Q J Med 2002; 95: 313-319
© 2002 Association of Physicians
Should patients with lacunar stroke and severe carotid artery stenosis undergo endarterectomy?
J. Kelly1,2,,
B.J. Hunt3,
A. Rudd1,2 and
R.R. Lewis1,2
1 From the Departments of Elderly Care,
2 Stroke Medicine and
3 Haematology, St Thomas's Hospital, London, UK
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Introduction
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The concept of lacunar infarction (LI) has been long recognized,
but it was Fisher who first drew attention to the association
with distinct clinical syndromes.
1–4 In his original description,
LIs were described as small subcortical infarcts affecting the
basal ganglia, internal capsule, thalamus or pons, which occurred
in association with occlusion of deep penetrating arterioles
on a background of hypertensive small-vessel disease, chiefly
lipohyalinosis and microatheroma.
1–4
If this aetiopathogenetic description holds true for all patients, an associated severe ipsilateral carotid artery stenosis (CAS) would be regarded as coincidental rather than causative. Given that severe asymptomatic disease is often best managed medically, as the benefit of carotid endarterectomy (CEA) is marginal and cannot be recommended unless the perioperative complication rate is <3%,5–7 such a patient might be expected to gain little from surgery. However, recent National Stroke Guidelines recommend CEA for patients with non-disabling anterior circulation stroke and >70% ipsilateral CAS, . . . [Full Text of this Article]
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The diagnosis of lacunar infarction
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Can emboli cause lacunar infarction?
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Pathological studies
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Risk factor profiles
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Case reports of probable embolic LI
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Imaging
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Prevalence of an embolic source for LI
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Transcranial Doppler ultrasound studies
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Carotid endarterectomy in patients with lacunar infarction
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Conclusion
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Acknowledgments
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Notes
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References
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C. Jackson and C. Sudlow
Are Lacunar Strokes Really Different?: A Systematic Review of Differences in Risk Factor Profiles Between Lacunar and Nonlacunar Infarcts
Stroke,
April 1, 2005;
36(4):
891 - 901.
[Abstract]
[Full Text]
[PDF]
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