STA-MCA bypass for symptomatic carotid occlusion and haemodynamic impairment.
Patients with carotid artery occlusion and haemodynamic insufficiency have a high risk of stroke. Cerebral revascularization surgery improves cerebral blood flow, but it remains unclear whether this reduces the risk of stroke. This study assesses the long-term outcome of patients undergoing superficial temporal artery to middle cerebral artery (STA-MCA) bypass for symptomatic carotid occlusion. The long-term clinical follow-up and haemodynamic reserve, measured by (99)Technetium single photon emission computed tomography (Tc99 SPECT) scan with acetazolamide challenge, were reviewed for 19 consecutive patients before and after STA-MCA bypass. The stroke rate after bypass surgery was 8% per year. In patients waiting for surgery, the stroke rate was 18% per year. Cerebral perfusion assessed with SPECT scan improved in 88% of patients. These results are consistent with the high risks of haemodynamic infarction in untreated patients and a benefit from revascularization surgery. The percentage annual stroke risk compares favourably with an 18% rate reported for patients with internal carotid artery occlusion and impaired cerebrovascular reserve.
Jeffree
Rosalind L
RL
Institute of Neurological Sciences, Prince of Wales Hospital, High St, Randwick, New South Wales, 2031, Australia.
Stoodley
Marcus A
MA
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology*; D017023:Coronary Angiography / Q000379:methods; D003399:Craniotomy / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome
D013667:Technetium