A 10 year retrospective study of 103 patients with
amaurosis fugax was done. Sixty-two patients with symptoms of
amaurosis fugax underwent arteriography, which demonstrated ulcerated carotid plaque in 36 and hemodynamically significant
stenoses (greater than 75% diameter reduction) in 26. These 62 patients underwent
carotid endarterectomy. The other 41 patients who had proven ulcerated plaque (33 patients) or hemodynamic
stenoses (eight patients) were not treated surgically and served as a control series. No
strokes or deaths occurred in the immediate postoperative period. Follow-up of the 62 operated patients extending to 10 years (mean 4.2 years), revealed one (1.6%) patient with recurrent
amaurosis fugax symptoms, two (3.2%) with
transient ischemic attacks, and one (1.6%) with a
stroke in the operated hemisphere. In the nonoperated group, despite
aspirin or
warfarin treatment, four (9.7%) patients had ongoing
amaurosis fugax symptoms, and two (4.8%) developed
transient ischemic attacks that led to
carotid endarterectomy. One (2.4%) other patient developed sudden, permanent
monocular blindness, and two (4.8%) suffered hemispheric
strokes, one of which was fatal. The cumulative morbidity (ongoing ocular or
transient ischemic attack symptoms, perioperative and late
stroke) in the operated group was 6.4% (four patients), while the cumulative morbidity in the nonoperated group was significantly higher at 21.9% (nine patients) (p = 0.02). When patients present with symptoms of
amaurosis fugax and have demonstrable carotid bifurcation disease,
carotid endarterectomy is recommended.
Amaurosis fugax should be regarded as a harbinger of
monocular blindness and
stroke.