Brain, Vol. 110, No. 3, 777-791, 1987
© 1987 Guarantors of Brain
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NATURAL HISTORY OF ASYMPTOMATIC EXTRACRANIAL ARTERIAL DISEASE
RESULTS OF A LONG-TERM PROSPECTIVE STUDY
From the Department of Neurology, University Medical School Düsseldorf, FRG
Correspondence to:
Correspondence to: Professor M. Hennerici, Neurologische Klinik der Universitat, Moorenstrasse 5, D–4000 Dusseldorf 1, West Germany.
The natural history of asymptomatic extracranial arterial disease (EAD) was studied prospectively in 339 patients admitted for serial ultrasound Doppler examinations. Annual mortality was high at 7%, but stroke mortality was low at 0.6%: 82 patients (24%) died during the follow-up period, which lasted up to seven years (median: 29 months), only 10 from stroke but 41 from cardiac causes. The risk of suffering a stroke without premonitory transient ischaemic attacks (TLAs) was similarly low at 0.4%. Progression of EAD was the only predictor established to indicate the individual patient's cerebrovascular prognosis among a series of criteria tested (age, sex, degree and extent of carotid and/ or vertebral disease, risk factors and indicators of atherosclerosis). Deterioration of EAD was observed in 108 (36%) of 296 patients by repeated Doppler examination, 174 (59%) remained constant and 14 (5%) showed an improvement. The observed low rate of strokes without premonitory TIAs is not in favour for early crotid endarterectomy in the majority of neurologically asymptomatic patients.
Received September 24, 1985. Revised July 17, 1986. Accepted July 31, 1986.
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