{"id":2781,"date":"2023-02-10T10:39:11","date_gmt":"2023-02-10T10:39:11","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=2781"},"modified":"2023-02-24T12:33:09","modified_gmt":"2023-02-24T12:33:09","slug":"8-indikacije-za-endarterektomiju-kod-simptomatske-karotidne-stenoze","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=2781","title":{"rendered":"8. INDIKACIJE ZA ENDARTEREKTOMIJU KOD SIMPTOMATSKE KAROTIDNE STENOZE"},"content":{"rendered":"

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

<\/p>\n

INDIKACIJE ZA ENDARTEREKTOMIJU KOD SIMPTOMATSKE KAROTIDNE STENOZE<\/h1>\n

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

\n

To soon is unnecessary, to late is useless.<\/p>\n

H.J.M. Barnet<\/em><\/p>\n<\/div>\n

\n

Simptomski<\/b> <\/b>bolesnici<\/b> <\/b>imaju epizode tranzitornih ishemi\u010dkih ataka, prolaznog gubitka vida (amaurosis fugax) ili ishemi\u010dkog mo\u017edanog udara.<\/p>\n

Karotidna hirurgija je u ranoj fazi bila optere\u0107ena predrasudama i strahom zbog neophodnosti klemovanja arterija koje ishranjuju mozak. Zato su pokrenute velike studije. Rezultati tri velike multicentri\u010dne prospektivne randomizirane studije u\u010dinili su karotidnu hirurgiju, verovatno nau\u010dno najbolje ispitanom obla\u0161\u0107u hirurgije uop\u0161te. Mnoge indikacione dileme re\u0161ene su kada su, gotovo istovremeno, zavr\u0161ene studije:<\/p>\n

    \n
  • North American Symptomatic Carotid Endarterectomy Trial (NASCET),<\/li>\n
  • European Carotid Surgery Trial (ESCT) <\/span><\/sup> <\/span><\/sup>i<\/li>\n
  • Veterans Administration (VA) Symptomatic Trial<\/li>\n<\/ul>\n<\/div>\n
    \n

    Kumulacioni rizik od mo\u017edanog udara i pojave simptoma ishemije,
    posle 8 godina smanjen je za tre\u0107inu u operisanih<\/em><\/p>\n<\/div>\n

    \"\"<\/p>\n

    \n

    Komitet za nadgledanje rezultata NASCET prekinuo je ovu studiju jer su prvi statisti\u010dki rezultati ubedljivo pokazali dramati\u010dno bolje rezultata u<\/b> <\/b>simptomatskih<\/b> <\/b>pacijenata<\/b> <\/b>(TIA)<\/b> <\/b>sa<\/b> <\/b>stenozom<\/b> <\/b>karotidne<\/b> <\/b>arterije<\/b> <\/b>ve\u0107om<\/b> <\/b>od<\/b> <\/b>70%<\/b>, koji su bili operisani,<\/span> <\/span>u<\/span> <\/span>odnosu<\/span> <\/span>na<\/span> <\/span>medikametozno<\/span> <\/span>le\u010dene<\/span> <\/span>pacijente<\/span>.<\/span> <\/span>U<\/span> <\/span>studiji<\/span> <\/span>NASCET,<\/span> <\/span>u <\/span>simptomatskih<\/span> <\/span>bolesnika<\/span> <\/span>sa<\/span> <\/span>stenozom<\/span> <\/span>karotidne<\/span> <\/span>arterije<\/span> <\/span>preko<\/span> <\/span>70%<\/span> <\/span>,<\/span> <\/span>kumulacioni<\/span> <\/span>rizik<\/span> <\/span>od<\/span> <\/span>mo\u017edanog<\/span> <\/span>udara<\/span> <\/span>u<\/span> <\/span>distribuciji<\/span> <\/span>analizirane<\/span> <\/span>arterije<\/span> <\/span>posle<\/span> <\/span>dve<\/span> <\/span>godine<\/span> <\/span>iznosio<\/span> <\/span>je<\/span> <\/span>26%<\/span> <\/span>u<\/span> <\/span>neoperisanih<\/span> <\/span>bolesnika,<\/span> <\/span>prema<\/span> <\/span>9%<\/span> <\/span>u<\/span> <\/span>operisanih.<\/span><\/p>\n

      \n
    • U<\/span> <\/span>indikacionim<\/span> <\/span>razmi\u0161ljanjima<\/span> <\/span>va\u017ena<\/span> <\/span>je<\/span> <\/span>jo\u0161<\/span> <\/span>i:<\/span><\/li>\n
    • U\u010destalost<\/span> ishemi\u010dkih epizoda,<\/li>\n
    • Stepen karotidne stenoze i<\/li>\n
    • Morfolo\u0161ke odlike<\/span> <\/span>plaka.<\/span><\/li>\n<\/ul>\n

      Simptomatski<\/b><\/span> <\/b><\/span>stadijum<\/b><\/span> <\/b><\/span>karotidne<\/span> <\/span>bolesti<\/span> <\/span>manifestuje<\/span> <\/span>se<\/span> <\/span>prolaznim<\/span> <\/span>ili<\/span> <\/span>trajnim<\/span> <\/span>neurolo\u0161kim<\/span> <\/span>de<\/span>fi<\/span>citom<\/span> <\/span>u<\/span> <\/span>prednjem<\/span> <\/span>(karotidom)<\/span> <\/span>ili<\/span> <\/span>zadnjem<\/span> <\/span>(vertebralnom)<\/span> <\/span>slivu.<\/span> <\/span>Simptomi<\/span> <\/span>i<\/span> <\/span>znaci<\/span> <\/span>ishemije<\/span> <\/span>u<\/span> <\/span>karotidnom<\/b><\/span> <\/b><\/span>slivu<\/b><\/span> <\/b><\/span>su:<\/span> <\/span>nesvestica,<\/span> <\/span>omaglica,<\/span><\/p>\n

      malaksalost,<\/span> <\/span>hemipareza,<\/span> <\/span>hemiplegija,<\/span> <\/span>amaurosis<\/span> <\/span>fugax,<\/span> <\/span>aphasio,<\/span> <\/span>disphasio<\/span> <\/span>itd.<\/span><\/p>\n

      Simptomi<\/span> <\/span>i<\/span> <\/span>znaci<\/span> <\/span>posteriorne<\/b><\/span> <\/b><\/span>(vertebralne)<\/b><\/span> <\/b><\/span>insu<\/span>fi<\/span>cijencije<\/span> <\/span>su<\/span> <\/span>vrtoglavica,<\/span> <\/span>omaglice,<\/span> <\/span>nesvestice,<\/span> <\/span>dilopije,<\/span> <\/span>ataksija,<\/span> <\/span>bilateralni<\/span> <\/span>motorni<\/span> <\/span>ili<\/span> <\/span>senzorni<\/span> <\/span>de<\/span>fi<\/span>cit,<\/span> <\/span>nesigurnost<\/span> <\/span>pri<\/span> <\/span>hodu,<\/span> <\/span>homonimni<\/span> <\/span>defekti<\/span> <\/span>vi\u0111enja,<\/span> <\/span>dizartrija<\/span> <\/span>i<\/span> <\/span>drop<\/span> <\/span>ataci<\/span> <\/span>(iznenadni<\/span> <\/span>pad<\/span> <\/span>bez<\/span> <\/span>gubitka<\/span> <\/span>svesti).<\/span><\/p>\n

      Prema<\/span> <\/span>te\u017eini<\/span> <\/span>ishemi\u010dkog<\/span> <\/span>neurolo\u0161kog<\/span> <\/span>de<\/span>fi<\/span>cita<\/span> <\/span>mo\u017eemo<\/span> <\/span>razlikovati:<\/span><\/p>\n

      Tranzitorni<\/b><\/span> <\/b><\/span>ishemi\u010dki<\/b><\/span> <\/b><\/span>atak<\/b><\/span> <\/b><\/span>(TIA):<\/b><\/span> <\/b><\/span>neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>traje<\/span> <\/span>nekoliko<\/span> <\/span>minuta<\/span> <\/span>do<\/span> <\/span>24<\/span> <\/span>\u010dasa,<\/span> <\/span>povla\u010di<\/span> <\/span>se<\/span> <\/span>bez<\/span> <\/span>posledica,<\/span> <\/span>ali<\/span> <\/span>ima<\/span> <\/span>tendenciju<\/span> <\/span>ponavljanja.<\/span><\/p>\n

        \n
      • Crescendo<\/span> <\/span>TIA<\/span> <\/span>oki<\/span> <\/span>neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>(RIND)<\/span> <\/span>je<\/span> <\/span>fokalni<\/span> <\/span>neurolo\u0161ki<\/span><\/li>\n
      • dgovara<\/span> <\/span>u\u010destalim<\/span> <\/span>hemisferi\u010dnim<\/span> <\/span>ili<\/span> <\/span>monokularnim<\/span> <\/span>TIA,<\/span><\/li>\n
      • koji<\/span> <\/span>traju<\/span> <\/span>od<\/span> <\/span>nekoliko<\/span> <\/span>minuta<\/span> <\/span>do<\/span> <\/span>nekoliko<\/span> <\/span>sati,<\/span> <\/span>ne<\/span> <\/span>osatavljaju\u0107i<\/span> <\/span>rezidualni<\/span> <\/span>neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>u<\/span> <\/span>me\u0111ufazama.<\/span> <\/span>Ishemi\u010dki<\/span> <\/span>ataci<\/span> <\/span>pove\u0107avaju<\/span> <\/span>svoju<\/span> <\/span>u\u010destalost<\/span> <\/span>i<\/span> <\/span>te\u017einu.<\/span><\/li>\n
      • Reverzibilni<\/span> <\/span>ishemi\u010d<\/span><\/li>\n
      • de<\/span>fi<\/span>cit<\/span> <\/span>koji<\/span> <\/span>traje<\/span> <\/span>du\u017ee<\/span> <\/span>od<\/span> <\/span>24h<\/span> <\/span>.<\/span> <\/span>Tegobe<\/span> <\/span>se<\/span> <\/span>povla\u010de<\/span> <\/span>tokom<\/span> <\/span>7<\/span> <\/span>dana<\/span> <\/span>bez<\/span> <\/span>zaostajanja<\/span> <\/span>permanentnog<\/span> <\/span>neurolo\u0161kog<\/span> <\/span>de<\/span>fi<\/span>cita.<\/span><\/li>\n
      • Progresivni<\/span> <\/span>ishemi\u010dki<\/span> <\/span>neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>(PIND):<\/span> <\/span>Neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>koji<\/span> <\/span>se<\/span><\/li>\n
      • razvija<\/span> <\/span>tokom<\/span> <\/span>24-48<\/span> <\/span>\u010dasova<\/span> <\/span>i<\/span> <\/span>ima<\/span> <\/span>progresivan<\/span> <\/span>karakter.<\/span><\/li>\n<\/ul>\n

        Akutni<\/b><\/span> <\/b><\/span>ishemi\u010dki<\/b><\/span> <\/b><\/span>neurolo\u0161ki<\/b><\/span> <\/b><\/span>de<\/b><\/span>fi<\/b><\/span>cit<\/b><\/span>,<\/span> <\/span>ili<\/span> <\/span>Frischer<\/i><\/span> <\/i><\/span>Schlaganffall<\/i><\/span>,<\/span> <\/span>frank<\/i><\/span> <\/i><\/span>stroke<\/i><\/span>.<\/span> <\/span>Hroni\u010dni<\/b><\/span> <\/b><\/span> <\/b><\/span>ishemi\u010dki<\/b><\/span> <\/b><\/span> <\/b><\/span>neurolo\u0161ki<\/b><\/span> <\/b><\/span> <\/b><\/span>de<\/b><\/span>fi<\/b><\/span>cit<\/b><\/span> <\/b><\/span> <\/b><\/span>(HIND)<\/b><\/span> <\/b><\/span> <\/b><\/span>ili<\/span> <\/span> <\/span>Postapoplektischer<\/i><\/span> <\/i><\/span>Endzustand<\/i><\/span>,<\/span> <\/span>Completed<\/i><\/span> <\/i><\/span>stroke<\/i><\/span>,<\/span> <\/span>podraumeva<\/span> <\/span>pacijente<\/span> <\/span>koji<\/span> <\/span>su<\/span> <\/span>pre\u017eiveli<\/span> <\/span>mo\u017edani udar<\/span> <\/span>sa<\/span> <\/span>de<\/span>fi<\/span>nitivnim<\/span> <\/span>neurolo\u0161kim<\/span> <\/span>lezijama.<\/span><\/p>\n

        Kod<\/span> <\/span>bolesnika<\/span> <\/span>sa<\/span> <\/span>TIA<\/span> <\/span>stopa<\/span> <\/span>rizika<\/span> <\/span>od<\/span> <\/span>mo\u017edanog<\/span> <\/span>udara<\/span> <\/span>je<\/span> <\/span>13-15%<\/span> <\/span>u<\/span> <\/span>toku<\/span> <\/span>prve<\/span> <\/span>godine,<\/span> <\/span>dok<\/span> <\/span>je<\/span> <\/span>kumulacioni<\/span> <\/span>rizik<\/span> <\/span>posle<\/span> <\/span>pet<\/span> <\/span>godina<\/span> <\/span>30-35%.<\/span> <\/span>Kod<\/span> <\/span>bolesnika<\/span> <\/span>koji<\/span> <\/span>su<\/span> <\/span>do\u017eiveli<\/span> <\/span>mo\u017edani<\/span> <\/span>udar,<\/span> <\/span>rizik<\/span> <\/span>za<\/span> <\/span>novi<\/span> <\/span>ponovni<\/span> <\/span>je<\/span> <\/span>jo\u0161<\/span> <\/span>ve\u0107i.<\/span><\/p>\n<\/div>\n


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

        INDIKACIJE ZA ENDARTEREKTOMIJU KOD SIMPTOMATSKE KAROTIDNE STENOZE To soon is unnecessary, to late is useless. H.J.M. Barnet Simptomski bolesnici imaju epizode tranzitornih ishemi\u010dkih ataka, prolaznog gubitka vida (amaurosis fugax) ili ishemi\u010dkog mo\u017edanog udara. Karotidna hirurgija je u ranoj fazi bila optere\u0107ena predrasudama i strahom zbog neophodnosti klemovanja arterija koje ishranjuju mozak. Zato su pokrenute velike […]<\/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-2781","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n8. INDIKACIJE ZA ENDARTEREKTOMIJU KOD SIMPTOMATSKE KAROTIDNE STENOZE - KAROTIDNA HIRURGIJA<\/title>\n<meta name=\"description\" content=\"Simptomski bolesnici imaju epizode tranzitornih ishemi\u010dkih ataka, prolaznog gubitka vida (amaurosis fugax) ili ishemi\u010dkog mo\u017edanog udara.Karotidna hirurgija je u ranoj fazi bila optere\u0107ena predrasudama i strahom zbog neophodnosti klemovanja arterija koje ishranjuju mozak.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.karotidnahirurgija.com\/?page_id=2781\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"8. 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