Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Abstract

Background and Purpose In a group of patients with highgrade asymptomatic carotid artery stenosis, we prospectively determined the prevalence and radiological characteristics of clinically asymptomatic brain infarction evident on computed tomography. Risk factors and extent of carotid disease were also determined.Methods Patients randomized into the Asymptomatic Carotid Atherosclerosis Study (ACAS) underwent a neurological history, a detailed stroke/transient ischemic attack questionnaire, and a detailed neurological examination. Computed tomography scans were examined by standardized criteria developed as part of a quality-control program supervised by a neuroradiologist. The presence, location, and size of all cerebral infarctions evident by computed tomography were determined.Results Among 1132 patients, 848 had no history of stroke or transient ischemic attack. One hundred twenty-six patients (15%) had a silent infarct; 95 (11%) had one, 24 (3%) had two,

Duplex color doppler evaluation of carotid atherosclerosis in patient with silent cerebral infarction detected by MRI

“…this suggests that the progression of arteriosclerotic change in the brain was paralleled by systemic atherosclerosis and conversely that assessment of systemic atherosclerosis could predict latent damage to the brain, almost similar findings reported by various investigators from different countries. 3,4,5,11,12,13,14 The characteristics of SCI lesions were similar to the results of other studies. 13,15,16,17 that is, they were usually smaller than 1cm,were mostly in the basal ganglia (P<0.01) and had a higher incidence in right cerebral hemisphere (P<0.05) signified non-dominant hemisphere predominance for SCI.…”

“…Similar type of findings were also observed by other investigators. [3][4][5][12][13][14][15]21 age, hypertension and plaque score strongly and independently correlated with the occurrence of SCI of brain, compatible with results of other studies. 22,23,24 Conclusion Silent cerebral infarction (SCI) detected incidentally by MRI is considered the preliminary stage of accidental stroke and assumed to be secondary to atherosclerotic vascular disease (ASVD).…”

“…These findings were consistent with the findings of some other investigators. 12,13,17,18,19,20 although the possibility of embolic events from these lesions could not be wholly excluded because vessels with high grade stenosis showed combined ulcerated lesions. Significant association (P<0.002) and (P<0.001) were found for >50% right internal carotid artery and left internal carotid artery stenosis respectively for ipsilateral >1cm SCI in brain.…”

Left-Sided Strokes Are More Often Recognized Than Right-Sided Strokes

“…1,5 Previous MRI studies also suggested that right-sided strokes are more often unnoticed because they found more right-sided silent infarcts in patients with carotid stenosis and atrial fibrillation. 6,7 An important advantage of MRI studies is that these not only detect clinical strokes but also clinically silent infarcts, thereby providing a better estimate of the true distribution of left-and right-sided infarcts. To our knowledge, no study has compared the distribution of clinical strokes with that of MRI-defined cerebral infarcts within an unselected community-dwelling population.…”

S3-Leitlinie Extracranielle Carotisstenose

“…Die [14]. Auf der anderen Seite besteht beim Nachweis solcher stummer Ischämien häufig die Schwierigkeit, dass das Infarktalter nicht genauer angegeben werden kann.…”