Angiographic investigation of patients with transient ischaemic attacks.

Among the various manifestations of cerebrovascular disease none is more important than the phenomenon of transient ischaemic attacks. This importance stems from the fact that, though these short-lived disturbances of neurological function may continue for years without apparent detriment to the patient, they often give warning of an impending stroke. Most commonly they are associated with atherosclerosis; in addition there are precipitating factorswhich include anaemia (Siekert, Whisnant, and Millikan 1960,) polycythaemia (Millikan, Siekert, and Whisnant 1960), hypotensive episodes (Denny-Brown and Meyer, 1957), hypertensive episodes (Kendell and Marshall, 1963), and rheumatic endocarditis (Hutchinson and Stock, 1963). As these precipitating factors occur in only a small proportion, probably not more than 5%, of the patients who comewith transient ischaemic attacks as their presenting complaint, it is important to obtain further understanding of the genesis of their attacks and this may be achieved by visualizing the vessels supplying the brain by angiographic means. Although there have been many reports of extensive series of patients with cerebrovascular disease studied by angiography (Gurdjian, Lindner, Hardy, and Webster, 1960; Meyer, Sheehan, and Bauer, 1960; Bauer, Sheehan, and Meyer, 1961; Muller, Greitz, Liliequist, and Hellstrom, 1964), most have included so wide a variety of types of cerebrovascular disease that it is difficult to determine the pattern of angiographic findings at the stage when the patients are experiencing only transient ischaemic attacks. Poser, Snodgrass, and Faris (1962), however, utilizing a catheter introduced via the brachial artery, studied 89 patients with intermittent cerebrovascular insufficiency and found that of the 288 vessels visualized, 109 (38 %) showed some abnormality, 66 patients having a lesion of some kind. The present study was undertaken to supply further information upon this type of case.