Estenosis carotídea e infarto lacunar

Perforating artery disease is still the main cause of lacunar infarcts (LI), while the relationship between this type of ischemia and carotid stenosis (CS) is controversial.To assess the association between CS and LI in patients with criteria of localized ischemia in the carotid territory separately analyzing isolated LI and multiples LIs.Three hundred and thirty patients with a first episode of cerebral infarct in the area supplied by the carotid artery were registered prospectively. There were 205 LI (135 isolated and 70 multiple) which could be differentiated from 125 non-lacunar infarcts (NLI). The vascular risk factors were determined and the degree of carotid stenosis measured by duplex-colour ultrasound exploration.In the isolated LI group the frequency of presentation of CS greater than 50% was 22% for the artery ipsilateral to the LI and 8% for the contralateral artery. For significant CS (> 70%) frequencies of 14% (ipsilateral) and 8% (contralateral) were observed. On comparative analysis with the NLI group, the presence of stenosis greater than 50 to 70% was significantly higher in these for both ipsilateral and contralateral arteries. In the LI group, isolated CS was significantly more frequent on the side which was homolateral to the ischemia as compared to its isolated presence on the contralateral side (22/30 vs 4/12; OR: 5.5 [95% CI: 1.2-23]). Ipsilateral CS greater than 70% behaved as a factor which was significantly associated with the multiple LI subtype with a unilateral pattern.CS should be considered a risk factor for LI.