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September 1954


Author Affiliations


From the Neurological Unit, Boston City Hospital, and the Department of Neurology, Harvard Medical School.

AMA Arch NeurPsych. 1954;72(3):296-312. doi:10.1001/archneurpsyc.1954.02330030030003

THE IMPORTANCE of collateral circulation in the brain has been evident since the observations of Astley Cooper on ligation of the common carotid artery in man1 and ligation of the principal cerebral vessels in the dog.2

It is also common neurological experience that there is considerable variation in capacity for adjustments in the cerebral circulation from one person to another, for carotid occlusion in one person may occur without symptoms, whereas the infarction of most of a cerebral hemisphere may follow in another. The anatomical explanation for this is, in part, the variation in size of the communicating arteries of the circle of Willis. Such variation of collateral circulation prompts the neurosurgeon to compress the carotid artery preoperatively as a test of collateral circulation before ligating this vessel. Recent experience with arteriography has shown that some persons may successfully survive for years without either one or the other