Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease

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.

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 κ to assess inter-rater reliability of SBI evaluation.

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 (κ=0.818).

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.