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Overview of Cerebrovascular Disease

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Noninvasive Vascular Diagnosis

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Abstract

Stroke is the third leading cause of death in industrialized nations, with an annual incidence of about 700,000 stroke events. Ischemic strokes constitute 80–86% of all strokes. It has been estimated that ≥50% carotid stenosis may be responsible for up to 25% of all ischemic strokes. This chapter highlights the basic anatomy and pathophysiology of the extracranial carotid system. The common carotid bifurcation and the proximal internal carotid artery account for 50% of the lesions. The most common cause of cerebral ischemic events is embolic phenomena, primarily arterial in origin (carotid) and secondary to cardiac sources. The work-up of patients presenting with asymptomatic carotid bruits or TIAs should include initial carotid duplex scanning. Duplex scanning of the carotid bifurcation provides a highly accurate method of identifying significant lesions of the internal carotid artery as well as of separating lesions into general pathologic categories. Carotid CTA/MRA may be added to the work-up of these patients, particularly if the carotid duplex ultrasound is inadequate, and conventional arteriography is usually reserved for use prior to CAS. Management of these patients includes medical treatment alone or CEA/CAS with medical treatment.

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References

  1. Centers for Disease Control and Prevention (CDC). Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR Morb Mortal Wkly Rep. 2001;50:120–5.

    Google Scholar 

  2. Broderick J, Brott T, Kothari R, et al. The greater Cincinnati/Northern Kentucky stroke study: preliminary first-ever and total incidence rates of stroke among blacks. Stroke. 1998;29:415–21.

    Article  PubMed  CAS  Google Scholar 

  3. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics – 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–146.

    Article  PubMed  Google Scholar 

  4. Hankey GJ. Impact of treatment of people with transient ischemic attacks on stroke incidence and public health. Cerebrovasc Dis. 1996;6:26–33.

    Article  Google Scholar 

  5. Eastcott HHG, Pickering GW, Robb CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;2:994–6.

    Article  Google Scholar 

  6. DeBakey ME. Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up. JAMA. 1975;233:1083–5.

    Article  PubMed  CAS  Google Scholar 

  7. The CASSANOVA Study Group. Carotid surgery vs. medical therapy in asymptomatic carotid stenosis. Stroke. 1991;22:1229–35.

    Article  Google Scholar 

  8. Asymptomatic Carotid Atherosclerosis Study Group. Study design for randomized prospective trial of carotid endarterectomy for asymptomatic atherosclerosis. Stroke. 1989;20:844–9.

    Article  Google Scholar 

  9. Hobson II RW. Management of symptomatic and asymptomatic carotid stenosis: results of current randomized clinical trials. In: Bernstein EF, editor. Vascular diagnosis. 4th ed. St Louis: Mosby; 1993. p. 446–51.

    Google Scholar 

  10. MRC, Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal stroke by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491–500.

    Article  Google Scholar 

  11. Mayberg MR, Wilson SE, Yatsu F. For the veterans affairs cooperative study program 309 trialist group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA. 1991;266:3289–94.

    Article  PubMed  CAS  Google Scholar 

  12. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–53.

    Article  Google Scholar 

  13. European Carotid Surgery Trialists’ Collaborative Group. MRC European carotid surgery trial. Interim results for symptomatic patients with severe (70–99 %) or with mild (0–29 %) carotid stenosis. Lancet. 1991;337:1235–43.

    Article  Google Scholar 

  14. Brott TG, Hobson 2nd RW, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med. 2010;363:11–23.

    Article  PubMed  CAS  Google Scholar 

  15. International Carotid Stenting Study Investigators, Ederle J, Dobson J, Featherstone FL, Bonati LH, van der Worp HB, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet. 2010;375:985–97.

    Article  PubMed  Google Scholar 

  16. Mas JL, Chatellier G, Beyssen B, EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protection: ­clinical alert from the endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3 S) trial. Stroke. 2004;35:e18–20.

    PubMed  CAS  Google Scholar 

  17. SPACE Collaborative Group, Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrick G, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomized non-inferiority trial. Lancet. 2006;368:1239–47. Erratum appears in Lancet 2006;368:1238.

    Article  PubMed  CAS  Google Scholar 

  18. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.

    Article  PubMed  CAS  Google Scholar 

  19. Layton KF, Kallmes DF, Cloft HJ, Lindell EP, Cox VS. Bovine aortic arch variant in humans: clarification of a common misnomer. AJNR Am J Neuroradiol. 2006;27:1541–2.

    PubMed  CAS  Google Scholar 

  20. Berguer R, Kieffer E, editors. Surgery of the arteries to the head. Heidelberg: Springer; 1992.

    Google Scholar 

  21. Anson BJ, McVay CB. Surgical anatomy, vol. 1. Philadelphia: WB Saunders Co; 1971. p. 3–6.

    Google Scholar 

  22. Larson Jr CP. Anesthesia and control of the cerebral circulation. In: Wylie EJ, Ehrenfeld WK, editors. Extracranial cerebrovascular disease: diagnosis and management. Philadelphia: WB Saunders Co; 1970. p. 152–83.

    Google Scholar 

  23. Reivich M, Hooling HE, Roberts B, et al. Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med. 1961;265:878–85.

    Article  PubMed  CAS  Google Scholar 

  24. Connolly JE, Stemmer EA. Endarterectomy of the external carotid artery: its importance in the surgical management of extracranial cerebrovascular occlusive disease. Arch Surg. 1973;106:799–802.

    Article  PubMed  CAS  Google Scholar 

  25. Ehrenfeld WK, Lord RSA. Transient monocular blindness through collateral pathways. Surgery. 1969;65:911–5.

    PubMed  CAS  Google Scholar 

  26. Cook PJ, Honeybourne D, LIP GY, et al. Chlamydia pneumonia antibody titers are significantly associated with stroke and transient cerebral ischemia: the West Birmingham stroke project. Stroke. 1998;29(2):404–10.

    Article  PubMed  CAS  Google Scholar 

  27. Sillesen H, Nielsen T. Clinical significance of intraplaque hemorrhage in carotid artery disease. J Neuroimaging. 1998;8(1):15–9.

    PubMed  CAS  Google Scholar 

  28. Blaisdell FW, Hall AD, Thomas AN, et al. Cerebrovascular occlusive disease. Experience with panarteriography in 300 consecutive cases. Calif Med. 1965;103:321–9.

    PubMed  CAS  Google Scholar 

  29. Hass Wk, Field WS, North RR, et al. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA. 1968;203:961–8.

    Article  PubMed  CAS  Google Scholar 

  30. AbuRahma AF. Overview of cerebrovascular disease. In: AbuRahma AF, Diethrich EB, editors. Current noninvasive vascular diagnosis. Littleton: PSG Publishing; 1988. p. 1–7.

    Google Scholar 

  31. Strandness DEJ, Sumner DS. Hemodynamics for surgeons. New York: Grune & Stratton, Inc; 1975. p. 512–24.

    Google Scholar 

  32. Kakkos SK, Sabetai M, Tegos T, Stevens J, Thomas D, Griffin M, Geroulakos G, Nicolaides AN. Asymptomatic carotid stenosis and risk of stroke (ACSRS) study group. J Vasc Surg. 2009;49:902–9.

    Article  PubMed  Google Scholar 

  33. Hessel SJ, Adams DF, Abrams HL. Complications of angiography. Radiology. 1981;138:273–81.

    PubMed  CAS  Google Scholar 

  34. Miyazaki M, Kato K. Measurement of cerebral blood flow by ultrasonic Doppler technique: hemodynamic comparison of right and left carotid artery in patients with hemiplegia. Jpn Circ J. 1954;29:383.

    Article  Google Scholar 

  35. Goldberg RD. Doppler physics and preliminary report for a test for carotid insufficiency. In: Goldberg RD, Saris LV, editors. Ultrasonics in ophthalmology: diagnostic and therapeutic applications. Philadelphia: WB Saunders; 1967. p. 199.

    Google Scholar 

  36. Brockenbrough EC. Screening for prevention of stroke: use of a Doppler flow meter. Seattle: Seattle Parks Electronics; 1970.

    Google Scholar 

  37. Mozersky BJ, Hokanson DE, Sumner DS, et al. Ultrasonic visualization of the arterial lumen. Surgery. 1972;72:253–9.

    PubMed  CAS  Google Scholar 

  38. Barber FE, Baker DW, Strandness Jr DE, et al. Duplex scanner. II. For simultaneous imaging of artery tissues and flow. Ultrasonic symposium. Proc IEEE. 1974;74:CHO8961SU.

    Google Scholar 

  39. Gee W, Smith CA, Hinson CE, et al. Ocular pneumoplethysmography and carotid artery disease. Med Instrum. 1974;8:244–8.

    PubMed  CAS  Google Scholar 

  40. AbuRahma AF, Diethrich EB. Diagnosis of carotid arterial occlusive disease. Vasc Surg. 1980;14:23–9.

    Article  Google Scholar 

  41. AbuRahma AF, Osborne L. Comparison of the pneumoculoplethysmography (GEE) and the digitalized pulse timing oculoplethysmography (ZIRA). Am Surg. 1983;49:548–50.

    PubMed  CAS  Google Scholar 

  42. Muller HR. The diagnosis of internal carotid artery occlusion by the directional Doppler sonography of the ophthalmic artery. Neurology. 1972;22:816–32.

    Article  PubMed  CAS  Google Scholar 

  43. Burger R, Barnes RW. Choice of ophthalmic artery branch for Doppler cerebrovascular examination: advantages of the frontal artery. Angiology. 1977;28:421–6.

    Article  PubMed  CAS  Google Scholar 

  44. Polak JF, Dobkin GR, O’Leary DH, et al. Internal carotid artery stenosis: accuracy and reproducibility of color Doppler assisted duplex imaging. Radiology. 1989;173:793–8.

    PubMed  CAS  Google Scholar 

  45. Spadone DP, Barkmeier LD, Hodgson KJ, et al. Contralateral internal carotid artery stenosis or occlusion: pitfall of correct ipsilateral classification. A study performed with color-flow imaging. J Vasc Surg. 1990;11:642–9.

    PubMed  CAS  Google Scholar 

  46. Londrey GL, Spadone DP, Hodgson KJ, et al. Does color-flow imaging improve the accuracy of duplex carotid evaluation? J Vasc Surg. 1991;13:359–63.

    Google Scholar 

  47. Mattow MA, Hodgson KJ, Ramsey DE, et al. Identifying total carotid occlusion with color-flow duplex scanning. Eur J Vasc Surg. 1992;6:204–10.

    Article  Google Scholar 

  48. AbuRahma AF, Robinson PA, Khan S, et al. Effect of contralateral severe stenosis or carotid occlusion on duplex criteria of ipsilateral stenoses: comparative study of various duplex parameters. J Vasc Surg. 1995;22:751–62.

    Article  PubMed  CAS  Google Scholar 

  49. AbuRahma AF, Pollack JA, Robinson Pa, et al. The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion. Am J Surg. 1997;174:185–7.

    Article  PubMed  CAS  Google Scholar 

  50. AbuRahma AF, Robinson PA, Stickler DL, et al. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials. Ann Vasc Surg. 1998;12:349–58.

    Article  PubMed  CAS  Google Scholar 

  51. Lovelace TD, Moneta GL, Abou-Zamzam AH, Edwards JM, Yeager RA, Landry GJ, Taylor LM, Porter JM. Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60 %. J Vasc Surg. 2001;33:56–61.

    Article  PubMed  CAS  Google Scholar 

  52. Nederkoorn PJ, Mali WPTM, Eikelboom BC, Elgersma OEH, Buskens E, Hunink MGM, Kappell LJ, Buijs PC, Wust AFJ, van der Lugt A, van der Graaf Y. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002;33:2003–8.

    Article  PubMed  Google Scholar 

  53. Ricco JB, Camiade C, Roumy J, Neau JP. Modalities of surveillance after carotid endarterectomy: impact of surgical technique. Ann Vasc Surg. 2003;17:386–92.

    Article  PubMed  Google Scholar 

  54. Moore WS. For severe carotid stenosis found on ultrasound, further arterial evaluation is unnecessary. Stroke. 2003;34:1816–7.

    Article  PubMed  Google Scholar 

  55. Rothwell PM. For severe carotid stenosis found on ultrasound, further arterial evaluation prior to carotid endarterectomy is unnecessary: the argument against. Stroke. 2003;34:1817–9.

    Article  PubMed  Google Scholar 

  56. Nederkoorn PJ, van der Graaf Y, Hunink Y. Duplex ultrasound and magnetic resonance angiography compares with digital subtraction angiography in carotid artery stenosis. Stroke. 2003;34:1324–32.

    Article  PubMed  Google Scholar 

  57. Kern R, Szabo K, Hennerici M, Meairs S. Characterization of carotid artery plaques using real-time compound B-mode ultrasound. Stroke. 2004;35:870–5.

    Article  PubMed  Google Scholar 

  58. Sumner DS. Use of color-flow imaging technique in carotid artery disease. Surg Clin North Am. 1990;70:201–11.

    PubMed  CAS  Google Scholar 

  59. Ackerstaff RGA, Moons KGM, van de Vlasakker CJW, Moll FL, Vermeulen FEE, Algra A, Spencer MP. Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke. 2000;31:1817–23.

    Article  PubMed  CAS  Google Scholar 

  60. Barnett HJM, Taylor DW, Eliasziw MA, et al. For the NASCET collaborators: benefits of carotid endarterectomy in patients with symptomatic, moderate, or severe stenosis. N Engl J Med. 1998;339:1415–25.

    Article  PubMed  CAS  Google Scholar 

  61. Murad MH, Shahrour A, Shah ND, Montori VM, Ricotta JJ. A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs stenting. J Vasc Surg. 2011;53:792–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, 3110 MacCorkle Ave SE, Charleston, WV, 25304, USA

    Ali F. AbuRahma M.D., RVT, RPVI

  2. Charleston Area Medical Center, Charleston, WV, USA

    Ali F. AbuRahma M.D., RVT, RPVI

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  1. Ali F. AbuRahma M.D., RVT, RPVI
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Correspondence to Ali F. AbuRahma M.D., RVT, RPVI .

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Editors and Affiliations

  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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AbuRahma, A.F. (2013). Overview of Cerebrovascular Disease. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_6

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  • DOI: https://doi.org/10.1007/978-1-4471-4005-4_6

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