Stroke: ipsilateral bruit, diabetes and previous TIA increased the risk of severe carotid stenosis.

Clinical bottom line (level 1b)

  1. About a seventh of patients admitted with acute stroke, TIA or retinal stroke had severe carotid stenosis.
  2. Patients were at increased risk of severe carotid stenosis if they had: ipsilateral bruit, diabetes or had a previous TIA.
  3. Patients were at a decreased risk of severe carotid stenosis if they had a lacunar event.
Mead et al: Journal of Neurological Neurosurgery and Psychiatry 1999; 66: 16-19
Expires November 2002

The study

Prospective cohort study with blinded outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, UK

726 patients (aged ?, ?% male) acute stroke, transient ischaemic attack or retinal stroke admitted to the hospital or referred to neurovascular clinics

Excluded if
  • primary intracerebral haemorrhage
  • total anterior circulation strokes
  • uncertain Oxford Community Stroke Project stroke type with midline lesions on computed tomography
  • posterior circulation events



    • Factors studied:
  • severe carotid stenosis
  • ipsilateral bruit
  • diabetes
  • previous TIA
  • lacunar event




    • Multivariate analysis was carried out to adjust for confounding factors.

    followed for until diagnosis
    Outcomes studied:
  • severe carotid stenosis

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    severe carotid stenosis until diagnosis 96/726 13.2%
    (10.8% to 15.7%)

    prognostic factor for
    severe carotid stenosis     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    ipsilateral bruit ? 70/726
    (9.64%)     		11.2
    (7.00 to 18.8)     		2
    (2 to 3)
    diabetes ? 32/726
    (4.40%)     		2.30
    (1.10 to 4.70)     		19
    (7 to 239)
    previous TIA ? 39/726
    (5.40%)     		2.40
    (1.20 to 4.00)     		15
    (8 to 99)
    lacunar event ? 142/726
    (19.6%)     		0.40
    (0.20 to 0.80)     		-9
    (-30 to -7)

    Citation

    1. Mead GE, Wardlaw JM, Lewis SC, et al: Can simple clinical features be used to identify patients with severe carotid stenosis on Doppler ultrasound?. Journal of Neurological Neurosurgery and Psychiatry 1999; 66: 16-19
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Rowan Harwood

    Clinical Question.
    Patient severe carotid stenosis
    Intervention or Exposure presence of prognostic features
    Comparison absence of prognostic factors
    Outcome severe carotid stenosis