Cerebral Revascularization

  • Robert F. Spetzler
  • Fred Williams
Conference paper


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.


Cerebral Blood Flow Internal Carotid Artery Middle Cerebral Artery Occlusion Acute Stroke Ischemic Penumbra 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blaisdell WF, Clauss RH, Galbraith JG, et al. (1969) Joint study of extracranial arterial occlusion. JAMA 209:1889–1895PubMedCrossRefGoogle Scholar
  2. 2.
    Britton M, Roden A (1985) Progression of stroke after arrival at hospital. Stroke 16:629–632PubMedCrossRefGoogle Scholar
  3. 3.
    Diaz FG, Ausman JI, Mehta B, et al. (1985) Acute cerebral revascularization. J Neurosurg 63:200–209PubMedCrossRefGoogle Scholar
  4. 4.
    Gagliardi R, Benvenuti L, Guizzardi G (1983) Acute operation in cases of middle cerebral artery occlusion. Neurosurgery 12:636–639PubMedCrossRefGoogle Scholar
  5. 5.
    Gratzl O, Schmiedek P, Spetzler R, et al. (1976) Clinical experience with extra-intracranial arterial anastomosis in 65 cases. J Neurosurg 44:313–324PubMedCrossRefGoogle Scholar
  6. 6.
    Grillo P, Patterson RH (1975) Occlusion of the carotid artery: Prognosis (natural history) and the possibility of surgical revascularization. Stroke 6:17–20PubMedCrossRefGoogle Scholar
  7. 7.
    Moulin DE, Lo R, Chiang J, et al. (1985) Prognosis in middle cerebral artery occlusion. Stroke 16:282–284PubMedCrossRefGoogle Scholar
  8. 8.
    Ojemann RG, Crowell RM, Roberson GH, et al. (1975) Surgical treatment of extracranial carotid occlusive disease. Clin Neurosurg 22:214–263PubMedGoogle Scholar
  9. 9.
    Selman WR, Spetzler RF, Roski RA, et al. (1982) Barbiturate coma in focal cerebral ischemia: Relationship of protection to timing of therapy. J Neurosurg 56:685–690PubMedCrossRefGoogle Scholar
  10. 10.
    Strong AJ, Venables GS, Gibson G (1983) The cortical ischaemic penumbra associated with occlusion of the middle cerebral artery in the cat: 1. Topography of changes in blood flow, potassium ion activity, and EEG. J Cereb Blood Flow Metabol 3:86–96CrossRefGoogle Scholar
  11. 11.
    Sundt TM Jr (1987) Occlusive cerebrovascular disease. Saunders, Philadelphia, pp 269–279, 467-476Google Scholar
  12. 12.
    Weinstein PR, Anderson GG, Telles DA (1986) Neurological deficit and cerebral infarction after temporary middle cerebral artery occlusion in unanesthetized cats. Stroke 17:318–324PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 1988

Authors and Affiliations

  • Robert F. Spetzler
    • 1
  • Fred Williams
    • 1
  1. 1.Barrow Neurological InstitutePhoenixUSA

Personalised recommendations