虚血性脳血管障害33例の外科的治療の経験

抄録

The extra-intracranial arterial bypass operation was performed in 33 patients with ischemic cerebral vascular diseases. None of 5 patients in the TIA group was suffering from episodes of cerebral ischemia postoperatively. In two out of 7 patients in the progressing stroke group and five out of 19 cases in the completed stroke group, a marked recovery of neurological functions was noted within the first week after the operation. Two cases of moya-moya disease are included in this series. One of them, showing a completed stroke, recovered completely after the operation. In another patient of moya-moya disease with TIA, the bypass operation was performed in order to prevent attacks.
Minimum numbers of stitches had been used for anastomosis to prevent thrombotic complications based upon the results of the first animal studies which had been reported, and an intravenous infusion of low molecular dextran solution was made intra- and postoperatively in the first 11 cases. However, one of the 11 patients died of a subdural hematoma within 48 hours postoperatively and another patient with a postoperative epidural hematoma recovered up to the preoperative condition after removal of the hematoma. None of the last 22 cases received an intravenous infusion of the solution. In this group of patients, an extracranial artery was cut at 45 degree angle, and a further longitudinal incision of the artery was added in order to enlarge the anastomosing area. Then two vessels were carefully anastomosed, so that a good intimal adaptation can be obtained, with no regard to numbers of stitches grounded on the second animal studies which is described in this paper. Follow-up angiography was performed in the 31 patients. The over-all patency rate was 90.3%and 100%in the last 22 cases.
It is important in order to obtain a good patency of the anastomosed area to make anastomosis between two vessels carefully by the above method.