Special Problems Associated With Surgical and Thrombolytic Treatment of Strokes

IN RECENT years many new approaches to the treatment of cerebral infarction due to occlusive cerebral vascular disease have appeared. The most important of these have been anticoagulants,1,2fibrinolytic agents,3-5and surgical excision of occlusive lesions in the major extracranial arteries supplying the brain.6-8The previous hopeless, helpless attitude of the physician treating the stroke patient has, as a result, been replaced by enthusiasm for these as yet incompletely evaluated methods. In recent months this fervor has been further stimulated by the report of the President's Commission on Heart Disease, Cancer and Stroke.9This paper will describe special complications of surgical and thrombolytic procedures which deserve attention and present very recent advances in surgical concept and technique which promise to overcome areas of potential difficulty and to markedly improve present therapeutic results.10,11 This report is based on an analysis of 97 operative procedures in the