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    Öğe
    Procedural and mid-term outcomes of carotid artery stenting and carotidendarterectomy in asymptomatıc patients: A single center experience
    (2020) Budak, Ali Baran; Sarıyıldız, Husniye; Günertem, Eren; Kulahcıoglu, Emre; Orhan, Gurdal; Tümer, Naim Boran; Kunt, Atike Tekeli
    Aim: Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes. The management of CS in an asymptomatic patient has been less clear. In situations were carotid endarterectomy (CEA) is thought to be more risky, surgeons must also have enough experience and capability to perform carotid artery stenting (CAS) to provide suitable, patient-tailored treatment. In this study, the same investigator performed all interventions (CAS and CEA), and one type of stenting device and EPD was used. In addition, periprocedural monitoring was carried out for at least 24 h. The objective of this study was to compare procedural results and 12-month follow-up outcomes of patients who were treated by the same operator- either CAS or CEA- in one year.Material and Methods: A retrospective single-center review involving asymptomatic patients with severe stenosis of the ICA caused by atherosclerotic disease who was treated with either stenting with embolic protection (Group 1, n=17) or carotid endarterectomy (group 2, n=18) according to their clinical and anatomical risk profile between 1 January 2018 and 31 December 2018 at Numune Research and Training Hospital, Department of Cardiovascular Surgery, Ankara-Turkey was conducted. A duplex ultrasound (DUS) and neurological assessment was obtained prior to hospital discharge as a baseline, 30-days, 6 months, and 1 year thereafter. Patients’ demographic and clinical characteristics, angiographic variables, primary endpoints including the composite of death, stroke and myocardial infarction during the 30 days after the procedure or ipsilateral stroke during the 365 days after the procedure was compared. Primary endpoints also including primary technical success, periprocedural clinical success, primary patency, clinical failure, periprocedural adjunctive maneuvers and secondary endpoints including complications, freedom from clinically driven target-lesion revascularization at 12 months, freedom from death, freedom from all stroke and freedom from restenosis rates were assessed and compared between the groups. Results: High-risk anatomical criteria were present in 8 (47.0%) patients, high-risk clinical criteria were present in 11 (64.7%) patients. Group 2 patients were older (67.7±7.4 vs 71.2± 6.9, p<0.05), but hyperlipidemia (58.8% vs 44.4%, p<0.05), chronic renal insufficiency requiring hemodialysis (11.7% vs 0.0%, p<0.05) and left ventricular dysfuntion (17.6% vs 0.0%, p<0.05) were significantly more frequent in Group 1. CCDS of group 1 was significantly lower than group 2 (4.7 ± 1.3 vs 7.3 ± 1.2; p<0.05, respectively). The lesions of the patients undergoing CEA were significantly longer (12.7 ± 2.6 vs 18.5 ± 4.2 mm.; p<0.05) and more calcified (11.7% vs 50.0%, p<0.05) than the patients in group 1. Likewise, the degree of stenosis in group 2 was significantly more than that of group 1 (81.4 ± 4.2 vs 88.3±6.4 %; p<0.05, respectively). Primary technical success was 100% for both groups. Periprocedural clinical success was 100% for Group 1, and 94.4% for group 2. Primary patency rates at 1/6/12 months were 100%/ 94.1%/94.1% for group 1, and 100%/100%/94.4% for group 2. Freedom from restenosis and freedom from CD-TLR at 12 months was 94.1% and 94.4% for group 1 and group 2. No death, major strokes, miyocardial infarction and systemic complications occured.Conclusion: This study showed similar short and mid-term results for CEA and CAS in asymptomatic patients with significant carotid disease. Although we have shown good results for both CEA and CAS, CAS should be limited to those cases that are not suitable for open surgery and treatment of asymptomatic carotid artery disease with CEA should be considered for patients with few risk factors and long life expectancy. Both CEA and CAS reduce the long-term stroke risk in asymptomatic patients. The appropiate treatment strategy should be selected according to the patient’s individual risk factors and imaging data.
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    Öğe
    The effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding after emergent isolated coronary artery bypass grafting (CABG) surgery
    (2020) Tümer, Naim Boran; Kunt, Atike Tekeli; Günaydın, Serdar; Özışık, Kanat; Günertem, Eren; Budak, Ali Baran; Babaroglu, Seyhan
    Aim: Bleeding is a major problem in cardiac surgery, and results in a high risk of allogeneic blood transfusion associatedwith increased morbidity and mortality. In recent years, studies in the literature reported that desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) reduces the blood loss after surgical interventions. The aim of the present study is to analyzethe effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding in patients that werepretreated with P2Y12 inhibitors by cardiologists and undergone emergent coronary artery bypass grafting (CABG) surgery.Material and Methods: The prospectively collected data of 62 adult patients who underwent emergent isolated CABGsurgery and pretreated with P2Y12 inhibitors by cardiologists were retrospectively reviewed. The perioperative data of thepatients included their demographic data, laboratory findings, the amount of blood loss from chest tubes, the amount ofblood product use, need of re-thoracotomy, morbidity and mortality. The patient population was divided into two groups:Group I: Patients that received tranexamic acid and DDAVP perioperatively (n=26); and Group II: Patients that receivedonly tranexamic acid perioperatively (n=36).Results: The two groups of patients had similar characteristics at baseline. There was a statistically significant differencebetween Group I and II regarding postoperative blood loss from the chest tubes, re-thoracotomy, red blood cell andthrombocyte transfusions (p<0.05). No statistically significant differences were observed between the two groups interms of fresh frozen plasma transfusion, inotropic support and mortality.Conclusion: We suggest that desmopressin in addition to tranexamic acid reduces bleeding and the amount of bloodproduct use in patients undergoing emergent isolated CABG surgery.