Extracranial cerebrovascular disease.
The prevention, management, and prognosis of patients with transient ischemic attack or stroke caused by extracranial cerebrovascular disease depend on the underlying pathophysiologic mechanisms involved. Atherosclerotic vascular disease is the predominant pathophysiologic mechanism. Management of this entity remains controversial and should be individualized. Recent data have clearly confirmed that carotid endarterectomy is better than medical therapy. Patients with a critically tight carotid stenosis appropriate in location to their symptoms are considered for carotid endarterectomy. This procedure should be performed only in the setting of excellent neuroradiologic support and surgical expertise, however, with a cumulative complication risk of less than 3%. Intimal dissection appears to be associated with a good prognosis with or without treatment. However, patients with symptoms should receive short-term therapy with antiplatelet or anticoagulant agents to prevent distal embolization. Corticosteroids are the drugs of choice for treatment of patients with extracranial arteritis. The presence of fibromuscular dysplasia in the cerebrovascular system has not proved to be a definitive risk for stroke or transient ischemic attack.
Lee
N S
NS
Department of Neurology, Lahey Clinic Medical Center, Burlington, Massachusetts.
Jones
H R
HR
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D001167:Arteritis / Q000150:complications; D002340:Carotid Artery Diseases / Q000150:complications* / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D005352:Fibromuscular Dysplasia / Q000150:complications; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008875:Middle Aged; D013348:Subclavian Artery; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis; D014711:Vertebral Artery