Tom 12, Nr 2 (2017)
CHOROBY TĘTNIC OBWODOWYCH
Opublikowany online: 2017-05-31

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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Wewnątrznaczyniowe leczenie objawowych zwężeń proksymalnych odcinków tętnic kręgowych

Piotr Paluszek12, Piotr Pieniążek12, Damian Maciejewski2, Karolina Dzierwa2, Łukasz Tekieli12, Roman Machnik12, Mariusz Trystuła1
Kardiol Inwazyjna 2017;12(2):37-42.

Streszczenie

Tętnice kręgowe, powstająca z ich połączenia tętnica podstawna oraz ich gałęzie stanowią tylny krąg unaczynienia (TKU). Odpowiada on za dostarczenie krwi do pnia mózgu, tylnej części wzgórza, móżdżku, części płatów skroniowych i potylicznych. Udary niedokrwienne stanowią około 70–80% przypadków wszystkich udarów mózgu, natomiast udary z TKU stanowią około 20–30% wszystkich udarów niedokrwiennych mózgu. Objawowe zwężenie tętnicy kręgowej jest powszechnie uznaną przyczyną udaru z TKU. W populacji osób z przebytym udarem z TKU, zwężenie tętnicy kręgowej > 50% stwierdza się u 20% chorych, z czego u 9% jest to główna przyczyna udaru. Obraz kliniczny niedokrwienia kręgowo-podstawnego jest bardzo różnorodny z powodu rozległego obszaru unaczynienia. Leczeniem pierwszego rzutu jest modyfikacja czynników ryzyka oraz farmakoterapia. Chorzy, u których leczenie zachowawcze nie przynosi zadowalających efektów, są kwalifikowani do leczenia interwencyjnego — metodami chirurgicznymi lub wewnątrznaczyniowymi. Pierwszy zabieg angioplastyki balonowej tętnicy kręgowej opisano w 1981 roku; obecnie standardem są zabiegi angioplastyki z implantacją stentu, co ujęto w wytycznych European Society of Cardiology (ESC) z 2011 roku. Stenty powlekane lekiem antymitotycznym mogą zmniejszać odsetek nawrotu zwężenia w stencie implantowanym do ujścia tętnicy kręgowej w porównaniu do klasycznych stentów metalowych, choć dane z literatury nie są jednoznaczne. Duży odsetek nawrotu zwężenia w stencie w tętnicy kręgowej pozostaje problemem, niemniej w większości przypadków chorzy mogą być skutecznie leczeni zabiegiem ponownej angioplastyki.

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