{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:33:55Z","timestamp":1715553235250},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1984,2]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 The clinical, angiographic, and surgical characteristics of 31 patients with high-grade middle cerebral artery (MCA) stenosis or occlusion (jointly termed \u201cMCA obstructions\u201d) referred for cerebral revascularization by extracranial-intracranial (EC-IC) bypass are reviewed. Overall, 12 (66%) of the 18 patients with stenosis and all 13 (100%) of those with complete occlusion experienced clinically evident infarctions. Twenty-five of these patients underwent arteriography at least twice during their clinical course. Eleven (44%) demonstrated significant improvement in flow or complete resolution of obstruction on their second study. Ten of these 11 were patients in whom the initial arteriography was done within 2 weeks of symptom onset. Five other patients with stenosis exhibited obstruction that was worse on serial arteriography without surgical intervention.<\/jats:p>\n<jats:p content-type=\"fine-print\">The high incidence of resolution of MCA obstructions indicates that surgery should not be contemplated in most instances until delayed arteriography has been performed, at least 6 weeks after the onset of symptoms. Proximal embolic sources, such as the cervical carotid bifurcation, should receive carotid endarterectomy and repeat arteriography in appropriate patients prior to consideration of EC-IC bypass. Persistent high-grade MCA obstructions are thereafter potential candidates for EC-IC bypass, since leptomeningeal collateral vessels are marginal in their protective ability. Overall, of 15 patients who underwent an EC-IC bypass procedure, 14 were either stable or improved postoperatively, and 13 have been free of any further ischemic events without the use of major anticoagulant agents.<\/jats:p>","DOI":"10.3171\/jns.1984.60.2.0296","type":"journal-article","created":{"date-parts":[[2009,5,8]],"date-time":"2009-05-08T16:23:03Z","timestamp":1241799783000},"page":"296-304","source":"Crossref","is-referenced-by-count":16,"title":["Indications for surgical intervention in middle cerebral artery obstruction"],"prefix":"10.3171","volume":"60","author":[{"given":"Arthur L.","family":"Day","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1161\/01.STR.12.2.228","article-title":"Embolism distal to stenosis of the middle cerebral artery.","volume":"12","author":"Adams","year":"1981"},{"key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"353","DOI":"10.3171\/jns.1967.27.4.0353","article-title":"Occlusion of the middle cerebral artery: serial angiography as a guide to conservative therapy.","volume":"27","author":"Allcock","year":"1967"},{"key":"b3","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1161\/01.STR.12.4.454","article-title":"Reversal of focal \u201cmisery-perfusion syndrome\u201d by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. 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