> <\/span>terapije<\/span> <\/span>mo\u017e<\/span>e<\/span> <\/span>posti\u0107<\/span>i<\/span> <\/span>sli\u010da<\/span>n<\/span> <\/span>pozitivn<\/span>i<\/span> <\/span>efekat<\/span>.<\/span> <\/span>V<\/span>e\u0107in<\/span>a<\/span> <\/span>lekar<\/span>a<\/span> <\/span>smatr<\/span>a<\/span> <\/span>d<\/span>a<\/span> <\/span>j<\/span>e<\/span> <\/span>z<\/span>a<\/span> <\/span>ispoljavanj<\/span>e<\/span> <\/span>efekata<\/span> <\/span>medikamentne<\/span> <\/span>terapije<\/span> <\/span>potrebno<\/span> <\/span>vi\u0161e<\/span> <\/span>meseci.<\/span> <\/span>Potencijalni<\/span> <\/span>zna\u010daj<\/span> <\/span>ranog<\/span> <\/span>zapo\u010dinjanja<\/span> <\/span>medikamentne<\/span> <\/span>terapije<\/span> <\/span>ispitivan<\/span> <\/span>je<\/span> <\/span>u<\/span> <\/span>nedavno<\/span> <\/span>objavljenoj<\/span> <\/span>Express<\/i><\/span> <\/i><\/span>studiji.<\/span> <\/span>Dokazano<\/span> je <\/span>smanjenje<\/span> <\/span>u\u010destalosti<\/span> <\/span>mo\u017edanog<\/span> <\/span>udara<\/span> za <\/span>period<\/span> od 90 <\/span>dana<\/span> <\/span>od<\/span> <\/span>pojave<\/span> <\/span>prvih<\/span> <\/span>simptoma<\/span> <\/span>sa<\/span> <\/span>10,2%<\/span> <\/span>na<\/span> <\/span>2,1%,<\/span> <\/span>agresivnom<\/span> <\/span>antitrombocitnom,<\/span> <\/span>antihipertenzivnom<\/span> <\/span>i<\/span> <\/span>statinskom<\/span> <\/span>terapijom,<\/span> <\/span>ako<\/span> <\/span>je<\/span> <\/span>ona<\/span> <\/span>zapo\u010deta<\/span> <\/span>ve\u0107<\/span> <\/span>u<\/span> <\/span>prvih<\/span> <\/span>24<\/span> <\/span>\u010dasa<\/span> <\/span>od<\/span> <\/span>po\u010detka<\/span> <\/span>pojave<\/span> <\/span>simptoma<\/span> <\/span>mo\u017edane<\/span> <\/span>ishemije.<\/span>6<\/span><\/sup><\/p>\n

      Klini\u010dka<\/span> <\/span>manifestacija<\/span> <\/span>bilo<\/span> <\/span>kog<\/span> <\/span>oblika<\/span> <\/span>ateroskleroze<\/span> <\/span>(karotidna,<\/span> <\/span>koronarna,<\/span> <\/span>renovaskularna,<\/span> <\/span>mezenteri\u010dna<\/span> <\/span>i<\/span> <\/span>periferna),<\/span> <\/span>ukazuje<\/span> <\/span>na<\/span> <\/span>postojanje<\/span> <\/span>aterosklerotskog<\/span> <\/span>procesa<\/span> <\/span>i<\/span> <\/span>u<\/span> <\/span>ostalim<\/span> <\/span>delovima<\/span> <\/span>arterijskog<\/span> <\/span>sistema.<\/span> <\/span>U<\/span> <\/span>pacijenata<\/span> <\/span>sa<\/span> <\/span>karotidnom<\/span> <\/span>bole\u0161\u0107u,<\/span> <\/span>postoji<\/span> <\/span>ne<\/span> <\/span>samo rizik<\/span> <\/span>od<\/span> <\/span>razvoja mo\u017edanog<\/span> <\/span>udara,<\/span> <\/span>ve\u0107 <\/span>i<\/span> <\/span>rizik<\/span> <\/span>od<\/span> <\/span>infarkta<\/span> <\/span>miokarda,<\/span> <\/span>periferne<\/span> <\/span>arterijske<\/span> <\/span>okluzivne<\/span> <\/span>bolesti<\/span> <\/span>i<\/span> <\/span>drugih<\/span> <\/span>ishemijskih<\/span> <\/span>komplikacija.<\/span><\/p>\n<\/div>\n

      \"\"
      \n\"\"<\/p>\n

      \n

      Zadebljanje intima medija kompleksa, <\/em>Intiama media thickness IMT, kao mera potencijalne aterogeneze u sklopu <\/em>metaboli\u010dkog sindroma.<\/em><\/p>\n<\/p>\n<\/div>\n

      \"\"<\/p>\n

      \n

      Color Duplex ultrasonografija karotidne bifurkacije u pra\u0107enju stenoza koje jo\u0161 uvek ne zahtevaju hirur\u0161ko le\u010denje<\/em><\/p>\n<\/div>\n

      \"\"<\/p>\n

      \n

      Prizidna tromboza na ranom postoperativnom Duplex-ultrazvu\u010dnom nalazu.<\/em><\/p>\n

      \n<\/div>\n


      \n<\/p>\n","protected":false},"excerpt":{"rendered":"

      MEDIKAMENTOZNA TERAPIJA KAROTIDNE BOLESTI Ironically, a major goal for vascular surgeons is to make themselves superflous, by ways of preventing or medically treating atherosclerosis. We are coming to an era where all people could be regarded as either patients or prospective patients. A.J. Kroese Insistiranje na modifikaciji \u017eivotnih navika, statinska i antiagregaciona terapija, sa adekvatnom […]<\/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-2695","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n7. 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