Basal Cerebral Computed Tomography as Diagnostic Tool to Improve Patient Selection in Asymptomatic Carotid Artery Stenosis

Abstract

One-hundred patients were included to evaluate the role of cerebral computed tomography (CT) to improve patient selection in asymptomatic internal carotid stenosis. Symptomatic patients were assigned to group A, asymptomatic patients to group B. A cerebral CT pattern A was observed in groups A and B in 60% and 20%, respectively (P < .0001). Between A and B groups, type 6 plaques were found, respectively, in 26.7% and 7.5% of patients (P = .01); a type 5 in 51.7% and 45% (P = .32) of patients; and a type 4 in 21.7% and 47.5% of patients, respectively (P = .006). Within B group, the association of CT pattern A and histological plaque level 4, 5, and 6 was, respectively, 25% (P = .15), 50% (P = .53), and 25% (P = .16). In group B, a 7-fold risk increase in CT pattern A was found in patients with level 6 plaque. In asymptomatic patients with high-risk plaque, a basal cerebral CT scan can be used as diagnostic tool to improve patient selection for intervention.

The detrimental impact of silent cerebral infarcts on asymptomatic carotid endarterectomy outcome

“…A cerebral CT scan was routinely performed before CEA (multislice, 16-slice, GE Light Speed scanner; General Electric, Milwaukee, Wisc). The identification of a cerebral ischemic lesion was categorized according to Stevens 12 and the Asymptomatic Carotid Stenosis and Risk of Stroke classification 6 (Table I), by expert neuroradiologists, and classified as follows (the present classification for the identification of the embolic nature of the cerebral lesion was validated by previous studies [13][14][15][16] ):…”

Late spontaneous recanalization of symptomatic atheromatous internal carotid artery occlusion

“…9,10 However, recent studies which focused on the asymptomatic ICA stenosis support the idea that the combination of several factors may identify patients who will benefit from other therapeutic approaches apart from medical treatment. A complex atherosclerotic carotid plaque, [11][12][13] positive cerebral CT findings such as silent infarcts, [11][12][13][14] the degree of the carotid stenosis, [11][12][13]15 disturbances in cerebral vasoreactivity, 13 or history of contralateral transient ischemic attacks 15 may identify those patients who will need interventional treatment. [11][12][13] Moreover, patients with previous symptomatic carotid artery pathology would have a relatively unstable carotid plaque composition, with higher prevalence of intraplaque hemorrhage, compared with patients who have never experienced ipsilateral events.…”

Identifying Asymptomatic Carotid Stenosis Patients at High Risk of Cerebrovascular Events

“…1 Thalamic or cortical/subcortical infarctions in or near the anterior/middle cerebral artery territory or basal ganglia were demonstrated by CT in 60% versus 20% for symptomatic and asymptomatic patients, respectively. In addition, symptomatic patients had a higher incidence of ''vulnerable'' carotid plaques (odds ratio: 4.49; 95% confidence interval: 1.21-16.60; P ¼ .01).…”

“…Pecoraro et al in this issue of Angiology evaluate the use of cerebral computed tomography (CT) scans as a tool to identify patients with asymptomatic internal carotid artery stenosis at high risk of ischemic cerebrovascular events. 1 Thalamic or cortical/subcortical infarctions in or near the anterior/middle cerebral artery territory or basal ganglia were demonstrated by CT in 60% versus 20% for symptomatic and asymptomatic patients, respectively. In addition, symptomatic patients had a higher incidence of ''vulnerable'' carotid plaques (odds ratio: 4.49; 95% confidence interval: 1.21-16.60; P ¼ .01).…”

“…The authors postulated that the combination of a complex atherosclerotic carotid plaque with positive cerebral CT findings could be used to identify a subgroup of asymptomatic patients who will benefit from carotid revascularization. 1 This editorial discusses some issues regarding the management of patients with asymptomatic carotid artery stenosis.…”