抄録
Fourty-one patients with cerebrovascular occlusive diseases and one patient with a giant aneurysm of the left internal carotid artery, which had proved in capable of direct surgical ablation, underwent STA-MCA anastomosis in our service for last 4 years. The occlusive cerebrovascular disease included 11 cases of the internal carotid artery (ICA) occlusion, 23 cases of MCA occlusion and 7 cases of ICA and MCA stenosis. As clinical manifestations of these cases, 11 cases had transient ischemic attack (TIA) and/or prolonged reversible neurological deficits (PRND), a case had progressing stroke, 12 cases had minor completed stroke (mn. CS) and 17 cases had major completed stroke (mj. CS). One case of PRND was died after surgery because of unknown etiology of cerebral infarction. Postoperative course of the other cases were uneventful.
For postoperative evaluation of the effectiveness of the anastomosis, complete disappearance of TIA or PRND or significant improvements of motor or sensory deficits were evaluated as effective. The efficacies were noted 9 cases (82%) out of 11 cases of TIA and/or PRND group, 8 cases (67%) out of 12 cases of mn. CS group and 3 cases (18%) out of 17 cases of mj. CS group.
There were 14 cases which fitted the clinical criteria of the“Cooperative study of E/I arterial anastomosis (Barnett)” and the efficacy of the surgery of this group was noted in 10 cases (71%) with the patency rate of 86%of the cases. It was interesting that 2 cases had transient postoperative occlusion of the donar artery of the anastomosis. Angiographical examination suggested us that the cause of occlusion was a sort of vasospasm of the donar artery.
Lastly, it was reported that a case, 25 years old, male, who admitted to our service with chief complaint of progressing loss of vision of his left eye and severe headache, underwent the left STA-MCA anastomosis as an adjunct in the treatment of his left giant internal carotid aneurysm. The patient had the left internal carotid ligation afterwards, and his giant aneurysm, which occupied nearly full of his left middle fossa, became small as size of finger tip angiographically.
