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August 1970

Centrifugal Cerebral Ischemia

Author Affiliations

New Orleans
From the Department of Surgery, Tulane University School of Medicine and Charity Hospital of Louisiana, New Orleans.

Arch Surg. 1970;101(2):155-160. doi:10.1001/archsurg.1970.01340260059010

Eighteen of twenty patients with subclavian or innominate artery obstruction experienced episodes of transient cerebral arterial insufficiency; one patient suffered acute stroke and coma; all patients had angiographic evidence of subclavian or innominate artery obstruction; and most were shown to have retrograde flow in a vertebral artery. Two clinical patterns were apparent by arteriographic studies. Six patients had single lesions of a subclavian artery resulting in centrifugal cerebral ischemia. A second group of 14 patients had other significant lesions of either the carotid or vertebral-basilar arterial systems. Carotid-subclavian bypass or aorto-subclavian bypass are the preferred methods of reconstruction of subclavian obstructions. Of these two approaches, the extrathoracic procedure is preferable.