Surgery For Carotid Artery Disease
Özet
Carotid artery stenosis is a prevalent cardiovascular condition, particularly in individuals over sixty, serving as a primary, preventable cause of stroke, transient ischemic attacks, and amaurosis fugax. Diagnosis relies on various imaging modalities, including non-invasive color Doppler ultrasonography, magnetic resonance angiography, computed tomographic angiography, and digital subtraction angiography, which remains the clinical gold standard. Patient management consists of medical and surgical strategies. Medical treatment involves intensive risk-factor modifications, lipid-lowering statin therapy, and antiplatelet agents like aspirin or clopidogrel. For moderate (50–69%) and severe (70–99%) stenosis, surgical intervention is highly superior to medical therapy alone. Carotid endarterectomy (CEA) is the gold standard surgical treatment, performed via classic, eversion, or modified eversion techniques. Temporary shunts are utilized during CEA to maintain cerebral perfusion in patients with inadequate collateral circulation, indicated by criteria such as contralateral stenosis of 70% or more. Conversely, carotid artery stenting (CAS) is an endovascular alternative reserved for patients at high surgical risk. Despite advancements, CEA remains the definitive gold standard treatment, though both options carry complication risks like nerve injuries and stroke.
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