Amaurosis fugax: the importance of carotid plaque morphology

Amaurosis fugax, or transient monocular blindness, was first associated with carotid bifurcation disease in 1951. Although amaurosis fugax is often considered by vascular surgeons to be premonitory for cerebral stroke, recent studies indicate that this disease process may be more benign than previously thought. A total of 97 patients presented with amaurosis fugax to our vascular laboratory from November 1983 to January 1988. There were 81 males and 16 females, mean age 67.2 years. The common, internal and external carotid arteries were imaged in standard longitudinal and cross-sectional views. Repeat scans were performed at six months and 12 months after the first visit, then yearly thereafter. Out study confirms the correlation between heterogeneous, complex carotid plaques and the development of amaurosis fugax. Endarterectomy can safely be performed in this group of patients, preventing further symptoms or development of stroke. We advocate duplex scanning to assess the carotid bifurcation and allow non-invasive follow-up of disease progression.