Prevention of complications resulting from endovascular carotid sacrifice: a retrospective assessment.

Abstract

OBJECTIVE:

To determine the protective effects of various periprocedural interventions in the prevention of cerebral ischemia as a complication of endovascular carotid sacrifice (ECS).

METHODS:

Thirty-two cases of ECS performed at our institution, between October 1987 and July 1998, were reviewed. Fifteen patients underwent superficial temporal artery-to-middle cerebral artery bypass surgery. In 21 patients, the carotid artery was occluded proximal to the target lesion; and in 11 patients, a lesion trapping procedure was performed. Six patients were prophylactically anticoagulated, 14 received antiplatelet agents prophylactically, and 12 received no pharmacoprophylaxis.

RESULTS:

Among the six patients who were anticoagulated, there were no embolic events. Embolic events affected 4 of 14 patients receiving prophylactic antiplatelet agents, 2 of 12 patients receiving no pharmacoprophylaxis, 1 of 11 patients who underwent a trapping procedure, and 5 of 21 patients whose carotid artery was occluded proximal to the target lesion. Postocclusion cerebral ischemia developed in 7 of 15 patients who underwent bypass surgery, and in 1 of the remaining 17.

CONCLUSION:

Superficial temporal artery-to-middle cerebral artery bypass did not protect against postocclusion cerebral ischemia after ECS in this series (P = 0.01). Although the small number of patients studied precludes statistical validity (P = 0.29), the trends suggest that antiplatelet agents provide no protection against postocclusion cerebral emboli after ECS. Prophylactic anticoagulation (P = 0.32) and lesion trapping (P = 0.12) may reduce the frequency of postocclusion embolic events after ECS; however, because of the small number of patients, statistical significance could not be demonstrated.

• Authors: T Abruzzo, G J Joseph, D S Owens, R C Dawson 3rd, J Reid, D L Barrow
• Journal: Neurosurgery (Neurosurgery) Vol. 46 Issue 4 Pg. 910-6; discussion 916-7 (Apr 2000) ISSN: 0148-396X [Print] United States
• PMID: 10764264 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors

Topics

• Aged
• Anticoagulants (therapeutic use)
• Brain Ischemia (etiology, prevention & control)
• Carotid Arteries (surgery)
• Carotid Artery Diseases (surgery, therapy)
• Cerebral Revascularization
• Female
• Humans
• Intracranial Aneurysm (surgery, therapy)
• Intracranial Embolism (etiology)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Postoperative Complications (prevention & control)
• Preventive Medicine (methods)
• Retrospective Studies
• Treatment Failure