Background/Aim. A certain percentage of patients with asymptomatic carotid
stenosis have an unstable carotid plaque. For these patients it is possible
to register by modern imaging methods the existence of lesions of the brain
parenchyma - the silent brain infarction. These patients have a greater risk
of ischemic stroke. The aim of this study was to analyze the connection
between the morphology of atherosclerotic carotid plaque in patients with
asymptomatic carotid stenosis and the manifestation of silent brain
infarction, and to analyze the influence of risk factors for cardiovascular
diseases on the occurrence of silent brain infarction and the morphology of
carotid plaque. Methods. This retrospective study included patients who had
been operated for high grade (> 70%) extracranial atherosclerotic carotid
stenosis at the Clinic for Vascular and Transplantation Surgery of the
Clinical Center of Vojvodina over a period of 5 years. The patients analyzed
had no clinical manifestation of cerebrovascular insufficiency of the carotid
artery territory up to the time of operation. The classification of carotid
plaque morphology was carried out according to the Gray-Weale
classification, after which all the types were subcategorized into two
groups: stable and unstable. Brain lesions were verified using preoperative
imaging of the brain parenchyma by magnetic resonance. We analyzed
ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients
78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in
the male patients (male/female ratio = 24.8% : 17.8%), but without a
statistically significant difference (p > 0.05). The risk factors
(hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus)
showed no statistically significant impact on carotid plaque morphology and
the occurrence of silent brain infarction. Silent brain infarction was
detected in 30.8% of the patients. Unstable carotid plaque was found in a
larger percentage of patients with silent brain infarction (36.4% : 29.3%)
but without a significant statistical difference (p > 0.05). Conclusions.
Even though silent brain infarction is more frequent in patients with
unstable plaque of carotid bifurication, the difference is of no statistical
significance. The effects of the number and type of risk factors bear no
statistical significance on the incidence of morphological asymptomatic
carotid plaque.
Asymptomatic Carotid Stenosis in Patients on Medical Treatment Alone