title: Silent ischemic lesion laterality in asymptomatic internal carotid artery stenosis relates to reduced cerebral vasoreactivity.
abstract: BACKGROUND
  We investigated the relationship between silent ischemic lesions, defined as hyperintense lesions on T2-weighted magnetic resonance imaging scans of brain white matter and cerebral hemodynamics (baseline cerebral blood flow and cerebral vasoreactivity).
  
  
  METHODS
  Between January 2007 and December 2012, 61 patients with asymptomatic internal carotid artery stenosis were evaluated for asymptomatic silent ischemic lesions, acute infarction, and cerebral hemodynamics. Patients were divided into 2 groups based on silent ischemic lesion distribution; the Symmetry group (n= 34) included patients who showed symmetrical distribution of lesions (or had no lesions), and the Asymmetry group (n= 27) included patients with a greater number of lesions in the ipsilateral than that in the contralateral hemisphere. The Asymmetry group was further divided into Internal (n= 15) and External (n= 12) types.
  
  
  RESULTS
  Two External-type patients (17%) showed spotty asymptomatic acute infarction in the ipsilateral hemisphere. There were no significant differences in patient characteristics, histopathological findings, vascular risk factors, or cerebral blood flow values between the groups. The mean cerebral vasoreactivity value in the ipsilateral hemisphere for the Internal type was 13.0 ± 15.2% (range: -11.4% to 41.6%), which was significantly lower than values of the contralateral hemisphere (36.7 ± 20.8%; range: 3.9% to 75.7%;P<.01) and ipsilateral hemispheres of the other groups (P<.01).
  
  
  CONCLUSIONS
  The finding that increased ipsilateral asymmetrical silent ischemic lesions correlated with cerebral vasoreactivity reduction may help predict the risk of cerebral infarction in patients with asymptomatic internal carotid artery stenosis.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Isozaki
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.affiliation: Department of Radiology, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Department of Pathology, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: Department of Radiology, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Naoaki
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Center Research Institute, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
keywords: Cerebral blood flow; cerebral vasoreactivity; internal carotid artery stenosis; silent ischemic lesions