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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Case 1. A 65 year old male had left hemiparesis with sudden onset since 8 years ago, which gradually aggravated for these 2 years. On Sept. 27, 1973, he was admitted to the Department of Neurosurgery, Kitano Hospital. There was left spastic hemiparesis with hemisensory disturbance and he could not walk without help for the maked spasticity. Left carotid angiogram revealed the complete occlusion of the internal carotid artery and marked stenosis of the external carotid artery at the common carotid bifurcation. External carotid endarterectomy was performed on Nov. 19, 1973, which was followed by STA-MCA anastomosis 2 months later. The spasticity of extremities and left hemisparesis were gradually improved and he was able to walk without help. Case 2. On Apr. 14, 1974, a 63 year old female developed complete stroke with right hemiparesis and speech disturbance after transient ischemic attacks of 5 days duration. On Aug. 9, he was admitted and had emotional incontinence, right hemiparesis, Gerstmann's syndrome and motor aphasia. Left carotid angiogram revealed a saccular aneurysm of the middle cerebral artery and the occlusion of the distal middle cerebral arterys. These findings suggested that the occlusion was caused by embolus from the middle cerebral aneurysm, and the combined surgery with STA-MCA anastomosis and operation for the aneurysm was planned. On Aug. 30, 1974, under left frontotemporal craniotomy, aneurysmal neck clipping and aneurysmectomy were performed and thereafter, STA-MCA double anastomosis was done. One week after operation, the gradual improvement of pre-operative symptomes was noted. Recently, STA-MCA anatomosis is well known to be one of the effective operative methods for the occlusive methods for the occlusive cerebrovascular diseases and in addition, we found that the combination of STA-MCA anastomosis with other operations was effective for unusual cases presenting in this report. Furthermore, except for the occlusive cerebrovascular diseases, we usually plan STA-MCA anastomosis for the cases of 1) carotid ligation or trapping for carotid-cavernous sinus fistula and some internal carotid aneurysms, 2) some intracranial tumors with the danger involving the main cerebral arteries by operation to protect the cerebrovascular insufficiency.
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PMID:[The combination of STA-MCA anastomosis with another operation for the occlusive cerebrovascular disease (author's transl)]. 55 37

A study of 1,000 STA-MCA by-pass procedures in stroke patients is described as "extremely encouraging", with greater than 90% patency rate and marked improvement in patients who had not responded to medical management or had been turned away from routine vascular surgery.
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PMID:Microsurgical cerebral revascularization for the treatment of stroke. 64 93

A series of 58 operations on 56 patients, in whom a branch of the superficial temporal artery was anastomosed to a branch of the middle cerebral artery (STA-MCA bypass or Yasargil procedure), is reviewed. These operations were performed chiefly for occlussions or for inaccessible stenotic lesions of the internal carotid or middle cerebral arteries. Patency in eight patients operated on from April 1971 through November 1973 was low (25%). Patency in patients operated on since July 1974 has been high (95%). There have been no deaths and no major ischemic strokes attributable to the surgery. The rationale for this procedure is considered in relationship to the anatomy and physiology of the cerebral circulation and the pathogenesis of syndromes of cerebral ischemia. The operation appears to have a low morbidity in good-risk patients. The role of this operation in managing common manifestations of cerebral vascular disease such as focal transient cerebral ischemic attacks (TIAs) and amaurosis fugax, although not fully established, appears encouraging. The procedure seems useful for orthostatic cerebral ischemia caused by multiple occlusions of major extracranial (and intracranial) vessels and, occasionally, for progressing strokes related to internal carotid artery occlusion, both of which are relatively uncommon manifestations of cerebral vascular occlusive disease. It may have application in the rare "slow stroke." The procedure is probably of limited value, if any, in the management of large completed infarcts but may be indicated in selected patients with small infarctions who have preserved most of their cerebral function and who have had evidence of subsequent focal ischemic events. The procedure is useful for bypassing giant aneurysms or basofrontal tumors invading major vessels. It may have a role in the management of fibromuscular disease of the internal carotid artery.
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PMID:Bypass surgery for vascular disease of the carotid system. 99 50

25 patients have been operated on by means of extra-intracranial anastomosis (22 with STA-MCA anastomosis, 3 with occipital-MCA anastomosis). 23 patients underwent an angiographic study early after surgery (two weeks). The patency rate is 14 out of 23 (13 STA, 1 occipital anastomosis). In comparison of its pre-operative size, the afferent artery has enlarged in the most cases, particularly in patients with complete obliteration, either of the carotid artery, or of the middle cerebral artery. In every case, only a limited part of the MCA territory is visualized through the anastomosis. In no case was the complete MCA field visualized; the frontal branches, particularly, are not supplied through a temporal anastomosis. In the case of occipital anastomosis, both upper and lower branches of MCA are supplied through the new channel. 11 patients underwent a second angiographic study, from one year through 28 months after the first one. In three patients with no patency on the first angiography the anastomosis remained non patent. So, in this series, no anastomosis was seen to became patent secondarily. In 8 patients with patency on the first control, the anastomosis remained patent on the second angiography. In patients with a pre-operative stenosis, no increasing of the size of the vessel could be noticed. The filling of the MCA branches is difficult to be discussed, for in these cases, the angiographies were not performed selectively through the external carotid artery. In patients with a pre-operative thrombosis, an enlarging of the vessels was seen, as well as an extension of the intra-cranial filling through the anastomosis. Clinical correlations are the following ones: the most patients with TIA's had a stenosis. They presented no increasing of the size of the vessels. They were doing well after operation, as if a little more of blood supply was sufficient to improve the general blood perfusion. Every patient with stroke had a pre-operative thrombosis and presented an enlarging of the vessels with a better filling on the second angiography, as if a great deal of additional blood supply was required; the clinical improvement is slow (3 out of 5) and remains often incomplete.
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PMID:[Extra-intracranial anastomosis: radio-clinical correlations]. 101 21

Regional cerebral blood flow (rCBF) studies were performed during the postoperative period on 16 patients with internal carotid occlusions and inaccessible stenoses, and middle cerebral artery occlusion and stenoses, who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. The intra-arterial xenon method with selective application of the xenon bolus through the internal carotid and the newly established superficial temporal channel has allowed comparison of the flow provided by the pathological input with flow through the new input. The results show that initial rCBF (rCBF1) was globally reduced in all patients to a mean of 28.4 +/- 11.9 ml/100 gm/min at a mean pCO2 of 29.6 +/- 9.55 mm Hg. Patients with transient ischemic attacks (TIA) and minor strokes with minimal residua (RIND) had a mean rCBF1 of 30.4 +/- 11.6 ml/100 gm/min at a mean pCO2 of 30 +/- 10 mm Hg, while patients with completed strokes had a mean rCBF1 of 25.0 +/- 12.4 ml/100 gm/min at a mean pCO2 of 29.1 +/- 8.8 mm Hg. There was no significant difference between these two groups. This finding suggests that in this small group of patients with TIA's and RIND's, the cause of the stroke is probably related more to decreased perfusion than embolus, and may explain why these patients' symptoms improve after STA-MCA anastomosis. The results of this study suggest that in addition to an inaccessible lesion, global or focal decreased rCBF is a necessary criterion in the definition of indications for intracranial revascularization procedures.
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PMID:Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis. 119 37

Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery.
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PMID:Chronic subdural hematoma following bypass surgery--report of three cases. 138 57

Twenty-seven patients with minor completed and major stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The regional cerebral blood flow (rCBF), using inhalation of stable xenon and computed tomographic scanning (Xes CT-CBF study), and the mode of transit time (MTT) in the MCA territory using intra-arterial digital aortography were measured. Activated rCBF and MTT was measured 20 minutes after the administration of acetazolamide (10 mg/kg) in 14 patients. Nineteen of the 23 patients with minor stroke (Group 1) showed immediate improvement in their neurological state within a few days of the operation, while four patients with minor stroke (Group 2) and four patients with major stroke (Group 3) showed no improvement. Based on the rCBF obtained with the Xes CT-CBF study, affected side rCBF/unaffected side rCBF and %f [(peak DSA number/affected side MTT)/(peak DSA number/unaffected side MTT)] were compared. There was a significant positive correlation. Affected side MTT in Group 1 was 6.41 +/- 1.16 sec, preoperatively, and significantly decreased to 5.13 +/- 0.91 sec after the operation. On the other hand, preoperative MTT in Group 2 was 4.40 +/- 0.81 sec and 4.76 +/- 0.89 sec, postoperatively. Preoperative %f in Group 1 was 0.514 +/- 0.143 and significantly increased to 0.739 +/- 0.154, postoperatively. Group 2 showed no change. Vasodilatory capacity with acetazolamide showed a marked improvement in Group 1, postoperatively. Our study indicated that if MTT is moderately lengthened, %f is moderately decreased, and vasodilatory capacity is impaired, in patients with minor ischemic stroke will benefit from STA-MCA anastomosis.
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PMID:Hemodynamic evaluation before and after the STA-MCA anastomosis--with special reference to measurement of regional transit time with intra-arterial digital subtraction angiography. 170 56

Sixteen patients with minor completed stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The acetazolamide-activated regional cerebral blood flow (rCBF) was measured 20 minutes after the injection using inhalation of stable xenon and computed tomographic scanning (Xes CT-CBF study) pre- and postoperatively. Eleven patients (Group 1) showed immediate improvement in neurological state within a few days of the operation, while five (Group 2) showed no improvements. Preoperative rCBF in the ischemic areas without infarction was 30.8 +/- 3.0 ml/100 gm/min in Group 1 and 53.0 +/- 5.2 ml/100 gm/min in Group 2. Preoperative vasodilatory capacity with acetazolamide in Group 1 was 5.7 +/- 8.6 and significantly increased to 19.8 +/- 4.9 after surgery. In Group 2, pre- and postoperative vasodilatory capacity was 12.7 +/- 3.1 and 14.9 +/- 2.9, respectively, and there was no significant change. These results suggested that minor stroke patients with moderate decrease of affected side rCBF (less than 40 ml/100 gm/min) and with hemodynamic impairment may have the surgical indication for STA-MCA anastomosis.
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PMID:Hemodynamic evaluation in patients with superficial temporal artery-middle cerebral artery anastomosis--stable xenon CT-CBF study and acetazolamide. 171 45

Changes in cerebral hemodynamics due to reconstructive cerebral vascular surgery were evaluated using positron emission tomography (PET). Three minor stroke cases and 1 TIA case, brought on by main trunk stenosis, were included. STA-MCA anastomoses was performed in two of the cases and carotid endarterectomy was performed in the remaining two cases. CBF, CBV, OEF, CMRO2 and CBF/CBV were investigated using PET with the ROIs fixed in both normal and stenosis areas. On the two cases of STA - MCA anastomosis, clear hemodynamic improvement was not demonstrated. On the two carotid endarterectomy cases, the hemodynamic factors showed improvement.
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PMID:[An evaluation of cerebral blood flow and metabolism of reconstructive vascular surgery using positron emission tomography--a report of 4 cases]. 174 96

In order to clarify the effectiveness of extracranial- intracranial bypass in cases of vertebro-basilar occlusive disease, we investigated the operative complication, clinical course and follow-up study of 30 cases undergoing superficial temporal artery-superior cerebellar artery (STA-SCA) bypass surgery. Postoperative angiogram showed the patency of the anastomoses in all cases. No serious surgical complications were observed. The outcome on discharge was excellent, with no morbidity and one mortality which was due to cardiac infarction. In the follow-up study, there were four cases with ischemic symptoms, two with transient ischemic attack and two with completed stroke, one of which was a supratentorial infarction due to internal carotid artery occlusion and the other was a small infarction of pons. There were also two deaths due to cardiac infarction and diabetes mellitus. Favorable outcomes were obtained for the remaining cases. The present study suggests that, STA-SCA bypass, can be performed without surgical and systemic complications and used as an effective therapy for vertebrobasilar ischemia.
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PMID:Clinical analysis of STA-SCA bypass for vertebrobasilar occlusive disease. 175 11


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