Skip to main content

Indications for Surgery in Patients with Several Cerebrovascular Lesions

  • Chapter
Book cover Microsurgery for Cerebral Ischemia

Abstract

This study covers patients with TIA (transient ischemic attacks), PRIND (persistent reversible ischemic neurologic deficit), or minor CS (completed stroke) who were considered for EC-IC bypass surgery (extracranial-intracranial arterial bypass) and/or TEA (thrombendarterectomy). In a series of 53 patients with cerebrovascular insufficiency we found 14 suffering from more than one cerebrovascular lesion. The main point of interest was to learn more about priorities when two or more operative procedures become disputable in one patient. Another question of equal interest was the limits regarding age of patient and number of operable lesions. A problem much discussed in recent years is the value of EC-IC bypass in patients with carotid stenosis at one bifurcation and internal carotid artery (ICA) occlusion on the contralateral side (SO patients).2,3,6,7,14,15,18,20,23,26,28 ICA stenosis and aneurysm in the same patient have been treated following differing priorities with varying success.1,16,17,24,25,27

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams, H.P. Carotid stenosis and coexisting intracranial aneurysm. Arch Neurol 34: 515–516, 1977.

    PubMed  Google Scholar 

  2. Andersen, Ch.A., et al. Unilateral internal carotid arterial occlusion: special considerations. Stroke 8: 669–671, 1977.

    Article  PubMed  CAS  Google Scholar 

  3. Anderson, R.E., Reichman, O.H., Davis, D.O. Radiological evaluation of temporal artery-middle cerebral artery anastomosis. Radiology 113: 73–79, 1974.

    PubMed  CAS  Google Scholar 

  4. Auer, L., Oberbauer, R., Lanner, G. Zur neuro-chirurgischen Behandlung des Schlaganfalls. Proc Ost Chir Kongreß 1978, in press.

    Google Scholar 

  5. Auer, L., Oberbauer, R. Carotid angiography findings before and after extra-intracranial arterial bypass operation. Seara Med Neurocir Brasil 7: 43–62, 1978.

    Google Scholar 

  6. Chater, N. Surgical results and measurements of intraoperative flow in microneurosurgical anastomosis. In Microneurosurgical Anastomosis for Cerebral Ischemia, G.M. Austin, editor, Charles C Thomas, Springfield, 1976, pp 295–304.

    Google Scholar 

  7. Clark, E., Harrison, C.V. Bilateral carotid artery occlusion. Neurology 6: 705–712, 1956.

    Google Scholar 

  8. Collins, G.J., et al. Stroke after carotid end-arterectomy. Stroke 8: 14, 1977.

    Google Scholar 

  9. Denck, H. Chirurgische Schlaganfallprophylaxe. Pro Med Nov 14–21, 1976.

    Google Scholar 

  10. Denton, I.C., Gutman, L. Surgical treatment of symptomatic carotid stenosis and asymptomatic ipsilateral intracranial aneurysm. J Neurosurg 38: 662–665, 1973.

    Article  PubMed  Google Scholar 

  11. Donaghy, P. Pitfalls in extracranial-intracranial blood flow diversion. In Microneurosurgical Anastomoses for Cerebral Ischemia, G. M. Austin, editor, Charles C Thomas, Springfield, 1976, pp 305–307.

    Google Scholar 

  12. Easton, J.D., Sherman, D.G. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke 8: 565–568, 1977.

    Article  PubMed  CAS  Google Scholar 

  13. Eisenberg, R.L., et al. Relationship of transient ischemic attacks and angiographically demonstrable lesions of carotid artery. Stroke 8: 483–486, 1977.

    Article  PubMed  CAS  Google Scholar 

  14. Fields, W.S., Edwards, W.H., Crawford, E.S. Bilateral carotid artery thrombosis. Arch Neurol 4: 369–375, 1961.

    PubMed  CAS  Google Scholar 

  15. Fields, W.S., Lemak, N.A. Joint study of extra-cranial arterial occlusion. X. Internal carotid artery occlusion. JAMA 235: 2734–2738, 1976.

    Article  PubMed  CAS  Google Scholar 

  16. Fields, W.S., et al. Controlled trial of aspirin in cerebral ischemia. Stroke 8: 301–314, 1977.

    Article  PubMed  CAS  Google Scholar 

  17. Fields, W.S., Weibel, J. Coincidental internal carotid stenosis and intracranial saccular aneurysm. Trans Am Neurol Assoc 95: 237–238, 1970.

    PubMed  CAS  Google Scholar 

  18. Fisher, C. M. Senile dementia—A new explanation of its causation. Can Med Assoc J 65: 1–7, 1951.

    PubMed  CAS  Google Scholar 

  19. Gallhofer, B., Ladurner, G. Lechner, H. Prog-nosis of prophylactic anticoagulant treatment in ischemic stroke. Neurology, in Druck, 1978.

    Google Scholar 

  20. Gratzl, O., Schmiedek, P., Steinhoff, H., Enzenbach, R. Microneurosurgical anastomoses for cerebral ischemia in 39 patients—clinical results, angiography and regional cerebral blood flow. In Microneurosurgical Anastomoses for Cerebral Ischemia, G.M. Austin, editor, Charles C Thomas, Springfield, 1976, pp 308–319.

    Google Scholar 

  21. Holbach, H.K., et al. Differentiation between reversible and irreversible post-stroke changes in brain tissue: its relevance for cerebrovascular surgery. Surg Neurol 7: 325–331, 1977.

    PubMed  CAS  Google Scholar 

  22. Koos, W.T., Kletter, G. Experiences with extra-intracranial arterial bypass in patients with completed stroke.

    Google Scholar 

  23. Peerless, S.J., Chater, N.L., Ferguson, G.F. Multiple vessel occlusion in cerebrovascular disease—a further follow-up of the effects of microvascular bypass on the quality of life and the incidence of stroke. In Microsurgery for Stroke, P. Schmiedek, editor, Springer- Verlag, New York, 1978, pp 251–259.

    Google Scholar 

  24. Pool, L.J., Potts, D.G. Aneurysms and Arteriovenous Anomalies of the Brain: Diagnosis and Treatment. Harper & Row, New York, 1965.

    Google Scholar 

  25. Portnoy, H.D., Avellanosa, A. Carotid aneurysm and contralateral carotid stenosis with successful surgical treatment of both lesions. J Neurosurg 32: 476–482, 1970.

    Article  PubMed  CAS  Google Scholar 

  26. Sampson, D., Watts, C., Clark, K. Cerebral revascularization for transient ischemic attacks. Neurology, in press.

    Google Scholar 

  27. Shoumaker, R.D., Avant, W.S., Cohen, G.H. Coincidental multiple asymptomatic intracranial aneurysm and symptomatic carotid stenosis. Stroke 7: 504–506, 1976.

    Article  PubMed  CAS  Google Scholar 

  28. Wortzmann, G., Barnett, H., Lougheed, W. Bilateral carotid artery occlusion. Can Med Assoc J 99: 1186–1192, 1968.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1980 Springer-Verlag New York Inc.

About this chapter

Cite this chapter

Auer, L.M., Heppner, F. (1980). Indications for Surgery in Patients with Several Cerebrovascular Lesions. In: Peerless, S.J., McCormick, C.W. (eds) Microsurgery for Cerebral Ischemia. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-6090-5_47

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-6090-5_47

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-6092-9

  • Online ISBN: 978-1-4612-6090-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics