EFFECT OF TRANSFUSION THERAPY ON ARTERIOGRAPHIC ABNORMALITIES AND ON RECURRENCE OF STROKE IN SICKLE-CELL DISEASE

  • 1 January 1984
    • journal article
    • research article
    • Vol. 63  (1) , 162-169
Abstract
Stroke is a relatively frequent and severe complication of sickle cell disease. Cerebral arteriograms were performed in 30 patients with sickle cell disease to evaluate the cause of acute neurologic deficits and to assess the effects of transfusion therapy given for a yr or more after the acute episode. Patients (23) with motor and speech deficits had multiple abnormalities of major cerebral arteries. The internal carotid, and anterior and middle cerebral arteries showed stenosis and/or occlusion at their comon junction. Irregular luminal surfaces suggested that endothelial damage and intimal hyperplasia were the basis of stroke. Prolonged transfusion therapy nearly stopped progression of stenosis and markedly decreased the irregularity of the luminal surfaces; in 4 untransfused patients, the degree of stenosis doubled and the luminal abnormalities persisted. Prior to transfusion, 90% of patients had recurrence of stroke. With transfusion therapy, only 10% of patients had recurrence despite persistent arterial abnormalities. Clinical recurrences/patient month decreased 75-fold. The patients tolerated prolonged transfusion therapy well, despite progressive Fe accumulation. Seven patients with smooth abnormalities of a single artery, nonocclusive changes or with normal arteriograms did not receive transfusions. Only 1 of this group had recurrence of symptoms.