engleski

Clinical and experimental evaluation of the patient with carotid disease before surgery or stenting: "The Surgeons' View"

Considering the facts that modern Vascular surgery is Quality of life surgery, is a prototype for EMB surgery, it is highly specialized, improves tendencies to minimal invasivity and reqiures expensive and specialized equipment and diagnostic tools, the most important events that happened in vascular diagnostic are the appearance of ultrasound, computed tomography and starting of endovascular surgery. Advantages of the ultrasound diagnostic are: it enables qualitative analysis of the plaque, is easily accessible, it is mobile, minimally invasive, can be applied repeatedly, it is partially standardized (non-operator dependent), can be backed-up with the documentation and significantly lower the costs. On the other hand, the disadvantages are: it is still partially operator dependent, has the easy access to the education and training (short courses), it is not specialized, limited with scull structures, it is limited by individual savings regarding the equipment, all accessible parameters during investigations are frequently skipped and there is a lack of feed-back information of the patient outcome. The most important fact is that CFD, Power doppler and TCD enabled qualitative, besides only quantitative analysis of the carotid plaque. SonoCT, CTA scans of the carotid artery and XRES-CFD technology are depicting the future of the preoperative carotid diagnostic. TCD criteria for estimation of the operative risk of stroke can be summarized as follows: if there is no collateralisation on TCD there is a need for shunt. Reversed flow on a diseased side is a favourable sign and presents a lower risk. If flow direction cannot be determined, or multiple occlusions in Willis circle present, there is a high risk for the patient. Isolated stenosis of one MCA is acceptable for CEA.

vascular ultrasound; carotid disease

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