The silent brain infarct in carotid surgery

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Carotid artery disease's destructive potential is underestimated by clinical classifications focusing only on symptomatic brain areas.
• Asymptomatic patients may have undetected brain infarctions (silent infarcts) on CT scans.
• Silent infarcts must be considered when evaluating carotid lesion behavior and surgical morbidity.

Purpose of the Study:

• To investigate the prevalence and impact of "silent" brain disease in patients undergoing carotid operations.
• To assess the correlation between clinical presentation, arteriography findings, and preoperative/postoperative CT scans in carotid artery disease.

Main Methods:

• Prospective study of 100 carotid operations in 91 patients.
• Preoperative and postoperative neurological examinations and CT scans.
• Arch and four-vessel selective arteriography.

Main Results:

• 86% of patients had a history of neurological problems.
• Preoperative CT scans revealed infarctions in 21% of patients, with only 57% correlating to symptoms.
• Postoperatively, 4 patients had new neurological deficits with new infarcts; 8 additional patients had silent infarcts without deficits.

Conclusions:

• Carotid artery disease frequently leads to silent brain infarctions, impacting clinical assessment and surgical outcomes.
• Current clinical classification underestimates the disease's impact by not accounting for asymptomatic infarctions.
• Further consideration of silent infarcts is crucial for accurate patient management and risk stratification in carotid artery disease.