IN THE MANAGEMENT of patients who require deliberate occlusion of the extracranial vascular supply to the brain, for whatever cause, reliable assessment of the tolerance to such occlusive procedures is critical.
The search for these techniques of assessment has brought insight into multiple facets of cerebral metabolism, functional survival, and circulatory dynamics; but indicators of function that can be reliably and safely measured and that give us infallible predictions as to the safety of the surgical procedures, are still needed.
The following is a consideration of certain of those techniques of assessment which can be used before, during, or after deliberate cervical artery occlusion for intracranial vascular disease.
Techniques of Assessment
Clinical Trial of Occlusion.—
The clinical trial is, of course, the most meaningful test, but there are problems in its interpretation, and its application is not without risk.1,2 Six of these risks are the following: (1) A
Stern WE. Circulatory Adequacy Attendant Upon Carotid Artery Occlusion. Arch Neurol. 1969;21(5):455–465. doi:10.1001/archneur.1969.00480170027002
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