[Surgical prevention and treatment of cerebral ischemia].

Cerebral ischemic attack is a common disease and a major health, social and economic problem. The authors discuss the diagnostics of cerebrovascular insufficiency, and the indications for a surgical intervention. They analyse the frequency of surgical and early postoperative complications in patients undergoing surgery for stenotic changes in the arteries of the aortic arch. In 625 reconstructive procedures performed, operative and early postoperative neurologic deficits were observed in 16 (2.5%) patients. In 5 patients (0.8%), neurologic deficit disappeared during the early postoperative period, while in 11 (1.7%) patients persisted after the patient's discharge from the hospital. This paper also reports the late results of surgical treatment in a group of 62 patients followed up at 4 to 6 years or approximately for five years after operation. The authors also investigate the results of pharmacotherapy in a group of 32 patients who were not willing to accept the recommended surgery and who were followed up for a period of 3 to 6 years or approximately for 4.5 years postangiography. The results of surgical treatment were correlated with the pharmacotherapy results. There is a statistically significant difference to the advantage of surgically treated patients (P less than 0.001). It is concluded that reconstructive interventions on the cervical part of cerebral arteries indicated in the case of obliterative arteriosclerosis seem to prevent or considerably decrease the incidence of recurrent cerebral attack. In addition, the incidence of neurologic surgical deficit is considerably decreased by the routine application of a temporary intraluminal bypass.