SILENT EMBOLIC INFARCTS ON COMPUTED TOMOGRAPHY BRAIN SCANS AND RISK OF IPSILATERAL HEMISPHERIC EVENTS IN PATIENTS WITH ASYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS.

Kakkos Sk, Sabetai M, Tegos T, Stevens J, Thomas D, Griffin M, Geroulakos G, Nicolaides An

    Risultato della ricerca: Article

    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.
    Lingua originaleEnglish
    pagine (da-a)-
    Numero di pagine8
    RivistaJournal of Vascular Surgery
    Volume49
    Stato di pubblicazionePublished - 2009

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    Carotid Stenosis
    Tomography
    Stroke
    Brain
    Pathologic Constriction
    Nervous System
    Transient Ischemic Attack
    Amaurosis Fugax
    Carotid Endarterectomy
    Lost to Follow-Up
    Basal Ganglia
    Natural History

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    SILENT EMBOLIC INFARCTS ON COMPUTED TOMOGRAPHY BRAIN SCANS AND RISK OF IPSILATERAL HEMISPHERIC EVENTS IN PATIENTS WITH ASYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS. / Kakkos Sk, Sabetai M, Tegos T, Stevens J, Thomas D, Griffin M, Geroulakos G, Nicolaides An.

    In: Journal of Vascular Surgery, Vol. 49, 2009, pag. -.

    Risultato della ricerca: Article

    @article{ba7679865c6041dd919a498e7e028b97,
    title = "SILENT EMBOLIC INFARCTS ON COMPUTED TOMOGRAPHY BRAIN SCANS AND RISK OF IPSILATERAL HEMISPHERIC EVENTS IN PATIENTS WITH ASYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS.",
    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.",
    keywords = "EMBOLIC INFARCTS TOMOGRAPHY CAROTID ARTERY STENOSIS.",
    author = "{Kakkos Sk, Sabetai M, Tegos T, Stevens J, Thomas D, Griffin M, Geroulakos G, Nicolaides An} and Salvatore Novo",
    year = "2009",
    language = "English",
    volume = "49",
    pages = "--",
    journal = "Journal of Vascular Surgery",
    issn = "0741-5214",
    publisher = "Mosby Inc.",

    }

    TY - JOUR

    T1 - SILENT EMBOLIC INFARCTS ON COMPUTED TOMOGRAPHY BRAIN SCANS AND RISK OF IPSILATERAL HEMISPHERIC EVENTS IN PATIENTS WITH ASYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS.

    AU - Kakkos Sk, Sabetai M, Tegos T, Stevens J, Thomas D, Griffin M, Geroulakos G, Nicolaides An

    AU - Novo, Salvatore

    PY - 2009

    Y1 - 2009

    N2 - 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.

    AB - 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.

    KW - EMBOLIC INFARCTS TOMOGRAPHY CAROTID ARTERY STENOSIS.

    UR - http://hdl.handle.net/10447/59075

    M3 - Article

    VL - 49

    SP - -

    JO - Journal of Vascular Surgery

    JF - Journal of Vascular Surgery

    SN - 0741-5214

    ER -