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.
Highlights
IntroductionThe intracranial aneurysm has a relative prevalence of 3 – 6% across the global population with predominance amongst the females is associated with impairment in the wall of cerebral vessels leading to localized swelling or out pouching of the vessel.[1]
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 temporary artery occlusion (TAO) in patients with advancing age could decrease the frequency of post-operative ischemic changes due to vasospasm in such patients
Summary
The intracranial aneurysm has a relative prevalence of 3 – 6% across the global population with predominance amongst the females is associated with impairment in the wall of cerebral vessels leading to localized swelling or out pouching of the vessel.[1]. The primary focus of the treatment approach is preventing re-rupture.[5]. Intracranial aneurysm due to its subtle nature and adverse impact pose major challenges in the clinical care setting. Proximal temporary artery occlusion (TAO) is a routine technique used for the treatment of aneurysms often to avoid premature rupture of aneurysms and to facilitate final dissection. The focus of this study was to compare the outcome of the TAO vs no TAO during aneurysm surgery in terms of clinically significant postoperative ischemic changes due to vasospasm
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