Arteriographic comparison of amaurosis fugax and hemispheric transient ischaemic attacks

The results of carotid angiography were compared in 53 patients with amaurosis fugax and 92 with hemispheric transient ischaemic attacks (TIAs). Evidence of extracranial disease was found in 71% of those with retinal ischaemia and these patients rarely had evidence of intracranial disease (11%) or normal angiograms (15%). By contrast patients with hemispheric symptoms less frequently showed disease of the cervical carotid artery (36%) and more often had intracranial disease (27%) or normal angiograms (35%). It is suggested that amaurosis fugax is usually due to emboli originating in the internal carotid artery but that the pathogenesis of cerebral TIAs in the carotid territory is more heterogeneous. These conclusions have implications for the design and interpretation of both medical and surgical trials.