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

Among 239 patients with transient ischemic attacks, mild stroke, or transient monocular visual symptoms who had superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass, no deaths occurred during the operation or within 30 days thereafter. After the first month, mortality on an actuarial basis was 3% per year. Survival at 5 years was 84% in comparison with an expected survival of 89% for persons of comparable age and sex in a general population. Among the 25 deaths that occurred during follow-up, 2 were due to stroke and 16 to cardiac causes. Of 28 strokes that occurred, 5 occurred during operation or that same day, and 3 others occurred within 30 days postoperatively. Thereafter, strokes occurred at the rate of 2.5% per year on an actuarial basis; a third of the strokes occurred contralateral to the surgical site. No difference was found in survival or in survival free of stroke among patients who had proven carotid artery occlusion (N = 157), carotid siphon stenosis (N = 53), or MCA stenosis or occlusion (N = 29). In regard to the probability of stroke, this group of patients compares favorably with population studies of patients with transient ischemic attacks of undetermined cause. When this surgical group was compared with 130 nonsurgical patients who had had ischemic symptoms related to proven internal carotid artery occlusion between 1965 and 1975, however, we could not conclude that the risk of occurrence of stroke was less in patients who had STA-MCA bypass than in the nonsurgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term mortality and stroke morbidity after superficial temporal artery-middle cerebral artery bypass operation. 398 76

Seventeen patients with basal occlusive disease have been seen over the past 4 years. Nine of these had a classical moyamoya appearance on angiography. Of these nine, seven were adults and two were children. Eight had ischemic episodes, and one had a hemorrhage. One had neurofibromatosis with a chiasmal glioma and had received radiotherapy. Eight patients underwent superficial temporal-middle cerebral artery (STA-MCA) bypass, and one refused operation. Six patients improved, one had a stroke on the opposite side, and one died. Eight patients had unilateral basal arterial occlusive disease. Of these, three had ischemic episodes, four had hemorrhages, and one had only headaches. Four were adults, and four were children. Five underwent STA-MCA bypass with improvement, one with headaches had an aneurysm treated, and two were not operated upon. Considerations regarding the cause, therapeutic options, and disease course in these patients are discussed.
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PMID:Basal arterial occlusive disease. 408 Jan 27

Hemodynamic changes were examined with an ultrasonic Doppler flowmeter and with a sound-spectrograph in 5 patients with internal carotid giant aneurysms or with recurrent laryngeal cancer undergoing gradual carotid occlusion. The ultrasonic Doppler technique was useful for preoperative assessment of intracranial cross-filling and as a practical guide for the graded reduction of blood flow in the carotid artery. The degree of flow increase in the contralateral carotid artery when the ipsilateral carotid artery was totally occluded was greater in postoperative gradual occlusion than in intraoperative rapid occlusion. In one patient with bilateral internal carotid artery giant aneurysms, whose left internal carotid artery had already been ligated at its origin, gradual occlusion of the right internal carotid artery was performed after the bilateral superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. Flow in the donor artery of the right STA-MCA anastomosis developed with increasing occlusion of the right internal carotid artery.
Stroke
PMID:Ultrasonic Doppler assessment of hemodynamics in gradual carotid ligation. 645 40

Ultrasonic Doppler studies were made pre- and postoperatively in 22 patients undergoing STA-MCA anastomosis. A quantitative evaluation of the bypass was attempted by determining the STA blood flow velocity and pattern. The STA velocity on the Doppler sonogram was compared with the degree of intracranial vascular filling via anastomotic channels and the STA diameter on angiogram. The STA velocity was increased and the blood flow pattern of STA altered from an external carotid pattern to an internal carotid pattern in a patent bypass. The results were in good agreement with angiographic findings. The are of intracranial vascular filling via a vewly formed bypass on angiogram was proportional to the increase in STA velocity. As the STA diameter enlarged, the STA velocity increased progressively. It is suggested the Doppler flowmetry is reliable as a semi-quantitative means of evaluationg the STA-MCA anastomosis.
Stroke
PMID:Ultrasonic evaluation of superficial temporal artery-middle cerebral artery anastomosis. 645 27

A 50-year-old woman noticed right motor and sensory paralysis in the morning of December 15, 1978, which improved gradually to be able to walk during 20 days. She had recurrence of incomplete paralysis of right extremities with speech disturbance and admitted to our department on April 7. Neurological examination revealed right hemiparesis. Plain skull rentogenorgram showed a calcification extending posteriorly from the left anterior clinoid process. CT scan showed a mass lesion located at the left frontal lobe to the ambient cistern. The mass lesion showed high density, but its midportion was isodensity. The left carotid angiogram demonstrated abnormally curved, tortuous and dilated internal carotid artery at the intracavernous portion (C3) to bifurcation (C1). The cerebral circulation time was greatly delayed, which regained about 6 seconds for the visualization of the distal portion of the middle cerebral artery. On the basis of the above, we considered that the first right hemiparesis was due to emboli produced in the dolichoectasia and the following progressive stroke was attributable to the low perfusion demonstrated by a great delay of circulation time. The operation was performed to trap the dolichoectasia after STA-MCA anastomosis. However, trapping procedure was very difficult because of hardness of the distal portion of the involved artery. Therefore, surgery was concluded with STA-MCA anastomosis and only proximal internal carotid clipping. The postoperative angiography demonstrated well functional anastomosis and obliteration of dolichoectasia. She discharged on improvement of her condition on the 23rd day after operation. CT scan performed 6 months after operations showed the mass lesion to have become definitely reduced in size. The application of bypass surgery to the internal carotid dolichoectasia was reported with review of the literatures.
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PMID:[A case of internal carotid dolichoectasia]. 646 50

rCBF was measured by 133Xenon inhalation at rest and during pCO2 manipulation in 19 patients prior to and at various times after STA-MCA bypass surgery. The resting flow increased gradually postoperatively, seemingly more due to progressive clinical recovery from the original neurologic disability than due to the surgical intervention. CO2 reactivity increased in some patients, more in those who preoperatively had the poorest reactivity. The negative relationship between preoperative reactivity and postoperative change in reactivity was highly significant. These observations are consistent with the interpretation that the surgery did not significantly affect the resting flow level but did augment the collateral reserve in those cases in which it had been most severely impaired by the arterial lesion.
Stroke
PMID:The hemodynamic effect of STA-MCA bypass. 680 23

Extracranial to intracranial (EC/IC) microvascular bypass grafts are being performed with increasing frequency for the treatment of cerebral ischemia due to "inaccessible" cerebrovascular disease including carotid artery occlusion and middle cerebral artery occlusion and stenosis. Patency rates, complications, and indications for superficial temporal to middle cerebral artery (STA-MCA) bypass are discussed. EC/IC bypasses can reduce or completely arrest TIAs in selected patients. The long term effect on stroke protection of a functioning STA-MCA bypass is now the subject of multinational controlled investigation.
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PMID:Microvascular bypass procedures for ischemic cerebrovascular disease. 705 5

Regional cerebral blood flow and vasomotor reactivity were measured in 33 patients with surgically remediable hemispheric ischemia by the 133Xe inhalation method prior to superficial temporal to middle cerebral artery (STA-MCA) by-pass. Thirteen patients also underwent LCBF and L lambda measurements by the stable xenon CT method for comparison. Twenty-four had proximal occlusion of one or both internal carotid arteries, 9 had intracranial occlusive disease (4 internal carotid, 5 middle cerebral). Measurements were repeated at intervals up to 30 months following surgery and compared to measurements in a similar group (N = 13) treated medically. In the surgically treated group 22 patients had recurrent TIAs, of whom 12 also had minor residual neurological deficits from recent small cerebral infarctions with potential for recovery (RINDs) while the remaining 11 had RINDs without TIAs. After surgery 28 improved with cessation of TIAs and/or neurological recovery, 3 remained unchanged, 2 cases worsened. Compared to age-matched normal hemispheric F1 (gray matter) values, pre-operative F1 values in the STA-MCA group were reduced in both ischemic and opposite hemispheres. Ischemic regions showed imparied vasomotor reactivity to 5% CO2 or 100% O2 inhalation. After surgery, mean hemispheric F1 values increased + 12.8% on the by-pass side and + 10.5% on the contralateral side. Mean F1 increases reached a maximum 3 months after by-pass, most evident in ipsilateral frontal regions (+ 24.2%). Vasomotor reactivity did not significantly improve. Medically treated cases did not show similar F1 increases. Thirteen with carotid occlusive disease (8 with TIAs, 5 with small recent infarcts) underwent CT LCBF and L lambda measurements before and after STA-MCA by-pass. Cases with recent infarcts showed reduced LCBF and L lambda values which increased significantly after STA-MCA by-pass, however the total group operated upon showed only trends for CBF increases, probably due to large standard deviations encountered in serial measurements.
Stroke
PMID:Redistribution of cerebral blood flow following STA-MCA by-pass in patients with hemispheric ischemia. 714 91

Eight dogs had a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, followed immediately by ligation of the ipsilateral middle cerebral artery. Subsequently, utilizing the radioactive microsphere technique, regional cerebral blood flow determinations were made both before and after ligation of the superficial temporal artery. A significant reduction in blood flow of 20-35% was noted in both cerebral hemispheres, caudate and thalamic nuclei, brain stem and cerebellum following occlusion of the bypass. It is our impression that this generalized reduction in flow is due to a redistribution of blood from normal areas previously supplied by the bypass. This implies that the newly created extracranial to intracranial arterial anastomosis reduces the shunting of blood from zones of higher to zones of lower flow through the circle of Willis and leptomeningeal collaterals. It also suggests a mechanism for the development in neurological function referable to areas of the brain remote from the bypass which is detected in some patients after STA-MCA anastomosis.
Stroke
PMID:Influence of superficial temporal artery to middle cerebral artery bypass on cerebral blood flow in dogs with middle cerebral artery occlusion. 723 68

A 41-year-old Libyan woman with Moyamoya disease and persisting post-stroke neurological deficits was treated by a superficial temporal-middle cerebral artery (STA-MCA) anastomosis. The postoperative angiograms revealed that the STA was rapidly irrigating the territory of the middle cerebral artery including those regions that had been filled preoperatively via different networks of collaterals. Furthermore prompt venous drainage was seen to occur postoperatively. Following surgery EEG analyses revealed considerable increase in the electrical brain activity, and neurological examinations showed reversal of neurological deficits. The dependence of the postoperative neurological improvement on the increased cerebral blood supply through the new collateral channel could be demonstrated by the effect of temporary occlusion of the STA on the electrical brain activity.
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PMID:Superficial temporal-middle cerebral artery anastomosis in Moyamoya disease. 737 42


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