The Silent Brain Infarct Before and After Carotid Surgery

Cerebral tomographic findings in patients undergoing carotid endarterectomy for asymptomatic carotid stenosis: short-term and long-term implications

“…The concept of SBI and its theoretic and physiopathologic implications has been extensively explored mainly by neurologists. [4][5][6][8][9][10]14,15,21,22,[29][30][31][32] An important study on this issue by Brott et al 6 reported the prevalence of and the radiologic and clinical characteristics of patients with asymptomatic brain infarctions, within the setting of the Asymptomatic Carotid Atherosclerosis Study trial. Likewise, in a detailed review Caplan 5 analyzed the frequency of unexpected infarctions, their detection on MRI as compared with CT, their location and type, and their correlation with clinical features.…”

“…The significance of lesions found with CT scans in asymptomatic patients with carotid stenosis who are undergoing CEA remains an open issue, particularly when considering surgical treatment. 7,[11][12][13][14][15] In a previous paper we reviewed CT scanning records of 844 patients who underwent CEA for symptomatic and asymptomatic disease. 7 In the present study preoperative CT scans of asymptomatic patients of our previous study cohort, together with CT scans of an additional 48 asymptomatic patients who were recruited subsequently, were reviewed by a neuroradiologist to further define the role of preoperative cerebral imaging before CEA.…”

The Role of Carotid Stenosis in Vascular Cognitive Impairment

“…It is not possible to assess the role of factors such as the degree of stenosis, presence of TIA or the effects of operative procedure (such as the use of intra-operative shunting), as these are stated in only a small number of studies. The possibility of both symptomatic and silent stroke occurring during the peri-operative period may also confound the relationship between stenosis and cognitive impairment [27, 28]. Studies using aspects of both verbal and performance IQ show conflicting results, with an improvement in performance IQ [7, 21]/verbal IQ [10], or neither [9, 13, 15, 18].…”