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Stenoses of the distal segments of the internal carotid artery
Insights
Patients with internal carotid artery stenosis experienced transient ischemic attacks, but most maintained good neurological health with aspirin. External carotid-internal carotid artery bypass surgery is recommended for severe cases to prevent occlusion.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Distal internal carotid artery stenosis poses a risk of neurological events.
- Transient ischemic attacks (TIAs) are common initial symptoms.
Purpose of the Study:
- To evaluate the outcomes of patients with distal internal carotid artery stenosis.
- To assess the efficacy of aspirin and external carotid-internal carotid artery (EC/IC) bypass in managing this condition.
Main Methods:
- Retrospective analysis of 51 patients with distal internal carotid artery stenosis.
- Administration of aspirin to all patients.
- Surgical intervention with EC/IC bypass in selected patients.
Main Results:
- 31 of 51 patients presented with TIAs.
- Despite frequent emboli, 46 patients remained neurologically stable.
- 4 patients developed total occlusion, leading to severe deficits.
- 4 of 23 patients undergoing EC/IC bypass experienced postoperative occlusion without neurological consequences.
Conclusions:
- Occlusion presents a higher risk than embolization in internal carotid artery stenosis.
- EC/IC bypass is the preferred treatment for severe distal stenosis or mural thrombi to prevent adverse neurological outcomes.
Abstract:
In 31 of 51 patients with stenosis of the distal segments of the internal carotid artery, the first symptom was a transient ischemic attack. In spite of the high incidence of angiographically proved emboli, 46 patients remained in good neurological condition. Aspirin was given to all patients. In 4 patients a total occlusion developed, causing severe neurological deficit. This indicates that the danger of occlusion is significantly higher than that of embolization. External carotid-internal carotid artery bypass was carried out in 23 patients; occlusion developed during the postoperative observation period in 4 patients without any neurological consequences. It can be concluded that an EC/IC bypass operation is the method of choice in treating patients with severe distal stenosis or recent mural thrombi.