Comparison of Surgical Outcome of Anterior Circulation Aneurysms With and Without Proximal Temporary Artery Occlusion

Abstract

Objective: To compare the outcome of the TAO vs. no TAO during aneurysm surgery in terms of clinically significant postoperative ischemic changes due to vasospasm. Material and Methods:  A quasi-experimental study was conducted at Lahore General Hospital wherein 82 patients were enrolled. This study was conducted when the first author was working as PGR at LGH Lahore during 2015 to 2017. Patients were followed from admission to three-month post-op. During the follow-up, patients with clinical substantial post-op ischemic changes were calculated on CT Angiography for the presence of vasospasm. Results:  Mean age of the patients was 45.23 years. Proximal TAO was done in 30% (n=25) patients. Clinically significant post-op ischemic changes were seen in 29.3% (n = 24) patients. Of the patients who underwent proximal TAO, longer occlusion time (> 10 mins) was significantly associated with ischemic changes (p-value 0.015). Age > 50 years also showed a statistically significant association with clinical vasospasm (p-value < 0.001). Conclusion:  Temporary proximal artery clipping when employed within a limited duration appears to be safe and has no significant impact on clinical vasospasm. Since vasospasm is multifactorial, avoiding a longer duration of proximal TAO in patients with advancing age could decrease the frequency of post-operative ischemic changes due to vasospasm in such patients.