Hitno ugrađivanje stenta u karotidu pre kardiohirurške intervencije kod mladog muškarca sa akutnim ishemijskim moždanim udarom izazvanim aortnom i karotidnom disekcijom

  • Rade Popovic Clinic for Neurology, Military Medical Academy, Belgrade, Serbia
  • Sonja Radovinović-Tasić Institute for Radiology, Military Medical Academy, Belgrade, Serbia
  • Siniša Rusović Institute for Radiology, Military Medical Academy, Belgrade, Serbia
  • Toplica Lepić Clinic for Neurology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Radoje Ilić Clinic for Cardiosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Ranko Raičević Clinic for Neurology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Dragana Obradović Clinic for Neurology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150402091P
Ključne reči: aorta||, ||aorta, carotid artery, internal, dissection||, ||a. carotis interna, disekcija, stroke||, ||mozak, veliki, infarkt, cardiovascular surgical procedures||, ||hirurgija, kardiovaskularna, procedure, stents||, ||stentovi, young adults||, ||mlade osobe, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Disekcija aorte je najčešće i po život opasno oboljenje aorte. Neurološki simptomi se javljaju kod 17–40% bolesnika. Lečenje ovih bolesnika je predmet kontroverzi. Prikaz bolesnika. Prikazali smo bolesnika starog 37 godina, koji je primljen u centar hitne pomoći zbog slabosti levostranih ekstremiteta. Simptomi su se javili dva sata pred prijem. Bolesnik nije imao glavobolju, ni bolove u grudima. Somatski pregled bio je bez patološkog nalaza. U neurološkom pregledu objektivizirana je laka konfuznost, plegija levostranih ekstremiteta, centralni facijalis levo, ekstenzioni plantarni odgovor levo National Institutes of Health Stroke Scale (NIHSS) skor bio je 10. Posumnjano je na ishemijski infarkt mozga, te je odmah urađeno snimanje glave multislajsnim skenerom (MSCT) sa angiografijom, na kome je uočena suspektna disekcija intrapetroznog dela desne unutrašnje karotidne arterije (ACI). Nakon toga urađen je dopler krvnih sudova vrata na kome je uočena disekcija desne zajedničke karotidne arterije. Urađena ekstrakranijalna MSCT angiografija ukazala je na disekciju luka aorte koja se širila ka brahiocefaličnom stablu i desnoj zajedničkoj karotidnoj arteriji. Odmah je urađena digitalna suptrakciona angiografija i u istom aktu postavljenja su dva stenta u brahiocefalično stablo i desnu zajedničku karotidnu arteriju. Šest sati nakon prijema, zbog disekcije ascedentne aorte, bolesnik je podvrgnut operaciji, kada je rekonstruisana ascendentna aorta i urađena resuspenzija aortnog zaliska. Šestog postoperativnog dana razvio se medijastinitis. Lečenje je pokušano visokim dozama antibiotika, međutim 35. postoperativnog dana bolesnik je preminuo. Zaključak. Kod mlađih bolesnika sa sumnjom na infarkt mozga i promenljivim neurološkim deficitom hitna MSCT angiografija glave i vrata ili dopler karotidnih i vertebralnih arterija su obavezni u cilju isključivanja aortne i karotidne disekcije. Brza dijagnoza omogućava hitnu ugradnju stenta u karotidu i kardiohirurgiju. Prema nama dostupnim podacima iz literature, ovo je prvi objavljen prikaz hitne ugradnje stenta u karotidu kod akutnog infarkta mozga nakon dijagnoze karotidne i aortne disekcije, a neposredno pre kardiohirurške intervencije.

 

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Objavljeno
2017/03/20
Broj časopisa
Vol. 73 Br. 7 (2016)
Rubrika
Prikaz bolesnika