Asymptomatic carotid lesions and silent cerebral infarction

Few studies have investigated the relationships between asymptomatic carotid lesions and silent infarcts confirmed on magnetic resonance imaging.

A consecutive series of 117 subjects (average age, 62 +/- 9.4 years) who were free from neurological deficit but had at least one established risk factor for stroke were investigated by B-mode carotid ultrasonography and magnetic resonance imaging of the brain. Carotid lesions were evaluated by plaque score, maximum percent stenosis, and the existence of ulcerated lesions. The relations between the carotid lesions and the incidence, size, or localization of the brain lesions were investigated.

The incidence of silent infarcts was 42% in all subjects and significantly increased with advancing age (P < .05). Most lesions were smaller than 1 cm in diameter and were usually localized in the subcortical white matter or the basal ganglia. The percentage of subjects with infarcts increased significantly as the plaque score increased (P < .05) or when subjects had high-grade stenosis (P < .05) or ulcerated lesions (P < .01). These relationships were also noted in each decade of age. A higher incidence of larger lesions (> 1 cm) was found in the brain hemisphere ipsilateral to the carotid lesion, particularly in subjects with high-grade stenosis or ulcerated lesions (P < .01). Multivariate analysis indicated significant correlations with silent infarcts for age, hypertension, and plaque score.

Both the severity and characteristics of asymptomatic carotid lesions estimated by B-mode ultrasonography were closely related to the appearance of silent infarcts. These results demonstrate that noninvasive assessment of carotid lesions can be useful in predicting the existence of silent cerebral infarction even in patients free from neurological deficits.