, Volume 38, Issue 1, pp 25–30 | Cite as

Incidental intracranial vascular pathology in patients investigated for carotid stenosis

  • P. D. Griffiths
  • S. Worthy
  • A. Gholkar
Diagnostic Neuroradiology


The assessment of cervical and cranial carotid arteries for atherosclerotic disease is the second commonest referral for angiography in our neuroradiological department; in 1993 this accounted for approximately 17% of the total cases. This is due to the resurgence of interest in endarterectomy for severe carotid stenosis. Although the degree of stenosis can usually be assessed adequately by duplex Doppler ultrasonography, angiography is still recommended as a preoperative examination. The intracranial vessels are visualised, which we consider important when planning vascular surgery. We present a prospective study of 100 patients referred for angiographic assessment of carotid stenosis. As well as giving information about the carotid bifurcation, angiography showed 9 patients to have aneurysms, 2 arteriovenous malformations and 15 severe intracranial atherosclerosis. We consider these “incidental” findings important for future management and highlight the need for thorough assessment of the intracranial vessels in these patients by angiography.

Key words

Carotid stenosis Endarterectomy Aneurysm Arteriovenous malformation 


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  1. 1.
    Gresham GE, Phillips TF, et al (1979) Epidemologic profile of long term stroke disability: the Framingham study. Arch Phys Med Rehabil 60:487–491Google Scholar
  2. 2.
    Dennis M, Bamford J, Sandercock P, Warlow C (1990) Prognosis of TIA in the Oxfordshire community stroke project. Stroke 21:848–853Google Scholar
  3. 3.
    Hankey GJ, Slattery JM, Warlow CP (1991) Prognosis and prognostic factors of retinal infarction: a prospective cohort study. BMJ 302:499–504Google Scholar
  4. 4.
    Dennis MS, Bamford JM, Sandercock PAG, Warlow CP (1989) A comparison of risk factors and prognosis for TIA and minor ischaemic strokes, the Oxfordshire community stroke project. Stroke 20:1494–1499Google Scholar
  5. 5.
    European Carotid Surgery Trialists' Collaborative Group (1991) MRC European carotid surgery trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1244Google Scholar
  6. 6.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med 325:445–452Google Scholar
  7. 7.
    Steinke W, Kloetzsch C, Hennerici M (1990) Carotid artery disease assessed by colour Doppler flow imaging. A J R 154:1061–1068Google Scholar
  8. 8.
    Choi SS, Crampton A (1961) Atherosclerosis of arteries of neck. Post mortem angiographic and pathologic study. Arch Pathol 72:379–385Google Scholar
  9. 9.
    Hutchinson EC, Yates PO (1957) Carotico-vertebral stenosis. Lancet I:2–8Google Scholar
  10. 10.
    Little JR, St Louis P, Weinstein M, Dohn DF (1982) Giant fusiform aneurysm of the cerebral arteries. Strokes 12: 183–188Google Scholar
  11. 11.
    Ujiie H, Sato K, et al (1993) Clinical analysis of incidentally discovered unruptured aneurysms. Stroke 24:1850–1856Google Scholar
  12. 12.
    Wiebers DO, Whisnant JP, Sundt TM Jr, O'Fallon WM (1987) The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23–29Google Scholar
  13. 13.
    Hankey GJ, Warlow CP, Sellar RJ (1990) Cerebral angiographic risk in mild cerebrovascular disease. Stroke 21: 209–222Google Scholar
  14. 14.
    Turner WH, Murie JA (1989) IVDSA for extracranial carotid artery disease. Br J Surg 76:1247–1250Google Scholar
  15. 15.
    Kido DK, Barsotti JB, et al (1991) Evaluation of the carotid artery bifurcation: comparison of MRA and digital subtraction arch aortography. Neuroradiology 33:48–51Google Scholar
  16. 16.
    Polak JF, Kalina P, Donaldson MC, et al (1993) Carotid endarterectomy: preoperative evaluation of candidates with combined Doppler sonography and MR angiography. Radiology 186:333–338Google Scholar
  17. 17.
    Masaryk TJ, Obuchowski NA (1993) Non-invasive carotid imaging: caveat emptor. Radiology 186:325–331Google Scholar
  18. 18.
    Little JR, Sawhny B, Weinstein M (1980) Pseudo-tandem stenosis of the internal carotid artery. Neurosurgery 7: 574–577Google Scholar
  19. 19.
    Schuler JJ, Flanigan P, et al (1982) The effect of carotid siphon stenosis on stroke rate, death and relief of symptoms following elective carotid endarterectomy. Surgery 92:1058–1067Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. D. Griffiths
    • 1
  • S. Worthy
    • 1
  • A. Gholkar
    • 1
  1. 1.Department of NeuroradiologyNewcastle General HospitalNewcastle upon TyneUK

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