Surgical Management of Cerebral Vascular Insufficiency

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Abstract
The commonest cause of cerebral vascular insufficiency is arteriosclerotic involvement of the caroticovertebral system. Although the significance of these lesions in patients with cerebral arterial insufficiency was recognized by Chiari1 and Hunt6 decades ago, the segmental nature of arteriosclerosis and recognition of early clinical manifestations of carotid and vertebral artery occlusion were not described until recent years.5,7 Early attempts in the treatment of these occlusive lesions, such as procaine (Novocain) block of the cervical sympathetic ganglion, denervation of contralateral carotid sinus, and establishment of caroticojugular fistula, proved ineffective. Renewed effort was urged for direct arterial surgery. The accumulated experience with other segmental arterial lesions and development of carotid angiography9 led to the application of operative procedures which had proved effective in surgery of aortoiliac and femoropopliteal occlusions. Satisfactory results following endarterectomy,2 excisional treatment,4,8 and grafting procedures3 of the involved arteries introduced a new

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