Related Experiment Videos
Collateral circulation in internal carotid artery occlusion. A study by duplex scan and magnetic resonance
C Macchi1, R Molino Lova, B Miniati
1Department of Cardiovascular Medicine, Don Gnocchi Foundation, University of Florence, Florence, Italy.
Insights
Collateral circulation, often through external carotid artery branches, is crucial for preventing stroke symptoms in internal carotid artery (ICA) occlusion. Duplex scan effectively detects this vital collateral network.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Internal carotid artery (ICA) occlusion presents a spectrum of clinical effects, from asymptomatic cases to severe hemispheric stroke.
- Understanding collateral circulation is key to predicting patient outcomes in ICA occlusion.
- Assessing the diagnostic performance of duplex scan for collateral evaluation is important.
Purpose of the Study:
- To correlate symptoms in patients with ICA occlusion with their collateral circulation development.
- To evaluate different types of collateral circulation.
- To appraise the sensitivity and specificity of duplex scan in detecting collateral circulation.
Main Methods:
- Forty-eight patients (24 male, 24 female, aged 50-83) with ICA occlusion or subocclusion were studied.
- Duplex scan and magnetic resonance (MR) angiography were performed.
- Patients were categorized into asymptomatic (19), permanent neurological symptoms (20), and transient symptoms (9).
Main Results:
- Collateral circulation was observed in 75% of patients, predominantly via homolateral external carotid artery branches (60%).
- Patients with permanent symptoms (8/20) were less likely to have collateral circulation compared to asymptomatic (19/19) and transient symptom (9/9) groups.
- Duplex scan demonstrated 78% sensitivity, 100% specificity, and 83% diagnostic accuracy for collateral circulation.
Conclusions:
- Collateral circulation, primarily through homolateral external carotid artery branches, is prevalent in ICA occlusion.
- The development of collateral circulation is inversely related to the occurrence of permanent neurological symptoms.
- Duplex scan is a valuable tool for diagnosing collateral circulation in ICA occlusion with good accuracy.
Background:
Clinical effects of internal carotid artery (ICA) occlusion may range from the absolute absence of symptoms to lethal hemispheric stroke. In this paper symptoms of patients with ICA occlusion have been related to the development of collateral circulation, different types of developed collateral circulation have been assessed, and the degree of sensitivity and specificity of duplex scan has been appraised.
Methods:
Forty-eight patients with ICA occlusion or subocclusion, 24 males and 24 females, aged between 50 and 83 years (67.7+/-7.15), underwent duplex scan and magnetic resonance (MR) angiography. Nineteen patients were completely asymptomatic, 20 patients showed permanent neurological symptoms and 9 patients had shown transient symptoms.
Results:
Twelve patients (25%) did not show any collateral circulation, 29 patients (60%) showed collateral circulation through homolateral external carotid artery branches and 7 patients (15%) showed collateral circulation through other circuits. Of the 20 patients with permanent symptoms only 8 showed collateral circulation. On the contrary, all the 19 asymptomatic patients and the 9 patients with transient symptoms showed collateral circulation. Eventually, duplex scan showed 78% sensitivity, 100%, specificity and 83% diagnostic accuracy.
Conclusions:
Our data show: 1) a clear-cut prevalence of collateral circulation through homolateral external carotid artery branches with respect to other possible collateral circulation; 2) an inverse relationship between the development of collateral circulation and the appearance of permanent symptoms; 3) a good diagnostic accuracy of duplex scan in revealing collateral circulation in the case of ICA occlusion.