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Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors
C J Klijn1, L J Kappelle, C A Tulleken
1University Department of Neurology, University Hospital Utrecht, Netherlands. cklijn@neuro.azu.nl
Insights
Patients with carotid artery occlusion face a significant stroke risk. Compromised cerebral blood flow further elevates this risk, highlighting the need for targeted treatments.
Area of Science:
- Neurology
- Vascular Medicine
- Cerebrovascular Disease
Background:
- Accumulating evidence suggests compromised cerebral blood flow, beyond embolism, contributes to transient ischemic attacks and stroke in internal carotid artery occlusion.
- Clinical features and cerebral blood flow measurements support this hypothesis.
Purpose of the Study:
- To review the role of compromised cerebral blood flow in symptomatic carotid artery occlusion.
- To evaluate treatment options in light of cerebral blood flow compromise.
Main Methods:
- Analysis of 20 follow-up studies on patients with transient ischemic attacks or minor ischemic stroke and carotid artery occlusion.
- Review of studies measuring cerebral blood flow using positron emission tomography, single-photon emission CT, transcranial Doppler, or stable xenon CT.
Main Results:
- The annual stroke risk for patients with carotid artery occlusion was 5.5%, with ipsilateral stroke risk at 2.1%.
- Patients with compromised cerebral blood flow exhibited a higher annual stroke risk (12.5% overall, 9.5% ipsilateral).
Conclusions:
- Compromised cerebral blood flow is a key factor in patients with symptomatic carotid artery occlusion.
- Medical and surgical treatment strategies should consider cerebral blood flow status.
Background:
Over the last several years evidence has accumulated that in addition to embolism, a compromised cerebral blood flow may play an important role in causing transient ischemic attacks and ischemic stroke in patients with occlusion of the internal carotid artery. This evidence is found in both clinical features and ancillary investigations, particularly measurements of cerebral blood flow.
Summary Of Review:
On the basis of 20 follow-up studies in patients with transient ischemic attacks or minor ischemic stroke associated with an occluded carotid artery, the annual risk of stroke was 5.5% (95% confidence interval [CI], 5.0% to 6.0%), and that of ipsilateral stroke (distinguished in 11 of the 20 studies) was 2.1% (95% CI, 1.6% to 2.8%). Patients with a compromised cerebral blood flow as measured by positron emission tomography, single-photon emission CT, transcranial Doppler, or stable xenon CT (six studies) have an even higher annual risk of stroke (all strokes: 12.5%; 95% CI, 8.9% to 17.6%; ipsilateral stroke: 9.5%; 95% CI, 6.4% to 14.0%).
Conclusions:
Because a compromised cerebral blood flow may be an important causal factor in patients with symptomatic carotid artery occlusion, medical and surgical options for treatment are reviewed in this light.