Objectives: This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. Methods: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n = 15), watershed (n = 9), and the presence of diffuse white matter changes (n = 95) were not considered to be embolic. Results: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P = .032). In 359 patients with <60% stenosis, embolic infarcts were not associated with increased risk (log-rank P = .65). In patients with 60% to 99% stenosis, the cumulative stroke-free rate was 0.92 (1.0% annual stroke rate) when embolic infarcts were absent and 0.71 (3.6% annual stroke rate) when present (log-rank P = .002). In the subgroup of 216 with moderate 60% to 79% stenosis, the cumulative TIA or stroke-free rate in the absence and presence of embolic infarcts was 0.90 (1.3% annual rate) and 0.65 (4.4% annual rate), respectively (log-rank P = .005). Conclusion: The presence of silent embolic infarcts can identify a high-risk group for ipsilateral hemispheric neurologic events and stroke and may prove useful in the management of patients with moderate asymptomatic carotid stenosis.
Silent embolic infarcts on computed tomographybrain scans and risk of ipsilateral hemisphericevents in patients with asymptomatic internalcarotid artery stenosis / Stavros K., Kakkos; Michael, Sabetai; Thomas, Tegos; John, Stevens; Dafydd, Thomas; Maura, Griffin; George, Geroulakos; Andrew N., Nicolaides; Study, Group; Adovasio, *. A. p. p. e. n. d. i. x. The ACSRS Study Group R.; Alo', Francesco Paolo; C. G. Cicilioni G. Ambrosio A. Andreev G. M., Andreozzi; F., Verlato; G. Camporese E. Arosio E. Barkauskas A. A. B., Barros D’Sa; P. Brannigan V., Batchvarova; A. Dramov P., Belardi; G. P., Novelli; Biasi, G. S. i. m. o. n. i. P. Bell G. M.; Bouchier Hayes, P. M. i. n. g. a. z. z. i. n. i. N. M. Bornstein D.; P. Fitzgerald M. A. Cairols P. G., Cao; P. DeRango G. P., Carboni; C. Geoffredo M. Catalano B., Chambers; M., Goetzmann; A. Dickinson D., Clement; M. Bobelyn S., Coccheri; E. Conti E., Diamantopoulos; E. A. Andreadis P. B., Dimakakos; T. Kotsis B. Eikelboom L. Entz T., Aloi Ferrari Bardile; M. Salerno J. Fernandes e., Fernandes; L. Pedro D. E., Fitzgerald; Anne O’Shaunnersy J. Fletcher S., Forconi; R., Cappeli; M., Bicchi; S. Arrigucci V., Gallai; G. Cardaiolli G., Geroulakos; S. Kakkos L. F. Gomez Isaza G., Gorgoyannis; N. Liasis M. Graf P. Guarini S. Hardy P., Harris; S. Aston G. Iosa A., Katsamouris; A. Giannoukas M. Krzanowski G. Ladurner J. Leal Monedero B. B. Lee C., Liapis; P. Galanis W., Liboni; E. Pavanelli E., Mannarino; G. Vaudo P., Mccollum; R. Levison G., Micieli; D. Bosone L., Middleton; M., Pantziaris; T. Tyllis E., Minar; A. Willfort L., Moggi; P. DeRango G., Nenci; S. Radicchia A., Nicolaides; S., Kakkos; D. Thomas L., Norgren; E. Ribbe S., Novo; R. Tantillo D. Olinic W. Paaske A. Pagnan P., Pauletto; V. Pagliara G. Pettina C., Pratesi; S. Matticari J., Polivka; P. Sevcik P., Poredos; A., Blinc; V. Videcnik A. Pujia A., Raso; P., Rispoli; M. Conforti T., Robinson; M. S. J. Dennis S. Rosfors G. Rudofsky T., Schroeder; Simoni, M. L. Gronholdt G.; C., Finocchi; G. Rodriguez C., Spartera; M., Ventura; P. Scarpelli M., Sprynger; B., Sadzot; C., Hottermans; Moonen P. R. Taylor A., Tovar Pardo; J. Negreira M., Vayssairat; JM Faintuch J. Valaikiené M. G. Walker A. R. Wilkinson International Advisory Committee H. J. M. Barnett The late E. F. Bernstein D. Clement Anne M. Jones W. Moore K. Myers The late D. E. Strandness J. Toole M. Tsapogas J., van Gijn (The Netherlands. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 49:(2009), pp. 902-909.
Silent embolic infarcts on computed tomographybrain scans and risk of ipsilateral hemisphericevents in patients with asymptomatic internalcarotid artery stenosis
ALO', Francesco Paolo;
2009-01-01
Abstract
Objectives: This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. Methods: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n = 15), watershed (n = 9), and the presence of diffuse white matter changes (n = 95) were not considered to be embolic. Results: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P = .032). In 359 patients with <60% stenosis, embolic infarcts were not associated with increased risk (log-rank P = .65). In patients with 60% to 99% stenosis, the cumulative stroke-free rate was 0.92 (1.0% annual stroke rate) when embolic infarcts were absent and 0.71 (3.6% annual stroke rate) when present (log-rank P = .002). In the subgroup of 216 with moderate 60% to 79% stenosis, the cumulative TIA or stroke-free rate in the absence and presence of embolic infarcts was 0.90 (1.3% annual rate) and 0.65 (4.4% annual rate), respectively (log-rank P = .005). Conclusion: The presence of silent embolic infarcts can identify a high-risk group for ipsilateral hemispheric neurologic events and stroke and may prove useful in the management of patients with moderate asymptomatic carotid stenosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
