[Possibilities and limitations of surgical therapy of extracranial vascular occlusion causing stroke (author's...

On account of feared postoperative deterioration of the neurological condition and the high mortality, the indication for surgical therapy of a stroke of extracranial origin is often questioned. The mortality rate lies between 6.5% and 42%. Compared with the spontaneous healing process of the apoplectic insult by means of conservative therapy this demonstrates on average a smaller early mortality with a simultaneous higher remission rate of the neurological findings of maximally 70% compared with 48%. 90% of the predominantly arteriosclerotic carotid occlusions occur in the bifurcation area. 40% of the cases undergo additional stenosis or occlusion of the remaining arteries of the brain. Because of the knowledge of the pathogenesis and the pathophysiology of brain oedema on the remaining arteries of the brain. Because of the knowledge of the pathogenesis and the pathophysiology of brain oedema on the one hand, and the periodic relationship of carotid occlusion and incipient thrombosis on the other hand, the 6-hour limit is considered of great significance for operational success. The condition of angiographically-visible intracerebral collateralization and the strict elimination of all patients with unconsciousness or paralysis set forth further important criteria which must be fulfilled before operative procedures are contemplated. The performance of cerebral panangiography gives additional information about stenosis or occlusion of the other arteries. Indications for operation of extracerebral carotid occlusion must be determined individually on the basis of the above-mentioned guidelines.