Angiographic Collateral Circulation of Cerebral Artery Occlusion and Rehabilitation

1970 The Japanese Journal of Rehabilitation Medicine  
In the previous paper we made on the analysis of the relation between the cerebral angiographic findings and the rehabilitation effects in postapoplectic hemiplegic patients the cerebral artery occlusion was stated to be found in 41 cases out of 315 cases. In the cases of cerebral artery occlusion, it was observed that the recovery of the ADL (Activity of Daily Living) was generally delayed and the poor development of collateral circulation to be formed after the cerebral artery occlusion would
more » ... play a great role. This paper describes on the relation betweenn the development of collateral circulation and the rehabilitation effect. (1) Of 13 cases of internal carotid artery occlusion, the angiographic collateral circulation was observed in 9 cases, namely 6 cases through Willis circle, 1 case of anastomosis with arteria ophthalmica, 1 case of arteria occipitalis and 1 case of the formation of new artery. (2) Among 28 cases of intracranial cerebral artery occlusion, which included 23 cases of middle cerebral artery occulusion and 5 cases of anterior cerebral artery occlusion, the angiographic collateral circulation was observed in 19 cases, Nearly all of them had pial anastomosis with the cerebral trunk artery on the same side, and partially with the external carotid artery system. The formation of new artery was observed in 1 case. (3) The ADL in 12 cases of cerebral artery occlusion in which the angiographic collateral circulation was not observed, regardless of whether the case be the internal carotid artery occlusion or the intracranial artery occlusion, was entirely dependent in natural recovery (below 30% in evaluation of ADL), and even after rehabilitation practice, more than half of them were dependent and the rehabilitation potential was thought extremely low. (4) The 28 cases in which the collateral circulation was observed showed better rehabilitation effects than those 12 cases in which the collateral circulation was not observed. Two cases which received dual collateral blood supply from two systems of anterior cerebral artery and posterior cerebral artery in the same side of the focus were independent in the ADL (being over 90% in ADL), in good mental activity, and free from urinary and fecal incontinences, postapoplectic epilepsia and risk of recurrence. (5) Among collateral circulations in the cases of cerebral artery occlusion, the collateral circulation through Willis circle was the most effective to recovery of ADL, and was followed by the peripheral anastomosis between intracranial cerebral arteries. The recovery was especially good in the cases in which the anastomosis were formed with these two systems. On the other hand, collateral circulation from the external carotid artery system was seen in few cases and was thought of less clinical significance. In particular, in the case of cerebral artery occlusion of the elderly persons who had advanced arteriosclerosis, effective peripheral anastomosis did hardly develop and ADL was very hard to recover.
doi:10.2490/jjrm1963.7.175 fatcat:dwejg2dlcvennkzp22qa23fh2a