Abstract
The surgical indication of STA-MCA anastomosis for ischemic cerebrovascular disorder, especially completed stroke hasn't been determined. The authors researched 31 cases of completed stroke (mean of age was 56.4 years old) and discussed the indication of bypass surgery, evaluating their clinical symptoms bascd on a newly established rating scale “neurologic score”, and also evaluating the surgical effect by means of a newly defined “effect index”. The “neurologic score” contains eight symptoms as followings; state of consciousness, psychic state, motor function, sensory function, speech disturbance, visual field, agnosia and Gerstmann's syndrome and urinary and fecal incontinence, and it has three degrees. The“effect index” is defined as belows; (total neurologic score on the day before surgery-total neurologic score on 3 weeks after surgery)/total neurologic score on the day before surgery:_??_1.
The ratio of their patency was 93.8%. The number of symptomatically impoved cases after bypass surgery was 18 out of 31 cases (58%). The number of cases whose effect index was over 0.25 was 10 and over 0.5 was 3.
The effect index was over 0.25 in seven cases out of 12 cases of small size of focal low density, classified besed on CT firdings (Ia: normal, Ib: cerebral atrophy, II: small size of focal low density, III: moderate size of focal low density, IVa: multifocal low density, IVb: multilobar low density, IV,: diffuse low density). 2 out of 3 cases in III group and 3 out of 11 cases in IV group had symptomatical improvement. We also classified and studied the angiographical findings based on the affected pasition and its severity and there was no correlation between their affected types and clinical effect of bypass surgery in these 31 cases. It was concluded that even in completed stroke STA-MCA anastomosis was effective on those whose CT findings belonged. to“small size of focal low density”.
