Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease
Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease
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DOI：
10.1161/strokeaha.116.013193
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发表时间：
2016-05-01
期刊：
影响因子：
8.3
通讯作者：
Gupta, Ajay
中科院分区：
文献类型：
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作者：
Baradaran, Hediyeh;Gialdini, Gino;Gupta, Ajay
背景与目的颈动脉粥样硬化与同侧无症状性脑梗死（SBI）的关系尚不清楚。我们测试的假设，颅外颈内动脉（伊卡）狭窄是与一个更大的患病率SBI在大脑半球同侧伊卡疾病相比，未受影响的，对侧side.Methods，我们确定了患者单侧颅外伊卡狭窄50%的血管造影标准。我们纳入了近期进行脑磁共振成像的患者，这些患者既往无卒中或短暂性脑缺血发作病史。盲态阅片者确定是否存在前循环SBI。SBI定义为白色或深部灰质中的空腔腔隙性梗死或皮质灰质中T2高信号定义的皮质梗死。Wilcoxon符号秩检验用于比较大脑半球和科恩的SBI评估者间的信度sBIevaluation.Results在104例患者中，我们发现较高的患病率（33%）与伊卡疾病的对侧（20.8%）相比（P=0.0067）。两半球间腔隙性脑损伤（包括白色和深灰质）的患病率无显著差异（P=0.109），但伊卡疾病下游发生的皮质性脑损伤的患病率显著较高（P=0.0045）。高评分者间的可靠性进行了观察（=0.818）。结论无症状伊卡疾病患者表现出较高的患病率SBI下游的伊卡动脉粥样硬化性疾病相比，对侧，但只有皮质，而不是腔隙性SBI亚型。
Background and Purpose The relationship between carotid atherosclerosis and ipsilateral silent brain infarction (SBI) is unclear. We tested the hypothesis that extracranial internal carotid artery (ICA) stenosis is associated with a greater prevalence of SBI in the cerebral hemisphere ipsilateral to ICA disease compared with the unaffected, contralateral side.Methods We identified patients with unilateral extracranial ICA stenosis 50% on angiography by standard imaging criteria. We included patients with recent brain magnetic resonance imaging who had no previous history of stroke or transient ischemic attack. Blinded readers ascertained the presence of anterior circulation SBIs. SBI was defined as either a cavitary lacunar infarction in the white or deep gray matter or cortical infarction defined by T2 hyperintense signal in cortical gray matter. The Wilcoxon signed-rank test was used to compare SBI in the cerebral hemispheres and Cohen to assess inter-rater reliability of SBI evaluation.Results Among 104 patients, we found a higher prevalence of SBIs ipsilateral to ICA disease (33%) compared with the contralateral side (20.8%; P=0.0067). There was no significant difference in the prevalence of lacunar SBIs (including both white and deep gray matter) between hemispheres (P=0.109), but there was a significantly higher prevalence of cortical SBIs occurring downstream from ICA disease (P=0.0045). High inter-rater reliability was observed (=0.818).Conclusions Patients with asymptomatic ICA disease demonstrate a higher prevalence of SBI downstream from their ICA atherosclerotic disease compared with the contralateral side but only of the cortical and not lacunar SBI subtype.