Ischaemic Lacunar Stroke in the European Carotid Surgery Trial

We compared the degree of carotid stenosis, risk factor profile, and effect of carotid surgery on incidence and type of recurrent stroke in lacunar infarct and non-lacunar infarct patients from the European Carotid Surgery Trial. The two patient groups were defined by the site and size of any symptomatic infarct on the pre-randomisation CT scan. The follow-up ischaemic carotid strokes were classified into lacunar, non-lacunar or uncertain. The risk factor profile was similar for the 222 lacunar and the 404 non-lacunar infarct patients. However, lacunar infarct patients had less severe carotid stenosis (p< 0.001). Small numbers did not allow conclusions about the efficacy of carotid surgery in those few lacunar infarct patients who had severe carotid stenosis. These findings are consistent with the hypothesis that severe carotid stenosis in lacunar infarct patients is usually incidental, and so 'asymptomatic', and that lacunar infarcts are most likely to be due to intracranial small-vessel disease.