Cerebral ischemia symptoms in carotid artery occlusion: role of hemodynamic factors.

The acute outcome in 59 patients with carotid artery occlusion was studied and related to the angiographic pattern of collateral flow. No patient with TIA only had retrograde ophthalmic artery flow, although such a pattern was found in 50 percent of patients with stroke. In a follow-up study (mean 48 months), the same distribution of the collateral pattern was found on ultrasonic Doppler examination. The absence of substantial retrograde ophthalmic flow was associated with an increased contralateral carotid flow. The findings show that the efficiency of the collateral pathways, mainly the contralateral carotid artery and the circle of Willis, largely determines the outcome of carotid artery occlusion.