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Indications for Surgery in Patients with Several Cerebrovascular Lesions

  • L. M. Auer
  • F. Heppner

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

Keywords

Carotid Stenosis Internal Carotid Artery Stenosis Carotid Artery Occlusion Control Angiography Cerebrovascular Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Adams, H.P. Carotid stenosis and coexisting intracranial aneurysm. Arch Neurol 34: 515–516, 1977.PubMedGoogle Scholar
  2. 2.
    Andersen, Ch.A., et al. Unilateral internal carotid arterial occlusion: special considerations. Stroke 8: 669–671, 1977.PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson, R.E., Reichman, O.H., Davis, D.O. Radiological evaluation of temporal artery-middle cerebral artery anastomosis. Radiology 113: 73–79, 1974.PubMedGoogle Scholar
  4. 4.
    Auer, L., Oberbauer, R., Lanner, G. Zur neuro-chirurgischen Behandlung des Schlaganfalls. Proc Ost Chir Kongreß 1978, in press.Google Scholar
  5. 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. 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. 7.
    Clark, E., Harrison, C.V. Bilateral carotid artery occlusion. Neurology 6: 705–712, 1956.Google Scholar
  8. 8.
    Collins, G.J., et al. Stroke after carotid end-arterectomy. Stroke 8: 14, 1977.Google Scholar
  9. 9.
    Denck, H. Chirurgische Schlaganfallprophylaxe. Pro Med Nov 14–21, 1976.Google Scholar
  10. 10.
    Denton, I.C., Gutman, L. Surgical treatment of symptomatic carotid stenosis and asymptomatic ipsilateral intracranial aneurysm. J Neurosurg 38: 662–665, 1973.PubMedCrossRefGoogle Scholar
  11. 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. 12.
    Easton, J.D., Sherman, D.G. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke 8: 565–568, 1977.PubMedCrossRefGoogle Scholar
  13. 13.
    Eisenberg, R.L., et al. Relationship of transient ischemic attacks and angiographically demonstrable lesions of carotid artery. Stroke 8: 483–486, 1977.PubMedCrossRefGoogle Scholar
  14. 14.
    Fields, W.S., Edwards, W.H., Crawford, E.S. Bilateral carotid artery thrombosis. Arch Neurol 4: 369–375, 1961.PubMedGoogle Scholar
  15. 15.
    Fields, W.S., Lemak, N.A. Joint study of extra-cranial arterial occlusion. X. Internal carotid artery occlusion. JAMA 235: 2734–2738, 1976.PubMedCrossRefGoogle Scholar
  16. 16.
    Fields, W.S., et al. Controlled trial of aspirin in cerebral ischemia. Stroke 8: 301–314, 1977.PubMedCrossRefGoogle Scholar
  17. 17.
    Fields, W.S., Weibel, J. Coincidental internal carotid stenosis and intracranial saccular aneurysm. Trans Am Neurol Assoc 95: 237–238, 1970.PubMedGoogle Scholar
  18. 18.
    Fisher, C. M. Senile dementia—A new explanation of its causation. Can Med Assoc J 65: 1–7, 1951.PubMedGoogle Scholar
  19. 19.
    Gallhofer, B., Ladurner, G. Lechner, H. Prog-nosis of prophylactic anticoagulant treatment in ischemic stroke. Neurology, in Druck, 1978.Google Scholar
  20. 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. 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.PubMedGoogle Scholar
  22. 22.
    Koos, W.T., Kletter, G. Experiences with extra-intracranial arterial bypass in patients with completed stroke.Google Scholar
  23. 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. 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. 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.PubMedCrossRefGoogle Scholar
  26. 26.
    Sampson, D., Watts, C., Clark, K. Cerebral revascularization for transient ischemic attacks. Neurology, in press.Google Scholar
  27. 27.
    Shoumaker, R.D., Avant, W.S., Cohen, G.H. Coincidental multiple asymptomatic intracranial aneurysm and symptomatic carotid stenosis. Stroke 7: 504–506, 1976.PubMedCrossRefGoogle Scholar
  28. 28.
    Wortzmann, G., Barnett, H., Lougheed, W. Bilateral carotid artery occlusion. Can Med Assoc J 99: 1186–1192, 1968.Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1980

Authors and Affiliations

  • L. M. Auer
  • F. Heppner

There are no affiliations available

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