Recognising stroke prone patients with a poor collateral circulation

Abstract

The prognosis in carotid disease is extremely variable and is influenced by the availability of collateral circulation. This study investigates the possibility of recognising patients with a poor collateral potential by using non-invasive tests.

Preoperative OPG and EEG were compared with intraoperative EEG during test clamping in 208 carotid endarterectomies. Clamping ischaemia occurred in 29 patients (14%). Preoperative EEG had a sensitivity of 62% and a specificity of 82%. OPG showed a sensitivity of 96% and a specificity of 54%. Combined OPG and EEG resulted in a sensitivity of 93% and a specificity of 73%.

Both tests are safe and easy to perform and interpret. These techniques can be used to identify those patients with carotid stenosis who have an increased risk of stroke due to a poor collateral circulation and may help to refine the indications for carotid endarterectomy.