Risk factors and outcome of patients with carotid artery stenosis presenting with lacunar stroke

Objective: To examine the relationship between carotid artery stenosis, oth er risk factors, and lacunar stroke. Background: Carotid artery stenosis in patients presenting with lacune stroke may be coincidental or causal, The distinction by risk factor profile is uncertain. The risk and cause of subs equent stroke, and benefit of carotid endarterectomy (CE) is unknown. Metho ds: Stroke in patients entering the North American Symptomatic Carotid Enda rterectomy Trial were classified as nonlacunar, possible lacune (symptoms w ithout CT lacunae), or probable lacune (symptoms with CT lacunae). Results: Of 1,158 patients with hemispheric stroke, 493 had features of lacunar str oke (283 possible and 210 probable). Lacunar stroke presented more commonly in patients with milder (<50%) degrees of internal carotid artery (ICA) st enosis (p = 0.003). History of diabetes and hyperlipidemia., not hypertensi on, were associated independently even after accounting for the degree of s tenosis. Medically treated patients presenting with nonlacunar stroke had a low risk of subsequent lacunar events of 2.9% at 3 years in comparison wit h 9.2% for probable lacunar presentation (p = 0.03). For patients with 50 t o 99% ICA stenosis, the relative risk reductions (RRRs) in stroke from CE w ere 35% when the presenting stroke was probable lacunar versus 61% when the stroke was nonlacunar. Patients presenting with a possible lacunar stroke had a 53% RRR. Conclusions: History of diabetes and hyperlipidemia were mor e important than arterial hypertension as risk factors for patients with la cunar stroke. Patients presenting with lacunar stroke more often had milder ICA stenosis. Although CE reduced the risk of stroke in all patients with 50 to 99% ICA stenosis, lesser benefits were observed in patients presentin g with lacunar stroke.