Clinical Briefs-By Louis Kuritzky, MD
Causes and Severity of Ischemic Stroke in Patients with Internal Carotid Artery Stenosis
Carotid stenosis (cs) is a common concomitant of stroke. In persons with demonstrated CS, the likelihood of subsequent stroke referable to that stenosis has been poorly defined. Barnett and colleagues followed 2885 patients for five years who had been determined to have more than 70% symptomatic CS, delineating the underlying pathology of subsequent stroke. The population was derived from the North American Symptomatic Carotid Endarterectomy Trial, a study spanning the 1987-1997 interval.
As anticipated, most stroke was ischemic in origin (more than 95%). Large artery stroke was more than twice as frequent as cardioembolic and lacunar etiologies combined. In carotid arteries demonstrating 70-99% stenosis, as many as 20% of subsequent strokes are not apparently related to the underlying ipsilateral carotid disease. Final treatment strategies should take into account that carotid surgery alone does not entirely eliminate risk of subsequent stroke; incorporation of knowledge about the patients subsequent risk for lacunar and cardioembolic stroke is essential for maximum risk reduction.
Barnett HJ, et al. Causes and severity of ischemic stroke in patients with internal carotid artery stenosis. JAMA 2000;283:1429-1436.
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