Lougheed W M, Elgie R G, Barnett H J
Can Med Assoc J. 1966 Dec 17;95(25):1279-93.
Vascular reconstruction was attempted in 109 patients with carotid artery occlusion or stenosis. The follow-up on those with restored or improved flow was as long as nine years (average: two and one-half years).Arteriographic demonstration of lesions is mandatory. Complications were reduced by pre-arteriographic administration of anticoagulants and retrograde brachial arteriographic techniques.Although patients with stenosis are the best candidates, an attempt to restore flow in occluded vessels is warranted in all patients, except those with advanced disease or those who are drowsy and hemiplegic. Flow was restored in two-thirds of those who underwent early operation (under three days) and in one-quarter of those undergoing late operation. Even late operation restored flow in five of nine patients who presented with transient ischemic attacks.IN COMPLETED STROKES, OPERATION SHOULD BE LIMITED TO PATIENTS WITH: (1) minor strokes, (2) extensive strokes of short duration, and (3) extensive strokes of longer duration but with a worth-while outlook.When flow was restored or improved, symptoms were arrested in 93% of patients with transient ischemia, and at follow-up this result was maintained in 86%. Symptoms were arrested in 83% of those with strokes in evolution, and this was maintained at follow-up.Reconstruction combined with anticoagulant therapy of limited duration appears to be the optimal method of treatment.
对109例颈动脉闭塞或狭窄患者尝试进行血管重建。对血流恢复或改善的患者随访长达9年（平均：两年半）。病变的血管造影显示是必不可少的。通过血管造影前给予抗凝剂和逆行肱动脉血管造影技术减少了并发症。虽然狭窄患者是最佳候选者，但除了患有晚期疾病或嗜睡和偏瘫的患者外，对所有患者都应尝试恢复闭塞血管的血流。三分之二接受早期手术（三天内）的患者血流得以恢复，四分之一接受晚期手术的患者血流得以恢复。即使是晚期手术，在出现短暂性脑缺血发作的9例患者中，有5例血流得以恢复。对于完全性中风，手术应限于以下患者：（1）轻度中风；（2）短时间内广泛中风；（3）长时间广泛中风但预后良好。当血流恢复或改善时，93%的短暂性缺血患者症状停止，随访时这一结果保持在86%。83%的进展性中风患者症状停止，随访时这一情况得以维持。重建联合有限疗程的抗凝治疗似乎是最佳治疗方法。
