Clinical Indicators of Extracranial Carotid Artery Disease in Patients With Transient Symptoms

Abstract

Clinical Indicators of Extracranial Carotid Artery Disease in Patients With Transient Symptoms• The clinical findings in 64 patients with transient symptoms of unilateral carotid system ischemic disease (amaurosis fugax or transient focal cerebral ischemic attacks or both) were reviewed in an effort to determine the value of the neurovascular examination in predicting the presence and extent of roentgenographically demonstrated ipsilateral extracranial internal carotid artery disease. Amaurosis fugax seems to be a highly specific indicator of disease, being associated with 4% of normal vessels as compared to 27% for patients with transient focal cerebral ischemic attacks alone. In patients with transient symptoms, the incidence of a normal, ipsilateral carotid artery was 36% in the absence of any positive neurovascular findings, 15% in the presence of an ipsilateral carotid bruit, 6% in the presence of ipsilateral retinal embolic events, 5% in the presence of ipsilateral reduction in superficial temporal or carotid (or both) pulse, 4% in the presence of an ipsilateral reduction in retinal artery pressure, and 3% when more than one of these findings were noted. The neurovascular examination appears to be a useful adjunct in detecting the presence or absence of ipsilateral carotid disease. However, no combination of symptoms or signs would, in all cases, allow one to accurately determine whether a vessel was abnormal, stenotic, or occluded.

Amaurosis fugax in a Danish community: a prospective study.

“…l4>23 Of the 63 patients who underwent arteriography, 43 (68%) had an ipsilateral lesion apparently accessible to endarterectomy, that is, stenosis or irregularity of the proximal internal carotid artery wall. Almost identical percentages of operable lesions were reported by some workers, 2 " 412 whereas others found proportions in the range 35-55%. '• 791016 These differences may merely reflect variations in referral patterns and indications for angiography.…”

Bilateral loss of vision in bright light.

“…These episodes have often been associated with ipsilateral atherosclerotic carotid stenosis, with or without ulceration, with retinal microembolization. 3 Episodes usually consist of a loss of vision developing over seconds and lasting for several seconds or minutes. The patient may describe the experience as a curtain or shade obscuring part or all of the vision in one eye, or it may progress from peripheral to central in the affected visual field.…”

Impact of digital subtraction angiography on carotid evaluation.

“…*" Most patients presenting with the hard indications (eg. amaurosis fugax, definite carotid TIA) do, in fact, have stenosis, 27 which would be well demonstrated by DSAV at a savings of cost and reduced procedure risk. A new role for hemodynamically-based traditional noninvasive tests might be in selecting the most expedient definitive test for those with hard indications.…”