Amaurosis fugax: A major indicator of atherosclerotic carotid disease?

Forty-six consecutive patients aged between 24 and 72 years (mean 54.7 years) are described, who suffered one or more episodes of unilateral amaurosis fugax. In addition to ocular symptoms 23 patients experienced ischemic episodes involving the ipsilateral cerebral hemisphere. All cases underwent a standardized diagnostic protocol encompassing detailed clinical history, evaluation of risk factors for atherosclerosis, neurological and cardiologic examination, cerebral computed tomography scan. The angiographic study was done in 41 of 46 cases (89% As many as 81% of the patients presented one or more risk factors for atherosclerosis, with special regard to cigarette smoking (46% and hypertension (41% Computed tomography of the brain showed a cerebral infarction in 18 patients, only three of them experienced amaurosis fugax in absence of cerebral ischemic symptoms. Cardiologic investigation disclosed a potential cardioembolic disease in six patients. A silent myocardial ischemia was present in six cases, while three more patients had suffered a previous myocardial infarction. Cerebral angiography showed an internal carotid stenosis of > 50% or an occlusion, ipsilateral to the affected eye, in a percentage of patients as high as 71% All patients received antiplatelet drugs and 13 underwent carotid endarterectomy. Follow-up at 1-12 years (mean 45 months) was consistent with five deaths (two due to myocardial infarction and three unrelated to cerebral ischemia), four cases of recurrent amaurosis fugax, and two strokes. None of the surgical patients experienced recurrent ischemia of whatever nature (retinal or cerebral) after operation.