Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Abstract

Abstract-Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians. (Stroke. 2017;48:e44-e71.

Recurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors

“…(33) Therefore, identification of a silent brain infarction in a primary brain tumor patient might serve as an opportunity to prevent a disabling stroke through initiation of targeted stroke prevention therapies. (34)…”

The role of exercise in mitigating subcortical ischemic vascular cognitive impairment

“…Overall, data from both observational studies and RCT indicate that reducing blood pressure may directly reduce the incidence and progression of WMH (Smith et al 2017). For statin treatments, trials have provided conflicting evidence as to whether statin treatment reduces WMH progression (ten Dam et al 2005;Mok et al 2009;Xiong et al 2014;Smith et al 2017). In people with type 2 diabetes mellitus, glucoselowering therapy did not reduce WMH progression (Launer et al 2011), though the association between type 2 diabetes and WMH remains unclear -most studies have found no association or only a weak association between diabetes and WMH (Prins and Scheltens 2015).…”

“…In the PROGRESS MRI substudy of patients with symptomatic stroke, patients treated for high blood pressure were less likely to have new WMH at a mean 3-year follow-up (Dufouil et al 2005). Overall, data from both observational studies and RCT indicate that reducing blood pressure may directly reduce the incidence and progression of WMH (Smith et al 2017). For statin treatments, trials have provided conflicting evidence as to whether statin treatment reduces WMH progression (ten Dam et al 2005;Mok et al 2009;Xiong et al 2014;Smith et al 2017).…”

“…In the PROGRESS MRI substudy of patients with symptomatic stroke, patients treated for high blood pressure were less likely to have new WMH at a mean 3-year follow-up (Dufouil et al 2005). Overall, data from both observational studies and RCT indicate that reducing blood pressure may directly reduce the incidence and progression of WMH (Smith et al 2017 hypercholesterolemia and diabetes may cause cognitive impairment through other mechanisms. Vascular risk factors for SIVCI are associated with impaired endothelial-dependent vasodilation that is detectable before any morphological changes could be observed in the vessel wall.…”

Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings

“…It is estimated that for every clinically recognized stroke 5 silent strokes occur (Dempsey, et al 2010, Rocque, et al 2012). This results in approximately 11,000,000 silent strokes per year (Dempsey, et al 2010, Dempsey, et al 2017, Smith, et al 2000, Smith, et al 2017, Snowdon, et al). Silent strokes are often detected on brain imaging examinations and while individuals do not present with the classic stroke symptoms (numbness, muscle weakness, difficulty speaking, ocular changes), they may demonstrate cognitive decline, especially in their executive function (Dempsey, et al 2017, Jackson, et al 2016, Rocque, et al 2012).…”