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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1998 September;17(3):187-93


lingua: Inglese

The prev­a­lence of cere­bral ­infarcts in the asymp­to­mat­ic carot­id sur­gery trial (ACST) in rela­tion to prior con­tra­lat­er­al symp­toms

Robless P., Baxter A., Bryd S., Emson M., Halliday A. on ­behalf of the Asymptomatic Carotid Surgery Trial collaborators

From the Academic Surgical Unit, St. Mary’s Hospital, London, UK


Background. The ACST has ran­dom­ised over 1670 ­patients to deter­mine if carot­id endar­te­rec­to­my (CEA) pro­longs ­stroke free sur­vi­val ver­sus best med­i­cal treat­ment alone. Some ­patients have had con­tra­lat­er­al symp­toms to the side under inves­ti­ga­tion, for which CEA may have been per­formed. This study aims to deter­mine the prev­a­lence of hem­i­spher­ic cere­bral ­infarcts in rela­tion to prior con­tra­lat­er­al symp­toms.
Methods. Patients with pre­op­er­a­tive CT or MR scans were divid­ed into those with prior con­tra­lat­er­al ­stroke, cor­ti­cal TIA, amau­ro­sis fugax or no symp­toms.
Results. There were 1144 ­patients with pre­op­er­a­tive CT and 170 ­patients with MR scans. Incidence of con­tra­lat­er­al hem­i­spher­ic CT and MR ­infarcts were 19% (222/1144) and 20% (34/170) respec­tive­ly. Those with prior con­tra­lat­er­al ­stroke (141) had the high­est inci­dence of hem­i­spher­ic CT ­infarcts (62%). Those with TIA (129) had a 30% inci­dence of CT ­infarct. Incidence of hem­i­spher­ic CT ­infarcts were 17% with amau­ro­sis fugax (46) and 10% with no prior symp­toms (803). Mantel-Haenszel test for lin­e­ar asso­ci­a­tion was sig­nif­i­cant (p<0.001) for increas­ing sever­ity of symp­toms. Considering MR scans, those with prior con­tra­lat­er­al ­stroke (17) had the high­est inci­dence of hem­i­spher­ic MR ­infarcts (53%). Patients with TIA (23) or amau­ro­sis fugax (6) had a 27% inci­dence of MR infarc­tion. Those with no prior symp­toms (121) had a 14% inci­dence of MR ­infarcts. Mantel-Haenszel test was sig­nif­i­cant (p<0.001).
Conclusions. In the ACST, cur­rent­ly asymp­to­mat­ic ­patients have an inci­dence of con­tra­lat­er­al hem­i­spher­ic CT and MR ­infarcts pro­por­tion­al to the sever­ity of prior con­tra­lat­er­al symp­toms.

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