Abstract
The authors studied 18 cases of occlusive cerebrovascular disease with a tandem lesion, in order to evaluated results of different treatment modality and the surgical indication for carotid emdarterectomy (CEA). The tandem lesion was defined as a combination of angiographic pathologies both in the accessible cervical carotid (stenosis of light, moderate the severe degree; ulcer of small and large size) and in the ipsilateral main branch of the intracranial artery (stenosis; occlusion). The treatment for these patients consists of carotid endarterectomy for 10 patients and medical treatment for 8 patients Three of the 10 CEA cases were treated with middle cerebral artery thromboendarterectomy (2 cases) and with embolectomy and endarterectomy (1 case) simultaneously with the CEA. Results of the treatment were evaluated by the recurrence rate of neurological deficits before the treatment and by the survival rate in the long term follow-up study. The recurrence of the neurological deficits occured only in 2 cases of non-surgically treated patients with a carotid ulcer of the large size associated with distal lesions. In 6 cases of CEA patients, however, the distal lesions were left unoperated because of spontaneous recanalization (1 case), disappearance of preoperatively frequent TIAs after CEA (1 case) and a significant increase in the cerebral blood flow after the CEA (4 cases). The authors concluded that the present surgical indication of CEA for the tandem lesion is well accepted in terms of results of treatment except in the treatment for the distal lesions. The distal lesions should be treated after the CEA with extra-intracranial arterial bypass procedure if the postoperative increase in CBF is not significant.
