Brain revascularization in acute stroke situation. Results and indications.

1. REVASCULARISATION OF THE BRAIN IN ACUTE STROKE P. Pauliukas A. Mackevičius Vilnius University Emergency Hospital Department of Vascular Surgery

2. Brain blood flow levels Normal brain perfusion Reversible ischemia Non reversible ischemia Jones et al., 1981 Heiss & Rosner, 1983 “ Stroke. A practical guide to management” Warlow et al 1996

8. Results of brain revascularisation

9. 16% of patients have had critical stenoses of both internal carotid arteries ( ICA )

10. 23% of patients have had critical ICA stenosis on one side and ICA occlusion on the other side

11. Acute thrombosis of the critically stenosed right internal carotid artery ( emergency endarterectomy restored blood flow ) and chronic occlusion of the left internal carotid artery

12. Aplasia of the right vertebral artery and loop with kink of the left vertebral artery ( v/b stroke cleared after reconstruction, using internal shunt, of the kinked left vertebral artery )

13. Critical stenosis of the left ICA, loop with kink of the right vertebral artery and steal through the left cervical ascendens artery ( left subclavian and vertebral artery are occluded at their origins )

14. Critical stenosis of the left ICA, loop with kink of the right vertebral artery and steal through the left cervical ascendens artery ( left subclavian and left vertebral arteries are occluded ). The same patient as in previous slide

15. Distal autovenous shunt from the common carotid artery to the occluded left vertebral artery at the atlas level

16. CONCLUSIONS

18. Vilnius University Emergency Hospital