el-Fiki M, Chater N L, Weinstein P R
J Neurosurg. 1985 Oct;63(4):521-5. doi: 10.3171/jns.1985.63.4.0521.
The results of superficial temporal to middle cerebral artery bypass surgery for bilateral internal carotid artery occlusion were reviewed in 39 patients. Preoperative symptoms included recurrent transient ischemic attacks (TIA's) in 31 patients (80%) and mild or moderate stroke in 15 (29%). Deficits were unilateral in 23 cases and bilateral in 14. Dementia or personality changes were observed in 19 patients (49%). Operative morbidity occurred in six of 39 cases and was neurological in one; the surgical mortality rate was 8% (three of 39 patients), including two cases of cerebral hemorrhage. The outcome was good or excellent (relief of TIA's and reduction of neurological deficit) in 82% of patients over a follow-up period of 3 to 139 months. Five patients had a late postoperative stroke, which occurred in the unoperated hemisphere in each case; one patient had an ipsilateral TIA 6 years after the bypass procedure. These results suggest that an extracranial-intracranial arterial bypass procedure to augment collateral cerebral blood flow can be performed safely in patients with bilateral internal carotid artery occlusion and may be associated with relief of ischemic symptoms. Future studies may document a role for this procedure in the prevention of stroke.
对39例双侧颈内动脉闭塞患者进行颞浅动脉至大脑中动脉搭桥手术的结果进行了回顾性分析。术前症状包括31例（80%）患者反复出现短暂性脑缺血发作（TIA），15例（29%）患者出现轻度或中度中风。23例患者的神经功能缺损为单侧，14例为双侧。19例（49%）患者出现痴呆或人格改变。39例中有6例发生手术并发症，其中1例为神经功能方面的；手术死亡率为8%（39例患者中有3例），包括2例脑出血。在3至139个月的随访期内，82%的患者预后良好或极佳（TIA缓解，神经功能缺损减轻）。5例患者术后出现晚期中风，均发生在未手术侧半球；1例患者在搭桥手术后6年出现同侧TIA。这些结果表明，对于双侧颈内动脉闭塞患者，为增加大脑侧支血流而进行的颅外-颅内动脉搭桥手术可以安全实施，并且可能缓解缺血症状。未来的研究可能会证明该手术在预防中风方面的作用。
