Clinical and angiographic comparison of asymptomatic occlusive cerebrovascular disease

Abstract

We compared clinical and arteriographic features in 106 patients with symptomatic unilateral carotid territory occlusive disease to determine the frequency and distribution of occlusive arterial lesions in asymptomatic vessels. Among black patients who were predominantly from Chicago, young, and female, there were fewer transient ischemic attacks and myocardial infarcts, less claudication, and more asymptomatic lesions of the supraclinoid internal carotid artery, anterior cerebral artery stem, and the middle cerebral artery stem. Among white patients predominantly from New England, elderly, and male, there was more frequent and severe occlusive asymptomatic disease at extracranial carotid and vertebral artery sites. Knowledge of the distribution of asymptomatic lesions will help guide evaluation and treatment strategies for patients with occlusive cerebrovascular disease.

Risk Factors of Intracranial Cerebral Atherosclerosis among Asymptomatics

“…In fact, early autopsy studies for ICAS did not include many of the classic risk factors for atherosclerosis [4,5,6,7]. A majority of the angiography-based studies performed later were confined to stroke patients and lacked a disease-free comparison group [1,8,9,10,11]. Difficulties in differentiating atherosclerosis from emboli during the acute stage of stroke worsened the situation.…”

Large Artery Intracranial Occlusive Disease

“…It had received relatively little attention in the United States and North America, however, until it became better known in the late 1950s and 1960s. This was based on a series of brain autopsy studies in the south of the United States and the International Atherosclerosis Project, 3,4 conventional cerebral angiographic studies that we carried out in the 1980s among a racially mixed, hospital, referral-based population in Chicago, Ill, [5][6][7] and the international Extracranial-Intracranial Bypass Trial of the 1980s. 8 More recently, the importance of LAICOD has been highlighted by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study 9 and novel treatment approaches for this disorder such as angioplasty and stenting.…”

Epidemiology and Pathophysiology of Intracranial Large Artery Stenosis

“…Overall, the data consistently demonstrates that blacks, Asians, and Hispanics have more intracranial atherosclerotic disease in contrast to whites who have more extracranial carotid disease [10,[18][19][20][21][22][23][24]. As Asians, Hispanics, and blacks constitute the majority of the world's population, it may be inferred that intracranial stenosis is the most common stroke mechanism worldwide.…”