Extracranial surgery for the low-flow-endangered brain
R. H. Whitten, W. Gee, H. A. Kaupp and K. M. McDonald
Angiography documented severe (greater than 75%, cross-sectional area)
bilateral carotid stenotic or occlusive disease in 60 patients. One third
of these patients were thought to have transient ischemic symptoms of
low-flow rather than embolic etiology. Preangiographic ocular
pneumoplethysmography (OPG-Gee) was obtained in all patients. Postoperative
OPG studies were obtained in the 39 patients who underwent unilateral
carotid surgery. In seven of the 39 patients who were operated on,
bilateral procedures were performed; OPG studies were obtained after the
second procedure also. Comparison of the preoperative and postoperative OPG
studies provided convincing evidence that the establishment of major
carotid inflow should be the primary objective in patients with severe
bilateral carotid disease, and that distal extracranial-intracranial
reconstruction should be reserved for patients failing to respond to
augmented inflow because of deficient collateral vessels.