LACUNAR INFARCTIONS - COMPARATIVE-STUDY O F RISK-FACTORS AND CAROTID STENOSIS

Objective. In order to evaluate the pathogenic role of carotid atherom atosis and risk factors for the lacunar type of cerebral ischaemia a c omparative analysis was made between a group of patients with this typ e of stroke and other with non-lacunar infarctions. Unlike previous wo rks, patients with clinical-radiological criteria for ischaemia in the carotid territory were included in both groups. Methods. Ninety-eight patients with a first episode of stroke were selected prospectively. Strokes were classified as lacunar (52 patients) and non-lacunar (46 p atients). The following risk factors were evaluated: age, sex, increas ed blood pressure, left ventricle enlargement, smoking, alcohol intake , lipid profile, history of previous transient stroke, arterial retino pathy, diabetes, ischaemic heart disease and presence of peripheral ar teriopathy. The narrowing degree of the carotid artery was determined by means of Doppler ultrasonography. Results. Significant differences were found for the presence of two variables: hypertensive retinopathy was more prevalent in the lacunar group (p=0.003) and history of tran sient ischaemic stroke was recorded more frequently in association wit h non-lacunar infarction (p=0.01). A 50%-70% degree of narrowing in th e upper carotid artery was observed more frequently in association wit h non-lacunar infarctions (p<0.001) in the ipsilateral artery to the s ymptomatic hemisphere. In the heterolateral artery the narrowing degre e was similar for both groups (p=0.87). Conclusions. Lacunar and non-l acunar infarctions share the same risk factors; nevertheless, the dist ribution of atheromatous lesions was different. The presence of hypert ensive retinopathy is an excellent marker for perforant arterial disea se. The carotid stenosis is an unusual pathogenic mechanism for the de velopment of ischaemic lacunar syndrome with an appropriate injury vis ualized by CT.