Prophylactic urgent revascularization of the internal carotid artery in the symptomatic patient

Background: The symptomatic patient showing a string sign or ulcerative ste nosis of the internal carotid artery (ICA) is subject to a high risk of art erial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization. Patients and methods: During one year 186 operative revascularization proce dures of the ICA were performed on the symptomatic patient. 26 of them fulf illed the prophylactic urgency criteria: symptoms of the cerebrovascular in sufficiency and a string sign or ulcerative stenosis of the ICA with ulcera tion greater than 2 min in depth. These results were compared to the contro l group of the 157 procedures under elective circumstances. Results: Mean clamping time of the urgency and the elective patients were 2 3.8 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 ph ase, while this occurred in 3.8% in the elective group. Mortality rate in t he elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group. Conclusion: The urgent indication for the desobliteration of the ICA showin g a symptomatic string sign or ulcerative stenosis can be recommended. Earl y thrombosis or neurological defects during the waiting period may be preve nted without increasing complication rates.