Silent stroke and carotid stenosis.

Norris, John W.; Zhu, Chengcheng

doi:10.1161/01.str.23.4.483

Cited by 123 publications

(80 citation statements)

References 24 publications

(16 reference statements)

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“…In the ACAS population -to date the largest cohort prospectively examined for silent infarction -72% of the lesions were small and deep, and the remaining 28% were less than one-half cerebral lobe in size. In previous studies, silent infarcts were also small, whether detected in the setting of symptomatic stroke, 2628 TIA, 3 -5 -29 atrial fibrillation, 2022 carotid artery disease, 30 or coronary artery disease. 19 In our cohort, silent infarcts were significantly more frequent in the right hemisphere compared with the left.…”

Section: Discussionmentioning

confidence: 83%

“…However, when our analysis of silent infarction to stenosis was limited to those with the larger infarctions, no relation was detected. Norris and Zhu,30 on the other hand, suggest an association between severe stenosis and silent infarction. In a cohort of 381 patients without a history of stroke, 137 had a silent infarction seen by CT, and an increased frequency of silent infarction was noted in the severe stenosis group compared with the mild and moderate stenosis groups (P<.001).…”

Section: No (%) Of Patients With No Lesionsmentioning

confidence: 99%

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Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Brott

Tomsick

Feinberg

et al. 1994

Stroke

123

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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,

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Section: Discussionmentioning

confidence: 83%

Section: No (%) Of Patients With No Lesionsmentioning

confidence: 99%

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Brott

Tomsick

Feinberg

et al. 1994

Stroke

123

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“…While carotid IMT and stenosis have been demonstrated to have strong associations with clinically-evident stroke, 10,14,15 CT-defined infarcts, 16,17 and more recently with MRI-defined infarcts, 18,19 less information is available on relationships of atherosclerosis severity to other MRI abnormalities such as 3 and between ventricular and sulcal enlargement and severity of carotid atherosclerosis. 2 Given the strong and consistent relationships of MRI abnormalities to severity of carotid atherosclerosis, the question arises whether there are other ultrasound-definable characteristics of carotid disease that are related to MRI abnormalities.…”

Section: Carotid Disease and The Brainmentioning

confidence: 99%

“…16,17 One explanation is that MRI detects far more small lesions than large ones, 2 which, as described above, are less likely to be related to atherosclerotic large-vessel disease. 36 …”

Section: Manolio Et Al February 1999 361mentioning

confidence: 99%

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

182

160

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Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

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“…While not observed in ACAS, observations from the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) indicate the stroke-risk increases with the degree of carotid narrowing, and is as high as 18.5% over five years for angiographic stenosis between 75% and 94%. 30,31 There is some evidence that the presence of ipsilateral brain infarction on CTor MRI, [31][32][33] and plaque ulceration [34][35][36][37][38] may indicate an increased risk of stroke. Other less well-substantiated risk factors that might worsen the natural history of asymptomatic stenosis include the presence of an occluded contralateral carotid artery, 39 progressive stenosis, 40 a "soft" or echolucent plaque or evidence of intraplaque hemorrhage on ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Auditing Carotid Endarterectomy: A Regional Experience

Findlay

Nykolyn²,

Lubkey³

et al. 2002

Can. j. neurol. sci.

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326Studies and commentaries from the 1980s expressing concern about the efficacy, appropriateness, and complications of carotid endarterectomy (CEA), 1 -8 were followed by a series of multicenter randomized controlled trials comparing CEA to medical treatment alone. Reported throughout the 1990s, these studies validated the use of CEAunder certain circumstances, [9][10][11][12][13][14][15] and led to a rapid and large resurgence in the use of CEA in A B S T R A C T: Background: Proof from randomized controlled trials that carotid endarterectomy (CEA) is efficacious in stroke prevention has resulted in a large resurgence of its use in recent years. We wished to determine if patients in our region were being selected and treated with complication rates consistent with the randomized trials. Methods: We have completed four audits of CEAs performed in our region since 1994, each followed by feed-back of results to the participating surgeons. Operations for > 70% symptomatic stenosis were considered appropriate, those for 50%-69% symptomatic and > 60% asymptomatic stenosis were considered uncertain and all others, including those in medically or neurologically unstable patients, were designated inappropriate. In part 4, the referral source and nature of the patients was also determined. Results: Part 1 (April 1994 -September 1995 found that of 291 CEAs performed 33% were appropriate, 48% were uncertain and 18% were inappropriate, and 40% of patients who underwent CEA were asymptomatic. In part 2 (September 1996 -September 1997) appropriate indications significantly improved to 49% of 184 CEAs (P=0.005), uncertain indications remained nearly the same at 47%, inappropriate indications fell to 4% (P=0.00002), and asymptomatic patients remained at 40%. T h e results of part 3 (October 1997 -October 1998) remained nearly the same as part 2 (249 CEAs, 47% appropriate, 51% uncertain, 2% inappropriate, 45% asymptomatic). Part 4 (October 1999 -October 2000) results were significantly better than part 3, appropriate indications increasing from 47% to 58% of 222 CEAs (P=0.02), and an elimination of inappropriate operations (P=0.03). Stroke and death complications declined over the study period from an overall rate of 5.2% in part 1 to 2.3% in part 4. In part 4 the majority of patients (69%) were referred to surgeons directly from general practitioners, including 58 (73%) of the 80 asymptomatic patients who underwent CEA. Interpretation: Regular auditing and feedback of results and information to surgeons has resulted in significant and continued improvements in the surgical performance of CEAin our region. Since the majority of patients are referred directly to surgeons by general practitioners, it is important that this group of physicians be familiar with current CEA g u i d e l i n e s . RÉSUMÉ: Évaluation de l'endartérectomie carotidienne: une expérience régionale. Introduction: La preuve basée sur des études contrôlées randomisées que l'endartérectomie carotidienne (EAC) est efficace dans la prévention de l'accident vascul...

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Silent stroke and carotid stenosis.

Cited by 123 publications

References 24 publications

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Auditing Carotid Endarterectomy: A Regional Experience

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