Stroke, Vol 14, 867-875, Copyright © 1983 by American Heart Association
EB Ringelstein, H Zeumer and D Angelou
In order to relate clinical, angiologic and brain-morphological findings,
107 patients with internal carotid artery occlusion were examined
clinically and by Doppler sonography, computerized tomography and cerebral
angiography. During computerized tomography, haemodynamically induced
infarctions could be differentiated from those, caused by periocclusive
embolism towards the major brain arteries. This differentiation was based
on an integration of angiological as well as brain-morphological data and
implicates some important diagnostic, therapeutic and prognostic
consequences. The first group may benefit from immediate surgical
restoration of carotid blood flow and have a relatively good prognosis. By
contrast, subjects presenting territorial infarctions mostly experience
severe and permanent neurological deficits. They should not undergo
revascularization since endarterectomy increases the risk of cerebral
hemorrhage but cannot cause clinical improvement. In five patients,
following special angiographic techniques, the lesions of the internal
carotid artery turned out to be pseudoocclusions. This condition threatens
the patient considerably but is well accessible to surgical reconstruction.
Thus, pseudooclusion seems to be one of the most convincing indication for
emergency endarterectomy of the internal carotid artery.
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