MANAGEMENT OF OCCLUSIVE LESIONS OF BRANCHES OF AORTIC ARCH

The clinical progress of 157 patients with atherosclerotic occlusive lesions of the major branches of the aortic arch is reviewed, with emphasis on the relation of the lesions to cerebral symptoms or stroke. Fifty per cent of these patients were free of significant symptoms from the onset or were made so by a prior carotid bifurcation endarterectomy. No operations were performed on the major arch branches in these patients. The subclavian artery was the prominent site of the proximal lesion. Follow-up examinations indicate that the lesions in these patients do not in themselves lead to stroke and that the indications for operation, therefore, are determined by the need for relief of symptoms. Revascularization operations were performed on eighty patients with genuine disabling symptoms. The innominate and common carotid lesions were more prone to cause disability than were the subclavian. Removal or bypass of the obstructing lesion was generally satisfactory in relieving symptoms. © 1969.