Prophylactic urgent revascularization of the internal carotid artery in the symptomatic patient.
BACKGROUND
The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization.


METHODS
During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances.


RESULTS
Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group.


CONCLUSIONS
The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.
Peiper
C
C
Surgical University Clinic, RWTH Aachen, Germany. ch.peiper@chir.rwth-aachen.de
Nowack
J
J
Ktenidis
K
K
Hopstein
S
S
Keresztury
G
G
Horsch
S
S
D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000401:mortality / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D004630:Emergencies; D016894:Endarterectomy, Carotid; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome