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Isolated petrous carotid stenosis and transient ischemic attack
R L Levine1, F Hafeez, M A Khasru
1University of Wisconsin Stroke Program, Madison, WI, USA. levine@neurology.wisc.edu
Summary
Isolated petrous internal carotid artery (ICA) stenosis can cause recurrent transient ischemic attacks (TIAs). Diagnosis is achievable with magnetic resonance angiography, even when extracranial disease is absent.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Anterior circulation transient ischemic attacks (TIAs) are often linked to extracranial carotid arterial disease.
- Intracranial carotid or middle cerebral arterial disease is less commonly associated with TIAs compared to extracranial disease.
Purpose of the Study:
- To report on four patients experiencing recurrent, stereotypical TIAs due to isolated petrous internal carotid artery (ICA) stenosis.
- To highlight the diagnostic utility of magnetic resonance angiography (MRA) in identifying petrous ICA stenosis.
Main Methods:
- Case series of four patients with recurrent TIAs and isolated petrous ICA stenosis.
- Diagnostic imaging included magnetic resonance angiography (MRA).
- Conventional angiography and intra-arterial digital subtraction angiography were used for confirmation in select cases.
Main Results:
- All four patients presented with recurrent, stereotypical TIAs.
- Isolated stenosis of the petrous internal carotid artery (ICA) was identified as the cause.
- MRA effectively demonstrated the occlusive disease, confirmed by conventional angiography in two patients.
Conclusions:
- Petrous ICA stenosis, though often overlooked, can be a significant cause of TIAs.
- MRA is a sufficient diagnostic tool for identifying petrous ICA stenosis.
- Clinical focus should include evaluation for intracranial arterial disease, specifically petrous ICA stenosis, in TIA patients.