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Query: UMLS:C0917798 (cerebral ischemia)
 17,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

The long-term clinical results of STA-MCA anastomosis as well as the medical treatments were compared in cases that were confined as having a focal cerebral perfusion deficit with viable brain tissue, based on either the drug induced EEG and evoked potential test (DEE test) and/or by positron emission tomography (PET). The criteria for viable cerebral tissue was determined by the following four conditions: (1) functional reversibility could be confirmed by the DEE test; (2) a haemodynamic process could be found in the DEE test; (3) a haemodynamic compromise could be confirmed in the PET study; (4) misery perfusion could be confirmed in the PET study. From 1975 to 1989, 55 cases were confirmed as having viable brain tissue according to the DEE test and the PET study. Of the 55 cases, bypass surgery was performed on 35. Conservative treatment was given to the other 20 cases. There were 3 cases of perioperative neurological deterioration. One was permanent and the other 2 were transient. Results of the long-term follow up are as follows, Ipsilateral attack: 1 case (2.0%) received surgery, and 7 cases (35%) received conservative treatment. Re-attack in the contralateral or posterior circulation: 6 cases (17.2%) received surgery, and 1 case (5%) received conservative treatment. Seventy-seven per cent of the surgical cases improved or had no change in the final functional status, while only 55% of the conservative group either improved or showed no change. The incidence of ipsilateral cerebral ischaemia was significantly low in the surgical group. Contralateral and/or posterior circulation ischaemia tended to be high in this group, however.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of the clinical results of STA-MCA anastomosis and the medical treatment in the cerebral low perfusion patients with viable brain tissue. 168 45

Anesthetic management during 85 STA-MCA anastomoses with or without encephalo-myosynangiosis for 64 patients with Moyamoya disease was evaluated retrospectively. Anesthetic agents included nitrous oxide-NLA (GONLA), nitrous oxide-halothane (GOF), nitrous oxide-enflurane (GOE), and their combinations. Slight hypercarbia (40 mmHg less than PaCO2 less than 50 mmHg) was essential to avoid cerebral ischemia. Several procedures to control heart rate by beta blockade or to control hypertension by nitroglycerin were required, because tachycardia and hypertension interfered with fine surgical procedure. During microsurgery HR of GONLA anesthetized patients was significantly lower. Postoperatively the patients anesthetized by GOE showed significantly lower PaCO2 compared with the GONLA anesthetized patients. So we recommend GONLA for anastomosis in patients with Moyamoya disease.
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PMID:[Anesthetic management of revascularization for moyamoya disease]. 192 Jul 89

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

Long-term outcome and recurrence rate were discussed in 96 patients of TIA out of 792 of cerebral ischemic disease who were admitted to our hospital during the past 11 years. They all had had attacks in the territory of internal carotid artery. Ninety-three patients could be interviewed finally. They included 63 males and 30 females and the age ranged from 36 to 88 years with an average of 60.5 years. The follow-up period ranged from 4 months to 8 years and 10 months with an average of 3 years and 1 month. Cerebral angiography was performed in 88 patients of them and revealed 16 patients of internal carotid artery stenosis, 12 patients of middle cerebral artery stenosis, 19 patients of severe cerebral arteriosclerosis and 41 patients of normal findings. CT scan was performed in 88 patients and showed abnormal findings in 12 patients. Eleven patients of them had lacunar infarction. Twenty-four patients of arterial stenosis (14 patients of internal carotid artery stenosis and 10 patients of middle cerebral artery stenosis) had surgical treatment of STA-MCA anastomosis (the superficial temporal artery-the middle cerebral artery) and carotid endarterectomy because they were considered to be cause of TIA. The other 69 patients were treated conservatively mainly with antiplatelet therapy. Four of 24 surgical treated patients developed another attack of cerebral ischemia thereafter, 2 patients had TIA of the contra-lateral hemisphere, one had cerebral infarction in the territory of posterior cerebral artery and the rest had lacunar infarction in the contra-lateral basal ganglia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term follow-up study of 93 patients with TIA]. 372 72

STA-MCA anastomosis was performed in a total of eight patients ranging in age from five to 42 years for treatment of symptomatic Moyamoya disease. All of the patients presented with symptoms of cerebral ischemia. In most cases bilateral procedures were performed at separate operations. No patients have experienced increased neurological deficits as a result of surgery, while the ischemic symptoms have been relieved completely in most cases. The surgical procedure is especially demanding in the treatment of Moyamoya disease, but remains one of the few solutions to the treatment of this disease.
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PMID:The treatment of Moyamoya disease by superficial temporal-middle cerebral artery (STA-MCA) anastomosis. 381 65

The combined one-stage operations, STA-MCA anastomosis and internal carotid artery (ICA) ligation (or trapping) were carried out in 11 cases (Age): 18-79 yrs, Av.: 45.8 yrs) of ICA aneurysms which were inaccessible for a direct operation because of their locations and sizes. First the STA-MCA anastomosis was performed under general anesthesia. Then the patient was awaken and thereafter under local anesthesia the ICA was temporarily clamped for 30 min. under induced hypotension to check whether any ischemic signs appeared. This was followed by proximal ICA ligation when no ischemic signs were observed. In all 11 cases, the anastomosis was patent. The aneurysms disappeared. Neither cerebral ischemia nor rebleeding from the aneurysms was seen during the long follow-up. The mean value of the bypass flow was 119 m/min which was twice as much as that in the cases of other occlusive cerebrovascular diseases and which was about one third of the blood flow of the ICA. Cerebral blood flow measurements through 133Xe inhalation method revealed that there was no difference in rCBF values between the operated and non-operated sides and that their values were within normal limits. The postoperative blood pressure was unchanged in 42% of our 11 cases, temporarily elevated and thereafter normalized in 33% and persistently elevated in 25%. Ophthalmodynamometry showed that the pressure of the central retinal artery decreased postoperatively in a degree of 5-10% in comparison to the non-operated side. No visual impairment was observed postoperatively (except case 3, see the text). These combined operations, STA-MCA anastomosis and ICA ligation were beneficial in preventing the potential postoperative cerebral ischemia. Intra-arterial pressure measurements of the STA and MCA suggested that the one-stage operations of these two procedures are better than the two-stage operations for the patency of the anastomosis because the pressure gradient between the donor and recipient vessels is increased (from 10.3 mmHg to 49.3 mmHg) by this technique. Temporary ICA clamp for 30 min. under induced hypotension in local anesthesia is useful to check whether the one-stage operations can be tolerated or not. EC/IC bypass with an interposed saphenous vein graft is a more beneficial surgical technique than a routine STA-MCA anastomosis, because an immediate and larger amount of bypass flow can be obtained.
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PMID:[Extra-intracranial bypass and internal carotid artery ligation in one-stage operation for intracavernous and giant carotid aneurysm]. 664 36

The role of superficial temporal artery--middle cerebral artery (STA-MCA) anastomosis was investigated with an ultrasonic Doppler flowmeter in 3 patients with sphenoid ridge meningiomas and one with a parasellar malignant teratoma, all of which involved the intracranial internal carotid artery. The intraoperative Doppler flow study revealed a remarkable increase in flow volume of the STA after trial occlusion of the middle cerebral artery in one case and permanent occlusion in two cases. These results substantiate the effectiveness of STA-MCA anastomosis. We also discuss surgical and other contrivances for obtaining sufficient blood supply from this bypass to prevent cerebral ischaemia in the acute phase after elective or accidental occlusion of a major cerebral artery. This is the first report of STA-MCA anastomosis in cases with brain tumour.
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PMID:STA-MCA anastomosis in patients with skull base tumours involving the internal carotid artery--haemodynamic assessment by ultrasonic Doppler flowmeter. 674 50

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


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