[Indications for surgical treatment of cerebrovascular insufficiency in patients with occlusive lesions in the brachiocephalic vessels].

The authors studied and operated on 172 patients with cerebro-vascular insufficiency due to occlusional lesions of the brachiocephalic vessels. According to the pre-operational signs of cerebro-vascular insufficiency 4 clinical groups were distinguished; 1) with asymptomatical oclusions; 2) transient disorders of cerebral circulation; 3) with chronic cerebro-vascular insufficiency and 4) with ischemic strokes. On the basis of an analysis of the direct and remote results of reconstructional operations indications to surgical treatment were determined. The best results were obtained in patients of the 1st and the 2nd groups, where the blood flow in the reconstructed vessel was restituted in 74 and 92% of the cases. Poor result of surgical treatment was seen in patients with severe brain lesions, especially after repeated ischemic strokes. However, in patients of the 3d and 4th groups with moderately crude cerebral changes it was possible to restitute the blood flow in 57% of the cases most frequently on the side contralateral to the lesion. The conclusion is made that surgical treatment is definitely indicated in asymptomatic occlusions and transient disorders of cerebral circulation as well as in chronic cerebro-vascular insufficiency and ischemic strokes, if however, the neurological deficiency is moderate.