Millikan, Clark H.

Precise use of categorical terms and definitions is mandatory in discussing the use of anticoagulants in treating occlusive cerebrovascular disease. The components of the temporal profile of the disease are described. Six reports have appeared which describe the results of anticagulant therapy in transient cerebral ischemic attacks. From these six studies it is concluded that anticoagulant therapy significantly decreased the risk of cerebral infarction in patients who had attacks of transient focal cerebral ischemia. In the few carefully performed investigations of the use of anticoagulant for acute progressing stroke the evidence points to the lack of progression in patients receiving treatment when compared to individuals not getting such drugs. There continues to be a definite difference of opinion about the results of anticoagulant therapy in completed stroke. If anticoagulant is to be administered on a long-term basis, it must be considered dangerous and every effort made to control the level of anticoagulant action precisely. Hypertension must be effectively controlled.

The immediate postoperative cerebral complications of 65 carotid occlusions were evaluated. The occlusions were done in all but one case for intracranial saccular aneurysms and were performed by either direct ligation (quick type) or slow turning down of a Silverstone clamp or similar device (slow occlusion). Cerebral complications occurred in 21 patients. The quick type of occlusion of the artery resulted in a complication rate of 24% whereas the slow type had a rate of 38%. A total of 123 cases involving cerebral complications after carotid ligation were collected from the literature and evaluated. The combined total of 81 cases of transient complications that were collected from the literature and from our series showed that such deficits occur frequently from 10 minutes to six hours after the occlusion of the vessel.