Abstract T P389: Asymptomatic Carotid Stenosis and Silent Ischemic Brain Lesions

Abstract

Background and purpose: several studies have investigated the relationship between asymptomatic carotid stenosis (ACS) and silent ischemic brain lesions (SIBL); most of them are descriptive and link SIBL with carotid plaque morphology in the carotid territory involved. There are few controlled studies aimed to explore the relationship between ACS and SIBLs. Our objective was to evaluate SIBLs in patients with unilateral carotid stenosis, and to compare SIBL burden both hemispheres. Methods: patients with unilateral ACS >70% diagnosed by means of two matching methods (ultrasound and CT-angiography, or ultrasound MR angiography) were retrospectively included in this analysis. SIBL burden (periventricular and deep white matter hyperintesities (WMH), lacunar infarcts, cortical infarcts and yuxtacortical lesions) was compared between affected and non-affected side; WMH were categorized according to Fazekas scale. Results: fifty nine patients (mean age 75±7, 32% female) were included. Vascular risk factors profile was: hypertension 95%, dislipidemia 86%, smoking 54%, peripheral vascular disease 32%, diabetes 29%, coronary heart disease 24% and abdominal aorta aneurysm 7%. Ninety percent of patients were receiving aspirin, 93% statins and 92% antihypertensives drugs. There were no differences between white matter hypertensities, lacunar or cortical infarcts and yuxtacortical lesion burden between both sides (table). Conclusion: We found no difference in deep or periventricular hyperintesities, cortical and lacunar infarct and yuxtacortical lesion infarct burden related to the presence of severe ACS, suggesting that ACS is a marker of atherosclerosis and affection of more vascular beds. In our cohort, ACS seems not to be involved in subclinical ischemic brain damage facilitating pathogenic mechanisms as chronic reduced blood flow or silent microembolism.