Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study

Thomas G Brott, Thomas Tomsick, William Feinberg, Constance Johnson, José Biller, Joseph Broderick, Michael Kelly, James Frey, Skai Schwartz, Christine Blum, J. J. Nelson, Lloyd Chambless, James Toole

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Background and Purpose: In a group of patients with high-grade 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, and 7 (1%) had three or more infarcts. The infarct size was small and deep for 117 patients (72%), less than one-half lobe for 45 (28%), and one-half to less than one lobe for 1 (0.5%). The silent infarcts were evenly distributed ipsilaterally and contralaterally to the study artery but were significantly more frequent in the right hemisphere (P<.05). Factors associated with silent infarction were abnormal gait (P<.001), abnormal deep tendon reflexes or plantar responses (P=.038), but not degree of carotid stenosis. Silent infarction was less frequent among this totally asymptomatic cohort (15%) compared with those with transient ischemic attacks (34/139, 25%; P<.001). Conclusions: Silent infarction in the setting of asymptomatic carotid stenosis is not uncommon, but silent infarctions are rarely sizable. The clinical significance of silent cerebral infarction in patients with asymptomatic carotid artery stenosis has yet to be established.

Original languageEnglish (US)
Pages (from-to)1122-1129
Number of pages8
JournalStroke
Volume25
Issue number6
StatePublished - Jun 1994
Externally publishedYes

Fingerprint

Carotid Artery Diseases
Cerebral Infarction
Carotid Stenosis
Infarction
Transient Ischemic Attack
Tomography
Stroke
Brain Infarction
Abnormal Reflexes
Neurologic Examination
Gait
Quality Control
Arteries

Keywords

  • carotid artery diseases
  • cerebral infarction
  • clinical trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Brott, T. G., Tomsick, T., Feinberg, W., Johnson, C., Biller, J., Broderick, J., ... Toole, J. (1994). Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study. Stroke, 25(6), 1122-1129.

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study. / Brott, Thomas G; Tomsick, Thomas; Feinberg, William; Johnson, Constance; Biller, José; Broderick, Joseph; Kelly, Michael; Frey, James; Schwartz, Skai; Blum, Christine; Nelson, J. J.; Chambless, Lloyd; Toole, James.

In: Stroke, Vol. 25, No. 6, 06.1994, p. 1122-1129.

Research output: Contribution to journalArticle

Brott, TG, Tomsick, T, Feinberg, W, Johnson, C, Biller, J, Broderick, J, Kelly, M, Frey, J, Schwartz, S, Blum, C, Nelson, JJ, Chambless, L & Toole, J 1994, 'Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study', Stroke, vol. 25, no. 6, pp. 1122-1129.
Brott TG, Tomsick T, Feinberg W, Johnson C, Biller J, Broderick J et al. Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study. Stroke. 1994 Jun;25(6):1122-1129.
Brott, Thomas G ; Tomsick, Thomas ; Feinberg, William ; Johnson, Constance ; Biller, José ; Broderick, Joseph ; Kelly, Michael ; Frey, James ; Schwartz, Skai ; Blum, Christine ; Nelson, J. J. ; Chambless, Lloyd ; Toole, James. / Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study. In: Stroke. 1994 ; Vol. 25, No. 6. pp. 1122-1129.
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abstract = "Background and Purpose: In a group of patients with high-grade 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, and 7 (1{\%}) had three or more infarcts. The infarct size was small and deep for 117 patients (72{\%}), less than one-half lobe for 45 (28{\%}), and one-half to less than one lobe for 1 (0.5{\%}). The silent infarcts were evenly distributed ipsilaterally and contralaterally to the study artery but were significantly more frequent in the right hemisphere (P<.05). Factors associated with silent infarction were abnormal gait (P<.001), abnormal deep tendon reflexes or plantar responses (P=.038), but not degree of carotid stenosis. Silent infarction was less frequent among this totally asymptomatic cohort (15{\%}) compared with those with transient ischemic attacks (34/139, 25{\%}; P<.001). Conclusions: Silent infarction in the setting of asymptomatic carotid stenosis is not uncommon, but silent infarctions are rarely sizable. The clinical significance of silent cerebral infarction in patients with asymptomatic carotid artery stenosis has yet to be established.",
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AU - Kelly, Michael

AU - Frey, James

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N2 - Background and Purpose: In a group of patients with high-grade 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, and 7 (1%) had three or more infarcts. The infarct size was small and deep for 117 patients (72%), less than one-half lobe for 45 (28%), and one-half to less than one lobe for 1 (0.5%). The silent infarcts were evenly distributed ipsilaterally and contralaterally to the study artery but were significantly more frequent in the right hemisphere (P<.05). Factors associated with silent infarction were abnormal gait (P<.001), abnormal deep tendon reflexes or plantar responses (P=.038), but not degree of carotid stenosis. Silent infarction was less frequent among this totally asymptomatic cohort (15%) compared with those with transient ischemic attacks (34/139, 25%; P<.001). Conclusions: Silent infarction in the setting of asymptomatic carotid stenosis is not uncommon, but silent infarctions are rarely sizable. The clinical significance of silent cerebral infarction in patients with asymptomatic carotid artery stenosis has yet to be established.

AB - Background and Purpose: In a group of patients with high-grade 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, and 7 (1%) had three or more infarcts. The infarct size was small and deep for 117 patients (72%), less than one-half lobe for 45 (28%), and one-half to less than one lobe for 1 (0.5%). The silent infarcts were evenly distributed ipsilaterally and contralaterally to the study artery but were significantly more frequent in the right hemisphere (P<.05). Factors associated with silent infarction were abnormal gait (P<.001), abnormal deep tendon reflexes or plantar responses (P=.038), but not degree of carotid stenosis. Silent infarction was less frequent among this totally asymptomatic cohort (15%) compared with those with transient ischemic attacks (34/139, 25%; P<.001). Conclusions: Silent infarction in the setting of asymptomatic carotid stenosis is not uncommon, but silent infarctions are rarely sizable. The clinical significance of silent cerebral infarction in patients with asymptomatic carotid artery stenosis has yet to be established.

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