Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis

Kakkos, Stavros K.; Sabetai, Michael M.; Tegos, Thomas; Stevens, John; Thomas, Dafydd J.; Griffin, Maura; Geroulakos, George; Nicolaides, Andrew

doi:10.1016/j.jvs.2008.10.059

Cited by 144 publications

(104 citation statements)

References 34 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…In a large prospective multicenter study of 821 patients, 17% had a CT scan showing cortical, subcortical, and basal ganglia brain infarcts in patients with ≥60% asymptomatic carotid artery stenosis. In that study the cumulative strokefree rate was 0.92 (1.0% annual stroke rate) in the absence of embolic infarcts and 0.71 (3.6% annual stroke rate) in their presence (p<0.002; HR=3.0; 95%CI 1.46-6.29) 30 . The relationship between silent brain infarcts and type of plaque has also been proposed 77,78 .…”

Section: Baseline Infarcts On Ct Scan/mrimentioning

confidence: 80%

“…However, only 9% of patients with ≥70% stenosis were deemed to have high risk for cerebral or retinal events based on other risk factors, such as absence of contralateral TIA or stroke, no discrete white areas (DWAs), plaque area, and GSM. In addition, Kakkos et al, analyzing data of 462 ACAD patients with 60 to 99% stenosis, showed that silent CT embolic infarcts have doubled the risk for developing a stroke compared to those without infarction 30 . Therefore, the degree of stenosis alone may no longer reflect or predict the group of patients who will have a stroke and may benefit from carotid artery intervention.…”

Section: Degree Of Stenosismentioning

confidence: 99%

“…A reasonable number of patients with high-grade asymptomatic carotid stenosis will develop a silent embolic infarct, which may perhaps be predictive of a future TIA or stroke 30 . In a large prospective multicenter study of 821 patients, 17% had a CT scan showing cortical, subcortical, and basal ganglia brain infarcts in patients with ≥60% asymptomatic carotid artery stenosis.…”

Section: Baseline Infarcts On Ct Scan/mrimentioning

confidence: 99%

See 2 more Smart Citations

Stratifying risk: asymptomatic carotid disease

et al. 2012

View full text Add to dashboard Cite

Stroke generates significant healthcare expenses and it is also a social and economic burden. The carotid artery atherosclerotic plaque instability is responsible for a third of all embolic strokes. The degree of stenosis has been deliberately used to justify carotid artery interventions in thousands of patients worldwide. However, the annual risk of stroke in asymptomatic carotid artery disease is low. Plaque morphology and its kinetics have gained ground to explain cerebrovascular and retinal embolic events. This review provides the readers with an insightful and critical analysis of the risk stratification of asymptomatic carotid artery disease in order to assist in selecting potential candidates for a carotid intervention.

show abstract

Section: Baseline Infarcts On Ct Scan/mrimentioning

confidence: 80%

Section: Degree Of Stenosismentioning

confidence: 99%

Section: Baseline Infarcts On Ct Scan/mrimentioning

confidence: 99%

See 1 more Smart Citation

Stratifying risk: asymptomatic carotid disease

et al. 2012

View full text Add to dashboard Cite

show abstract

“…19 A total of 146 patients were found to have ipsilateral infarcts of possible embolic origin. After a mean follow-up of 44.6 months, 102 ipsilateral ischemic events were documented (stroke in 47, TIA in 39, and amaurosis fugax in 16).…”

Section: Silent Infarcts On Ctmentioning

confidence: 99%

Asymptomatic carotid artery stenosis: time to rethink our therapeutic options?

Morales-Valero

Lanzino²

2014

FOC

View full text Add to dashboard Cite

Asymptomatic carotid artery stenosis is a well-recognized risk factor for ischemic stroke, and its prevalence increases with age. In the late 1980s and in the 1990s, well-designed randomized trials established a definite advantage for carotid endarterectomy in reducing the risk of ipsilateral stroke when compared with medical therapy alone. However, medical treatment of cardiovascular disease has improved significantly over the past 2 decades, and this has, in turn, resulted in a decline of the stroke risk in patients with asymptomatic carotid artery stenosis treated medically. This improvement in medical therapy casts doubts on the effectiveness of large-scale invasive treatment in patients with asymptomatic carotid artery stenosis. Several studies have been conducted to identify possible subgroups of patients with asymptomatic stenosis who are at higher risk of stroke in order to maximize the potential benefits of invasive treatment. Ongoing large-scale trials comparing best current medical therapy to available invasive treatments, such as carotid endarterectomy and carotid artery stenting, are likely to shed some light on this debated topic in the near future. In this review, the authors summarize the current controversy surrounding the ideal management of asymptomatic carotid artery stenosis.

show abstract

“…Among individuals with asymptomatic carotid stenosis, silent infarcts associate with higher risk for stroke. 7 In addition, more extensive white matter disease of the brain associates with worse outcome after stroke 8 and may be a predictor of having a stroke in general. The other major consideration in management decisions of individuals with carotid stenosis is that primary carotid endarterectomy trials were conducted in an era before routine statin use; it is likely that the same studies done in the current climate would reveal lower rates of stroke in individuals in both treatment groups as a result of the use of statins.…”

mentioning

confidence: 99%