Stroke, Vol 25, 2356-2362, Copyright © 1994 by American Heart Association
A Lindgren, A Roijer, B Norrving, L Wallin, J Eskilsson and BB Johansson
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.
ARTICLES
Carotid artery and heart disease in subtypes of cerebral infarction
Department of Neurology, University Hospital, Lund, Sweden.
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