Background: the Oxfordshire Community Stroke Project (OCSP) devised a simpl
e clinical classification for acute stroke which predicted mortality functi
onal recovery and patterns of recurrent stroke. We aimed to determine wheth
er this could predict the presence of carotid disease and be used to select
which patients with acute stroke should be referred for carotid imaging wi
th a view to subsequent carotid endarterectomy.
Methods: we assessed patients with acute stroke admitted to seven hospitals
over a 10-month period. Patients were classified according to the OCSP sys
tem and their carotid arteries investigated using portable continuous-wave
Doppler. Those with abnormal portable assessments had colour duplex Doppler
imaging.
Results: of 305 patients with proven or probable cerebral infarction, sever
e (70-99%) ipsilateral carotid stenosis was found in 16 (16%) of the 101 wi
th partial anterior circulation infarct (PACI), four (4%) of the 100 with t
otal anterior circulation infarct (TACT), none of the 80 with lacunar infar
ct (LACI) and one (4%) of the 24 with posterior circulation infarct (POCI).
Complete ipsilateral carotid occlusion was found in 25 (25%) of the TACI g
roup, 11 (11%;) of the PACI group, three (4%) of the LACI group and none of
the POCI group. Severe carotid stenosis or occlusion was more common in th
e ipsilateral than the contralateral carotid artery for the TACI and PACI g
roups (chi(2) P<0.05), but there was no difference between ipsilateral and
contralateral carotid disease in the LACI and POCI groups. If the OCSP clas
sification is used to detect patients with 70-99% carotid stenosis, then th
e sensitivity is 76% and specificity is 70%.
Conclusion: these findings suggest that ipsilateral carotid disease is an i
mportant cause of stroke for those With anterior circulation infarcts but n
ot fur those with LACI or POCI, Subjects with PACI should be referred for e
arly carotid imaging to identify those with severe disease who may be suita
ble for elective carotid surgery.