颅内外血管架桥术治疗缺血性脑血管病疗效的再评价

目的 对颅内外血管架桥术治疗缺血性脑血管病的疗效进行再评价。 方法 对30例经正规内科治疗后仍有颈内动脉系统缺血症状的患者,进行了颞浅动脉-大脑中动脉吻合术,并对术后患者的脑血流改善情况及临床情况进行了分析。 结果 术前患者均为一过性缺血发作神经性缺损(TIA),可逆性缺血性神经障碍(RIND)和不典型脑缺血症状,术前CT,MRI检查无大面积脑梗死,SPECT·rCBF均有脑血流减低区。术后血管造影显示吻合口通畅率为86.7％,术后局部脑血流改善率为70％,随访仅发现2例患者有2次TIA,无完全性卒中发生,术前有轻度神经功能障碍的8例患者,术后均有不同程度的恢复。 结论颞浅动脉-大脑中动脉吻合术可预防颈内动脉系统血流动力学障碍性脑缺血发展成完全性卒中。     

冠心病合并缺血性脑血管病患者一站式完成心脑血管介入治疗的可行性研究

目的探索对冠心病合并缺血性脑血管病患者行一站式介入治疗的可行性。方法对首都医科大学附属北京友谊医院通州院区2019年2月至2020年1月收治的符合条件的冠心病合并缺血性脑血管病患者进行一站式心脑血管造影检查,然后经心血管和脑血管介入团队共同讨论决定介入治疗策略和方案,完成介入治疗。分析所有患者的临床资料、手术资料、随访结果。主要终点是院内和随访期内主要不良心脑血管事件(包括死亡、心肌梗死和卒中的复合事件)发生率。次要终点是主要终点中的任何一个(心肌梗死、卒中、死亡)及对比剂肾病、再入院。结果共入组30例患者,全部行一站式造影检查。其中,19例行经皮冠状动脉介入治疗,18例行脑血管介入治疗,包括13例同时行经皮冠状动脉和脑血管介入治疗者。共计一站式介入手术41次,其中一站式完成冠状动脉和脑血管介入治疗13次。所有患者治疗手术成功率为100%,住院期间和随访1~12个月内无主要不良心脑血管事件发生。2例患者再入院,包括1例股动脉并发症和1例肺部感染,均经治疗好转出院。结论一站式完成心脑血管介入治疗的模式可行,有较好的有效性和安全性,在有条件的医院可以推广开展。     

Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)     

Transesophageal Echocardiographic Diagnosis of Proximal Coronary Artery Stenosis in Patients with Ischemic Stroke

Atherosclerosis is the leading cause of death worldwide. It encompasses several clinical entities, including coronary artery disease and cerebrovascular disease. Because the underlying pathophysiological mechanism is the same, coronary artery disease and cerebrovascular disease frequently coexist. Transesophageal echocardiography (TEE) is routinely done in patients with ischemic stroke to exclude possible cardiac sources of cerebral embolism. Since the introduction of multiplane transesophageal transducers, it has become easier to visualize the proximal coronary arteries during transesophageal examinations. We report three cases in which routine TEE for ischemic stroke revealed significant coronary artery disease that was not previously suspected. In one patient, the stroke was so severe that further evaluation of the coronary artery disease was not deemed useful. The other two patients underwent coronary angiography based on the echocardiographic findings, confirming the lesions noted on the echocardiogram. Subsequently, both patients were successfully revascularized: one by percutaneous transluminal coronary angioplasty and the other by coronary artery bypass graft surgery. We conclude that the examination of coronary arteries during routine TEE for ischemic stroke may become a useful screening tool for the detection of coexisting, asymptomatic, significant proximal coronary artery disease.     

冠状动脉粥样硬化狭窄与脑动脉粥样硬化狭窄的关系

目的探讨颈动脉和（或）脑动脉粥样硬化狭窄与冠状动脉狭窄的关系。方法选择34例心内科住院伴有脑缺血症状、接受冠状动脉造影并颈动脉造影或全脑血管造影的患者。根据造影动脉管腔狭窄的程度分别分成三个亚组,冠状动脉狭窄分为轻度狭窄组（5例）、中度狭窄组（4例）、重度狭窄组（25例）;脑血管狭窄分为轻度狭窄组（6例）、中度狭窄组（4例）、重度狭窄组（24例）。结果冠状动脉狭窄与颈动脉或椎动脉狭窄程度分布一致,冠状动脉血管重度狭窄者25例,脑血管重度狭窄者24例,二者间差异无统计学意义;冠状动脉Califf危险记分≥2分者,脑血管中、重度狭窄的比例高达92％,且随着冠状动脉狭窄程度的加重,颈动脉及脑血管狭窄的程度亦加重。随访发现中重度双重狭窄（冠状动脉狭窄同时伴有脑动脉狭窄）病变的心脑事件发生明显增多,其中双重度狭窄死亡3例。结论颈动脉或椎动脉粥样硬化性狭窄的发生率及程度与冠状动脉狭窄是平行的。故对冠状动脉狭窄合并颈动脉和（或）椎动脉粥样硬化狭窄者,尤其伴有高血压、糖尿病、吸烟等多重危险因素时,应给予积极强化的联合治疗以减少心脑血管事件的发生。     

Chirurgische Koronarrevaskularisation am schlagenden Herzen

Since the introduction of off-pump coronary artery bypass grafting (OPCAB) for coronary multivessel disease there was growing interest to evaluate the impact of OPCAB surgery compared to conventional coronary artery bypass grafting (CCAB) with cardiopulmonary bypass and cardioplegic arrest. However, subsequent prospective randomized studies and meta-analyses comparing OPCAB and CCAB surgery were performed on low-risk patients or mixed-risk populations. They usually failed to demonstrate a significant benefit of OPCAB surgery on early mortality or perioperative major cardiac and cerebrovascular events. In recent years, efforts were made to analyze the meaning of beating-heart concepts for patients with specific cardiac and extracardiac risks like ischemic cardiomyopathy, older age, renal failure, acute coronary syndrome, left main stenosis and others. For these subsets of patients several mono- and multicenter studies are available today. Even if most of them were nonrandomized and thus failed to reach evidence level A according to the AHA/ACC (American Heart Association/American College of Cardiology) definition, they still allow analyzing interim results for each specific perioperative risk factor. Particularly multi-risk patients and patients with severely reduced left ventricular function seem to benefit in terms of perioperative mortality and major morbidity by avoiding cardiopulmonary bypass and cardioplegic arrest. Analyzing early results and long-term follow-up of 364 patients with severely reduced ejection fraction<20%, the authors found a long-term benefit for patients when using OPCAB strategies particularly due to reduced perioperative mortality. Moreover, for most subsets of patients with significant extracardiac risk factors the incidence or perioperative stroke was reduced. In patients with preoperative renal and pulmonary dysfunction a decrease of corresponding organ failure was found for OPCAB strategy. For most risk populations transfusion requirements were significantly lower in OPCAB compared to CCAB surgery. In none of the patients an unfavorable outcome of beating-heart surgery compared to CCAB was shown. For emergency patients with an acute coronary syndrome presenting stable and unstable hemodynamics the authors found a clinical benefit by using beating-heart strategies. Particularly in patients with cardiogenic shock, cardiopulmonary bypass was often required to guarantee adequate perioperative organ perfusion. However, these patients seemed to benefit from avoiding global cardiac ischemia and maintaining native coronary blood flow. Follow-up results were comparable for these patients. In conclusion, beating-heart coronary artery bypass grafting seems to be advantageous in various risk populations and should be considered for patients with more than average risks for cardiopulmonary bypass and cardioplegic arrest.     

颅内外血管旁路移植术治疗慢性缺血性脑血管病的随访研究

目的探讨颅内外血管旁路移植术对慢性缺血性脑血管病患者预防卒中的作用。方法回顾性分析首都医科大学宣武医院于2000年10月—2009年10月间因慢性缺血性脑血管病行颅内外血管旁路移植术217例患者的临床资料,并随访患者术后的血管造影、临床症状等资料及氙CT检测脑血流的改善情况。结果①217例患者平均年龄（42±13）岁,其中男131例（60．4％）,女86例（39．6％）。所有患者术前6个月内均存在脑缺血症状,包括短暂性脑缺血发作117例（53．9％）、可逆性神经功能缺损37例（17．1％）、完全性卒中63例（29．0％）。所有患者术前接受血流动力学评价,显示受累血管区局部脑血流量降低。②术前血管造影显示,烟雾病62例（28．6％）,一侧颈动脉闭塞72例（33．2％）,单侧大脑中动脉闭塞57例（26．3％）,介入治疗困难的颈动脉或大脑中动脉重度狭窄患者26例（12．0％）。③术后脑血管造影显示,388个吻合口中,380个通畅,通畅率为98．0％（380／388）。围手术期9例（4．1％）患者出现颅内血肿,1例（0．5％）因颅内血肿引发脑疝死亡。④217例患者中,10例患者失访,失访率4．6％。其中172例患者平均随访时间（38±18）个月,81例患者于手术后1年临床症状完全消失。⑤共50例患者术后1个月接受氙CT定量检测脑血流,显示患侧局部脑血流量较术前明显改善（t=3．312,P〈0．05）。结论通过对慢性缺血性脑血管病患者行颅内外血管旁路移植术后的中长期临床随访,显示颅内外血管旁路移植术对血流动力学性慢性缺血性脑血管病患者具有较好的疗效。     

症状性大脑中动脉M1段闭塞后存活患者的预后及其危险因素

目的探讨症状性大脑中动脉M1段闭塞后存活患者的预后及其危险因素。方法选取大脑中动脉M1段闭塞导致首次脑梗死且1个月时仍存活的患者126例,大脑中动脉M1段闭塞经脑血管造影证实,对患者进行随访研究,以脑卒中再发或死亡为终点事件。收集脑血管病的危险因素和血管病变特点,用单因素和多因素Cox回归模型进行危险因素分析。结果 126例大脑中动脉闭塞后存活患者中,平均随访35.7个月(3～66个月),终点事件发生率为14.3%,其中脑梗死再发13例,死亡5例,脑出血2例。单因素和多因素分析显示,冠心病和伴其他血管狭窄数与患者预后明显相关(OR=8.893,95%CI:2.885～27.418,P=0.000)。结论症状性大脑中动脉M1段闭塞存活患者长期预后良好,影响患者预后的因素是冠心病和伴有其他脑血管病变。     

颈动脉易损斑块与缺血性脑卒中复发的相关性研究

目的对颈动脉斑块进行评价,分析斑块性质、形态及其危险因素与缺血性脑卒中复发的相关性。方法选择经头颅CT和(或)MRI确诊为缺血性脑卒中复发患者209例,应用CT血管造影联合彩色多普勒超声检查证实122例有颈动脉斑块,根据斑块性质分为易损斑块组86例,稳定斑块组36例,分析斑块性质、形态,观察发生缺血性脑血管事件相关因素,比较2组缺血性脑卒中复发的时间、分布及狭窄的关系,Cox风险比例模型分析缺血性脑卒中复发与颈动脉斑块等危险因素间的相关性。结果 209例患者中,颈动脉斑块122例,占58.4%。与稳定斑块组比较,易损斑块组年龄更高,高血压和冠心病的比例更多(P<0.05)。Cox回归分析显示,易损斑块与冠心病是缺血性脑卒中复发的危险因素。结论颈动脉斑块性质、形态和冠心病是缺血性脑卒中复发的危险因素。     

Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery bypass grafting

BACKGROUND: Patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events while undergoing coronary artery bypass grafting. The presence of carotid artery stenosis increases the stroke rate in the perioperative period. In an effort to reduce the stroke rate, many institutions perform routine preoperative noninvasive assessment of the carotid arteries. METHODS AND RESULTS: We analyzed the clinical and laboratory data of 1,200 patients who underwent coronary artery bypass surgery in the last 2 years. Carotid Doppler was normal in 186 patients (15.5%), and showed <30% stenosis in 796 (66.3%), 30%-50% in 110 (9.2%), 50%-70% stenosis in 64 (5.3%) and critical (>70%) stenosis in 44 (3.7%) patients. Conventional risk factors such as hypercholesterolemia, hypertension, smoking and family history were not independent predictors of carotid artery stenosis. However, diabetes as a risk factor had a significant association with carotid artery disease (79.6% v. 43.8%, p<0.02). There was a trend towards increased prevalence of carotid artery stenosis in patients with > or = 2 risk factors (84.3% v. 68.8%). Patients with significant carotid artery stenosis had severe coronary artery disease (triple-vessel disease 93.3%, left main coronary artery disease 12.0%). Out of 44 patients with critical carotid artery stenosis, 27 were subjected to carotid angiography. Doppler findings correlated well with angiography. Seventeen patients underwent carotid artery intervention. None had any perioperative neurological events. A total of 5 (0.4%) patients had a major stroke. Coronary artery bypass grafting was done in 27 patients with critical stenosis without any intervention. The stroke rate (11.1%) was higher in these patients compared to patients with < 70% carotid artery disease or post-carotid intervention (2.5%) patients. Thus, untreated >70% carotid artery stenosis was associated with a higher stroke rate. CONCLUSIONS: Doppler screening of the carotid artery is helpful in detecting the subgroup of patients at increased risk of stroke. Patients with critical carotid artery stenosis should be subjected to angiography. Prophylactic intervention may reduce the occurrence of stroke in the perioperative period.     

Management of patients with symptomatic carotid artery occlusion

The annual risk of stroke in patients with symptomatic carotid artery occlusion (CAO) and impaired cerebral blood flow (CBF) is approximately 10%. Increased oxygen extraction fraction measured by positron emission tomography (PET) and low cerebrovascular reactivity assessed by transcranial Doppler is associated with an increased risk of recurrent ischemic stroke in these patients. Recently, other risk factors have been identified: (1) symptoms of purported hemodynamic origin; (2) ongoing symptoms in the presence of documented symptomatic CAO; (3) leptomeningeal collaterals visible on angiography; and (4) low NAA/choline ratio on magnetic resonance (MR) spectroscopy. Evidence is growing that a second extracranial-intracranial (EC-IC) bypass trial might be worthwhile in patients with symptomatic CAO. Probably, only patients with ongoing symptoms and compromised CBF should be included in such a trial. Current evidence based therapeutic options for patients with symptomatic CAO include antithrombotic medication and control of vascular risk factors. For stenosis of the contralateral internal or ipsilateral external carotid artery endarterectomy may be considered. Ongoing symptoms may cease after tapering of antihypertensive medication.     

非体外循环冠状动脉旁路移植术中应用主动脉近端吻合器的临床效果

目的评价主动脉近端吻合器在非体外循环冠状动脉旁路移植术中应用的临床效果。方法对84例冠状动脉粥样硬化性心脏病患者行非体外循环下冠状动脉旁路移植术。静脉桥近端吻合口摒弃传统侧壁钳钳夹下吻合的方法,应用主动脉近端吻合器完成。结果全组病例无死亡,无围术期心肌梗死,无围术期脑出血、脑梗塞等神经系统并发症。术后开胸止血1例,迟发性心包填塞1例,急性肾功能衰竭1例,上消化道大出血1例,均痊愈。结论冠状动脉旁路移植术中应用主动脉近端吻合器,操作简单、安全,可降低术后脑血管并发症的发生率。     

Basic mechanisms of stroke prevention with lipid-lowering therapy

Cholesterol-lowering therapy has not been considered an important risk factor for stroke; however, lipid-lowering therapies reduce cerebrovascular events in patients with coronary heart disease (CHD). The basic mechanisms of cerebrovascular protection have emphasized reduced atheroemboli from the left ventricle and aortic arch, delayed carotid artery disease progression, stabilization of vulnerable carotid atherosclerotic plaque, and improvement in cerebral blood flow.     

Is coronary magnetic resonance angiography already a clinically useful diagnostic tool?

Magnetic resonance imaging (MRI) allows the evaluation of coronary arteries non-invasively and without the use of ionizing radiation. Coronary magnetic resonance angiography (MRA) is technically demanding due to the small size, tortuous course, and bulk motion of the coronary arteries as well as signal from surrounding epicardial fat and myocardium. In comparison to invasive x-ray coronary angiography not all coronary artery segments can be assessed by coronary MRA. At present the diagnostic accuracy of coronary MRA for detection of significant stenosis in coronary arteries is suboptimal. The presence of coronary anomalies and the patency of aortocoronary bypass grafts can be assessed by MRA with high diagnostic accuracy. The combination of coronary MRA with other MRI techniques for detection of ischemia has the potential to be of clinical value in the diagnostic work-up of patients with coronary artery disease.     

颅内-外动脉搭桥术治疗缺血性脑血管病的疗效观察

目的探讨颅内-外动脉搭桥术治疗缺血性脑血管病的疗效。方法选取2007年1月—2010年5月于本院进行治疗的62例缺血性脑血管病患者为研究对象,根据手术方式将其分为对照组与观察组各31例,对照组采用颞浅动脉敷贴术进行治疗,观察组采用颅内-外动脉搭桥术进行治疗,将所有患者的有效率、并发症发生率及治疗前后大脑中动脉的血流动力学指标进行统计比较。结果观察组在有效率、并发症发生率及大脑中动脉的血流动力学指标方面均优于对照组,差异均有统计学意义(P<0.05)。结论颅内-外动脉搭桥术治疗缺血性脑血管病的疗效较好,可显著改善脑部血流。     

Clinical cerebrovascular anatomy

Stroke is often the result of carotid atheroma, which may cause ischemia via progressive arterial narrowing or lead to superimposed thrombus formation and subsequent atheroembolism to the intracerebral vasculature. Revascularization through carotid endarterectomy or carotid artery stenting with embolic protection devices has produced favorable results in appropriately selected patients. In planning the percutaneous approach, an arch aortogram is first acquired to determine arch type and identify the presence of any anatomic variants which may affect the approach to the procedure and catheter selection. Subsequent imaging of the cerebral vasculature is performed to delineate the collateral circulation that is present, including an evaluation of the Circle of Willis. Although Doppler ultrasound, computed tomography (CT), and magnetic resonance angiography (MRA) may be useful in evaluating the presence of carotid or cerebrovascular disease, digital subtraction angiography is required prior to performance of a percutaneous intervention in order to create a procedural “roadmap”. Additionally, the comprehensive management of cerebrovascular disease requires a detailed knowledge of the specific clinical syndromes that result from ischemia in each vascular territory. This methodical review of cerebrovascular anatomy and stroke syndromes will provide the operator with the tools to conduct a thorough neurological assessment prior to revascularization, evaluate any periprocedural complications that may arise, and evaluate the patient with suspected stroke. © 2009 Wiley‐Liss, Inc.     

Perkutane koronare Intervention versus Bypass-Operation bei Patienten mit Diabetes und koronarer Mehrgefäßerkrankung

Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons.     

Coronary endarterectomy and bypass grafting without cardiopulmonary bypass

We prospectively analyzed patients who underwent simultaneous off-pump coronary artery bypass grafting and endarterectomy between March 1, 1997 and February 28, 2002. The incidence of perioperative myocardial infarction, need for inotropic support, morbidity, long-time functional class, and mortality were evaluated.Nine endarterectomies were performed in eight patients, more frequently in the right coronary artery. Dopamine was used in four patients. One perioperative myocardial infarction (12.5%) occurred. No deaths occurred and all patients are now functional class I. Tests for ischemia have been negative in all patients.Coronary endarterectomy is an alternative procedure that has little morbidity and enables complete myocardial revascularization without cardiopulmonary bypass.     

Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm.

In the process of establishing a less invasive assessment strategy for coronary artery disease (CAD) in patients with infrarenal abdominal aortic aneurysm (AAA), the incidence of CAD and the surgical and mid-term outcomes were reviewed. From January 1994 through September 2001, 94 elective surgical repairs of AAA were carried out. Preoperative coronary angiography showed 43 patients (45.7%) had CAD: 29 (67.4%) were asymptomatic, 23 had single-vessel disease (1VD), 12 had 2VD and 8 had 3VD. Of the 43 patients with CAD, 19 (44.2%) underwent coronary interventional therapy before aortic surgery (11 percutaneous transluminal coronary angioplasty (PTCA), 8 coronary artery bypass grafting). Eight asymptomatic patients underwent coronary interventional therapy. None of the patients died of cardiac causes or experienced a postoperative cardiac event. During the follow-up period, 10 late deaths occurred: 7 patients with CAD, and 3 cerebrovascular or cardiac deaths. There was no statistical difference in the survival rate between the groups with and without CAD. Two patients with CAD underwent PTCA during the follow-up period. The findings confirm the need for a less invasive assessment strategy of CAD that does not overlook asymptomatic myocardial ischemia, because the incidence of CAD in patients with AAA is high.     

MANAGEMENT OF PATIENTS WITH SYMPTOMATIC CAROTID ARTERY OCCLUSION

The annual risk of stroke in patients with symptomatic carotid artery occlusion (CAO) and impaired cerebral blood flow (CBF) is approximately 10%. Increased oxygen extraction fraction measured by positron emission tomography (PET) and low cerebrovascular reactivity assessed by transcranial Doppler is associated with an increased risk of recurrent ischemic stroke in these patients. Recently, other risk factors have been identified: (1) symptoms of purported hemodynamic origin; (2) ongoing symptoms in the presence of documented symptomatic CAO; (3) leptomeningeal collaterals visible on angiography; and (4) low NAA/choline ratio on magnetic resonance (MR) spectroscopy.

Evidence is growing that a second extracranial–intracranial (EC–IC) bypass trial might be worthwhile in patients with symptomatic CAO. Probably, only patients with ongoing symptoms and compromised CBF should be included in such a trial. Current evidence based therapeutic options for patients with symptomatic CAO include antithrombotic medication and control of vascular risk factors. For stenosis of the contralateral internal or ipsilateral external carotid artery endarterectomy may be considered.

Ongoing symptoms may cease after tapering of antihypertensive medication.