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Superficial Temporal to Middle Cerebral Artery Anastomosis: Clinical Outcome in Patients With Ischemia of Infarction in Internal Carotid Artery Distribution

Superficial Temporal to Middle Cerebral Artery Anastomosis: Clinical Outcome in Patients With... Abstract • The clinical outcome of our first 40 patients (six with transient ischemic attacks, 22 with mild ischemic infarctions, and 12 with moderate ischemic infarctions) treated with a superficial temporal artery-middle cerebral artery anastomosis was analyzed. All cerebral ischemias or infarctions occurred in the internal carotid artery distribution. An independent neurologist observer recorded the patient's preoperative and postoperative medical and neurological histories and objective neurological findings. There was no operative mortality. During the period of observation (up to 36 months), four patients died of probable myocardial infarction. No patient suffered from recurrent cerebral infarction. Three patients experienced a single ischemic event postoperatively. Neurological deficits were either unchanged (21 patients) or improved (19 patients). Postoperative angiograms showed patency in 97% of the anastomoses. References 1. Yasargil MG: Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional extra-intracranial shunts , in Donaghy RMP, Yasargil MG (eds): Microvascular Surgery . St Louis, CV Mosby Co, 1967, pp 87-126. 2. Yasargil MG: Microsurgery Applied to Neurosurgery . Stuttgart, West Germany, Georg Thieme Verlag, 1969, p 105. 3. Gratzl O, Schmiedek P, Spetzler R, et al: Clinical experience with extra-intracranial arterial anastomosis in 65 cases . J Neurosurg 44:313-324, 1976.Crossref 4. Reichman OH: Neurosurgical microsurgical anastomosis for cerebral ischemia: Five years experience , in Scheinberg P (ed): Cerebrovascular Diseases . New York, Raven Press, 1976, pp 311-336. 5. Sundt TM Jr, Siekert RG, Piepgras DG, et al: Bypass surgery for vascular disease of the carotid system . Mayo Clin Proc 51:677-692, 1976. 6. Ausman JI, Lee MC, Klassen AC, et al: Stroke: What's new? Cerebral revascularization . Minn Med 59:223-227, 1976. 7. Yasargil MG, Krayenbuhl HA, Jacobson JH II: Microneurosurgical arterial reconstruction . Surgery 67:221-233, 1970. 8. Yasargil MG, Yonekawa Y: Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia . Neurosurgery 1:22-24, 1977.Crossref 9. McDowell FH: The extracranial/intracranial bypass study . Stroke 8:545, 1977.Crossref 10. Whisnant JP: Extracranial-intracranial arterial bypass . Neurology 28:209-210, 1978.Crossref 11. Ausman J, Latchaw RE, Lee MC, et al: Results of multiple angiographic studies on cerebral revascularization patients , in Schmiedek P (ed): Microsurgery for Stroke . New York, Springer Verlag, 1977, pp 222-229. 12. Grillo P, Patterson RH Jr: Occlusion of the carotid artery prognosis (natural history) and the possibilities of surgical revascularization . Stroke 6:17-20, 1975.Crossref 13. Dyken ML, Klatte E, Kolar OJ, et al: Complete occlusion of common or internal carotid arteries: Clinical significance . Arch Neurol 30:343-346, 1974.Crossref 14. Anderson CA, Rich NM, Collins GJ Jr, et al: Unilateral internal carotid arterial occlusion: Special considerations . Stroke 8:669-671, 1977.Crossref 15. Toole JF, Janeway R, Choi K, et al: Transient ischemic attacks due to arteriosclerosis . Arch Neurol 32:5-12, 1975.Crossref 16. Fields WS, Lemak NA: Joint study of extracranial arterial occlusion: X. Internal carotid artery occlusion . JAMA 235:2734-2738, 1976.Crossref 17. Hardy WG, Lindner DW, Thomas LM, et al: Anticipated clinical course in carotid artery occlusion . Arch Neurol 6:64-76, 1962.Crossref 18. Whisnant J, Matsumoto N, Elvebeck LE: Transient cerebral ischemic attacks in Rochester, Minnesota 1945-1969 . Mayo Clin Proc 48:194-198, 1973. 19. Chater N, Peters N: Neurosurgical microvascular bypass for stroke . West J Med 124:1-5, 1976. 20. Chater N, Mani J, Tonnemacher K: Superficial temporal artery bypass in occlusive cerebral vascular disease . Calif Med 119:9-13, 1973. 21. Fields WS: Selection of stroke patients for arterial reconstructive surgery . Am J Surg 125:527-529, 1973.Crossref 22. Barnett HJM, Peerless SJ, Wei M: The "stump" of the internal carotid artery: A source for further cerebral embolic ischemia, abstracted . Stroke 8:14, 1977. 23. Austin G, Laffin D, Hayward W: Physiologic factors in the selection of patients for superficial temporal artery to middle cerebral artery anastomosis . Surgery 75:861-868, 1974. 24. Schmiedek P, Gratzl O, Spetzler R, et al: Selection of patients for extracranial-intracranial arterial bypass surgery based on rCBF measurements . J Neurosurg 44:303-312, 1976.Crossref 25. Heilbrun MP, Reichman OH, Anderson RE, et al: Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis . J Neurosurg 43:706-716, 1975.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Superficial Temporal to Middle Cerebral Artery Anastomosis: Clinical Outcome in Patients With Ischemia of Infarction in Internal Carotid Artery Distribution

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1979.00500370031003
Publisher site
See Article on Publisher Site

Abstract

Abstract • The clinical outcome of our first 40 patients (six with transient ischemic attacks, 22 with mild ischemic infarctions, and 12 with moderate ischemic infarctions) treated with a superficial temporal artery-middle cerebral artery anastomosis was analyzed. All cerebral ischemias or infarctions occurred in the internal carotid artery distribution. An independent neurologist observer recorded the patient's preoperative and postoperative medical and neurological histories and objective neurological findings. There was no operative mortality. During the period of observation (up to 36 months), four patients died of probable myocardial infarction. No patient suffered from recurrent cerebral infarction. Three patients experienced a single ischemic event postoperatively. Neurological deficits were either unchanged (21 patients) or improved (19 patients). Postoperative angiograms showed patency in 97% of the anastomoses. References 1. Yasargil MG: Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional extra-intracranial shunts , in Donaghy RMP, Yasargil MG (eds): Microvascular Surgery . St Louis, CV Mosby Co, 1967, pp 87-126. 2. Yasargil MG: Microsurgery Applied to Neurosurgery . Stuttgart, West Germany, Georg Thieme Verlag, 1969, p 105. 3. Gratzl O, Schmiedek P, Spetzler R, et al: Clinical experience with extra-intracranial arterial anastomosis in 65 cases . J Neurosurg 44:313-324, 1976.Crossref 4. Reichman OH: Neurosurgical microsurgical anastomosis for cerebral ischemia: Five years experience , in Scheinberg P (ed): Cerebrovascular Diseases . New York, Raven Press, 1976, pp 311-336. 5. Sundt TM Jr, Siekert RG, Piepgras DG, et al: Bypass surgery for vascular disease of the carotid system . Mayo Clin Proc 51:677-692, 1976. 6. Ausman JI, Lee MC, Klassen AC, et al: Stroke: What's new? Cerebral revascularization . Minn Med 59:223-227, 1976. 7. Yasargil MG, Krayenbuhl HA, Jacobson JH II: Microneurosurgical arterial reconstruction . Surgery 67:221-233, 1970. 8. Yasargil MG, Yonekawa Y: Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia . Neurosurgery 1:22-24, 1977.Crossref 9. McDowell FH: The extracranial/intracranial bypass study . Stroke 8:545, 1977.Crossref 10. Whisnant JP: Extracranial-intracranial arterial bypass . Neurology 28:209-210, 1978.Crossref 11. Ausman J, Latchaw RE, Lee MC, et al: Results of multiple angiographic studies on cerebral revascularization patients , in Schmiedek P (ed): Microsurgery for Stroke . New York, Springer Verlag, 1977, pp 222-229. 12. Grillo P, Patterson RH Jr: Occlusion of the carotid artery prognosis (natural history) and the possibilities of surgical revascularization . Stroke 6:17-20, 1975.Crossref 13. Dyken ML, Klatte E, Kolar OJ, et al: Complete occlusion of common or internal carotid arteries: Clinical significance . Arch Neurol 30:343-346, 1974.Crossref 14. Anderson CA, Rich NM, Collins GJ Jr, et al: Unilateral internal carotid arterial occlusion: Special considerations . Stroke 8:669-671, 1977.Crossref 15. Toole JF, Janeway R, Choi K, et al: Transient ischemic attacks due to arteriosclerosis . Arch Neurol 32:5-12, 1975.Crossref 16. Fields WS, Lemak NA: Joint study of extracranial arterial occlusion: X. Internal carotid artery occlusion . JAMA 235:2734-2738, 1976.Crossref 17. Hardy WG, Lindner DW, Thomas LM, et al: Anticipated clinical course in carotid artery occlusion . Arch Neurol 6:64-76, 1962.Crossref 18. Whisnant J, Matsumoto N, Elvebeck LE: Transient cerebral ischemic attacks in Rochester, Minnesota 1945-1969 . Mayo Clin Proc 48:194-198, 1973. 19. Chater N, Peters N: Neurosurgical microvascular bypass for stroke . West J Med 124:1-5, 1976. 20. Chater N, Mani J, Tonnemacher K: Superficial temporal artery bypass in occlusive cerebral vascular disease . Calif Med 119:9-13, 1973. 21. Fields WS: Selection of stroke patients for arterial reconstructive surgery . Am J Surg 125:527-529, 1973.Crossref 22. Barnett HJM, Peerless SJ, Wei M: The "stump" of the internal carotid artery: A source for further cerebral embolic ischemia, abstracted . Stroke 8:14, 1977. 23. Austin G, Laffin D, Hayward W: Physiologic factors in the selection of patients for superficial temporal artery to middle cerebral artery anastomosis . Surgery 75:861-868, 1974. 24. Schmiedek P, Gratzl O, Spetzler R, et al: Selection of patients for extracranial-intracranial arterial bypass surgery based on rCBF measurements . J Neurosurg 44:303-312, 1976.Crossref 25. Heilbrun MP, Reichman OH, Anderson RE, et al: Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis . J Neurosurg 43:706-716, 1975.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1979

References

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