Risk of Hemorrhage and Ischemia after EC/IC Bypass Surgery - an Observational Analysis of 204 Consecutive Revascularization Procedures

Gerrit Alexander Schubert, MD1, Marcel Seiz, MD1, Peter Schmiedek, MD1, Claudius Thom, MD1

1Innsbruck, Austria

Keywords: outcome, stroke, hemorrhage, bypass, carotid disease

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     Cerebral revascularization procedures are a treatment option in selected patients at risk for impending stroke. Timely anticoagulation is essential to ensure bypass patency, but may be associated with an increased risk for hemorrhagic complications while omission may lead to postoperative ischemia.
     This study aims to elucidate potential risk factors for postoperative complications.
     We included 161 consecutive patients with cerebrovascular insufficiency undergoing a total of 204 revascularization procedures from 2005 to 2009 in our department.
     Modality of anticoagulation, coagulation panel, intraoperative complications, postoperative imaging, the need for surgical revision and outcome at time of discharge were analyzed.
     Of 204 procedures, a total of 9 hemispheres needed to undergo surgical revision for hematoma evacuation (4.4%). Pre- and intraoperative anticoagulation with aspirin, concomitant use of statins or demonstrated coagulopathy were not associated with an increased risk for revision. Pre- and intraoperative anticoagulation did not lower the risk of new ischemia, but lack of postoperative aspirin treatment significantly increased the incidence of infarction (p<0.001). The type of pathology (atherosclerotic disease vs MMD) did not influence the incidence of ischemia or need for revision. Both surgical revision and new ischemia were significantly associated with a worsening of overall outcome (p<0.001), as was the preoperative combination of aspirin and clopidogrel.
     This is a retrospective study.
     Both the need for revision surgery and the occurrence of ischemia after EC/IC bypass surgery are strong predictors for worsening in outcome.
     Single anticoagulation does not increase the risk for hemorrhagic complications, but is essential to minimize the risk of postoperative ischemia.


Project Roles:

G. Schubert (), M. Seiz (), P. Schmiedek (), C. Thom ()