The clinical course and outcome in patients with acute ischaemic stroke and transient ischaemic attack in relation to severe carotid disease.

Abstract

OBJECTIVES: To determine whether a severe ipsilateral carotid lesion influences the patient's clinical course and outcome in the acute phase of an ischaemic stroke or transient ischaemic attack (TIA). DESIGN: An evaluation of prospectively-collected and recorded clinical information and sonographic findings in patients treated in a stroke unit. SUBJECTS: Two hundred and sixty-six consecutive patients with acute ischaemic stroke or TIA in the carotid territory. MAIN OUTCOME VARIABLES: A sonography of the carotid arteries was performed in all cases. Stroke symptoms were continuously monitored and progression and recurrence particularly looked for. Patient outcome at discharge was also recorded. RESULTS: An ipsilateral carotid stenosis of > or = 70% was found in 11%, and 4% had an occlusion. These patients had no statistically significant increase in the rate of progression or recurrence of stroke during the acute phase. Furthermore, they did not become more disabled or in need of extended institutional care. CONCLUSIONS: Severe ipsilateral carotid disease does not significantly influence the acute clinical course or outcome in ischaemic stroke patients and there seems to be no need for urgent sonography and treatment.