Extracranial Vascular Disease Research Articles

Accuracy of transcutaneous Doppler ultrasonics in evaluating extracranial vascular disease.

T HE ultrasonic transcutaneous Doppler technique has been suggested as a safe method for determining extracranial carotid blood flow? -7,9,11-13 Application of this technique to occlusive extracranial carotid disease has been reported5 ,8 Arteriography has been the most helpful method used so far to verify the Doppler's effectiveness in diagnosing carotid artery disease. Since the Doppler primarily measures blood velocity, more direct determinations of blood flow would be valuable to check the Doppler's performance. The present study uses intraoperative electromagnetic flow determinations, direct carotid pressure recordings, occlusive carotid clamps (Selverstone), and arch arteriography in an effort to evaluate the effectiveness of the transcutaneous Doppler technique in determining carotid blood flow.

Cerebral Vascular Diseases

The modest price of this book makes it worthwhile for anyone interested in stroke. This holds even for the clinician who might not find much of immediate interest in the chapters on fluid dynamics, viscosity, platelet aggregation, and other facets of research in the fields of cerebral circulation and respiratory control. However, there are many pieces of information and interesting discussions of practical interest: identification of the stroke-prone patient; pathogenesis and medical treatment of intracerebral hemorrhage; reports of the joint cooperative studies on stroke, hypertension, and extracranial vascular occlusive disease; aids in diagnosis of cerebrovascular disease, the role of vascular disease in dementia; and effects of thromboendarterectomy in bilateral carotid occlusive disease. A new procedure for control of hypertension in humans—stimulalation of the carotid sinus nerve by implanted electrodes—is described; an old one—compression of the carotid artery and its sinus—is revived to help in evaluating cerebral-vascular collateral reserve. This transcript

Carotid endarterectomy without a shunt. Results using hypercarbic general anesthesia to prevent cerebral ischemia.

EARTERECTOMY for stenotic lesions of the carotid arteries provides effective relief of cerebrovascular insufficiency and prevents the development of stroke in patients with extracranial vascular disease.1Segmental vascular occlusive disease occurs in the region of the carotid artery bifurcation in many patients with various clinical syndromes of cerebrovascular insufficiency. On the basis of onset, extent of involvement, and persistence of neurologic deficits, these syndromes are classified into transient ischemic attacks, persistent progressive symptoms of stroke, acute completed stroke, and chronic completed stroke. Patients in these categories with occlusive carotid artery disease, as well as certain patients free of neurologic symptoms but with stenotic lesions demonstrated by arteriography, are subjected to an operation to remove the obstructing atherosclerotic lesions. At our institutions a technique was introduced for performing carotid endarterectomy in which general anesthesia with deliberate hypercarbia was employed to increase cerebral blood flow.2Use of this technique obviates

Arch aortography and cerebro vascular insufficiency

A prospective survey of 330 arch aortograms performed to investigate patients with suspected cerebrovascular insufficiency is analysed to assess the functional importance of extracranial vascular disease. A detailed statistical analysis of the extracranial arterial obstructive lesions is presented. Extracranial atheromatous stenosis or occlusions are often associated with clinical cerebrovascular insufficiency and the lesions are often multiple. Nevertheless extensive arterial disease may be present with minor (or no) symptoms. The critical factors in determining whether or not symptoms occur are the haemodynamic state and the adequacy of the collateral pathways. The functional integrity of the Circle of Willis is of major importance in this respect.