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Julien Bogousslavsky, MD; Vladimir C. Hachinski, MD, FRCP(C); Derek R. Boughner, MD; Allan J. Fox, MD; Fernando Viñuela, MD; Henry J. M. Barnett, MD

Arch Neurol. 1986;43(3):223-228.

Abstract
• Two hundred fifty consecutive patients with carotid transient ischemic attacks (TIAs) and no previous stroke were assessed with cerebral angiography (95%), two-dimensional echocardiography (86%), electrocardiography (100%), and Holter monitoring (99 selected patients). Angiography disclosed a lesion appropriate to the TIAs in 84%. Lesions also occurred in the asymptomatic carotid artery, but stenosis of more than 75% of the lumen diameter and ulcers were significantly more frequent on the symptomatic side. Twenty-three percent of the patients had a potential source of emboli from the heart, usually in the context of symptomatic heart disease. Among the 205 patients who underwent full angiographic and cardiac investigations, 6% had an isolated potential cardiac source of emboli and 19% had a potential cardiac source of emboli associated with appropriate carotid disease. The search for a potential cardiac source of emboli is strongly indicated in patients with carotid TIAs and known heart disease. In the patients with no history of heart disease, the yield of this search is low, but our results suggest that at least 14 of such patients have an undetected potential cardiac source of emboli. Cardiac and arterial lesions commonly coexist in carotid TIAs.

Author Affiliations
From the Departments of Clinical Neurological Sciences (Drs Bogousslavsky, Hachinski, and Barnett), Medicine (Dr Boughner), and Radiology (Drs Fox and Viñuela), University of Western Ontario, London. Dr Bogousslavsky is on leave from the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Drs Hachinski and Boughner are research associates of the Heart and Stroke Foundation of Ontario.

Footnotes
Accepted for publication Nov 5, 1985.

Reprint requests to University Hospital, Room 7 GE 5, PO Box 5339, Postal Station A, London, Ontario, Canada N6A 5A5 (Dr Hachinski).

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