Clinical experience with extra-intracranial arterial anastomosis in 65 cases

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✓ Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiography and regional cerebral blood flow (rCBF) studies are discussed. It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic focus is present. The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.

Article Information

Address reprint requests to: Otmar Gratzl, M.D., Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Neurochirurgische Klinik, D-8000 München 70, Marchioninistrasse 15, West Germany.

© AANS, except where prohibited by US copyright law.

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Figures

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    Postoperative angiogram of a 35-year-old woman, 3 years after EIAB shows left internal carotid artery occlusion (white arrow); open arrow illustrates site of anastomosis; small arrows delineate area of perfusion through superficial temporal artery (curved arrow) anastomosis. She presented with a history of two TIA's followed by sudden onset of left hemiparesis (Grade 2), and preoperative angiography revealed left internal carotid artery occlusion. The patient has improved postoperatively (Grade 1) and is now able to care for her household with 3 children.

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    Postoperative angiogram 8 months after EIAB in a 53-year-old man with PRIND (mild residual hemiparesis), who presented with bilateral internal carotid artery occlusions. Enlarged superficial temporal artery (curved arrow), site of anastomosis (open arrow) and extent of filling through EIAB (straight black arrows) can be seen. Patient's neurological deficit, which had persisted for 1 year prior to surgery disappeared within 1 week after EIAB.

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    Upper Left: Preoperative angiogram reveals middle cerebral artery occlusion (straight black arrow) with filling only of the posterior temporal branch (open arrow) in a 29-year-old man with completed stroke suffering from a left hemiparesis (Grade 2). Three sequential arteriographies over a 9-month period revealed the above findings. Curved arrow points to superficial temporal artery; small arrows surround ischemic area. Upper Right: Preoperative rCBF study reveals a mild general reduction of CBF with an additional relative ischemic focus in the frontoparietal area; arterial pressure CO2 = 41 mm Hg, MABP = 90 mm Hg. (Normal rCBF value is 50 ml/100 gm/min.) Lower Left: Postoperative common carotid cerebral angiography illustrates patent anastomosis (open arrow), superficial temporal artery (curved black arrows) and extent of filling through EIAB (small arrows). Lower Right: Postoperative rCBF study reveals marked improvement in previously focal ischemic area; arterial pressure CO2 = 42 mm Hg, MABP = 92 mm Hg.

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    Operative photograph of extra-intracranial arterial bypass procedure; curved arrow illustrates superficial temporal artery; open arrow points to site of anastomosis; cortical artery is marked with a straight arrow.

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    Pre- and postoperative incidence of TIA (arrows) in 10 patients. Vertical black lines represent time of surgery. Note that no TIA occurred postoperatively.

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