Timing of the Operation
It is surprising that the available literature rarely refers to the optimal timing of the operation. Gratzl (1975) is absolutely against surgery for traumatic vascular occlusions within the first hours after the trauma. This view is shared by Chater (1976), who had a postoperative fatality after surgery in the acute phase. Figures 98–103 show the angiogram of a patient after an extra-intracranial anastomosis operation for a left-sided carotid occlusion. Shortly after the operation the right carotid artery occluded. Twenty-four hours later, an extra-intracranial bypass was performed on the recent right carotid occlusion. This patient died of a massive cerebral edema 5 days after the second operation. Only one case has been described in the relevant literature (Yaşargil 1970, case 2) in which extra-intracranial anastomosis was performed 3 days after aneurysm surgery and completed stroke after operation. This patient made a very rapid postoperative recovery.