Key result
Minimizing stasis during vascular surgery remains critical to prevent thrombogenesis and stroke.
Why the study?
Factors influencing thrombus formation and fate, including vascular wall role in thrombogenesis and platelet function, are critical in stroke and cerebrovascular disorders.
This review outlines the hematological and vascular factors contributing to thrombogenesis and stroke, emphasizing the importance of surgical technique in preventing thrombosis during vascular reconstruction.
May inform surgical technique in neurosurgical vascular cases; leaves open need for prospective validation.
This review has highlighted some of the factors which influence the formation and fate of thrombi. Rheology and flow, the coagulation mechanism, the fibrinolytic enzyme system, and the properties of platelets to adhere and aggregate all play a significant role. Of paramount importance to neurosurgeons is the role of the vascular wall in thrombogenesis. The ulcerated atherosclerotic plaque demonstrates this point. Factors contributing to thromboembolism in this setting include stenosis and reduced flow, turbulence, and the elements in the lesion with which blood interacts. These are principally collagen, ADP, fatty acids, and the thromboplastic activity of vascular subendothelial tissue. Current concepts of the etiologies of atherosclerosis were discussed. Along with other predisposing factors, platelets may play a significant role in the initiation of the process. The current status of clinical trials with inhibitors of platelet function in the treatment of cerebrovascular disorders was reviewed. In vascular reconstructive surgery, the principles which underlie good technique are those which best insure against thrombosis. The briefest possible period of stasis during surgery should be maintained. The reconstruction should result in a smooth blood flow pattern with rapid runoff and minimal stenosis or gaps between apposed endothelial surfaces.
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Didisheim et al. (1976) conducted a review in Stroke and cerebrovascular disorders. This review highlights the roles of rheology, coagulation, platelets, and the vascular wall in thrombogenesis and stroke, emphasizing the importance of minimizing stasis during vascular surgery.
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