A Historical Survey of Extra-Intracranial Anastomosis

Abstract

The possible occlusion of the internal carotid artery or its branches has been known for centuries. As far back as 1684, Sir Thomas Willis described such an occlusion, and in 1818, Abercrombie reported a carotid occlusion associated with a cerebral focus. Cohnheim (1872) and Wernicke (1881) assumed that intracerebral changes were caused by occlusions or stenoses of the large afferent arteries. It was not until 1905 that a systematic pathological study of carotid occlusions was published (Chiari 1905). During the following decades, these findings were further supported by additional research work, but surgery was out of the question for lack of technical means. Therefore no measures could be taken to prevent an imminent stroke by eliminating a stenosis in the large afferent vessels. Due to insufficient knowledge in regard to the pathophysiology and pathogenesis of cerebral vascular occlusions and their symptoms, incorrect methods were adopted. For example, in selected cases a section of the stenosed carotid vessel was completely ligated to prevent embolism in cerebral vessels.