Indications for Extra-Intracranial Bypass Procedure: Pathological-Anatomical Considerations
Pathological changes alone are not a sufficient indication for an extra-intracranial bypass operation. Pathological changes must always be considered in relation to the clinically symptoms. Thus if the patient does not have any TIA in his case history nor any neurological symptoms, and if scintigraphy, CBF measurements, and computerized tomography do not reveal any pathological findings, surgery is not indicated, although the patient may have, for example, an occlusion of the internal carotid artery. Extra-intracranial anastomosis is also definitely contraindicated in cases in which neurological deficits are not accompanied by pathological anatomical changes. Such patients, however, must be carefully monitored and re-examined at regular intervals. They should be instructed to report immediately sudden deterioration in their visual acuity, dizziness, or increasing headaches, so that new tests can be performed. Routine check-ups can be helpful in detecting disorders that the patient himself is unaware of. Reduced mental activity in particular is often noticed as the first stage of a clinically manifest occlusion. In any case, it should be remembered that progressive arteriosclerosis in patients with vascular lesions can gradually affect existing collateral circulation, which may then cause a stenosis or even an occlusion in these regions.
KeywordsInternal Carotid Artery Middle Cerebral Artery Superficial Temporal Artery Carotid Occlusion Occipital Artery
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