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Carotid artery and heart disease in subtypes of cerebral infarction
A Lindgren1, A Roijer, B Norrving
1Department of Neurology, University Hospital, Lund, Sweden.
Insights
Carotid artery disease and major cardioembolic sources are more prevalent in cerebral infarction patients than controls. However, the cause of stroke remains unclear in one-third of patients, limiting the value of minor cardioembolic sources as a risk factor.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Cerebral infarction (stroke) is a leading cause of disability.
- Identifying the source of cerebral infarction is crucial for effective prevention and treatment.
- Prevalence of carotid artery disease and cardioembolic sources in stroke patients requires further investigation.
Purpose of the Study:
- To determine the prevalence of carotid artery disease and potential cardioembolic sources in patients with cerebral infarction compared to controls.
- To investigate these prevalences across different clinical subtypes of cerebral infarction.
Main Methods:
- A study involving 166 cerebral infarction patients and 59 age-matched controls.
- Utilized ultrasonography of carotid arteries, echocardiography (TTE and TEE), ECG, and neuroimaging (CT, MRI) or autopsy.
- Included clinical subtyping of cerebral infarctions.
Main Results:
- Carotid artery stenosis (≥80%) or occlusion was found in 21% of patients vs. 0% of controls (P < .001).
- Major cardioembolic sources were detected in 39% of patients vs. 5% of controls (P < .01).
- Atrial fibrillation was present in 21% initially and 28% on repeat ECG in patients.
- Carotid artery disease or major cardioembolic sources were more frequent in cortical stroke subtypes (66%) than lacunar syndromes (22%).
- The probable cause was identified in most patients: cardiac embolism (28%), carotid disease (8%), both (7%), lacunar infarction (23%).
- No clear cause was found in 34% of patients.
Conclusions:
- Prevalence of carotid artery disease and heart disease significantly differs between cerebral infarction subtypes.
- The etiology of cerebral infarction remains uncertain in approximately one-third of patients.
- Minor cardioembolic sources are common in both patients and controls, questioning their value as a stroke risk factor in the elderly.
Background And Purpose:
The aim of the study was to determine the prevalences of carotid artery disease and major and minor potential cardioembolic sources (1) in patients with cerebral infarction and age-matched control subjects and (2) in different clinical subtypes of cerebral infarction.
Methods:
A series of 166 consecutive patients with cerebral infarction and 59 control subjects was examined. The study protocol included clinical subtyping of the cerebral infarctions, ultrasonography of the carotid arteries, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG, and examination of the brain with computed tomography, magnetic resonance imaging, or autopsy.
Results:
Carotid artery stenosis > or = 80% or occlusion was present in 35 (21%) patients but in no control subjects (P < .001; chi 2 test). A major potential cardioembolic source was detected in 65 (39%) patients and 3 (5%) control subjects. Atrial fibrillation was present in 35 (21%) patients and 3 (5%) control subjects at initial ECG (P < .01) and in 47 (28%) patients at repeat examination; 17 patients had paroxysmal atrial fibrillation. Sinus rhythm and a major potential cardioembolic source were detected in 18 (11%) patients but in no control subjects (P < .01) at TTE (all patients and control subjects examined) or TEE (118 patients and 52 control subjects examined). The frequency of a minor potential cardioembolic source detectable at TTE or TEE was similar in the patient and control groups (51% and 53%, respectively [NS]) and increased significantly with age. A finding of carotid artery stenosis > or = 80% or occlusion, atrial fibrillation, or a major cardioembolic source detected at TTE or TEE was more frequent among patients with cortical symptoms from anterior or middle cerebral artery territories than among those with lacunar syndromes (66% versus 22%, respectively). The probable source of cerebral infarction was identified in most of the 166 patients: cardiac embolism in 28% of cases (n = 46), carotid artery disease in 8% (n = 14), both cardiac embolism and carotid artery disease in 7% (n = 11), and lacunar infarction in 23% (n = 38). In 57 (34%) of the patients no unequivocal cause of the cerebral infarction was found.
Conclusions:
The prevalences of carotid artery and heart disease differ significantly between clinical subtypes of cerebral infarction. The cause of cerebral infarction remains uncertain in one third of patients. Because a minor potential cardioembolic source occurs in about 50% of both patients and control subjects, this finding is of questionable value as a risk factor for stroke in the elderly.