[Obstruction of the internal carotid artery and cerebral malacias. Tomodensitometric factors of the prognosis in 150 cases].

Abstract

We studied clinical, CT, angiographic and prognostic parameters in 60 cases with an occlusion, 48 with a tight stenosis, and 42 with a moderate stenosis of an internal carotid artery (ICA). The volume of infarction ranged from 0 to more than 600 cm3. It was significantly related to the degree of ICA obstruction, the number of risk factors, but not to age or sex. The quality of the collateral supply did not significantly influence the size or localization of infarctions, although it was better in the patients with occlusion than in those with tight stenosis. Deep infarcts were associated with diabetes and hypertension. The volume of infarction and early/late neurological disability were closely related to each other. Early death was associated with large infarctions (greater than or equal to 250 cm3). Thus, massive sylvian infarction corresponded to a poor prognosis (life and neurological function), whereas no visible infarction on CT corresponded to a good prognosis. Superficial infarctions had a variable prognosis, and evolution of deep infarctions was size-dependent. Late death or delayed stroke were not predictable from CT parameters. The quality of collateral supply did not markedly influence the functional prognosis. The development of a unilateral ipsilateral ventricular dilation and cortical atrophy was related to the degree of obstruction and to the weakness of the collateral circulation. In occlusion patients, the occurrence of ventricular dilation was related to the volume of infarction; cortical atrophy developed later and was associated with superficial infarctions. In ICA occlusion or stenosis, the study of CT parameters may help delineate prognostic features and may thus ameliorate the therapeutic follow-up.