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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Acetylsalicylic acid resistance in patients with steno-occlusive cerebrovascular disease undergoing EC-IC bypass surgery

Meeting Abstract

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  • Daniel Jussen - Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin, Deutschland
  • Peter Horn - Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin, Deutschland
  • Peter Vajkoczy - Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1845

DOI: 10.3205/10dgnc316, URN: urn:nbn:de:0183-10dgnc3167

Published: September 16, 2010

© 2010 Jussen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.