Can symptoms in cerebrovascular attacks in patients with internal carotid artery stenosis predict the extent to which cerebral circulation is compromised?
Schroeder, T.; Aabech, J.; Utzon, N.P.; Sillesen, H.; Sørensen, P.S.
Ugeskrift for Laeger 150(25): 1550-1552
1988
ISSN/ISBN: 0041-5782 PMID: 3388565 Document Number: 323728
Narrowing of the internal carotid artery (IC) due to arterioscleroisis may result in transitory ischaemic attacks (TIA) or stroke. The symptoms are ascribed to one of the two mechanisms: embolization from the irregular vessel wall or haemodynamic insufficiency due to severe ICA stenosis with failure of the collateral blood flow. In order to investigate whether it is possible to identify patients with haemodynamic insufficiency on the basis of the symptomatology and arteriography, the authors compared 49 patients with low perfusion pressure to the brain with a control group also of 49 patients with normal perfusion pressure. The perfusion pressure was measured during carotid endartetectomy in ICA distal to the stenosis. No differences were observed in symptomatolgy between the two groups. The parameter, which best predicted whether patients had high or low pressure, was the degree of stenosis of the susequently operated ICA, as 70% were classified correctly. By combining the angiographic findings with the symptomatology in a discriminant analysis, significantly better results were obtained. The results of this investigation do not suggest, that the symptomatology in patients with suspected haemodynamic insufficiency due to of ICA stenosis can be differentiatied from patients with symptoms due to embolism. An explanation of this may be that ischaemic symptoms in patients with low perfusion pressure are, in many cases, also due to emboli.