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Timing Carotis Endarterectomie (CEA)

Timing Carotis Endarterectomie (CEA). Mw v R, 74 jaar 1 x periode, 5 minuten onverstaanbare klanken uitbrengen, goed begrip Enkele perioden, seconden tot minuut van uitval R gezichtsveld Aanvullend oz: CT: enkele kleine infarctjes; lab: chol 6,2; ECG: LVH; Duplex: stenose R ACI > 70%.

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Timing Carotis Endarterectomie (CEA)

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  1. Timing Carotis Endarterectomie(CEA) • Mw v R, 74 jaar • 1 x periode, 5 minuten onverstaanbare klanken uitbrengen, goed begrip • Enkele perioden, seconden tot minuut van uitval R gezichtsveld • Aanvullend oz: • CT: enkele kleine infarctjes; lab: chol 6,2; ECG: LVH; Duplex: stenose R ACI > 70%

  2. Timing Carotis Endarterectomie(CEA) • Bespreking vaatchirurgie • Resultaat: operatie over 4 weken; totaal 12 weken • 3 weken patient – HA – poli • 4 weken analyse poli • 5 weken CEA • Is dat erg?

  3. Timing Carotis Endarterectomie(CEA) • Vraag: is het tijdstip van CEA na cerebrale ischemie van belang voor de uitkomst? • Artikelen Peter Rothwell #6 endarterectomy, carotid 6146 #5 timing of surgery 8622 #5 AND # 6 68

  4. Timing Carotis Endarterectomie(CEA) • Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004 Mar 20;363(9413):915-24. • J.F. Fairhead Peter M. Rothwell. The Need for Urgency in Identification and Treatment of Symptomatic Carotid Stenosis Is Already Established. Cerebrovasc Dis 2005;19:355–358

  5. Timing Carotis Endarterectomie(CEA) • Acute interventies gevaarlijk

  6. Timing Carotis Endarterectomie(CEA) • ESCT en NASCET, 1998 definitieve resultaten • ECST: 3008 NASCET: 2885 • < 30% stenose: schadelijk • 30 -49% stenose: geen nut • 50 – 69% stenose: enig nut • > 70%: zeer nuttig

  7. Timing Carotis Endarterectomie(CEA) • Vraag: • Verschil uitkomst als CEA < 2, 2-4, 4 – 12, > 12 weken na ischemie?

  8. Kans op ‘event’ 36% 23% 19% 19%

  9. Timing Carotis Endarterectomie(CEA) • < 2 weken: absolute afname risico met 23% • 2 – 4 weken: absolute afname risico met 10% • 4 – 12 weken: 8% • > 12 weken: 7,5%

  10. Timing Carotis Endarterectomie(CEA) Conclusies • Snelle analyse en behandeling ZEER zinvol • Nu verloopt de organisatie niet vlot • Te doen: • Reorganisatie ‘TIA poli’ • Zorgen dat patienten snel bij ons behandeld worden • Verder overleg vaatchirurgie over logistiek

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