폐쇄성 뇌혈관 질환의 외과적 치료

Abstract

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery (MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerbellar artery (PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery (ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinks of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial (EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.