The problem with asymptomatic cerebral embolic complications in vascular procedures: what if they are not asymptomatic?

Cerebral embolic events related to carotid and cardiac disease have been known for decades. Recently, cerebral embolic events have become a focus of clinical importance as complications of vascular procedures. Further, the development of new technologies and procedures has increased the overall clinical significance. Although the relative safety of these procedures is usually defined by acute stroke risk, it is also becoming clear that far more subclinical events are occurring. Recent reports provided substantial evidence of memory loss, cognitive decline, and dementia related to these so-called silent infarcts. Literature reports of magnetic resonance imaging events lead to an estimate of as many as 600,000 patients with new brain injury each year in the United States alone. Given the magnitude of the numbers involved, the impact of accelerated cognitive loss and premature senescence in a vulnerable at-risk population could well be significant.