Dr C. Miller Fisher and the history of carotid artery disease

Our aim was to analyze the role that C. Miller Fisher (C.M.F.) had in promoting an understanding of carotid artery disease (CAD). Although Chiari in 1905 and later Hunt, Moniz, and Hultquist, among others, described the association of CAD and stroke, this received little attention until C.M.F. published his clinicoanatomic correlations in "Occlusion of the Carotid Arteries." Until then, some 55% of strokes were attributed to "vasospasm."

We analyzed articles ("Occlusion of the Internal Carotid Artery," 1951; "Occlusion of the Carotid Arteries," 1954; "Transient Monocular Blindness Associated with Hemiplegia," 1952; "The Microembolic Theory of Transient Ischemic Attacks," 1976; "A Clinico-pathologic Study of Carotid Endarterectomy Plaques," 1986) and conducted personal interviews with C.M.F.

During the 1950s, C.M.F. described the clinical implications of transient ischemic attacks and their relationship to CAD and stroke. The last sentence in the 1951 article read: "Unexplained cerebral embolism may arise from thrombotic material lying in the carotid sinus." In the same article he also wrote that "it is even conceivable that some day vascular surgery will find a way to by-pass the occluded portion of the artery during the period of ominous fleeting symptoms," heralding the future surgical treatment of carotid artery disease. C.M.F. called attention to the commonness of carotid disease, described transient monocular blindness, and studied the relationship between plaque pathology and clinical findings.

C.M.F.'s clinicopathologic observations were a major factor in promoting recognition of the clinical features, stroke risk, and treatment of CAD.