Recurrent Strokes Due to Occlusive Disease of Extracranial Vessels

A CEREBROVASCULAR accident of extracranial occlusive origin is usually due to segmental involvement of an arterial channel. With demonstrable stenosis of one carotid, the contralateral carotid artery may also be involved some time in the future. When both carotid arteries manifest stenosis, the clinical symptoms may be ascribed to one artery which may be surgically treated, but the contralateral vessel also may be eventually further stenosed or occluded. Usually, three or more years elapse before the contralateral carotid becomes stenosed or occluded symptomatically. The vertebral vessels are implicated much sooner and, in such cases, there is probably multiple vascular occlusive disease from the time of the initial symptoms. In a group of 130 endarterectomy patients, eight developed new strokes from occlusive involvement of other than the endarterectomized or occluded vessel. The follow-up period was 2 to 11 years. In five cases with one carotid involved, the contralateral carotid artery became