Carotid disease in acute stroke: a review

This article reviews the literature about carotid disease in acute stroke. Several conclusions are drawn. First, carotid disease is an important cause of ipsilateral cortical strokes, with significant ipsilateral disease found in about one fourth of patients. Second, the role of carotid disease in lacunar stroke is less certain but probably causes a small number of lacunar infarcts. Third, the majority of infarcts that occur with severe carotid stenosis or acute carotid occlusion are caused by cerebral emboli, whereas most infarcts with preexisting occlusion are probably caused by hemodynamic factors. Fourth, the optimal timing of carotid surgery in acute stroke is uncertain. Clinical trials of endarterectomy in acute stroke are now required.