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The significance of the cerebral collateral capacity in patients with carotid atheroma

Lookup NU author(s): Professor Gerard Stansby

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Abstract

OBJECTIVES: to identify the echodensity, stenosis of carotid plaques and cerebral collateral capacity that were associated with various ipsilateral presentations (retinal, cerebrovascular, asymptomatic). DESIGN: cross-sectional study. MATERIALS: forty-four patients, with 44 plaques associated with various presentations, were studied. METHODS: the duplex images of the plaques were analysed echomorphologically in a computer by means of Grey Scale Median (GSM) [hypoechoic (low GSM), hyperechoic (high GSM)]. The percentage (%) reduction of the mean velocity in the middle cerebral artery (PRMCA) on transcranial Doppler, during clamping in carotid endarterectomy, was evaluated to distinguish the competent cerebral collateral supply (low PRMCA) from the non-competent one (high PRMCA). RESULTS: the retinal symptoms were associated with plaques of low median GSM (0), severe median stenosis (90%) and low median PRMCA (0.31) as contrasted with the cerebrovascular symptoms (17, 84%, 0.47, respectively) and asymptomatic status (32, 83%, 0.4, respectively) [(p =0.038 (GSM), p =0.67 (stenosis), p=0.15 (PRMCA)]. The retinal and the cerebrovascular symptoms were distinct in terms of PRMCA (p=0.045). CONCLUSIONS: the retinal symptoms were produced by hypoechoic and possibly embologenic plaques, whereas the cerebrovascular ones possibly by the combination of carotid embolism and a non-competent cerebral collateral circulation. Asymptomatic status was associated with the absence of any relevant mechanism.


Publication metadata

Author(s): Stansby G; Tegos TJ; Sabetai MM; Robless P; Kalodiki E; Bassett P; Nicolaides AN

Publication type: Article

Publication status: Published

Journal: European Journal of Vascular and Endovascular Surgery

Year: 2000

Volume: 20

Issue: 5

Pages: 434-440

ISSN (print): 1078-5884

ISSN (electronic): 1532-2165

Publisher: Elsevier

URL: http://dx.doi.org/10.1053/ejvs.2000.1224

DOI: 10.1053/ejvs.2000.1224

Notes: 1078-5884 Journal Article


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