STA-MCA bypass in bilateral carotid artery occlusion: clinical results and long-term effect on cerebrovascular reserve capacity.
In this report we describe our experience with extracranial-intracranial arterial bypass surgery in a subgroup of 9 patients (mean age at surgery 61 +/- 9 years) with bilateral carotid artery occlusion, unilaterally symptomatic for occlusive cerebrovascular disease of haemodynamic origin. Haemodynamic insufficiency is characterized by a severely reduced cerebrovascular reserve capacity, measured with Xe-133 D-SPECT and acetazolamide challenge. Preoperatively, the mean baseline cerebral blood flow of 54 +/- 6 ml 100 g-1 min-1 did not change after challenge (54 +/- 5 ml 100 g-1 min-1) in the symptomatic hemisphere. Immediately following surgery an improvement in cerebrovascular reserve capacity for up to 14 +/- 8 ml 100 g-1 min-1 (1-2 years control) was noted. One patient subsequently died from a perioperative stroke, another patient died three months post-operatively from a myocardial infarction. Three patients were followed up to 4 years, four for 2 years. Patients with former transient ischaemic attacks had no further attacks, symptoms from PRIND or minor stroke did not progress further, nor did new symptoms occur. Unilateral extracranial-intracranial bypass surgery has a positive effect on clinical outcome in highly selected patients with bilateral carotid artery occlusion and cerebral ischaemia of haemodynamic origin.
Piepgras
A
A
Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
Leinsinger
G
G
Kirsch
C M
CM
Schmiedek
P
P
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome