[Lacunar infarcts. A comparative study of risk factors and carotid stenosis].
OBJECTIVE
In order to evaluate the pathogenic role of carotid atheromatosis and risk factors for the lacunar type of cerebral ischaemia a comparative analysis was made between a group of patients with this type of stroke and other with non-lacunar infarctions. Unlike previous works, 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 patients). The following risk factors were evaluated: age, sex, increased blood pressure, left ventricle enlargement, smoking, alcohol intake, lipid profile, history of previous transient stroke, arterial retinopathy, diabetes, ischaemic heart disease and presence of peripheral arteriopathy. 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 transient ischaemic stroke was recorded more frequently in association with non-lacunar infarction (p = 0.01). A 50%-70% degree of narrowing in the upper carotid artery was observed more frequently in association with non-lacunar infarctions (p < 0.001) in the ipsilateral artery to the symptomatic hemisphere. In the heterolateral artery the narrowing degree was similar for both groups (p = 0.87).


CONCLUSIONS
Lacunar and non-lacunar infarctions share the same risk factors; nevertheless, the distribution of atheromatous lesions was different. The presence of hypertensive retinopathy is an excellent marker for perforant arterial disease. The carotid stenosis is an unusual pathogenic mechanism for the development of ischaemic lacunar syndrome with an appropriate injury visualized by CT.
Tejada García
J
J
Sección de Neurología, Complejo Hospitalario del INSALUD, León.
Martínez Valderrábano
V
V
Fernández López
F
F
Hernández Echebarría
L
L
Balboa Arregui
O
O
Martínez Blanco
L
L
González Vega
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial
Infartos lacunares. Estudio comparativo de factores de riesgo y estenosis carotídea.