Indications for surgical treatment of occlusive disease of the afferent cerebral arteries.
Indications for reconstruction operations in the region of branches of the arch of the aorta must be based on a comprehensive evaluation of the neurological and angiographic finding and the general condition of the patient. This ensues from the experience assembled in more than 800 operations performed since 1959. To evaluate the surgical risk, a scoring system was elaborated which evaluates the partial risks of each basic aspect of indication. Based on the sum of partial risks, four grades were defined. Patients who meet the prerequisites for surgical risk I and II (mainly with transient ischaemic attacks and asymptomatic stenoses of the internal carotid artery) can be indicated, with regard to hitherto assembled results, unequivocally for reconstructions. In grade IV risk it is essential to consider whether the risk of the natural course is greater than the risk of the operation and whether the affection of the afferent cerebral artery is the main limiting factor. The authors discuss contemporary views on indications of acute reconstructions of stenoses and occlusions of the internal carotid artery based on the neurological and angiographic factor and the time factor. From the evaluation of results of 92 urgent operations on account of recent or imminent symptoms of cerebral ischaemia ensues that for the result the grade and dynamics of the ischaemic cerebral affection at the time of the operation are decisive.
D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal; D006801:Humans