To determine the indication of the by-pass operation for the stroke, we focussed on the cases showing High Density (H. D.) area in the postcontrast CT scans of the cerebral infarction. (the H. D. area was named as Ribbon H. D.). 38 cases of the Ribbon H. D. in the cerebral infarctions were verified concerning to the time of appearance of the H. D. area, features of its location and nature and its histological findings.
The Summary was as follows;
1. Ribbon H. D. reaches its peak in the latter half of the 2nd week after onset, and then gradually decreases.
2. Ribbon H. D. often appears along the cortical ribbon, and does not show massive shadow in the deep zone.
3. Ribbon H. D. is due to the transudation of contrast media, and does not always indicate hemorrhagic infarction.
4. Ribbon H. D. shows the incomplete necrosis, and in its nearby region we always find the slight lesions of only gliosis.
According to 1st, 2nd 3rd points of the summary, we considered,“It is not so dangerous that we perform the operation of STA-MCA anastomosis to the cases of Ribbon H. D. in the early stage.”
According to 4th point of the summary, we should rather perform the operation of STA-MCA anastomosis as early as possible. Aad then, according to this idea, anastomosis was actually done.
Result; But, we cannot find any correlation between the effect and the time of surgery.
Because, there is a difference of 20 years or more in average age between a group of Grade 1 (fully indipendent) and a group of Grade II (Handicapped) and III (disabled).
Our conclusion; Accordingly, at the present time, when the indication to TIA and RIND is accepted, to stroke, there is no alternative method but to select a logically good time and good case.
