Biomedical subjects
J J Gaul
Publications and source records attributed to J J Gaul.
Atherosclerotic plaque at the carotid artery bifurcation. Correlation of ultrasonographic imaging with morphology.
Morphologic characteristics of atherosclerotic plaque at the carotid artery bifurcation were compared to the appearance of the plaque on real-time B-mode ultrasonography. Mural plaques propagating along the wall of the carotid sinus had a 72% frequency of recent organizing hemorrhage. Nodular plaques causing local narrowing of the vessel had only a 23% incidence of organizing hemorrhage. This difference was significant (P less than 0.01). The presence of recent organizing hemorrhage in mural plaques may account for the increased frequency of symptoms previously observed to occur ipsilateral to mural plaques compared to nodular plaques.
Visual disturbance and carotid artery disease. 500 symptomatic patients studied by non-invasive carotid artery testing including B-mode ultrasonography.
Non-invasive carotid artery testing was performed on 500 consecutive patients with visual disturbances not related to local ophthalmic pathology to determine the extent of carotid artery disease, particularly in patients with symptoms not typical of amaurosis fugax. Three hundred eighty six patients (77.2%) had an abnormal study. However, the incidence of hemodynamically significant lesions was only 16%. The patients could be divided into three groups: Patients with symptoms that could be explained on an ocular basis, including amaurosis fugax, had a 79% incidence of ipsilateral carotid plaques. Patients with symptoms which could not be easily explained on an ocular basis, such as bilateral blurred vision, bilateral visual loss (both transient and permanent), and homonymous hemianopsia had an incidence of carotid artery plaques similar to patients with amaurosis fugax. Patients with unilateral blurred vision and bilateral scintillations had a lower incidence (57%) of carotid plaques than the other groups. Younger symptomatic patients had less carotid plaques than the overall series. Twenty-one percent of patients under age 50 had the Doppler finding of early systolic flutter turbulence, which is usually of mitral valve origin. Women predominated in the under 50 age group by about 2:1. In view of the prevalence of carotid plaques in the population of patients with visual symptoms other than amaurosis fugax, evaluation of these patients with non-invasive testing is indicated to determine which of these patients has hemodynamically significant obstruction to flow at the carotid artery bifurcation.