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


CONCLUSIONS
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.
Abruzzo
T
T
Department of Radiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Joseph
G J
GJ
Owens
D S
DS
Dawson
R C
RC
Reid
J
J
Barrow
D L
DL
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery / Q000628:therapy; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery / Q000628:therapy; D020766:Intracranial Embolism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D011315:Preventive Medicine / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors