Carotid Disease in Acute Stroke

Severe ipsilateral carotid stenosis and middle cerebral artery disease in lacunar ischaemic stroke: innocent bystanders?

“…The 'cut-off ' point for defining carotid stenosis in these studies ranged from > 50 % to > 70 %. Two studies found no difference in the prevalence of carotid stenosis ipsilateral or contralateral to the side of symptoms [7,10], and a further two found a non-significant trend towards a higher prevalence on the ipsilateral side [8,9]. The fifth study, the European Carotid Surgery Trial (ECST),found a significantly higher prevalence of severe stenosis on the ipsilateral than the contralateral side [11].…”

“…Our literature search identified five previous studies recruiting a total of 504 lacunar ischaemic stroke patients [7][8][9][10][11] (table 2). Carotid disease was identified using catheter angiography in two studies and Doppler ultrasound in three.…”

“…Similarly, in a study based in a neurosonography laboratory, patients who were thought (on clinical grounds) to have a severe stenosis may have been preferentially referred for imaging [9]. In the studies which recruited consecutive unselected patients [7,10], the prevalence of severe disease (however defined) was identical on the ipsilateral and contralateral sides. Finally, we cannot be certain that publication bias has not occurred i. e. that studies demonstrating that carotid stenosis was more common in the ipsilateral than contralateral side may have been preferentially submitted and accepted for publication.…”

“…By contrast, severe carotid disease is about three times more common on the ipsilateral than contralateral side in patients with cortical or large artery ischaemic strokes (partial and total anterior circulation strokes), suggesting a causative role [10].…”

Patterns of ischaemic cerebral diseases

“…The correspondence between the clinical classification and the CT/MR findings is not perfect, positive predictive value ranging from 71 to 83 [61]. Nevertheless the OCSP is very useful clinically because it is easy to communicate and predicts aetiology [62], case fatality, functional recovery and risk of recurrence of stroke patients. TACIs have a highest mortality while LACIs have the lowest.…”