{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:34:59Z","timestamp":1793111699467,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100002809","name":"generalitat de catalunya","doi-asserted-by":"publisher","award":["SLT042\/25\/000027"],"award-info":[{"award-number":["SLT042\/25\/000027"]}],"id":[{"id":"10.13039\/501100002809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Covert brain infarction is a frequent incidental neuroradiological finding increasingly recognized as clinically relevant due to its association with stroke, cognitive decline, and other adverse outcomes. However, substantial uncertainty remains regarding its optimal assessment and management, and existing guidelines provide limited and heterogeneous recommendations. We aimed to develop an international expert consensus on the evaluation and management of covert brain infarction using a modified Delphi methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A modified Delphi process was conducted with an international, multidisciplinary panel of 21 experts from 15 countries, including neurologists, neuroradiologists, neuroepidemiologists, and geriatricians. An initial questionnaire was developed from a structured literature review and identified clinical practice gaps. The survey included 91 statements across four domains: (1) prognosis, etiology, and screening; (2) neuroimaging-based management and follow-up; (3) cardiac evaluation; and (4) pharmacological management. Two iterative rounds were conducted, with anonymized responses, controlled feedback, and structured discussion. A 5-point Likert-type scale was used. Consensus was defined a priori as\u2009\u2a7e\u200970% agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Consensus was reached on 33\/91 statements (36.3%), moderate agreement on 43\/91 (47.2%), and no consensus on 15\/91 (16.5%). The panel agreed that covert brain infarction is associated with increased risk of ischemic stroke, cognitive impairment, and dementia, and that risk is higher with multiple lesions. Consensus supported targeted clinical evaluation, including a cardiac workup with transthoracic echocardiography in all patients and vascular imaging in selected cases. Routine population screening and systematic postprocedural imaging were not supported. Regarding management, consensus favored optimizing vascular risk factors, particularly strict blood pressure control in hypertensive patients. There was no consensus on routine antiplatelet therapy for incidental covert brain infarction, and anticoagulation was generally not supported in the absence of cardioembolic indications. Lipid-lowering therapy showed limited consensus regarding specific benefits for covert brain infarction\u2013related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This Delphi consensus highlights substantial variability in the perceived management of covert brain infarction and identifies areas of convergence, particularly in risk stratification and control of vascular risk factors. Key uncertainties remain regarding antithrombotic strategies, lipid-lowering therapy, and long-term surveillance. These results provide a pragmatic, expert-based framework to support clinical decision-making and further highlight the need for prospective studies and randomized trials in this rapidly evolving field.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930261496691","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:52:16Z","timestamp":1790927536000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["International modified Delphi consensus on assessment and management of covert brain infarction"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2821-9042","authenticated-orcid":false,"given":"Bruno Kusznir","family":"Vitturi","sequence":"first","affiliation":[{"name":"Division of Neurology, University of Milan, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1401-0181","authenticated-orcid":false,"given":"Terence J","family":"Quinn","sequence":"additional","affiliation":[{"name":"School of Cardiovascular &amp; Metabolic Health, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6tz","family":"Thomalla","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2226-4050","authenticated-orcid":false,"given":"Frank J","family":"Wolters","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank-Erik","family":"de Leeuw","sequence":"additional","affiliation":[{"name":"Department of Neurology, Center for Medical Neuroscience, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-0597","authenticated-orcid":false,"given":"Silja","family":"R\u00e4ty","sequence":"additional","affiliation":[{"name":"Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristeidis H","family":"Katsanos","sequence":"additional","affiliation":[{"name":"Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7123-2381","authenticated-orcid":false,"given":"Deidre Anne","family":"De Silva","sequence":"additional","affiliation":[{"name":"Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3247-3123","authenticated-orcid":false,"given":"Gisele","family":"Sampaio Silva","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"},{"name":"Department of Neurology and Neurosurgery, Universidade Federal de S\u00e3o Paulo (UNIFESP), S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5218-9015","authenticated-orcid":false,"given":"Brett","family":"Cucchiara","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, PA, 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Stroke and Dementia, John Radcliffe Hospital, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Rudilosso","sequence":"additional","affiliation":[{"name":"Functional Unit of Cerebrovascular Diseases, Hospital Cl\u00ednic de Barcelona, Barcelona, Spain"},{"name":"Fundaci\u00f3 de Recerca Cl\u00ednic Barcelona\u2014Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9976-2341","authenticated-orcid":false,"given":"Yongjun","family":"Wang","sequence":"additional","affiliation":[{"name":"China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P N","family":"Sylaja","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sree Chitra Tirunal Institute 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