Ulcerated
A theromatous Plaques of the Carotid A rtery Bifurcation• The clinical diagnosis of an ulcerated plaque at the bifurcation of the common carotid artery is based on: mid-carotid bruit, cholesterol or platelet emboli in the retina, transient ischemic attacks particularly with amaurosis fugax, and a reversible neurological deficit.In this series, thrombosis in situ was the final phenomenon in the natural history of the ulcerated plaque.In certain unusual instances it appears that the pathogenesis of a transient ischemic attack is a decrease in cardiac output (fall in systemic blood pressure) leading to a disproportionate decrease in cerebral blood flow in that portion of the arterial system distal to a pathologically narrowed artery.The ultimate diagnosis of an ulcerated plaque depends upon the radiological description at arteriography and upon direct visualization by the surgeon.Surgical treatment at the present time is the therapy of choice. Ulcerated carotid plaques may be bilateral, and, occasionally, are found at other levels than the bifurcation of the common carotid; however, ulcerated plaques were not seen in the intracranial vessels.
Additional Key Words cerebral emboli internal carotid artery transient ischemic attacks retinal emboli• Attention has been directed to atheromatous plaques in the first portion of the internal carotid artery as a potential source of retinal and cerebral emboli.1 " These emboli are important in the pathogenesis of transient ischemic attacks (TIA). These may be cholesterol emboli, from the atheromatous portion of a qlaque entering the circulation after there has been a break in the endothelium of the artery, or platelet-fibrin emboli which may arise from a variety of sources including the heart, aorta, cervical arteries, etc.The current practice is to describe stenotic lesions in the internal carotid artery in terms of the degree of stenosis in percent and the length of the lesion in millimeters. An additional criterion is the character of the lesion, that is, ulcerated, smooth or rough. This paper was submitted for publication in June, 1970.
912described the radiological appearance of ulcerated plaques of the carotid arteries. Since 1966 systematic observations of the retina (preradiologically, postradiologically, and surgically) and careful neurological examinations have been correlated with the pathological description of the atheromatous plaques obtained at the time of surgical procedure or autopsy. The purpose of this paper is to evaluate the clinical and radiological methods of diagnosis, to further clarify the criteria for the diagnosis of ulceration of atherosclerotic plaques in the carotid arteries and to correlate and corroborate all of these data with the degree and character of the pathological lesions studied at the time of surgery or autopsy.
MethodsThirty-seven patients admitted and studied at the Neurological Institute of Montevideo, Uruguay, constitute the basis for this report. Each patient had: clinical and neurological examinations, ophtha...
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