The Risk of Embolic Stroke -- Another Piece of the Puzzle

The three disease processes responsible for most ischemic strokes are large-vessel atherothrombotic disease (accounting for about 14 percent of ischemic strokes), small-vessel atherothrombotic or lipohyalinotic disease (i.e., lacunar stroke, accounting for about 27 percent), and embolic disease (accounting for about 59 percent). 1 , 2 Among patients with large-vessel atherothrombotic disease leading to ischemic strokes and transient cerebral ischemic attacks, two thirds have stenosis of more than 70 percent at the bifurcation of the common carotid artery. 3 , 4 In these circumstances, properly selected symptomatic patients, and possibly also asymptomatic patients, benefit from expertly performed carotid endarterectomy. Among the other one third of . . .