Microvascular neurosurgical arterial bypass for cerebral ischemia: A decade of development

Abstract

The microsurgical extracranial‐intracranial arterial bypass (EIAB) procedure, usually performed to anastomose the superficial temporal artery to a cortical branch of the middle cerebral artery, offers a therapeutic alternative in treating patients who present with symptoms of cerebral ischemia varying from transient ischemic attack (TIA) to stroke‐in‐evolution, and who have intracranial or otherwise inaccessible high cervical carotid lesions. Preoperative diagnostic steps include angiography, computer‐assisted tomography (CT) scan, and measurements of regional cerebral blood flow (rCBF). A comparison of our series of 172 patients with series reported in the literature suggests that EIAB is more effective than medical therapy in preventing the development of permanent neurological deficit after a series of TIA and in treating cases of stroke‐in‐evolution. It also can prevent further deterioration in selected patients after stroke. An analysis of patients who had an unfavorable outcome suggests that bilateral EIAB should be performed in a greater number of patients who have generalized low‐perfusion syndrome; that low doses of heparin should be administered intraoperatively and postoperatively in patients who have high‐grade siphon stenosis; and that aspirin should be given to patients experiencing TIA after EIAB.

Bilateral Occlusive Carotid Disease: Simultaneous or Staged Operation?

“…In occlusion of the in ternal carotid arte ry the external carotid system figures as an important collateral pathway (24) . Stenosis of its main trunk may cause temporary neurologic de ficit (5 , 13) and its significance is increased if an extraintracranial arterial bypass (E IAB) is indicat ed (5,30) . Conseque ntly a steno tic externa l carotid artery h as to be deso bliterated befo re EIAB is installed.…”