Document Detail

Silent cerebral events in asymptomatic carotid stenosis.
MedLine Citation:
PMID:  21722830     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Approximately 20% of strokes are attributable to carotid stenosis. However, the number of asymptomatic patients needed to prevent one stroke or death with endarterectomy is high at 17 to 32. There is a clear need to identify asymptomatic individuals at high risk of developing future ischemic events to improve the cost-effectiveness of surgery. Our aim was to examine the evidence for subclinical microembolization and silent brain infarction in the prediction of stroke in asymptomatic carotid stenosis using transcranial Doppler (TCD), computed tomography (CT), and magnetic resonance imaging (MRI).
METHODS: The review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Articles regarding humans between 1966 and 2010 were identified through systematic searches of Pubmed, MEDLINE, and EMBASE electronic databases using a predetermined search algorithm.
RESULTS: Fifty-eight full text articles met the inclusion criteria. A median of 28% of microemboli positive patients experienced a stroke or transient ischemic attack during follow-up compared with 2% of microemboli negative patients (P = .001). The same was true for the end point of stroke alone with a median of 10% of microemboli positive patients experiencing a stroke vs 1% of microemboli negative patients (P = .004). A specific pattern of silent CT infarctions was related to future stroke risk (odds ratio [OR] = 4.6; confidence interval [CI] = 3.0-7.2; P < .0001). There are no prospective MRI studies linking silent infarction and stroke risk.
CONCLUSIONS: There is level 1 evidence for the use of TCD to detect microembolization as a risk stratification tool. However, this technique requires further investigation as a stroke prevention tool and would be complemented by improvements in carotid plaque imaging.
Gayani Jayasooriya; Ankur Thapar; Joseph Shalhoub; Alun H Davies
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2011-09-06     Revised Date:  2014-05-30    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  227-36     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Asymptomatic Diseases
Carotid Stenosis / complications*,  diagnosis,  surgery
Cerebral Angiography / methods
Cerebral Infarction / diagnosis,  etiology
Cerebrovascular Disorders / diagnosis,  etiology*,  prevention & control
Endarterectomy, Carotid
Evidence-Based Medicine
Intracranial Embolism / diagnosis,  etiology
Magnetic Resonance Angiography
Patient Selection
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke / diagnosis,  etiology
Tomography, X-Ray Computed
Ultrasonography, Doppler, Transcranial
Grant Support
RCS/DMT 3RD ROUND (3)//The Dunhill Medical Trust

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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