Surgical Treatment for Cerebral Infarction

  • Jiro Suzuki


Surgical treatment of ischemic brain disorders was first reported by Strully et al. in 195375 and already the most representative kind of neurosurgery, carotid endarterectomy, has a history of more than 30 years. Moreover, since Yaşargi182 devised the superior temporal artery to middle cerebral artery (STA-MCA) anastomosis technique in 1967, a variety of vascular reconstruction methods have come into use. Together with developments in microsurgery, these techniques have been applied according to the sites of vascular occlusion and to recipient and donor vessels.


Internal Carotid Artery Cerebral Infarction Vein Graft Carotid Endarterectomy Carotid Stenosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Asplund K, Liliequist B, Fodstad H et al (1981) Long-term outcome in cerebrovascular disease in relation to findings at aor-tocervical angiography. A 12-year follow up. Stroke 12: 307–313PubMedCrossRefGoogle Scholar
  2. 2.
    Ausman JI, Diaz FG, de Reyes RA et al (1981) Anastomasis of occipital artery to anterior inferior cerebellar artery for vertebrobasilar junction stenosis. Surg Neurol 16: 99–102PubMedCrossRefGoogle Scholar
  3. 3.
    Ausman JI, Lee MC, Chater N (1979) Superificial temporal artery to superior cerebellar artery anastomosis for distal basilar artery stenosis. Surg Neurol 12: 277–282PubMedGoogle Scholar
  4. Barnett HJM, Peerless SJ, Kaufmann JCE (1978) “Stump” of internal carotid artery A source for further cerebral embolic ischemia. Stroke 9: 448–456PubMedCrossRefGoogle Scholar
  5. 5.
    Bauer RB, Meyer JS, Gothman JE, Gilroy J (1966) A controlled study of surgical treatment of cerebrovascular disease42 months experience with 183 cases. In: Millikan C, Sickert R, Whisman JP (eds) Cerebral vascular diseases. Grune and Stratton, New YorkGoogle Scholar
  6. 6.
    Blaisdell WF, Clauss RH, Galbraith JG et al (1969) Joint study of extracranial arterial occlusion. JAMA 209: 1889–1895PubMedCrossRefGoogle Scholar
  7. 7.
    Bogousslavsky J, Regli JF, Hungerdichler JP et al (1981) Transient ischemic attacks and external carotid artery. A retrospective study of 23 patients with an occlusion of the internal carotid artery. Stroke 12: 627–630PubMedCrossRefGoogle Scholar
  8. 8.
    Bosnic MA (1964) Cervical arterial pathways associated with brachiocephalic occlusion disease. AJR 91: 1232–1244Google Scholar
  9. 9.
    Caplan LR (1979) Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome. Stroke 10: 277–282PubMedCrossRefGoogle Scholar
  10. 10.
    Caplan LR (1981) Vertebrobasilar diseases. Time for a new strategy. Stroke 12: 111–114PubMedCrossRefGoogle Scholar
  11. 11.
    Chater N (1978) Microsurgical vascular bypass for occlusive cerebrovascular disease. In: Rand RW (ed) Microneurosur-gery. CV Mosby, St Louis, pp 71–92Google Scholar
  12. 12.
    Clark K, Perry MO (1966) Carotid vertebral anastomosis: an alternate technique for repair of the subclavian steal syndrome. Ann Surg 163: 414–416PubMedCrossRefGoogle Scholar
  13. 13.
    Clayson KR, Edwards WH (1971) Importance of the external carotid artery in extracranial cerebrovascular occlusive disease. South Med J 79: 904–909Google Scholar
  14. 14.
    Conolly JE, Stemmer EA (1973) Endarter-ectomy of the external carotid artery: its importance in the surgical management of extracranial cerebrovascular occlusive disease. Arch Surg 106: 799–802CrossRefGoogle Scholar
  15. 15.
    Correll JW, Quest DO, Darpenter DB (1985) Nonathermoatous lesions of the extracranial cerebral arteries. In: Smith RR (ed) Stroke and extracranial vessels. Raven Press, New York, pp 321–332Google Scholar
  16. 16.
    Countee RW, Vijayanathan T, Chavis P (1981) Recurrent retinal ischemia beyond cervical carotid occlusions. Clinical angiographic correlations and therapeutic implications. J Neurosurg 55: 532–542PubMedCrossRefGoogle Scholar
  17. 17.
    Countee RW, Vijayanathan T (1979) External carotid artery in internal carotid artery occlusions. Angiographic, therapeutic, and prognostic considerations. Stroke 10: 450–460PubMedCrossRefGoogle Scholar
  18. 18.
    Crawford ES, DeBakey ME, Fields WS (1958) Roentogenographic diagnosis and surgical treatment of basilar artery insufficiency. JAMA 168: 509–514CrossRefGoogle Scholar
  19. 19.
    Culligan JA (1960) Backling and kinking of the carotid vessels. Minn Med 43: 678–733PubMedGoogle Scholar
  20. 20.
    DeBenedetti G, Marra A, Pozzi M (1982) Bypass with basillic autogenous venous graft because of insufficient caliber of the superficial temporal artery. Surg Neurol 18: 303–306CrossRefGoogle Scholar
  21. 21.
    Diethrich EB, Liddicoat JE, McCutchen JJ et al (1968) Surgical significance of the external carotid artery in the treatment of cerebrovascular insufficiency. J Cardiovasc Surg 9: 213–223Google Scholar
  22. 22.
    Durward QJ, Ferguson GG, Barn HWK (1982) The natural history of asymptomatic carotid bifuraction plaques. Stroke 13: 459–464PubMedCrossRefGoogle Scholar
  23. 23.
    Eaton DJ, Sherman DG (1977) Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke 8: 565–568CrossRefGoogle Scholar
  24. 24.
    Eguchi T, Mayanagi Y, Funamura T (1982) Treatment of bilateral spontaneous carotidGoogle Scholar
  25. 25.
    Cavernous fistula by Hamby’s method combined with an extrancranial-intracranial bypass procedure. Neurosurgery 11: 706–711Google Scholar
  26. 26.
    Eguchi T, Mayanagi Y, Iai S et al (1983) Extracranial-intracranial bypass to the proximal posterior cerebral artery and to the proximal middle cerebral artery for multiple occlusive cerebrovascular disease. Surg Neurol 19: 131–136PubMedCrossRefGoogle Scholar
  27. 27.
    Fein JM (1985) Carotid enderterectomy. In: Fein JM (ed) Cerebrovascular surgery. Springer, New York Berlin Heidelberg, pp 399–421Google Scholar
  28. 28.
    Fields WS, Lamak NA, Frakowski RF et al (1977) Controlled trial of aspirin in cerebral ischemia. Stroke 8: 301–319PubMedCrossRefGoogle Scholar
  29. 29.
    Fields WS, Lemak NA, Frakowski RF et al (1978) Controlled trial of aspirin in cerebral ischemia. Part II: Surgical group. Stroke 9: 309–319PubMedCrossRefGoogle Scholar
  30. 29.
    Fields WS, Lemak NA (1976) Joint study of extrancranial arterial occlusion. IX Transient ischemic attacks in the carotid artery. JAMA 235: 2608–2610PubMedCrossRefGoogle Scholar
  31. 30.
    Finkenstein JM, Byer A, Rush BF Jr (1972) Subclavian-subclavian bypass for the subclavian steal syndrome. Surgery 71: 142–145Google Scholar
  32. 31.
    Fisher CM (1970) Occlusion of the vertebral arteries causing transient basilar symptoms. Arch Neurol 22: 13–19PubMedCrossRefGoogle Scholar
  33. 32.
    Galbraith JG, McDowell HA Jr (1969) Stroke and occlusive cerebrovascular disease. Reviews and surgical results in 265 cases. J Med Assoc Stroke Ala 38:1107–1111Google Scholar
  34. 33.
    Gautier JC (1985) Stroke-in-progression. Stroke 16: 729–733PubMedCrossRefGoogle Scholar
  35. 34.
    Goldstone J, Moore WS (1976) Emergency carotid artery surgery in neurologically unstable patients. Arch Surg 111: 1284–1291PubMedCrossRefGoogle Scholar
  36. 35.
    Goldstone J, Moore WS (1978) A new look at emergency carotid artery operations for the treatment of cerebral vascular insufficiency. Stroke 9: 599–602CrossRefGoogle Scholar
  37. 36.
    Hardin CA, Williamson WP, Steegmann AT (1960) Vertebral artery insufficiency produced by cervical osteoarthritis spurs. Neurology 10: 855–858PubMedGoogle Scholar
  38. 37.
    Heros RC, Sekhar LN (1981) Diagnostic and therapeutic alternatives in patients with symptomatic “carotid occlusion” referred for extrancranial-intracranial bypass surgery. J Neurosurg 54: 790–796PubMedCrossRefGoogle Scholar
  39. 38.
    Hodosh RM, Boone S (1981) Neurological manifestation of external carotid artery disease. Clin Neurosurg 28: 384–406PubMedGoogle Scholar
  40. 39.
    Hopkins LN, Bundy JC, Spetzler RF (1982) Revascularization of the rostral brain stem. Neurosurg 10: 364–369CrossRefGoogle Scholar
  41. 40.
    Humphries AW, Young JR, Santilli PH et al (1976) Unoperated asymptomatic significant internal carotid artery stenosis. A review of 182 instances. Surgery 80: 695–698PubMedGoogle Scholar
  42. 41.
    Hutchinson EC, Acheson EJ (1975) Strokes; natural history, pathology and surgical treatment. Saunders, LondonGoogle Scholar
  43. 42.
    Ishii R, Koike T, Takeuchi S (1983) Anastomosis of the superficial temporal artery to the distal anterior cerebral artery with interposed cephalic vein graft. J Neurosurg 58: 425–429PubMedCrossRefGoogle Scholar
  44. 43.
    Ito Z (1981) A new technique of intracranial anastomosis between distal anterior cerebral arteries (ACA) for ACA occlusion and its indication. Neurol Med Chir (Tokyo) 21: 931–939 (Eng Abstr)CrossRefGoogle Scholar
  45. 44.
    Jacobson JH II, Mozersky DJ, Mitty HA et al (1973) Axillary-axillary bypass for the “subclavian steal” syndrome. Arch Surg 106: 24–27PubMedCrossRefGoogle Scholar
  46. 45.
    Jacobson JH II, Suarez EL (1960) Microsurgery in anastomosis of small vessels. Surg Forum 11: 243–245Google Scholar
  47. 46.
    Jones HR, Millikan CH, Sandok BA (1980) Temporal profile of acute vertebrobasilar system cerebral infarction. Stroke 11: 173–177PubMedCrossRefGoogle Scholar
  48. 47.
    Jones HR, Millikan CH (1976) Temporal profile (clinical course) of acute carotid system cerebral infarction. Stroke 7: 64–71PubMedCrossRefGoogle Scholar
  49. 48.
    Kaplan HA (1961) Collateral circulation of the brain. Neurology 11: 9–15PubMedGoogle Scholar
  50. 49.
    Kelly AB (1925) Tortousy of the internal carotid artery in relation to the pharynx. J L Otology 40: 15–23Google Scholar
  51. 50.
    Khodadad G (1976) Occipital artery-posterior inferior cerebellar artery anastomosis. Surg Neurol 5: 225–227PubMedGoogle Scholar
  52. 51.
    Lawrie GM, Morris GC Jr, Chapman DW (1977) Patterns of patency of 596 vein grafts up to seven years after aorto-coronary bypass. J Thrac Cardiovasc Surg 73: 443–448Google Scholar
  53. 52.
    Lyons C, Galbraith G (1957) Surgical treatment of atherosclerotic occlusion of the internal carotid artery. Ann Surg 146: 487–498PubMedGoogle Scholar
  54. 53.
    Mehigan JT, Buch WS, Pipkin RD et al (1978) Subclavian-carotid transposition for the subclavian steal syndrome. Am J Surg 136 15–20PubMedCrossRefGoogle Scholar
  55. 54.
    Mentzer RM Jr, Finkelmeier BA, Crosby IK et al (1981) Emergency carotid endarterectomy for fluctuating neurologic dificits. Surgery 89: 60–66PubMedGoogle Scholar
  56. 55.
    Millikan CH, McDowell FH (1981) Treatment of progressing stroke. Stroke 12: 397–409PubMedCrossRefGoogle Scholar
  57. 56.
    Mohr JP (1982) Symptomatic carotid artery desease. Stroke 13: 431–433.PubMedCrossRefGoogle Scholar
  58. 57.
    Murphey F, Miller JH (1959) Carotid insufficiency diagnosis and surgical treatment. A report of twenty-one cases. J Neurosurg 16: 1–23PubMedCrossRefGoogle Scholar
  59. 58.
    North RR, Fields WS, DeBakey ME et al (1962) Brachial-basilar insufficiency syndrome. Neurology 12: 810–820PubMedGoogle Scholar
  60. 59.
    Nunn DB (1975) Carotid endarterectomy: analysis of 234 operative cases. Ann Surg 182: 733–738PubMedCrossRefGoogle Scholar
  61. 60.
    Ojemann RG, Crowell RM, Robertson GH et al (1974) Surgical treatment of extracranial carotid occlusive disease. Clin Neurosurg 22: 214–263Google Scholar
  62. 61.
    Patrick BK, Ramirez-Lassepas M, Synder BD (1980) Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 11: 643–648PubMedCrossRefGoogle Scholar
  63. 62.
    Reichman OH (1975) Extracranial-intracranial arterial anastomosis. In: Whisnant JP, Sandkok BA (eds) Cerebral vascular diseases. Grune and Stratton, New York, pp 175–185Google Scholar
  64. 63.
    Reichman OH (1976) Neurosurgical anastomosis for cerebral ischemia. Five year’s experience. In: Sheinberg P (ed) Cerebrovascular diseases. Raven Press, New York, pp 311–330Google Scholar
  65. 64.
    Robertson JT, Auer NJ (1982) Extracranial occlusive disease of the carotid artery. In: Youmanns JR (ed) Neurological surgery, vol 3, Saunders, Philadelphia, pp 1559–1583Google Scholar
  66. 65.
    Robertson JT, Watridge CB (1979) Surgical management of extracranial-intracranial occlusive disease. Symposium on clinical neurology. Med Clin North Am 63: 681–693PubMedGoogle Scholar
  67. 66.
    Robertson JT (1985) The surgical candidates. In: Smith RD (ed) Stroke and extracranial vessels. Raven Press, New York’ pp 167–174Google Scholar
  68. 67.
    Samson DS, Boones S (1978) Extracranial-intracranial (EC-IC) arterial bypass: past performance and current concepts. Neurosurg 3: 79–86CrossRefGoogle Scholar
  69. 68.
    Samson DS, Gerwertz BL, Beyer CW Jr et al (1981) Saphenous vein interposition grafts in the microsurgical treatment of cerebral ischemia. Arch Surg 116: 1578–1582PubMedCrossRefGoogle Scholar
  70. 69.
    Samson DS, Hodosh RM, Clark WK (1979) Microsurgical treatment of transient cerebral ischemia. Preliminary results in 50 cases. JAMA 241: 376–378PubMedCrossRefGoogle Scholar
  71. 70.
    Samson Y, Baron JC, Boussen MG et al (1985) Effect of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans. Stroke 16: 609–616PubMedCrossRefGoogle Scholar
  72. 71.
    Spetzler RF, Chater N (1974) Occipital artery-middle cerebral artery anastomosis for cerebral artery occlusive disease. Surg Neurol 2: 235–238PubMedGoogle Scholar
  73. 72.
    Story JL, Brown WE Jr, Eidelberg E (1979) Cerebral revascularization: cervical carotid-intracranial arterial long graft bypass. In: Marguth F, Brock M, Kazner E (eds) Advances in neurosurgery. Springer, Berlin Heidelberg New York, vol 7, pp 15–23Google Scholar
  74. 73.
    Story JL, Brown WE, Ansell LV et al (1985) The management of the vertebrobasilar insufficiency by extrancranial surgical procedure. In: Smith RR (ed) Stroke and extracranial vessels. Raven Press, New York, pp 227–254Google Scholar
  75. 74.
    Story JL, Brown WE Jr, Eidelberg E (1978) Cerebral revascularization: Common carotid to distal middle cerebral artery bypass. Neurosurg 2: 131–135CrossRefGoogle Scholar
  76. 75.
    Strully KJ, Hurwitt ES, Blankenberg HW (1953) Thrombo-endarterectomy. For thrombosis of the internal carotid artery in the neck. J Neurosurg 10: 474–481PubMedCrossRefGoogle Scholar
  77. 76.
    Sundt TM Jr, Siekert RG, Piepgras DG et al (1976) Bypass surgery for vascular disease of the carotid system. Mayo Clin Proc 51: 677–692PubMedGoogle Scholar
  78. 77.
    Sundt TM Jr, Piepgras DG (1978) Occipital to posterior inferior cerebellar artery bypass surgery. J Neurosurg 48: 916–928PubMedCrossRefGoogle Scholar
  79. 78.
    The EC/IC Bypass Study Group (1985) The international cooperative study of extracranial/ intracranial arterial anastomosis (EC/IC Bypass Study): Methodology and entry characteristics. Stroke 16: 397–406CrossRefGoogle Scholar
  80. 79.
    The EC/IC Bypass study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. New Eng J Med 313: 1191–1200CrossRefGoogle Scholar
  81. 80.
    Whylie EJ, Hein MF, Adam JE (1964) Intracranial hemorrhage following surgical revascularization for treatment of acute stroke. J Neurosurg 21: 212–215CrossRefGoogle Scholar
  82. 81.
    Weibel J, Fields WS (1965) Tortuousity, coiling and kinking of the internal carotid artery. I. Etiology and radiographic anatomy. Neurology 15: 7–18PubMedGoogle Scholar
  83. 82.
    Yasargil MG (1969) Anastomosis between the superficial temporal artery and a branch of the middle cerebral artery. In: Yasargil MG (ed) Microsurgery applied to neurosurgery. Thieme, Stuttgart’ pp 105–115Google Scholar

Copyright information

© Springer-Verlag/Wien 1987

Authors and Affiliations

  • Jiro Suzuki
    • 1
  1. 1.Division of Neurosurgery, Institute for Brain DiseasesTohoku University School of MedicineNagamachi, SendaiJapan

Personalised recommendations