抄録
The internal carotid artery was occluded by means of intravascular balloon or surgical ligation in 12 cases with negative study of proceeded balloon Matas tests. Of 12 cases, 7 were cerebral aneurysms, 4 carotid-cavernous fistulas (CCF), and one cavernous sinus meningioma. Delayed ischemic symptoms appeared in three of those during the follow-up period after the occlusion. One of them developed hemiplegia 4 days after the proximal ligation, another patient suffered numbness of the left upper extremity a few weeks after occlusion of the ICA, and the third cases sustained a transient ischemic attack 5 years after the operation. Mean stump pressure (MSP) and/or tomographic cerebral blood flow (CBF) measured after ICA occlusion were slightly decreased, but still above the critical value. A focal ischemic region was found in the territory of perforating arteries in 2 of 3 cases. In those patients, postocclusion blood pressure and/or flow studies turned out to be of less value in predicting delayed ischemic symptoms, because the perforating arteries rather than the cortical branches seemed to take part in the symptomatic ischemia. Antiplatelet agents might be necessary to prevent the delayed ischemic complication after permanent ICA occlusion.
