Edwards W H, Mulherin J L
Am Surg. 1983 Sep;49(9):465-71.
The pathophysiology of transient ischemic attacks (TIAs) is fairly well established. Hemispheric TIAs associated with extracranial carotid lesions have been evaluated extensively. Brain stem insufficiency accounts for between five to 15 per cent of patients with nonneurologic strokes. Basilar artery insufficiency is characterized by "drop attacks," syncope, or bilateral paresthesias. In evaluating some 2,300 patients with cerebral symptoms, we found 361 with brachiocephalic occlusion of such degree that surgery was recommended. We prefer direct anastomosis of the distal subclavian or vertebral artery to its adjacent common carotid artery. We have performed the operation 276 times with a 0% mortality and minimal morbidity. There have been no neurologic deficits as a result of interruption of cerebral flow.
短暂性脑缺血发作（TIA）的病理生理学已相当明确。与颅外颈动脉病变相关的半球性TIA已得到广泛评估。脑干功能不全在非神经性卒中患者中占5%至15%。基底动脉供血不足的特征为“跌倒发作”、晕厥或双侧感觉异常。在评估约2300例有脑部症状的患者时，我们发现361例存在头臂动脉闭塞，其程度已达建议手术的标准。我们更倾向于将锁骨下动脉或椎动脉远端直接吻合至其相邻的颈总动脉。我们已进行该手术276次，死亡率为0%，发病率极低。未因脑血流中断而出现神经功能缺损。
