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Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures
Bendszus M, Stoll G.. The Lancet. Neurology, 2006-04-01
Topic: Brain proteins, microglia and lab models
Cardiovascular and cerebrovascular disorders are the main cause of death and permanent disability worldwide. Improved diagnostic and therapeutic options for these diseases have led to increasing numbers of invasive procedures such as angiography, stent placement, and operations exceeding 4 million each year in the USA. Although clinical examinations suggest a relatively low risk for ischaemic complications affecting the brain, new magnetic resonance techniques have led to the awareness of much higher numbers of clinically silent ischaemic brain lesions. Diffusion-weighted MRI (DWI) has shown new ischaemic lesions in a substantial number of patients undergoing cardiac or carotid-artery surgery, and coronary or cerebral-angiographic interventions. The clinical impact of these "silent" ischaemic lesions within brain areas without primary motor, sensory, or linguistic function ("non-eloquent" brain areas) is debated. There is increasing evidence, however, that cumulative burden of ischaemic brain injury causes neuropsychological deficits or aggravates vascular dementia. Thus, DWI emerges as a valuable diagnostic method for the monitoring of periprocedural ischaemic events in the brain, and could be a surrogate parameter for optimising diagnostic and therapeutic vascular procedures in the future.
Key findings
- Although clinical examinations suggest a relatively low risk for ischaemic complications affecting the brain, new magnetic resonance techniques have led to the awareness of much higher numbers of clinically silent ischaemic brain lesions.
- Diffusion-weighted MRI (DWI) has shown new ischaemic lesions in a substantial number of patients undergoing cardiac or carotid-artery surgery, and coronary or cerebral-angiographic interventions.
- The clinical impact of these "silent" ischaemic lesions within brain areas without primary motor, sensory, or linguistic function ("non-eloquent" brain areas) is debated.
- There is increasing evidence, however, that cumulative burden of ischaemic brain injury causes neuropsychological deficits or aggravates vascular dementia.
- Thus, DWI emerges as a valuable diagnostic method for the monitoring of periprocedural ischaemic events in the brain, and could be a surrogate parameter for optimising diagnostic and therapeutic vascular procedures in the future.
Why it matters
This review is about silent brain ischaemic lesions seen on MRI after invasive heart and blood vessel procedures, not about treating or curing Alzheimer's disease. It notes that a cumulative burden of ischaemic brain injury may cause neuropsychological deficits or aggravate vascular dementia, but it does not test any treatment or prevention for Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 42/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (The Lancet. Neurology) |
| Journal's citation record | 3 / 4 | The Lancet Neurology: journal h-index 457 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2006 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 212 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.6 citations a year over 22 year(s) since 2006 |
| Impact for its field and year | 3 / 6 | Cited 6.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 11 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Guido Stoll: h-index 79 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Würzburg: institution h-index 852 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 16545753) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 42 / 100 | — |
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Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Bendszus, M., & Stoll, G. (2006). Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. The Lancet. Neurology. https://doi.org/10.1016/s1474-4422(06)70412-4
Vancouver
Bendszus M, Stoll G. Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. The Lancet. Neurology. 2006. doi:10.1016/s1474-4422(06)70412-4. PMID: 16545753.
BibTeX
@article{bendszus2006-16545753,
author = {Bendszus, M. and Stoll, G.},
title = {{Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures}},
journal = {The Lancet. Neurology},
year = {2006},
doi = {10.1016/s1474-4422(06)70412-4},
pmid = {16545753},
url = {https://doi.org/10.1016/s1474-4422(06)70412-4}
}
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