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Surgical treatment of cerebrovascular occlusive disease. A follow-up study

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Summary

This prospective open study of 124 patients [80% with completed stroke (CS), 16% with TIAS, 4% with PRIND] consecutively admitted between 1976 and 1981 investigates the rates of reinfarction after surgical treatment (extra-intracranial arterial bypass, EIAB and/or carotid thrombendarterectomy, TEA). 34% of patients had unilateral carotid stenosis, 26% unilateral internal carotid artery occlusion, 17% had occlusion of one and stenosis of the contralateral internal carotid artery, 14% bilateral carotid stenosis. Combined surgical morbidity and mortality was 5% after 158 operations in 124 patients; 7 of the 8 complications occurred in patients with CS.

Of the 120 survivors in the immediate postoperative period, after a mean follow-up period of 5.7 years ranging from 3–8 years, an infarct occurred in 5.8%,i.e., 1% per year; 3 of them occurred ipsilaterally, 2 contralaterally to the first infarct, two remained unknown. Among all 99 patients with CS, the reinfarction rate was 5% (1% per year); in CS patients with a minimal follow-up of 5 years, the annual reinfarction rate was 2%. Of fifty-three patients with completed stroke after EIAB with a mean follow-up of 4.6 years, 3.8% suffered reinfarction (0.8% per year). Among 26 patients with CS and unilateral carotid occlusion after a mean follow-up of 4.7 years, the reinfarction rate was 3.9% (0.8% per year). Among 46 patients with carotid occlusion with or without further stenotic or occlusive lesions, the reinfarction rate was 2.2%.

Comparing these follow-up data with results of medical treatment, it is concluded that a combination of surgical treatment and the administration of acetylsalicylic acid can be considered to improve the prognosis of patients with occlusive and/or stenotic cerebrovascular disease.

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Authors and Affiliations

  1. Universitätsklinik für Neurochirurgie, Graz, Austria

    L. M. Auer, R. W. Oberbauer, G. Clarici & R. Pucher

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  1. L. M. Auer
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  2. R. W. Oberbauer
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  3. G. Clarici
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  4. R. Pucher
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Auer, L.M., Oberbauer, R.W., Clarici, G. et al. Surgical treatment of cerebrovascular occlusive disease. A follow-up study. Acta neurochir 82, 102–109 (1986). https://doi.org/10.1007/BF01456368

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