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Internal carotid artery thrombosis after cervical corpectomy
B S Chozick1, P Watson, S H Greenblatt
1Department of Clinical Neuroscience, Brown University, Providence, Rhode Island.
Insights
Extensive anterior cervical surgery in elderly patients may increase stroke risk due to carotid artery thrombosis. Preoperative Doppler screening of carotid blood flow is recommended for high-risk individuals.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- A 74-year-old male experienced a large right hemispheric stroke 72 hours post-anterior corpectomy (C4-C5) for cervical myelopathy.
- The patient had ossification of the posterior longitudinal ligament, a condition requiring complex spinal surgery.
Observation:
- Angiography identified thrombosis in the proximal right internal carotid artery.
- The left internal carotid artery showed normal blood flow.
- Atherosclerosis was noted in the affected right carotid artery.
Findings:
- The carotid artery thrombosis is potentially linked to stasis caused by prolonged retraction during surgery.
- The patient's advanced age and atherosclerotic disease were significant risk factors.
Implications:
- Preoperative screening of internal carotid artery blood flow using Doppler ultrasonography is advised.
- This screening should be considered for middle-aged and elderly patients undergoing extensive anterior cervical surgery.
- Identifying patients at risk for atherosclerotic disease can help prevent perioperative ischemic events.
Summary Of Background Data:
A 74-year-old man suffered an extensive right hemispheric infarct 72 hours after undergoing anterior corpectomies of the C4 and C5 vertebrae for cervical myelopathy resulting from ossification of the posterior longitudinal ligament.
Results:
Angiography revealed proximal right internal carotid artery thrombosis with atherosclerosis and a normal left internal carotid artery. The thrombosis may have been due to stasis during lengthy retraction of an atherosclerotic carotid artery.
Conclusions:
Preoperative screening of internal carotid artery blood flow with Doppler ultrasonography is recommended before contemplating extensive anterior cervical surgery in middle-aged and elderly patients at significant risk for atherosclerotic disease.