Indications for surgical intervention in middle cerebral artery obstruction

1984 ◽  
Vol 60 (2) ◽  
pp. 296-304 ◽  
Author(s):  
Arthur L. Day
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Intervention ◽  
Carotid Bifurcation ◽  
High Grade ◽  
Content Type ◽  
High Incidence ◽  
Collateral Vessels ◽  
Artery Obstruction ◽  
Fine Print

✓ The clinical, angiographic, and surgical characteristics of 31 patients with high-grade middle cerebral artery (MCA) stenosis or occlusion (jointly termed “MCA obstructions”) referred for cerebral revascularization by extracranial-intracranial (EC-IC) bypass are reviewed. Overall, 12 (66%) of the 18 patients with stenosis and all 13 (100%) of those with complete occlusion experienced clinically evident infarctions. Twenty-five of these patients underwent arteriography at least twice during their clinical course. Eleven (44%) demonstrated significant improvement in flow or complete resolution of obstruction on their second study. Ten of these 11 were patients in whom the initial arteriography was done within 2 weeks of symptom onset. Five other patients with stenosis exhibited obstruction that was worse on serial arteriography without surgical intervention. The high incidence of resolution of MCA obstructions indicates that surgery should not be contemplated in most instances until delayed arteriography has been performed, at least 6 weeks after the onset of symptoms. Proximal embolic sources, such as the cervical carotid bifurcation, should receive carotid endarterectomy and repeat arteriography in appropriate patients prior to consideration of EC-IC bypass. Persistent high-grade MCA obstructions are thereafter potential candidates for EC-IC bypass, since leptomeningeal collateral vessels are marginal in their protective ability. Overall, of 15 patients who underwent an EC-IC bypass procedure, 14 were either stable or improved postoperatively, and 13 have been free of any further ischemic events without the use of major anticoagulant agents.

Middle meningeal to middle cerebral arterial bypass for cerebral revascularization

1979 ◽  
Vol 50 (6) ◽  
pp. 802-804 ◽  
Author(s):  
Clinton F. Miller ◽  
Robert F. Spetzler ◽  
Dennis J. Kopaniky
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Meningeal Artery ◽  
Cerebral Revascularization ◽  
Content Type ◽  
Arterial Bypass ◽  
Meningeal Artery ◽  
Fine Print

✓ A case is reported of successful anastomosis of the middle meningeal artery to a cortical branch of the middle cerebral artery. Based on the analyses of 50 random angiograms, the authors discuss the circumstances in which such an anastomosis might be practical and indicated.

Posttraumatic bilateral middle cerebral artery occlusion

1975 ◽  
Vol 42 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Skip Jacques ◽  
C. Hunter Shelden ◽  
D. Thomas Rogers ◽  
Anthony C. Trippi
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Cerebral Artery Occlusion ◽  
Fine Print

✓ The authors report a case of bilateral posttraumatic middle cerebral artery occlusion. Previously reported unilateral cases are reviewed and possible pathophysiological mechanisms disscussed.

Angiographic extravasation of contrast medium in acute traumatic subdural hematoma from arterial rupture

1972 ◽  
Vol 37 (2) ◽  
pp. 226-228 ◽  
Author(s):  
Jusuke Ito ◽  
Komei Ueki ◽  
Hisayuki Ishikawa
Keyword(s):  
Contrast Medium ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Subdural Hematoma ◽  
Carotid Angiography ◽  
Content Type ◽  
Arterial Rupture ◽  
Visual Evidence ◽  
Subpial Hemorrhage ◽  
Fine Print

✓ Carotid angiography of a patient with suspected subdural hematoma showed extravasation of the contrast medium from an ascending branch of the middle cerebral artery. The leak was verified at operation. There was no visual evidence of an aneurysm, angioma, subarachnoid or subpial hemorrhage.

Delayed breaking of a Heifetz aneurysm clip

1977 ◽  
Vol 47 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Antti Servo ◽  
Matti Puranen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Aneurysm Clip ◽  
Correct Placement ◽  
Left Middle ◽  
Fine Print

✓ An aneurysm of the left middle cerebral artery was treated by clipping with a Heifetz clip. The correct placement was confirmed angiographically immediately after the operation. At carotid angiography 1 year later the clip was found to have broken, and the aneurysm had increased in size.

The perforating branches of the middle cerebral artery

1985 ◽  
Vol 62 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Felix Umansky ◽  
Francisco B. Gomes ◽  
Manuel Dujovny ◽  
Fernando G. Diaz ◽  
James I. Ausman ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Interventional Neuroradiology ◽  
Great Majority ◽  
Outer Diameter ◽  
Main Trunk ◽  
Content Type ◽  
Brain Hemispheres ◽  
Medial Group ◽  
Fine Print

✓ The perforating branches (PFB's) of the middle cerebral artery (MCA) were studied in 34 unfixed brain hemispheres which were injected with a polyester resin and dissected under the operating microscope. Five hundred and eight vessels were identified and their site of origin, branching pattern, outer diameter (OD), and length recorded. Four hundred and two PFB's (79%) originated from the main trunk of the MCA before its division; the remaining 106 vessels (21%) had their origin from branches of the MCA as follows: superior trunk, 43 vessels (8.5%); inferior trunk, 30 vessels (6%); middle trunk, four vessels (0.8%); early temporal branch, 27 vessels (5.3%); and early frontal branch, two vessels (0.4%). The number of PFB's in each hemisphere varied from five to 29 (mean 14.9 ± 0.7 vessels). The great majority of PFB's (96%) originated along the proximal 17 mm of the MCA. The PFB's arising in the first 10 mm had a mean OD of 0.35 ± 0.01 mm and a mean length of 9.25 ± 0.19 mm, and those arising from the second 10 mm had a mean OD of 0.47 ± 0.02 mm and a mean length of 16.67 ± 1.4 mm. A clear distinction between a medial and lateral group of PFB's was present in only 14 hemispheres (41%). In nine hemispheres (26%), perforating vessels from the anterior cerebral artery (A1 segment) and from the recurrent artery of Heubner replaced the medial group of PFB's of the MCA. In one case this group originated in an accessory MCA. In three hemispheres (9%) a small anastomosis (OD 0.2 mm) was seen between a PFB of the recurrent artery of Heubner and one of the MCA. From a total of 508 PFB's, 255 vessels (50%) originated as single vessels, while 253 vessels (50%) originated as branches of common stems. The OD of the single vessels ranged from 0.1 mm to 1.1 mm (mean 0.39 ± 0.02 mm), and the length from 3 to 20 mm (mean 10.8 ± 0.2 mm). The common stems ranged in OD from 0.6 to 1.8 mm (mean 0.87 ± 0.04 mm), and in length from 1 to 15 mm (mean 4.1 ± 0.4 mm). The clinical application of these anatomical data to the management of aneurysms and arteriovenous malformations of the MCA, and in the field of interventional neuroradiology is described. The most frequent pathological entities involving the perforating vessels are also discussed.

Superficial temporal-middle cerebral artery bypass

1979 ◽  
Vol 51 (4) ◽  
pp. 455-465 ◽  
Author(s):  
Richard E. Latchaw ◽  
James I. Ausman ◽  
Myoung C. Lee
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Change Over Time ◽  
Content Type ◽  
Over Time ◽  
Fine Print ◽  
Temporal Middle

✓ Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced. The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation, with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.

Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion

1985 ◽  
Vol 62 (6) ◽  
pp. 831-838 ◽  
Author(s):  
Brian T. Andrews ◽  
Norman L. Chater ◽  
Philip R. Weinstein
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Slight Reduction ◽  
Content Type ◽  
Perioperative Stroke ◽  
Arterial Bypass ◽  
Mca Occlusion ◽  
Bypass Patency ◽  
Completed Stroke ◽  
Fine Print

✓ Forty-seven patients with middle cerebral artery (MCA) stenosis and 18 patients with MCA occlusion underwent extracranial-intracranial arterial bypass procedures. Patients presented with a history of transient ischemic attacks (TIA's), reversible ischemic neurological deficits, TIA's after initial stroke, stroke-in-evolution, or completed stroke. Angiography revealed that the MCA stenosis ranged from 70% to over 95%. Two patients (4.3%) in the stenosis group had a perioperative stroke (within 30 days of operation). There was no perioperative mortality. In the occlusion group, no patient had a perioperative stroke, and one patient (5.5%) died from a non-neurological disease. The TIA's resolved completely in 90% of the patients with stenosis and in 91.6% of those with occlusion. No patient with MCA stenosis had a late ipsilateral stroke, although five had a contralateral or vertebrobasilar stroke. One patient with MCA occlusion had a late ipsilateral stroke. The bypass patency rate at late follow-up review was 100%. The results of intracranial-extracranial arterial bypass procedures appear to be similar for patients with either stenosis or occlusion of the MCA. Symptomatic relief of TIA's was excellent and, in two patients with progressive stroke-in-evolution, the deficit was stabilized. The incidence of postoperative ipsilateral stroke was low in patients with TIA's alone or with TIA's after an initial stroke, but among patients with completed stroke, improvement was confined to slight reduction in the neurological deficit.

Proximal occlusion of the middle cerebral artery in C57Black6 mice: relationship of patency of the posterior communicating artery, infarct evolution, and animal survival

2004 ◽  
Vol 100 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Kazuhide Furuya ◽  
Nobutaka Kawahara ◽  
Kensuke Kawai ◽  
Tomikatsu Toyoda ◽  
Keiichiro Maeda ◽  
...  
Keyword(s):  
Survival Rate ◽  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Focal Cerebral Ischemia ◽  
Infarct Volume ◽  
Posterior Communicating Artery ◽  
Neurological Deficits ◽  
Content Type ◽  
Fine Print

Object. The intraluminal suture model for focal cerebral ischemia is increasingly used, but not without problems. It causes hypothalamic injury, subarachnoid hemorrhage, and inadvertent premature reperfusion. The patency of the posterior communicating artery (PCoA) potentially affects the size of the infarct. In addition, survival at 1 week is unstable. The authors operated on C57Black6 mice to produce proximal middle cerebral artery occlusion (MCAO) so that drawbacks with the suture model could be circumvented. Methods. The MCA segment just proximal to the olfactory branch was occluded either permanently or temporarily. After 1 hour of MCAO the infarct volume was significantly smaller than that found after 2 hours or in instances of permanent MCAO. The differences were assessed at 24 hours and 7 days after surgery (p < 0.05 and p < 0.001, respectively). The patency of the PCoA, as visualized using carbon black solution, did not correlate with the infarct size. Neurologically, the 1- and 2-hour MCAO groups displayed significantly less severe deficits than the permanent MCAO group on Days 1, 4, and 7 (p < 0.005 and p < 0.01, respectively). Although the infarct size, neurological deficits, and body weight loss were more severe in the permanent MCAO group, the survival rate at Day 7 was 80%. Conclusions. This model provides not only a robust infarct size (which is not affected by the patency of the PCoA), but also a better survival rate.

Ruptured aneurysms of the proximal middle cerebral artery

1973 ◽  
Vol 39 (4) ◽  
pp. 498-502 ◽  
Author(s):  
Matej Lipovšek
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bed Rest ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Carotid Ligation ◽  
Angiographic Evidence ◽  
Proximal Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ In 57 patients with proximal middle cerebral artery aneurysms, two forms of treatment are reviewed, namely, bed rest and common carotid ligation. Patients who had no angiographic evidence of spasm or accompanying hematoma did better with carotid ligation than with bed rest if they were treated within the first week of the onset of subarachnoid hemorrhage.

Dural-cortical anastomosis in pial arteriovenous malformation

1979 ◽  
Vol 50 (4) ◽  
pp. 522-524 ◽  
Author(s):  
Shiro Waga ◽  
Atsunori Morikawa ◽  
Tadashi Kojima
Keyword(s):  
Arteriovenous Malformation ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Meningeal Artery ◽  
Review Of The Literature ◽  
Total Removal ◽  
Content Type ◽  
Posterior Parietal ◽  
Meningeal Artery ◽  
Fine Print

✓ A patient is reported with a purely pial arteriovenous malformation (AVM) supplied from the posterior parietal artery. The prominent middle meningeal artery contributed to opacification of the angular branches distal to the AVM, but did not contribute to the AVM. After total removal of the AVM, the angular branches became opacified from the middle cerebral artery. Review of the literature suggests that hypertrophied dural arteries which do not contribute to the AVM's but which do opacify the cortical branches distal to the AVM's are rare.

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