Long-term outcome in cerebrovascular disease in relation to findings at aortocervical angiography. A 12-year follow up.

The natural history of cerebrovascular disease (CBVD) was evaluated in 169 non-treated patients followed for at least 12 years after aortocervical angiography. The outcome was related to type and location of atherosclerotic changes in the neck vessels. At the time of angiography, 108 patients had completed strokes, 20 had transient ischemic attacks (TIAs), and 41 had angiography for reasons other than acute CBVD. In patients with stroke, non-stenotic lesions as well as stenoses/occlusions were associated with a better long-term survival when they affected the vertebral territory than when the carotid arteries were involved. Patients with normal angiograms had no better prognosis than those with non-stenotic atherosclerosis. Only 2 of 12 deaths in patients with lesions in the vertebral artery were caused by cerebrovascular accidents. In all other groups (normal, carotid lesions only, changes in both carotid and vertebral arteries) the majority of deaths were attributed to CBVD. Rates of recurrent stroke were relatively low in patients with changes in the vertebral arteries and in subjects with non-stenotic lesions in one carotid artery. Intermediate rates were observed when the angiograms were normal, high rates when compound lesions had been demonstrated at angiography. Results show that in patients with stroke the location of atherosclerotic changes to different vessel territories appears to predict the clinical course better than the extent of the lesion(s). No specific angiographic finding was associated with a high initial and a low rate of stroke recurrencies. Therefore, drug therapy to prevent recurrent stroke must probably be life-long in all patients with CBVD not treated by surgery.