engleski

MONITORING OF PATIENTS AFTER CAROTID INTERVENTIONS

Ultrasound studies are routinely performed in stroke centers. Their greatest advantage is real-time, bedside evaluation of morphology and hemodynamic of brain vessels. The major goal is to identify large obstructive lesions in the extracranial and intracranial arteries. By means of microembolic signals (MES) detection, embolic signals can be monitored, since its appearance represents an increased stroke risk. Cerebral vasomotor reactivity (VMR) testing can indicate exhausted reactivity as a risk factor for stroke. The degree of stenosis of the internal carotid artery (ICA) is the main parameter used for therapeutic approaches. Multiple randomized trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CE) in reducing the risk of stroke. Carotid angioplasty and stenting (CAS) was also introduced for this purpose. The long-term patency of the carotid artery after CE or CAS is an important factor for successful operation. The incidence of recurrent carotid stenosis ranges from 1-37% after CE with only 0-8% of patients having restenosis-related symptoms. More patients had advanced stenosis of the ipsilateral carotid artery 1 year after endovascular treatment than after endarterectomy. Generally, recurrent carotid stenosis is attributed to myointimal hyperplasia during the early postoperative period, within 3 years after CE, or recurrent atherosclerosis thereafter. The management of recurrent carotid stenosis after CE remains a dilemma. Therefore, noninvasive carotid follow-up in combination with TCD for evaluation of hemodynamic redistribution and collateral flow assessment, VMR testing and MES detection are feasible and important methods.

carotid follow-up; stroke

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