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Surgical treatment of cerebrovascular occlusive disease
1Department of Neurosurgery, University of Tennessee, Memphis 38163.
Insights
Surgical treatments for blocked arteries in the brain, like carotid endarterectomy, are well-established. While other procedures are under review, carotid endarterectomy remains a key therapy for specific conditions.
Area of Science:
- Neurology
- Vascular Surgery
- Cerebrovascular Medicine
Background:
- Cerebrovascular occlusive disease presents complex therapeutic challenges.
- Surgical interventions have evolved significantly throughout history.
- Carotid endarterectomy is the predominant surgical procedure for these conditions.
Purpose of the Study:
- To review the historical context and current status of surgical therapies for cerebrovascular occlusive disease.
- To evaluate the established role of carotid endarterectomy.
- To discuss the future prospects of extracranial-intracranial bypass surgery.
Main Methods:
- Historical review of surgical techniques for cerebrovascular occlusive disease.
- Analysis of the current clinical standing of carotid endarterectomy.
- Discussion of prospective studies and clinical scrutiny of bypass procedures.
Main Results:
- Carotid endarterectomy is a widely accepted and practiced surgical intervention.
- The superficial temporal middle cerebral artery bypass is the only extracranial-intracranial procedure with prospective study data.
- Significant debate exists regarding the future utility of extracranial-intracranial bypass.
Conclusions:
- Carotid endarterectomy is a proven and established therapy for selected cases of carotid stenosis and ulceration.
- The long-term future of extracranial-intracranial bypass surgery is uncertain.
- Further prospective studies are likely to refine the role of carotid endarterectomy.
Abstract:
Surgical therapy for cerebrovascular occlusive disease has a rich and fascinating history. Carotid endarterectomy is the most commonly performed operation for cerebrovascular disease. Other ingenious efforts have been tried and, of these, only the superficial temporal middle cerebral artery bypass procedure has been prospectively studied. All efforts at extracranial and intracranial vascular surgery are under scrutiny presently and many feel that the extracranial-intracranial bypass procedure has little, if any, future. The efficacy of carotid endarterectomy will probably be studied prospectively, but, for the immediate future, endarterectomy is a well-established therapy for certain cases of carotid stenosis or ulceration.