Twenty-one patients underwent surgery for unruptured cerebral aneurysms associated with ischemic cerebrovascular disease between 1980 and 1989. In five patients (group A), extracranial-intracranial (EC-IC) bypass or carotidendarterectomy (CEA) was performed at the same time as aneurysm surgery. In five patients (group B), EC-IC bypass or CEA was performed subsequent to aneurysm surgery. In eleven patients (group C), revascularization was not performed. Two patients in group A had ischemic complications (reversible ischemic neurological deficits, RIND), and one patient in group B had a hemorrhagic complication postoperatively. However no permanent deficit developed in any of these patients. Two of these patients had perioperative problems, one in group A had intraoperative hypocapnia and one in group B had been under medication with an antiplatelet drug preoperatively.
The risk of aneurysm surgery for patients who have indications for cerebral revascularization are greater than for patients without such indication. And the risk of surgical complications is greatest when aneurysm surgery is performed concomitantly with revascularization. One reason may be that the brain of these patients is hypoperfused, and is vulnerable to brain retraction, hypocapnia or hypotention. The other reason may be that the temporary arterial occlusion during revascularization or the change of blood flow after revascularization increases the risk of surgical complications.
We conclude that usually, it may better to perform aneurysm surgery without performing revascularization, and when we perform revascularization at the same time, it is more important to pay careful attention to perioperative management including tender operative manipulation of the brain tissue with proper intraoperative monitoring.

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Among 365 consecutive patients with intracerebral hemorrhage, examined between March 1980 and November 1986, thirty-six cases (31 men and five women) were found to have a history of cerebral ischemic stroke. This group of patients was studied in this paper retrospectively. The mean age at the time of the hemorrhagic stroke was 62.0 and the age range was from 41 to 80.
Clinically, twenty-nine of the 36 cases had had major completed strokes, four had had vertebrobasilar insufficiencies, two had had transient ischemic strokes and one had had a progressing stroke. Thirty patients had had positive findings in computed tomography, 80%of which showed lacunar infarctions in the basal ganglia or thalamus. Angiography performed in 22 cases had revealed only five occlusive or stenotic lesions.
For the prevention of recurrent cerebral ischemia, seventeen of the 36 patients had been treated with antiplatelet drugs (APT (+) group). The other 19 cases had received neither antiplatelet drugs nor anticoagulants (APT (-) group). In the APT (+) group, 13 had had aspirin and/or trapidil, three had had ticlopidine and one had had dipyridamole.
Thirty-one patients were hypertensive[APT (+) 17; APT (-) 14]. There was one cerebral subcortical hemorrhage, and 14 putaminal, 16 thalamic, and five infratentorial hemorrhages. Especially in the APT (+) group, 16 of 17 (94%) hemorrhages were putaminal or thalamic. Dividing the volume of hematoma into “small” (<10ml), “medium” (10-30ml) and “large” (>30ml), there were eight small, six medium and three large hematomas in the APT (+) group, and 14 small, four medium and one large in the APT (-) group. The mean volume was 15.8ml in the APT (+) group and 9.6ml in the APT (-) group.
Prognosis after hemorrhagic stroke was divided into two groups: namely “good” or “poor”. In the APT (-) group, 14 patients were considered “good” and five “poor”, while only five in the APT (+) group were “good” and 12 were “poor”. The tendency was that patients of advanced age, with completed major stroke, lacunar infarction on CT scan, thalamic hemorrhage or large hematoma volume had a poor prognosis.
For the treatment and/or the prevention of cerebral ischemic strokes, many clinicians recently use antiplatelet drugs, whose efficacy, however, is not free of controversy. This report suggests that, to avoid hazardous hemorrhagic complications, meticulous care should be taken to control the blood pressure, especially in aged patients with lacunar infarction.

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