CERVICOCEPHALIC ANGIOGRAPHY FOR CEREBROVASCULAR INSUFFICIENCY

Abstract

Cervicocephalic arteriography was performed via the brachial or the femoral route in 250 patients with clinical cerebrovascular insufficiency. Several different types of lesions were demonstrated, both intra- and extra-arterial in location. Presumably atherosclerotic plaques constituted the majority of the lesions at all ages. A definite increase of the incidence of demonstrable occlusive or obstructive lesions occurred with advancing age. In the patient series, over 80% of the patients had radiologic involvement of at least one of the neck vessels. A group of 93 healthy men were subjected to the same radiologic procedure. The same types of lesions were demonstrated in these asymptomatic individuals as in patients, although in almost 2/3 of them, as opposed to less than 1/5 of the patients, all vessels were free of lesions. Based upon the comparison between the patients and the asymptomatic control series, we feel that at least 2 factors may contribute significantly to the pathogenesis of clinical cerebrovascular insufficiency: The number of the neck vessels actually affected by obstructive lesions and the extent of atherosclerosis present in the intracerebral blood vessels. Thus, in some individuals with multiple neck vessel lesions, clinical symptomatology may not appear until cerebral arteriosclerosis becomes severe, or vice versa. Trans-femoral, or transbrachial, cervicocephalic arteriography should be reserved for patients who can be considered as potential candidates for neck vessel surgery.