Silent cerebral infarction associated with coronary artery disease

Silent brain infarction in the presence of systemic vascular disease

Objective

To determine the prevalence of asymptomatic brain ischaemic in the presence of vascular disease in other arterial territories.

Design

Studies up to January 2011 were identified through comprehensive search strategies. Arcsine transformation for meta-analysis was used to calculate the standardized mean difference (SMD) and 95% confidence intervals (CI).

Setting

A systematic review and meta-analysis were performed.

Participants

For each study, the proportion of patients positive for SBI in the presence of other systemic vascular disease was extracted and analyzed.

Main outcome measures

Using a random-effects model, a pooled effect estimate interpreted as a percentage prevalence of disease was calculated.

Results

SBI in the presence of acute ischaemic stroke was found in 23% (SMD 0.99; P < 0.001; 95% CI 0.88–1.10); a 35% prevalence was found in patients with coronary artery disease (SMD 1.26; P < 0.001; 95% CI 0.95–1.58); and a 14% prevalence in patients with peripheral artery disease (SMD 0.48; P < 0.002; 95% CI 0.42–0.54), although the data-set in the latter is smaller.

Conclusions

Patients with systemic vascular disease are at an increased risk of silent brain infarction.

Feasibility and application of single 5F multipurpose catheter in coronary and peripheral angiography via a transradial approach

OBJECTIVE

Atherosclerosis is a systemic disease, in which coronary and peripheral angiographies are required to be done at the same time in a large number of patients. To shorten the procedure time, and reduce complications, we tested the feasibility and the safety of using a single 5F multipurpose catheter, via transradial approach, for coronary, cerebral and renal angiographies.

METHODS

One thousand and ninety-two patients were enrolled in the study. The procedure time, local vessel complications, duration of hospitalization, and costs were evaluated.

RESULTS

Among 1092 patients, the radial artery puncture was successful in 1081 patients, a successful coronary angiography via the radial artery was done in 1074 patients, and the remaining 18 patients had to be accessed via the femoral artery. Thus, successful angiography rate was 97.7% for the right coronary artery, 95.8% for the left coronary artery, 100% for the right cerebral artery, 95.2% for the left subclavian artery, 96.1% for the left carotid artery and 83.1% for the renal artery. The failures were caused by abnormal curvature of the aortic arch and abnormal origins of the above-mentioned arteries. There were 1460 artery stenosis lesions found in 661 patients and 624 lesions (93.3%) needed stents via the transradial approach. The mean procedure time was 20.9 ± 9.3 min including puncture, angiography and hemostasis time. There were 4.35% complications. No local hematoma, hand ischemia, or cerebral infraction was found in this study.

CONCLUSION

Angiography using a single 5F multipurpose catheter, via transradial approach, is associated with a short procedure time and a low rate of complications without affecting the angiography success rate.

Clinical utility of evaluating intracranial artery stenosis and silent brain infarction to predict the presence of subclinical coronary artery disease in ischemic stroke patients

OBJECTIVE

We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients.

METHODS

The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as > or =50% stenosis on coronary computed tomographic angiography.

RESULTS

Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), > or =50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05).

CONCLUSION

The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.

Silent cerebral infarction in patients with dilated cardiomyopathy: Echocardiographic correlates

BACKGROUND

Patients with dilated cardiomyopathy (DCM) have an increased risk of thromboembolic events. Incidence of silent cerebral infarction (SCI) has not been investigated in these patients. The aim of this study was to investigate the incidence of SCI in patients with DCM and to determine its associations with echocardiographic parameters.

METHODS AND RESULTS

Seventy-two patients (mean age 62+/-12 years) with DCM underwent cranial magnetic resonance imaging in addition to transthoracic and transesophageal echocardiographic examination. A total of 56 age-matched healthy volunteers served as a control group for comparison SCI prevalence. Prevalence of SCI was significantly higher in patients with DCM (35% vs. 3.6%; p<0.001). In DCM group, patients with SCI had significantly impaired left ventricular systolic function, higher frequency of restrictive diastolic filling, moderate to severe left atrial spontaneous echo contrast (SEC), aortic SEC, and complex atherosclerosis or calcified plaques in the aorta. In logistic regression analysis, type of diastolic filling emerged as the only independent risk factor for SCI (p<0.001). When the type of diastolic filling was removed from the analysis, ejection fraction, marked left atrial SEC, complex-calcified aortic atheroma and age appeared as the other independent risk factors (p = 0.003, p = 0.009, p = 0.013 and p = 0.018, respectively).

CONCLUSION

SCI is a frequent finding in DCM patients. Impaired systolic function, restrictive filling pattern, presence of moderate to severe left atrial SEC, and complex atherosclerosis in the aorta are the factors contributing to the development of SCI.

Metabolic Syndrome as an Independent Risk Factor of Silent Brain Infarction in Healthy People

BACKGROUND AND PURPOSE

Metabolic syndrome (MetS) is associated with an increased risk of the subsequent development of cardiovascular disease or stroke. Moreover, a silent brain infarction (SBI) can predict clinical overt stroke or dementia. We examined the associations between SBI and MetS in apparently healthy individuals.

METHODS

We evaluated 1588 neurologically healthy subjects (927 males and 661 females) who underwent brain MRI at Seoul National University Hospital Healthcare System Gangnam Center. MetS was defined using the criteria of the National Cholesterol Education Program Adult Treatment Panel III. We examined associations between full syndrome (> or =3 of the 5 conditions) as well as its components and SBI by controlling possible confounders.

RESULTS

Eighty-eight (5.5%) were found to have > or =1 SBI on MRI. Age was found to be significantly related to SBI prevalence (odds ratio [OR], 1.06; 95% CI, 1.04 to 1.09). A history of coronary artery disease was associated with an elevated odds ratio of SBI (OR, 2.83; 95% CI, 1.38 to 5.82), and MetS was significantly associated with SBI (OR, 2.18; 95% CI, 1.38 to 3.44). The components model of MetS showed a strong significance between an elevated blood pressure (OR, 3.75; 95% CI, 2.05 to 6.85) and an impaired fasting glucose (OR, 1.74; 95% CI, 1.08 to 2.80) and the risk of SBI.

CONCLUSIONS

MetS was found to be significantly associated with SBI. This finding has clinical utility in terms of identifying healthy people at increased risk of developing SBI.

Silent cortical strokes associated with atrial fibrillation

To clarify whether silent cortical strokes (SCS) could be a predictor of symptomatic stroke in patients with atrial fibrillation (AF), 72 patients with AF (50 with chronic AF, 22 with paroxysmal AF) were studied. Patients with mitral stenosis, history of myocardial infarction, or dilated cardiomyopathy were excluded from this study. Using cranial magnetic resonance imaging (MRI), the patients were divided into those with SCS (23 patients, Group 1) and those without SCS (49 patients, Group 2). The incidence of symptomatic stroke was then compared between the two groups. Three patients (13%) in Group 1 developed symptomatic brain infarction; this is statistically significant (p < 0.05), compared with the patients in Group 2, none of whom experienced symptomatic stroke. We suggest that SCS is a predictor of symptomatic cerebral infarct in patients with AF. Therefore, it is thought to be important to diagnose SCS using cranial MRI or computed tomography and to keep patients with SCS under close surveillance.