Brain CT infarction in patients with carotid atheroma. Does it predict a future event

Background. The aim of the present study was to investigate the predictive value for subsequent stroke of different patterns of brain CT infarction in patients with carotid atheroma. Methods. Prospective study on 138 patients, with 138 carotid plaques, having, on presentation, a greater than 50% stenosis on duplex scanning and associated with an ipsilateral (to the plaque) amaurosis fugax (AF), hemispheric transient ischaemic attack (HTIA) or which were asymptomatic. This carotid artery defined the side of interest. All patients had a brain CT scan on presentation and subsequently were followed for a period of 1-5 years (mean 3.14). The baseline CT neurovascular findings on the side of interest were classified as pattern A (discrete subcortical and cortical infarctions), pattern B (haemodynamic infarctions, widespread white matter lesions, basal ganglia infarctions and lacunae) and normal CT. Results. On follow-up, 5/27 (18.5%) of patients with pattern A, 4/38 (10.5%) with pattern B and 3/73 (4.1%) with normal CT appearance developed stroke in the hemisphere of interest (Cox regression: p=0.02). Conclusions. Pattern A confers an unfavourable prognosis in patients with carotid atheroma who are either asymptomatic or presented with amaurosis fugax or hemispheric transient ischaemic attacks.