Symptomatic internal carotid artery occlusion: the implications of haemodynamic compromise

Abstract

Patients who present with TIA or at most moderately disabling ischaemic stroke associated with an occlusion of the internal carotid artery have a relatively low risk of recurrent ischaemic stroke, in particular if no stroke has occurred during the first 18 months after the first signs or symptoms. Even patients with a bilateral occlusion of the ICA have a relatively low risk of recurrent ischaemic stroke. However, there is a subgroup of patients with ongoing symptoms after documentation of ICA occlusion or clinical signs of haemodynamic compromise that have a higher risk of recurrent ischaemic stroke. The studies in this thesis aimed to improve the identification of the patient at increased risk of recurrent ischaemic stroke based on clinical characteristics and haemodynamic measurements with transcranial Doppler (TCD) with CO2-reactivity or oxygen-15 positron emission tomography (PET) studies. Another aim was to study the haemodynamic effect of a therapeutic strategy consisting of surgery or stenting of stenosed cerebropetal arteries or tapering of antihypertensive medication.