中大脳動脈閉塞症例に対する直達手術

抄録

Occlusive cerebral vascular diseases have been treated by means of extra-intracranial arterial by-pass. However, the occlusion due to an apparent embolus is excluded from indications for the by-pass surgery as well as the occlusion at the middle portion of middle cerebral artery (MCA) where perforating arteries branch.
The authors presented three cases of middle cerebral artery endarterectomy (MEA) and two cases of embolectomy, performed on patients whose MCA occlusions were contraindicated for the by-pass surgery.
Postoperative angiograms of these patients showed reperfusion of the perforating arteries and MCA in all cases. However, only two patients, who underwent embolectomy 6 and 12 hours after the onset of hemiplegia, improved remarkably postoperatively.
Serious operative complications such as hemorrhagic infarction or severe brain edema were not encountered.
Literatures were reviewed and a brief discussion was made with regard to the difference of incidence of hemorrhagic infarction and severe brain edema between clinical cases and experimental animals.