The role of antiplatelet drugs in carotid reconstructive surgery

Neurologic events following carotid reconstructive surgery for symptomatic cerebral occlusive disease are generally reported to be one to two per cent. One of the events leading to this incidence is thrombosis of the endarterectomized internal carotid artery (ICA) after surgery. Since antiplatelet drugs have been found to be effective in altering platelet-induced thrombosis, we undertook a clinical trial of administration of aspirin (or aspirin-like) drugs to a group of patients who were to undergo ICA endarterectomy. This group was then compared to a comparable group from the previous year in whom drugs had not been administered. Thrombosis resulting in hemiparesis occurred on six occasions in five patients in the group that did not receive drugs. Thrombosis was not observed in two patients exhibiting hemiparesis in the drugs group. On the basis of these results, we concluded that the incidence of neurological complications following carotid reconstructive surgery can be further reduced by the use of aspirin and aspirin-like drugs.