Should patients presenting with lacunar stroke be considered for carotid endarterectomy?
Large-artery disease is commonly associated with intracranial small-vessel disease, the site of lesions causing lacunar stroke. NASCET entered 1158 patients with hemispheric stroke, of whom 493 (42.6%) had clinicoradiologic features of lacunar stroke: 283 defined as possible and 210 as probable.32 With medical treatment these lacunar stroke patients had a lower risk of large-artery stroke than did those presenting with large-artery stroke and conversely a higher risk of further lacunar stroke. Lacunar strokes were more likely to be observed in patients with mild to moderate stenosis. Among patients with stroke other than lacunar stroke who had 50% to 99% stenosis of the internal carotid artery, the risk of stroke associated with medical treatment at 3 years was reduced by carotid endarterectomy from 24.9% to 9.7%, an absolute risk reduction of 15.2%. Among patients with “probable” lacunar stroke at entry, risk of subsequent stroke was reduced from 25.5% to only 16.5%, an absolute risk
