J.Jpn. Surg. Soc.. 80(12): 1602-1606, 1979

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Report on the annual meeting

SURGICAL TREATMENT IN THE ACUTE STAGE OF CEREBRAL INFARCTION

Cerebral tissue is considered to be very susceptible to ischemia and experimental anoxia for 4-5 minutes is reported to be enough long to produce irreversible changes of neuron. Clinical ischemia is, however, quite different from such total anoxia because of the existence of collateral circulation. Some clinical and experimental data indicate functional reversibility of neuron even in much longer lasting ischemia for several hours. Besides, acute revascularization is considered to prevent cerebral edema and hemorrhagic infarction which usually take place in cases with spontaneous recanalization in occlusions of the internal carotid artery (ICA) or the middle cerebral artery (MCA).
Six cases treated with revascularization procedure in the acute stage (within 48 hours) of cerebral infarction have been documented. Either microsurgical STA-MCA bypass or thromboembolectomy of the MCA have been used as revascularization procedure. Remarkable functional reversibility was obtained in the case of MCA embolectomy performed within 8 hours after a MCA embolism. Two cases of stroke in evolution revealed also good functional reversibility. The other three cases remained unchanged in neurological findings but revealed no signs of hemorrhagic infarction except one case with incomplete documentation.
These encouraging results coincides well with the above mentioned thesis. Revascularization within six to eight hours seems to be the time limit to obtain functional reversibility. Brain protective agent against ischemia such as barbiturates or other measures might prolong the time limit.

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