Cerebral Revascularization

Abstract

Carotid and cerebral vascular surgeons have generally opposed early intervention in acute stroke because the nonfunctioning brain tissue was presumed necrosed, and revascularization risked hemorrhagic infarction with little potential benefit. Recently, however, the theory of the ischemic penumbra has described acute stroke as a centrifugal distribution of cell states ranging from death at the center of the lesion through irreversible and reversible intermediate pathologic states to a peripheral region of normal brain tissue. The proportion of cells in each state is a function of collateral blood supply and the duration of ischemia. This theory suggests that early treatment may help in acute stroke. Medical methods have sought to improve the microcirculation by hemodynamic and hématologic manipulation and by cerebral cellular protection with pharmacologic agents. This review, however, focuses on surgical approaches.