ACUTE OCCLUSION OF THE CAROTID-ARTERY - E MERGENT SURGICAL-TREATMENT

Conservative medical treatment of acute occlusion of the extracranial internal carotid artery usually gives mediocre results. When a major n eurological deficit is involved, mortality can reach 16 to 55 %, morbi dity due to definitive deficit 40 to 69 % and cure only 2 to 12 %. It is thus logical to attempt revascularization as an emergency procedure . In situ intraarterial fibrinolysis is appropriate for acute occlusio n in the intracranial territory of the internal carotid involving seve re neurological deficits but surgery is more adapted and safer for acu te occlusion of the extra-cranial internal carotid. In a personal seri es of 8 patients, we had 1 death, 1 aggravation, 1 improvement and 5 < < cures >>, (62.5 %). Based on data in the literature and our experien ce, we assessed the advantages of emergency surgery (immediate and def initive re-establishment of the carotid flow and vascularization of th e hemisphere before installation of irreversible brain damage) and con ditions suggesting chances of success: 1) diagnosis by noninvasive ech o-Doppler of the cervical vessels and transcranial Dopler, without pre operative arteriography or CT-scan, 2) operation before 6 hours, 3) qu ality of the desobstruction, 4) no post-operative anti-coagulant treat ment, 5) control of post-operative episodes of hypertension (J Mal Vas c, 1996; 21, Suppl. A : pages 90-96).