Artikel
Acetylsalicylic acid resistance in patients with steno-occlusive cerebrovascular disease undergoing EC-IC bypass surgery
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Veröffentlicht: | 16. September 2010 |
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Objective: Cerebral revascularization using standard extracranial-intracranial (EC-IC) arterial bypass surgery may be used to revert hemodynamic compromise in symptomatic patients with steno-occlusive cerebrovascular disease. Acetylsalicylic acid (ASS) is prescribed as standard perioperative medication in order to avoid early bypass failure. In this study we prospectively determined ASS resistance using PFA-100® test for patients planned for EC-IC bypass surgery and the effectiveness of dose increase on ASS resistance.
Methods: A total of 40 patients fulfilling the criteria for EC-IC bypass surgery were screened for ASS resistance using PFA-100®. Furthermore we determined smoking prevalence among those patients. They were divided into two groups. Group A: 20 patients with atherosclerotic steno-occlusive cerebrovascular disease (CVD), group B: 20 patients with non-atherosclerotic steno-occlusive cerebrovascular disease (moyamoya disease).
Results: Group A (atherosclerotic steno-occlusive CVD) consisted of 14 male and 6 female patients. The median age was 58.4±10.4 years. We found a ratio of 40% of non-responders to ASS 100 mg/die. 62.5% of those non-responders were smokers. Compared to this group B (non-atherosclerotic steno-occlusive CVD) consisted of only 4 male and 16 female patients with a median age of 29.8±16.4 years. There were only 15% of ASS non-responders. All of those non-responders were smokers. The majority of the non-responders could be treated with a higher dose of ASS (300 mg/die instead of 100 mg/die). Three patients remained ASS non-responders. Two of them suffered an early bypass failure, both were smokers.
Conclusions: ASS resistance is common in the population of patients undergoing EC-IC bypass surgery and can have a significant effect on adverse vascular events after surgery. It can be screened and easily treated via dose increase ensuring the outcome of patients undergoing EC-IC bypass surgery.