Degree Of Atherosclerotic Involvement Research Articles

Hemispheric TIA and amaurosis fugax: What is their relation to stenotic lesions of internal carotid artery?

We evaluated the correlation of clinical and echo-Doppler findings from the internal carotid artery (ICA) in 17 patients with amaurosis fugax (AF) and in 68 patients with hemispheric TIA (H-TIA). In the study population as a whole, moderate stenoses (20%-49% diameter reduction) were the most prevalent finding in the symptomatic ICA, being detectable in 51.6% of cases. Total occlusions were found in an unexpectedly high percentage (7.5%). Asymptomatic ICAs, that were contralateral to the symptoms, showed the same degree of atherosclerotic involvement as the symptomatic ICAs. When we compared AF with H-TIA, we found a significantly higher prevalence of severe hemodynamically significant stenoses in the former (52.6% vs. 18.8%, chi-square test 10.85, P less than 0.05). Thus, we conclude that in the vast majority of patients with transient neurological symptoms a bilateral ICA involvement is to be expected. The side on which the symptoms occur does not indicate which ICA is more severely stenotic except in AF, where a severe involvement of the ipsilateral ICA is most likely.

Predictive variables in reoperation for coronary artery disease

Seventy-one consecutive patients undergoing reoperation for coronary artery disease (1968 to 1976) were evaluated. Clinical indication for reoperation was recurrent angina pectoris in all patients. The cause of recurrent symptoms was related to occlusion of previously placed bypass grafts in 59 patients (83 percent) and to progressive atherosclerosis or the presence of previously unbypassed lesions in 12 patients (17 percent). Complete follow-up (mean 2.2 years) demonstrated symptomatic improvement in 42 patients (59 percent); 19 patients (27 percent) were relieved of angina entirely. Two patients (2.8 percent) died in the perioperative period. Technical problems anticipated with reoperation, such as inability to identify target vessels and excessive bleeding, were not encountered. Preoperative clinical status and coronary anatomic data, including the distribution of coronary disease, individual vessel size and degree of atherosclerotic involvement, indication for reoperation, and the completeness of the initial revascularization procedure, were analyzed and correlated with postoperative clinical status. Favorable coronary anatomy, defined as adequate vessel size (≥2.0 mm.) and a proximal distribution of atherosclerotic involvement, was the one factor which showed a significant correlation (p < 0.05) with improved clinical status. Prior postcardiotomy syndrome and prior infarction in two myocardial sites showed a significant correlation (p < 0.05) with unimproved clinical status. Our findings suggest that reoperation can be accomplished with low morbidity and mortality rates and that there is the potential for therapeutic benefit in the majority of cases.