Internal carotid artery occlusion: clinical and therapeutic implications.

Abstract

SUMMARY Five hundred patients referred to the Cerebrovascular Clinic of the Johannesburg Hospital were examined by a battery of noninvasive tests and angiography. Thirty four occlusions of the internal carotid artery were found in 32 patients. These patients were prospectively evaluated, including clinical examination, analysis of risk factors and subsequent management. This group of patients was followed up for a mean period of 18 months, and the clinical and laboratory findings and follow up data of this group were compared to an age and sex matched group of patients with matched presenting symptoms, but with patent internal carotid arteries on angiography. Four clinical patterns emerged in the patients with occluded carotid arteries; asymptomatic (3), TIA's (17), initial fixed stroke (7), and TIA with subsequent stroke (5). Follow up of the occluded group revealed 19 patients (59%) with no further symptoms and no indication for surgical intervention. Nine patients required surgery; 4 external carotid endarterectomies (ipsilateral), 4 internal carotid endarterectomies (contralateral), and one extracranial to intracranial bypass. Two were lost to follow up and one died. After 18 months mean follow up 29 patients (91%) were well and asymptomatic. Follow up for a similar period of the non-occluded group revealed three deaths, three late strokes and three myocardial infarctions. None were lost to follow up. After 19 months mean follow up 26 patients (81%) were well with no new neurological symptoms. The prognosis of appropriately treated patients with total occlusion of the internal carotid artery does not appear to be worse than in patients with similar presenting features and patent carotid arteries. The role of surgery in preventing further emboli despite the presence of a total internal carotid occlusion is highlighted.

Prognosis of Symptomatic Carotid Artery Occlusion

“…Wade et al [26] _______ ___________ (bilateral carotid occlusion) Fritz et al [27] - [20] - Results (table 1, fig. 1, 2) There are eleven prospective studies [8,[20][21][22][23][24][25][26][27][28]; Hey man, cited in ref.…”

“…In 1985, Fritz et al [27] prospectively evaluated 500 patients with TIA, minor stroke or asymptomatic carotid bruit and found angiographic evidence of ICA occlusion in 32 patients (6.4%). The ICA occlusion was asymptom atic in 3 patients and symptomatic in 29 patients; carotid TIA 17, retinal infarct 1, carotid stroke 11.…”

Outcome in Patients with Symptomatic Occlusion of the Internal Carotid Artery or Intracranial Arterial Lesions: A Meta-Analysis of the Role of Baseline Characteristics and Type of Antithrombotic Treatment

“…After exclusion of patients as described in the Methods section, the 44 studies consisted of 3,457 patients (range 7–714 per study; 2,902 patients with extracranial ICA occlusion, 224 with intracranial ICA stenosis or occlusion, 293 patients with stenosis or occlusion of the MCA, whereas in 38 patients the location of the arterial lesion was not specified), with 12,457 patient-years of follow-up (range 10–3,320 per study). Fifteen studies had a prospective design [1, 4, 5, 6, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]and 29 were retrospective [3, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48]. Thirty-four studies included patients only if the carotid or MCA lesion had been demonstrated by angiography, whereas in 8 studies the carotid lesion could also be demonstrated by duplex [4, 6, 17, 18, 41, 43, 46, 48]or magnetic resonance angiography [4].…”

Correlations Between Atherosclerosis and Stroke –Can We Predict It?

“…This concept is in direct conflict with the opinion of Gomensoro et al that "when a lesion progressed to complete thrombosis, there was no long er any possibility for emboli to pass into the distal circulation." [18] In the current era of intensive medical therapy, carotid artery disease rarely progresses to occlusion and, when it does, patients' risk of ipsilateral stroke is very low, according to an observational study published online September 21, 2015, ahead of print in JAMA Neurology.…”