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Disabling cerebral transient ischemic attacks.

P W McCormick1, F J Tomecek, J McKinney

  • 1Department of Neurological Surgery, Henry Ford Neurosurgical Institute, Detroit, Michigan.

Journal of Neurosurgery
|December 1, 1991
PubMed
Summary
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Surgical revascularization effectively treats disabling transient ischemic attacks (TIAs) when medical therapy fails. This approach offers significant symptom resolution and improved quality of life for patients with severe neurological dysfunction.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Cerebrovascular Surgery

Background:

  • Disabling transient ischemic attacks (TIAs) represent a significant clinical challenge, often refractory to maximal medical therapy.
  • Identifying patients with severe lifestyle restriction due to recurrent TIAs is crucial for considering advanced treatment options.

Observation:

  • Nineteen patients with disabling TIAs underwent detailed vascular assessment, including four-vessel angiography and xenon cerebral blood flow studies.
  • Seventeen patients received surgical bypass procedures, including superficial temporal artery (STA)-middle cerebral artery (MCA) and aorta-carotid artery bypasses.
  • Perioperative complications included one death and four strokes.

Findings:

  • Of the 16 surviving surgically treated patients, 81% experienced excellent to good outcomes with complete TIA resolution.

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  • Two patients managed medically continued to have vertebrobasilar insufficiency episodes.
  • Surgical revascularization demonstrated a high success rate in improving neurological function and reducing TIA frequency.

    • Implications:

    • Cerebral revascularization surgery may be a viable option for carefully selected patients with disabling TIAs unresponsive to medical management.
    • Despite high perioperative risks in this unstable patient group, surgical intervention offers substantial long-term benefits.
    • Further research into the natural history and optimal management of disabling TIAs is warranted.