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Stroke With Internal Carotid Artery Stenosis
Alexander Tsiskaridze, MD;
Gérald Devuyst, MD;
Gabriel R. de Freitas, MD;
Guy van Melle, PhD;
Julien Bogousslavsky, MD
Arch Neurol. 2001;58:605-609.
Background Stroke patterns in patients with different degrees of carotid stenosis
have not been systematically studied.
Objective To determine first-ever stroke subtypes in nonselected patients with
extracranial internal carotid artery (ICA) stenosis, based on a primary care
hospital stroke registry.
Methods One hundred seventy-three patients who experienced their first-ever
stroke and who had 50% or greater (North American Symptomatic Carotid Endarterectomy
Trial method) ipsilateral extracranial ICA stenosis, corresponding to 6.5%
of 2649 patients with anterior circulation stroke included in the Lausanne
Stroke Registry, were studied. All these patients underwent Doppler ultrasonography,
carotid angiography (conventional or magnetic resonance angiography), neuroimaging
(computed tomography or magnetic resonance imaging), and other investigations
from the standard protocol of the Lausanne Stroke Registry.
Results We found the following types of infarct in the middle cerebral artery
territory: anterior pial in 54 (31%) of the patients; subcortical, 34 (20%);
posterior pial, 32 (19%); large hemispheral, 20 (12%); and border zone, 17
(10%). There were multiple pial in 14 (8%) and multiple deep infarcts in 2
(1%) of the patients. Moderate (50%-69%) ICA stenosis was significantly associated
with large hemispheral infarcts and a normal contralateral ICA (P = .04 and P = .02, respectively). Seventy
percent to 89% of ICA stenosis was associated with prior transient ischemic
attacks (P = .02). After adjusting for cardioembolism,
border zone infarcts showed a strong trend to appear mostly in patients with
90% to 99% ICA stenosis (P = .06).
Conclusions The association of a large hemispheral infarct with moderate ICA stenosis
suggests a large embolism and/or an inadequate collateral supply. While an
embolism may also contribute, the association of border zone infarcts with
90% to 99% ICA stenosis emphasizes the significance of hemodynamic disturbance
in the pathogenesis of these types of infarct.
From the Department of Neurology, Centre Hospitalier Universitaire
Vaudois (Drs Tsiskaridze, Devuyst, de Freitas, and Bogousslavsky), and the
University Institute of Social and Preventive Medicine (Dr van Melle), Lausanne,
Switzerland; and the Sarajishvili Institute of Neurology, Tbilisi, Georgia
(Dr Tsiskaridze).
Corresponding author and reprints: Gerald Devuyst, MD, Department
of Neurology, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne,
Switzerland (e-mail: Gerald.Devuyst{at}chuv.hospvd.ch).
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