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

Cerebral autoregulation is impaired in ischaemic regions. We hypothesized that pre-existing STA-MCA bypass would be superior to delayed revascularization in maintaining ipsilateral rCBF and preserving cerebral autoregulation following experimental stroke. Two series of dogs were tested to evaluate this hypothesis, but which was disproved for the chosen experimental conditions. In the first, eight dogs underwent craniotomy, STA-MCA bypass, and radiolabeled microsphere rCBF determinations. Blood pressure was manipulated with intravenous adenosine and levarterenol. Ischaemic zone rCBF was measured at MAP 60 mm Hg (97.2 ml.min-1.100 g-1) and MAP 140 mm Hg (113.6) (p = NS), in the intact arterial system with the patent bypass in place. An hemispheric ipsilateral ischaemic lesion was then created, and three further microsphere rCBF determinations were made at MAP 60 mm Hg (41.7 ml.min-1.100 g-1), MAP 100 mm Hg (52.6) and MAP 140 mm Hg (58.3). There were no significant differences between these measurements (ANOVA p = NS). In a second series of five animals the bypass was placed and the stroke lesion created first. Ischaemic zone rCBF was then measured at MAP 60 mm Hg (35 ml.min-1 . 100 g-1) and MAP 140 mm Hg (44 ml.min-1 . 100g-1) (p = NS), with the patent bypass in place. The bypass was then clamped for 15 minutes and profound ischaemia confirmed (5 ml.min-1 . 100 g-1, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cerebral autoregulation following prophylactic and delayed experimental STA-MCA bypass. 260 72

From 250 patients suffering from cerebral ischemia who were subjected to microsurgical anastomosis STA-MCA between 1979 and 1986 there was chosen a group of patients who were examined retrospectively at a period of 1-7 years after surgery. Some patients were examined clinically at average post-operation periods of 10-20 days, several months, 1.5 year and 4 years. Results of angiography and CT examination both before and after operation were also taken into consideration. From patients examined in this way there was selected a group with less severe forms of the disease, mainly Prolonged Reversible Ischaemic Neurological Deficit, with a Completed Stroke, and next a group of patients who showed worsening of the neurological condition after operation--transient or permanent and a group of patients who died some time after operation. The results of examination were subjected to statistical analysis. On the base of this the author attempts to answer the question whether, with present diagnostic technique limited to clinical examination, angiography and CT examination, groups of patients can be selected in which operative risk will be reduced to a minimum and the result of operation will be advantageous to the patient.
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PMID:An assessment of the results of treatment of cerebral ischaemia by microsurgical anastomosis of STA-MCA on the basis of catamnestic examination. 264 31

In a series of patients with unilateral supratentorial ischemia, clinical scores and parameters derived from computer analysis of the EEG and from measurement of the CBF were determined in the first several weeks after the stroke. Seventeen of these patients underwent a carotid-endarterectomy and 15 a STA-MCA bypass operation. Matched control patients were selected from the remaining cases. All patients, including the controls, were eligible for vascular surgery. The measurements were repeated respectively 3 months and 3 years after the first examination. Clinical improvement occurred in all groups. The degree of these clinical changes was similar for operated and non operated cases. EEG changes indicated more improvement in the cases without surgery. Finally, the CBF was remarkably stable in all patients. The overall effects of reconstructive vascular surgery on the recovery after cerebral ischemia appeared to be negligible.
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PMID:Long-term clinical and neurophysiological effects of reconstructive vascular surgery for cerebral ischemia. 272 55

This report summarizes the protocol of a randomized trial of superficial temporal artery-middle cerebral artery (STA-MCA) bypass procedure and presents the entry characteristics of its patients. The trial has been designed to determine whether this EC/IC bypass reduces the rate of subsequent stroke among patients with recent hemispheric or retinal strokes and/or transient ischemic attacks who have angiographically proven atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery. Of the 1377 eligible patients entered from the 71 participating centers, 714 (52%) have been assigned to medical treatment alone (daily aspirin and aggressive hypertension control) while 663 (48%) have been assigned to receive STA-MCA bypass in addition to medical therapy. The two treatment groups have been well balanced for important prognostic factors. Bypass patency rates of 95% have been documented. At the end of the study in mid-1985, an average follow-up of five years and a minimum follow-up of 33 months will have been achieved. On both clinical and methodologic grounds, this study will have provided a rigorous test of the STA-MCA bypass procedure.
Stroke
PMID:The International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis (EC/IC Bypass Study): methodology and entry characteristics. The EC/IC Bypass Study group. 286 Jul 39

Eight cases of stroke in children treated with surgery are reported. Four of the patients had Moya-moya disease and presented with TIA. They were treated by surgically creating collaterals through the STA-MCA bypass, encephalomyosyangiosis and encephalomyoarteriosynangiosis operations. Three patients with traumatic or idiopathic carotid artery stenosis or occlusion presented with TIA and were treated with STA-MCA bypass. One patient with idiopathic carotid artery stenosis presented with a complaint of a continuous swishing noise in the ear and had a STA-MCA bypass followed by carotid artery ligation. Although stroke in children is usually secondary to systemic disease, there is a group of children with surgically treatable disease who need to be identified and treated. The potential benefit of surgery may depend on the promptness with which a definitive diagnosis is reached.
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PMID:Cerebrovascular occlusive disease in children: a survey. 306 71

In order to establish more strict and objective indication for EC-IC bypass, a retrospective study on the surgical effect on cerebral blood flow (CBF) and neurological function was carried out in 37 cases. STA-MCA bypass was carried out on 20 cases with IC occlusion and 17 cases with MCA occlusion. Twenty-two cases with completed stroke, 9 cases with TIA and 6 cases with RIND. All patients were able to ambulate before surgery, and none of them were hemiplegic. CBF study by 133Xe inhalation method was carried out before and 2 to 4 weeks after surgery. Bypass was patent in all cases. Thirty percent of all cases showed more than 16% increase in CBF (++ group) on the side of bypass surgery and another 30% demonstrated 6 to 15% increase (+). On the other hand 30% of cases appeared to be unchanged (+/-), and 10% showed more than 6% decrease (-). The less the pre-operative CBF value was, the more the post-operative CBF was expected to be increased. Patients with pre-operative CBF less than 60% of normal value (ISI = 63 +/- 4) showed remarkable increase (++), and those with 60 to 70% showed moderate increase (+). Contrarily, cases with more than 70% of normal value showed either no change or decrease. Neurological change was evaluated as to disappearance of TIA attack and improvement of hemiparesis or mental dysfunction. Seventy-seven percent of patients in groups with (++) and (+) effect on CBF showed improvement in neurological function, whereas only 27% of patients in groups with (+/-) and (-) effect demonstrated improvement, which was statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgical indication for extracranial-intracranial arterial bypass determined by cerebral blood flow study and neurological function--a retrospective study]. 343 27

To elucidate hemodynamic changes and prognosis after STA-MCA anastomosis, thirteen cases with middle cerebral artery stenosis were systematically analyzed from the pre- and postoperative findings of cerebral angiography, CT scan and rCBF. They were followed up about 3 years long on the average postoperatively. Postoperative angiography revealed patent bypass in all cases. No remarkable changes at the site of stenosis were observed in the group A (6 in 13 cases), who had angiographically sufficient inherent collateral circulation. By contrast, group B (7 in 13 cases), who had insufficient inherent collateral circulation, showed remarkable progress in the degree of stenosis and significant changes of flow patterns were observed after operation. However, these postoperative changes did not bring any clinical deterioration. During follow-up period (31.2 months on the average) after operation, no cerebrovascular accident were encountered in all cases and clinically improved. In conclusion, the STA-MCA bypass rendered more beneficial effect to the patient with MCA stenosis when compared with natural histories reported in the literature.
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PMID:[Follow-up results after STA-MCA anastomosis in cases of middle cerebral artery stenosis]. 362 66

A twenty-year-old female, who had multi-agent chemotherapy for eighteen months after surgical resection of a choriocarcinoma originating from the left adnexa, was hospitalized because of a cerebrovascular accident. Her complaints were unconsciousness, generalized convulsion and left hemiparesis. Although both plain and contrast enhanced CT scans demonstrated only acute subdural hematoma in the right frontoparietal region associated with midline shift, no tumor shadow was recognized over the cortex or intraparenchymally. A carotid angiogram revealed a large and irregularly shaped aneurysm at a peripheral branching of the angular artery. Evacuation of the hematoma, resection of the aneurysm and revascularization for the defect of the parent artery by transplantation of a part of STA by means of microsurgical anastomosis were done at an emergency operation. Nevertheless the graft did not prove to be patent on the post-operative angiogram. Due to retrograde filling of the distal portion of the angular artery through collateral channels, the patient has been completely free of neurological deficit and her performance of daily activities has been excellent. No appearance of other intracranial metastasis of the tumor has been detected for six months thereafter. Histological examination of the resected aneurysm demonstrated that choriocarcinoma composed of cytotrophoblasts and syncitiotrophoblasts filled the lumen of the aneurysm. The van Gieson's staining clarified the invasion of the tumor into the vascular wall causing disruption of lamina elastica beneath the fairly intact adventitia. Microscopic findings of the specimens taken from adjacent brain tissue and overlying dura mater confirmed absence of metastatic lesion in them.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case report of neoplastic aneurysm due to metastatic choriocarcinoma]. 370 40

The authors report a case of superficial temporal to superior cerebellar artery anastomosis (STA-SCA anastomosis) for progressing rostral brain stem infarction with an excellent result. Precise operative techniques were also described. A 47-year-old male was admitted to our hospital on November 9, 1984, because of sudden onset of dysarthria and ataxic gait. CT revealed a low density area in the pons. Left vertebral angiogram showed occlusion of the left vertebral artery just distal to the origin of the posterior inferior cerebellar artery (PICA). Arterial branch of the left cerebellar hemisphere were filled via the left PICA to the left SCA and anterior inferior cerebellar artery anastomosis. Right brachial angiogram showed the hypoplastic right vertebral artery which ended at the PICA. The rostral basilar artery, both posterior cerebral arteries (PCA's) and right SCA were filled through anastomosis from the right PICA. The posterior circulation was not filled by either of the carotid arteries. In spite of antiplatelet agglutination therapy, the patient had two more episodes of dysarthria, dysphagia, right hemiparesis and gait disturbance. Because of progressing stroke, STA-SCA anastomosis was carried out on the right side on February 27, 1985. During operation, the blood pressure was maintained above the level of 130 mmHg, and intravenous mannitol injection and spinal drainage were done to preserve the right temporal lobe from intracerebral hematoma and/or edema caused by retraction. Postoperatively, the patient has been free from new ischemic attack. He has only slight hemiparesis now eight months after operation. Right external carotid angiogram showed a patent STA-SCA bypass and good filling of SCA's and PCA's bilaterally.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Superficial temporal to superior cerebellar artery anastomosis for rostral brain stem infarction]. 380 95

A prospective study of mean hemispheric cerebral blood flow (CBF) correlated with clinical status has now been completed for the past 54 months. Thirty-eight patients underwent superficial temporal to middle cerebral artery (STA-MCA) by-pass. They were compared with 22 patients with similar arteriographic lesions and clinical symptoms, treated medically throughout the same interval of time. Assignment to either treatment group was not randomized but depended solely on choice of patient or treating physician. Both groups were matched for age, clinical symptoms, angiographic abnormalities, and CBF values. All patients had proximal occlusion of one internal carotid artery or intracranial occlusive disease of the internal carotid or middle cerebral arteries. CBF measurements and clinical evaluations were repeated at regular intervals up to 54 months following surgery or institution of medical treatment. Mean follow up interval after STA-MCA by-pass was 28.7 months and for medical treatment was 29.7 months. Mean hemispheric CBF values for STA-MCA patients became significantly increased 2 weeks after operation. After that, CBF flow values decreased. At 24 months after surgery, flow values for surgically treated patients were significantly higher than among those treated medically, although there were no differences in flow values between the two groups at 3, 6, 12, 36 and 48 months. Prospective clinical evaluations after STA-MCA by-pass were as follows: 12 (32%) improved with cessation of TIAs and/or neurological improvement, 16 (42%) remained unchanged, 7 (18%) deteriorated (due to new or recurrent strokes) and 3 (8%) expired. Clinical results were the same for medical treatment: 6 (27%) improved, 10 (46%) unchanged, 4 (18%) deteriorated due to new or recurrent stroke, and 2 (9%) expired.
Stroke
PMID:Long-term assessment of cerebral perfusion following STA-MCA by-pass in patients. 396 72


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