STA-MCA bypass in bilateral carotid artery occlusion: Clinical results and long-term effect on cerebrovascular reserve capacity

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Abstract
In this report we describe our experience with extracranial-intracranial arterial bypass surgery in a subgroup of 9 patients (mean age at surgery 67±9 years) with bilateral carotid artery occlusioni, unilaterally symptomatic for occlusive cerebrovascular disease of haemodynamic origin. Haemodynamic insufficiency is characterized by a severely reduced cerebrovascular reserve capacity, measured with Xe-133 D-5PECT and acetazolamide challenge. Preoperatively, the mean baseline cerebral blood flow of 54 ± 6 ml 100 g–1 min–1 did not change after challenge (54 ± 5 ml 100 g–1 min–1) in the symptomatic hemisphere. Immediately following surgery an improvement in cerebrovascular reserve capacity for up to 14 ± 8 ml 100 g–1 min –1 (1-2 years control) was noted. One patient subsequently died from a perioperative stroke, another patient died three months post-operatively from a myocardial infarction. Three patients were followed up to 4 years, four for 2 years. Patients with former transient ischaemic attacks had no further attackssymptoms from PRIND or minor stroke did not progress further, nor did new symptoms occur. Unilateral extracranial-intracranial bypass surgery has a positive effect on clinical outcome in highly selected patients with bilateral carotid artery occlusion and cerebral ischaemia of haemodynamic origin. [Neurol Res 1994; 16: 104-107]

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