Alteration of flow dynamics in the carotid artery system of "stroke" patients. Clinical and arteriographic study.

Abstract

Percutaneous retrograde arch aortography was performed in a series of 94 patients with symptoms suggesting cerebrovascular insufficiency. In 26 of these a major stenosis (greater than 50% reduction of measured luminal diameter) was present in the cervical carotid artery(s). In 75% of this subgroup an arleriographic flow pattern was seen which correlated closely with the lateralization of cerebral ischemic manifestations. This pattern consists of a 0.5 sec or greater delay in linear flow of contrast material through the stenosed carotid artery as compared with the contralateral one. Evidence is presented to support the assumption that such a finding reflects an actual diminution of volume blood flow and is the result of the stenosis demonstrated. Two control groups of 19 neurologically normal and 60 neurologically symptomatic patients without significant stenosis of larger cerebral vessels were studied by arteriography in an identical manner. No patient in either control group manifested a unilateral delay in linear flow. Provided artefact can be excluded, this sign is believed to be a valuable index of the clinical significance of cervical carotid artery stenosis.