Cerebral Microvascular Surgery in Completed Stroke

Abstract

The use of microvascular surgical techniques in the management of transient ischemic attacks has been well known since 1967 when the elegant work of Yasargil⁴ and Donaghy¹ was published. The use of cerebral bypass procedures in patients who have sustained a completed stroke is much less established. It is a generally accepted principle, however, that revascularization procedures are considered to be ineffective when attempting to improve a sustained neurologic deficit of a moderate to severe degree.³ Whether the procedure will be of benefit to this type of patient remains unsettled, and possibly will continue to be unsettled in light of the restrictions placed on microvascular surgeons with the anticipated international multicenter cooperative study of EC-IC bypass surgery. The current study is intended to eliminate patients who have aphasia, dementia, and loss of ambulation from being included as candidates for an extracranial-intracranial bypass procedure.