Weiss K, Firt P, Hejhal L
Czech Med. 1980;3(3):206-12.
Indications for reconstruction operations in the region of branches of the arch of the aorta must be based on a comprehensive evaluation of the neurological and angiographic finding and the general condition of the patient. This ensues from the experience assembled in more than 800 operations performed since 1959. To evaluate the surgical risk, a scoring system was elaborated which evaluates the partial risks of each basic aspect of indication. Based on the sum of partial risks, four grades were defined. Patients who meet the prerequisites for surgical risk I and II (mainly with transient ischaemic attacks and asymptomatic stenoses of the internal carotid artery) can be indicated, with regard to hitherto assembled results, unequivocally for reconstructions. In grade IV risk it is essential to consider whether the risk of the natural course is greater than the risk of the operation and whether the affection of the afferent cerebral artery is the main limiting factor. The authors discuss contemporary views on indications of acute reconstructions of stenoses and occlusions of the internal carotid artery based on the neurological and angiographic factor and the time factor. From the evaluation of results of 92 urgent operations on account of recent or imminent symptoms of cerebral ischaemia ensues that for the result the grade and dynamics of the ischaemic cerebral affection at the time of the operation are decisive.
主动脉弓分支区域重建手术的指征必须基于对神经学和血管造影结果以及患者一般状况的全面评估。这是根据自1959年以来进行的800多次手术积累的经验得出的。为了评估手术风险，制定了一个评分系统，该系统评估指征各个基本方面的部分风险。根据部分风险的总和，定义了四个等级。根据迄今积累的结果，符合手术风险I和II级先决条件（主要是短暂性脑缺血发作和颈内动脉无症状狭窄）的患者可以明确地进行重建手术。在IV级风险中，必须考虑自然病程的风险是否大于手术风险，以及传入脑动脉的病变是否是主要限制因素。作者基于神经学和血管造影因素以及时间因素，讨论了关于颈内动脉狭窄和闭塞急性重建指征的当代观点。从对92例因近期或即将出现脑缺血症状而进行的紧急手术结果的评估中可以看出，对于结果而言，手术时缺血性脑病变的等级和动态情况起决定性作用。
