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(Stroke. 2003;34:1409.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment: The Fall and Rise of Lacunar Infarction With Carotid Stenosis

Department of Neurology, Lausanne-CH, Lausanne, Switzerland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Lacunar infarction (LI) is one of the most common subtypes of ischemic stroke.¹ Introduced by Fisher,² the term lacunar infarction is now established in the literature. However, the concept of LI remains a subject of debate,³ since lacunar syndromes were not found to be exclusively pathognomonic of small-artery disease.

In this issue of Stroke, Tejada et al⁴ address the potential relationship between LI and the presence of an internal carotid artery stenosis (ICAS). Whether this finding is causative or coincidental is debatable. Previous studies^5–7 have already investigated the question with opposite opinions.^8–14 In the ECST study, patients with LI had less severe ICAS, leading to the hypothesis that severe ICAS in patients with LI may just be coincidental.⁹ Recently, studies using carotid and transcranial ultrasound^15,16 have revisited this question. In the study of Cupini et al,¹⁵ the intima-media thickness (IMT) of carotids as measured by ultrasound was significantly higher in patients with nonlacunar infarction (NLI) versus both those with LI and controls. The IMT, considered as an early marker of atherosclerosis when increased, may have a predictive value to separate LI versus NLI. However, another study¹⁷ also using the IMT did not find a difference between LI and NLI. Mead et al¹⁶ studied patients with recent LI and compared the results of carotid and middle cerebral artery (MCA) ultrasound. The authors¹⁶ could not find a difference between patients with LI and those with NLI for either carotid or MCA disease. They concluded that ICA stenosis in patients with LI . . . [Full Text of this Article]

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