The safety of aeroplane travel in patients with symptomatic carotid occlusion

Abstract

Objective Patients with carotid stenosis or occlusion may be at increased risk for stroke during air travel. Records from the Carotid Occlusion Surgery Study (COSS), a randomized trial of surgical revascularization for complete carotid artery occlusion and hemodynamic ischemia, were examined for evidence of stroke related to air travel. Methods COSS subjects who travelled by airplane to a regional Positron Emission Tomography (PET) center for a screening cerebrovascular hemodynamic evaluation were identified. Maximum altitude and total flight time were estimated based on the distance between origin and destination. Ischemic events were determined by a structured telephone interview within 24 hours of travel. Patient demographics, co-morbidities, OEF data and 24-hour interview responses were recorded. Results Seventy-seven patients with symptomatic carotid occlusion travelled by airplane to a single PET center (174 flights). Fifty two (67.5%) were male and 25 (32.5%) were females. The average age was 58.7 ± 1.4 years. Twenty-seven patients (35.1%) demonstrated evidence of ipsilateral hemodynamic cerebral ischemia as measured by PET OEF, while 50 (64.9%) had normal OEF. Patients flew an average distance of 418.9 ± 25.9 miles for 107.1 ± 4.7 minutes per trip. No patient reported symptoms of a transient ischemic attack or stroke during or within 24 hours after airplane travel (95% CI 0 – 2.0%). Conclusions The risk of stroke as a consequence of air travel is low, even in a cohort of patients at high risk for future stroke owing to hemodynamic impairment. These patients with should not be discouraged from air travel.

The Impact of Temporary Stay at High Altitude on the Circulatory System

“…Polycythemia is an important risk factor increasing the likelihood of stroke [ 27 ]. Interestingly, even among patients diagnosed with symptomatic stenosis of the carotid artery and the resulting cerebral blood supply disorders, there is no contraindication to flying [ 86 ].…”

“…Suggested therapeutic recommendations for patients with cardiovascular diseases at high altitudes.Trekking or hiking at high altitude ≤3 months after stroke or TIA should be avoided -randomized controlled study IC recommendation[1] Stenosis of the carotid artery and the resulting cerebral blood supply disorders-is no contraindication to flying[85]-case-control study HACE should be treated with dexamethasone; thrombolysis is not recommended (only in case of ischemic stroke)[86]-case report…”

Stroke in Commercial Flights

“…They did not find any clinical episode in none of the 174 flights. 6 However, all the flights were of short duration (mean 107±4.1 minutes), although in our series 8 of 12 strokes linked to highgrade carotid stenosis or occlusion occurred in longer flights (>4 hours). The risk of stroke in established chronic carotid occlusions, which lead to compensatory changes in brain hemodynamics to preserve global perfusion, is known to be lower than that of high-grade carotid stenosis.…”

Deterioration and Recurrence in Flight Passengers with Ischemic Stroke: An Evidence Based Case Report

“…Traveling by air transportation, such as airplanes and helicopters, also can increase the risk of stroke [8][9][10].…”