Abstract
Silent cerebral lesions are increasingly found in mass screenings using MRI and magnetic resonance angiography (MRA). The purpose of this paper is to assess the usefulness of two non-invasive clinical tests—carotid ultrasound examination and brachial-ankle pulse wave velocity (baPWV) measurement—for predicting silent cerebral infarction (SCI) and silent intracranial arterial stenosis. Data were collected on 480 asymptomatic adult subjects who participated in a brain screening program at a single hospital between April 2003 and March 2006. All participants underwent baPWV measurement, B-mode ultrasonography of carotid arteries, MRI, and MRA. Data on 476 (99.1%) subjects were included in the analysis. Among these, 273 (57.4%) were male and the mean age was 51.5 years; 161 (33.8%) had carotid plaque; 33 (6.9%) had increased intima-media thickness (IMT); 99 (20.8%) had SCI; and 7 (1.5%) had intracranial arterial stenosis. The multivariate analysis showed that age (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.08–1.17), carotid plaque (OR: 2.69; 1.59–4.56), increased IMT (OR: 2.40; 1.02–5.65), and a history of hypertension treatment (OR 2.22; 1.11–4.43) were significantly associated with SCI. Also, increased IMT (OR 9.70: 1.48–63.71) was related to intracranial arterial stenosis. Brachial-ankle PWV was related to SCI (p<0.01) and intracranial stenosis (p=0.01) in univariate analysis but not in multivariate analysis. The presence of carotid plaque and that of increased IMT on ultrasound examination are useful for assessing the risk of SIC. Increased IMT is also predictive of intracranial arterial stenosis.
Similar content being viewed by others
Article PDF
References
Nowaczenko M, Sarzynska-Dlugosz I, Czlonkowska A : Prevalence of carotid arteries atherosclerotic changes in ischemic stroke patients. Neurol Neurochir Pol 2003; 37: 27–36.
Cao JJ, Thach C, Manolio TA, et al: C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the cardiovascular health study. Circulation 2003; 108: 166–170.
Handa N, Matsumoto M, Maeda H, et al: Ischemic stroke events and carotid atherosclerosis: results of the Osaka follow-up study for ultrasonographic assessment of carotid atherosclerosis (the OSACA study). Stroke 1995; 26: 1781–1786.
Hunt KJ, Evans GW, Folsom AR, et al: Acoustic shadowing on b-mode ultrasound of the carotid artery predicts ischemic stroke: the atherosclerosis risk in communities (ARIC) study. Stroke 2001; 32: 1120–1126.
Oliviero U, Orefice G, Coppola G, et al: Carotid atherosclerosis and ischemic stroke in young patients. Int Angiol 2002; 21: 117–122.
Blaser T, Hofmann K, Buerger T, et al: Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis. Stroke 2002; 33: 1057–1062.
Iannuzzi A, Wilcosky T, Mercuri M, et al: Ultrasonographic correlates of carotid atherosclerosis in transient ischemic attack and stroke. Stroke 1995; 26: 614–619.
Jungquist G, Nilsson B, Ostberg H, et al: Carotid artery blood flow velocity related to transient ischemic attack and stroke in a population study of 69-year-old men. Stroke 1989; 20: 1327–1330.
Saruta T : The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). Nippon Rinsho 2005; 63: 952–958 ( in Japanese).
Cifkova R, Erdine S, Fagard R, et al: Practice guidelines for primary care physicians: 2003 ESH/ESC hypertension guidelines. J Hypertens 2003; 21: 1779–1786.
Imanishi R, Seto S, Toda G, et al: High brachial-ankle pulse wave velocity is an independent predictor of the presence of coronary artery disease in men. Hypertens Res 2004; 27: 71–78.
Ogawa O, Onuma T, Kubo S, et al: Brachial-ankle pulse wave velocity and symptomatic cerebral infarction in patients with type 2 diabetes: a cross-sectional study. Cardiovasc Diabetol 2003; 2: 10.
Matsuoka O, Otsuka K, Murakami S, et al: Arterial stiffness independently predicts cardiovascular events in an elderly community—Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study. Biomed Pharmacother 2005; 59: S40–S44.
Bernick C, Kuller L, Dulberg C, et al: Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology 2001; 57: 1222–1229.
Shinkawa A, Ueda K, Kiyohara Y, et al: Silent cerebral infarction in a community-based autopsy series in Japan: the Hisayama study. Stroke 1995; 26: 380–385.
Vermeer SE, Hollander M, van Dijk EJ, et al: Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam scan study. Stroke 2003; 34: 1126–1129.
Longstreth WT Jr, Bernick C, Manolio TA, et al: Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the cardiovascular health study. Arch Neurol 1998; 55: 1217–1225.
Kobayashi S, Okada K, Koide H, et al: Subcortical silent brain infarction as a risk factor for clinical stroke. Stroke 1997; 28: 1932–1939.
Yamashina A, Tomiyama H, Takeda K, et al: Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002; 25: 359–364.
Paivansalo M, Rantala A, Kauma H, et al: Prevalence of carotid atherosclerosis in middle-aged hypertensive and control subjects: a cross-sectional systematic study with duplex ultrasound. J Hypertens 1996; 14: 1433–1439.
Japanese Society for Detection of Asymptomatic Brain Diseases : The guidelines for brain MRI mass screening. The Society 2003, available at http://www.snh.or.jp/jsbd/pdf/guideline2003.pdf [ accessed November 11, 2006].
Chambless LE, Heiss G, Folsom AR, et al: Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997; 146: 483–494.
O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr, Cardiovascular Health Study Collaborative Research Group: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340: 14–22.
Yamashita H, Fujikawa T, Yanai I, et al: Cognitive dysfunction in recovered depressive patients with silent cerebral infarction. Neuropsychobiology 2002; 45: 12–18.
Maeshima S, Moriwaki H, Ozaki F, et al: Silent cerebral infarction and cognitive function in middle-aged neurologically healthy subjects. Acta Neurol Scand 2002; 105: 179–184.
Fujikawa T, Yamawaki S, Touhouda Y : Background factors and clinical symptoms of major depression with silent cerebral infarction. Stroke 1994; 25: 798–801.
Yanai I, Fujikawa T, Horiguchi J, et al: The 3-year course and outcome of patients with major depression and silent cerebral infarction. J Affect Disord 1998; 47: 25–30.
Inoue K, Matsumoto M, Shono T, Toyokawa S, Moriki A : Increased intima media thickness and atherosclerotic plaques in the carotid artery as risk factors for silent brain infarcts. J Stroke Cerebrovasc Dis 2007; 16: 14–20.
Manolio T, Kronmal R, Burke G, et al: Magnetic resonance abnormalities and cardiovascular disease in older adults: the cardiovascular health study. Stroke 1994; 25: 318–327.
Korogi Y, Takahashi M, Mabuchi N, et al: Intracranial vascular stenosis and occlusion: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography. Radiology 1994; 193: 187–193.
Korogi Y, Takahashi M, Nakagawa T, et al: Intracranial vascular stenosis and occlusion: MR angiographic findings. Am J Neuroradiol 1997; 18: 135–143.
Sawada M, Yano H, Shinoda J, Funakoshi T, Kumagai M : Symptomatic middle cerebral arterial stenosis and occlusion: comparison of three-dimensional time-of-flight magnetic resonance angiography with conventional angiography. Neurol Med Chir 1994; 34: 682–685.
Wong KS, Li H, Chan YL, et al: Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke 2000; 31: 2641–2647.
Thomas GN, Lin JW, Lam WW, et al: Increasing severity of cardiovascular risk factors with increasing middle cerebral artery stenotic involvement in type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease. Diabetes Care 2004; 27: 1121–1126.
Mattace-Raso FU, van der Cammen TJ, Hofman A, et al: Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006; 113: 601–603.
Stork S, van den Beld AW, von Schacky C, et al: Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation 2004; 110: 344–348.
Sutton-Tyrrell K, Najjar SS, Boudreau RM, et al: Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in wellfunctioning older adults. Circulation 2005; 111: 3384–3390.
Yamashina A, Tomiyama H, Takeda K, et al: Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002; 25: 359–364.
Munakata M, Ito N, Nunokawa T, Yoshinaga K : Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens 2003; 16: 653–657.
Tamaki T, Sawada K, Hayashi S, Node Y, Teramoto A : Carotid atherosclerosis and arterial peripheral pulse wave velocity in cerebral thrombosis. J Clin Neurosci 2006; 13: 45–49.
Kobayashi K, Akishita M, Yu W, Hashimoto M, Ohni M, Toba K : Interrelationship between non-invasive measurements of atherosclerosis: flow-mediated dilation of brachial artery, carotid intima-media thickness and pulse wave velocity. Atherosclerosis 2004; 173: 13–18.
Nakamura U, Iwase M, Nohara S, et al: Usefulness of brachial-ankle pulse wave velocity measurement: correlation with abdominal aortic calcification. Hypertens Res 2003; 26: 163–167.
Li B, Gao H, Li X, Liu Y, Wang M : Correlation between brachial-ankle pulse wave velocity and arterial compliance and cardiovascular risk factors in elderly patients with arteriosclerosis. Hypertens Res 2006; 29: 309–314.
Nakanishi N, Shiraishi T, Wada M : Brachial-ankle pulse wave velocity and metabolic syndrome in a Japanese population: the Minoh study. Hypertens Res 2005; 28: 125–131.
Bokura H, Kobayashi S, Yamaguchi S : Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol 1998; 245: 116–122.
Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW : Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow-Robin spaces. Am J Roentgenol 1988; 151: 551–558.
Takao M, Koto A, Tanahashi N, et al: Pathologic findings of silent, small hyperintense foci in the basal ganglia and thalamus on MRI. Neurology 1999; 52: 666–668.
Yamada N, Yaginuma T, Iwasa H, et al: Brain dock report: evaluation of risk factors and higher cerebral function in nonsymptomatic cerebral infarction. Jichi Med Sch J 1998; 21: 223–237.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matsumoto, M., Inoue, K. & Moriki, A. Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions. Hypertens Res 30, 767–773 (2007). https://doi.org/10.1291/hypres.30.767
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.30.767
Keywords
This article is cited by
-
Carotid plague formation is associated with ankle–brachial index in elderly people
Aging Clinical and Experimental Research (2020)
-
Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study
Journal of Interventional Cardiac Electrophysiology (2018)
-
The epidemiology of silent brain infarction: a systematic review of population-based cohorts
BMC Medicine (2014)
-
Silent brain infarct is independently associated with arterial stiffness indicated by cardio-ankle vascular index (CAVI)
Hypertension Research (2012)