Race, sex and occlusive cerebrovascular disease: a review.

Abstract

IDEALLY, treatment of a patient with cerebral ischemia should be guided by knowledge of the nature, location, and severity of the occlusive disease within the extracranial and intracranial vessels.'To plan efficient evaluation of the individual patient, the responsible clinician must be familiar with the relative probability of finding occlusive lesions at various sites within the vascular tree since individual imaging and non-invasive tests have different capabilities with regard to various vascular loci. 2 A growing body of data suggests that there are important differences in the distribution of occlusive vascular disease in Blacks and Whites and in men and women.This review summarizes the presently available data. Early Pathological Studies in PredominantlyWhite Patient Populations In 1951, Fisher reviewed the autopsy results of 200 patients with cerebrovascular disease and did not find a single example of occlusion of the middle cerebral artery (MCA).3 Previously, most patients with anterior circulation infarcts were given the clinical diagnosis of MCA occlusion.In Fisher's experience, internal and carotid artery (ICA) occlusion was more common.3 ' 4 Adams and Vander Eecken 5 found that the commonest sites of occlusive cerebrovascular lesions were the origins of the ICA, the sigmoid portions of the intracranial ICA, the first 3 to 4 cm. of the proximal MCAs, the anterior cerebral arteries (ACA) just proximal and distal to the anterior communicating artery, and the proximal vertebral, basilar, and posterior cerebral arteries (PCA).Using a dissecting technique that involved the removal of the vertebral arteries with the cerebral vertebrae en bloc, Hutchinson and Yates noted that atherosclerosis of the vertebral artery was most prevalent in the proximal portion of the vertebral artery and often was contiguous with atheroma within the parent subclavian artery.6 The severity of atheroma within the proximal vertebral artery often paralleled that within the proximal ICA.7 Baker and lannone described the location and severity of atherosclerosis in 173 consecutive autopsies.8 Lesion grading was based on fatty deposits and calcification; luminal stenosis was only one factor studied.The most common sites of involvement were the ICA origin and distal basilar artery; the proximal and mid-portion of the basilar artery, and the MCA were next most frequently involved, followed by