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Wang GX, Zhang D, Wang ZP, Yang LQ, Zhang L, Wen L. Risk Factors for the Rupture of Bifurcation Intracranial Aneurysms Using CT Angiography. Yonsei Med J 2016; 57:1178-84. [PMID: 27401649 PMCID: PMC4960384 DOI: 10.3349/ymj.2016.57.5.1178] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the clinical and morphological characteristics in relation to risk of bifurcation intracranial aneurysm rupture. MATERIALS AND METHODS Data from 202 consecutive patients with 219 bifurcation aneurysms (129 ruptured and 90 unruptured) managed at the authors' facility between August 2011 and July 2014 were retrospectively reviewed. Based on their clinical records and CT angiographic findings, the ability of risk factors to predict aneurysm rupture was assessed using statistical methods. RESULTS Age, hypertension, diabetes mellitus, and cerebral atherosclerosis were negatively correlated with aneurysm rupture. Aneurysms located in the middle cerebral artery, daughter artery ratio, lateral angle ratio (LA ratio), and neck width were negatively correlated with rupture. Aneurysms located in the anterior communicating artery, irregularity, with daughter sac, depth, width, maximum size, aspect ratio (AR), depth-to-width ratio, and bottleneck factor were significantly and positively correlated with rupture. Binary logistic regression model revealed that irregular shape [odds ratio (OR) 6.598] and AR (OR 3.507) strongly increased the risk of bifurcation aneurysm rupture, while age (OR 0.434), cerebral atherosclerosis (OR 0.125), neck width (OR 0.771), and LA ratio (OR 0.267) were negatively correlated with rupture (p<0.05). Receiver operating characteristic analysis revealed the threshold values of AR and LA ratio to be 1.18 and 1.50, respectively. CONCLUSION Age (≥60 yr), cerebral atherosclerosis, and aneurysms with a larger neck width and larger LA ratio are protective factors against bifurcation aneurysm rupture. An aneurysm with an irregular shape and an increased AR reflect the greater likelihood of a rupture.
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Affiliation(s)
- Guang Xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Zhi Ping Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Liu Qing Yang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Lei Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
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Dieleman N, van der Kolk AG, Zwanenburg JJM, Brundel M, Harteveld AA, Biessels GJ, Visser F, Luijten PR, Hendrikse J. Relations between location and type of intracranial atherosclerosis and parenchymal damage. J Cereb Blood Flow Metab 2016; 36:1271-80. [PMID: 26661234 PMCID: PMC4929701 DOI: 10.1177/0271678x15616401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the relation between location and type of intracranial atherosclerosis (ICAS) and cortical microinfarcts (CMIs) and macroinfarcts in 18 patients presenting with ischemic stroke (n = 12) or transient ischemic attack (TIA) (n = 6) using 7 tesla MR imaging. The protocol included: 3D T2-weighted FLAIR and 3D T1-weighted Magnetization-Preparation Inversion Recovery Turbo Spin Echo sequence. ICAS lesions and infarcts were scored by two raters. The relation between ICAS lesions, calculated ratios of ICAS lesion characteristics, location, and infarcts were examined using linear regression analyses. A total number of 75 ICAS lesions (all patients), 101 CMIs (78% of patients), and 31 macroinfarcts (67% of patients) were found. Seventy-six and sixty-five percent of the CMIs and macroinfarcts, respectively, were found in the same vascular territory as the ICAS lesions (p = 0.977, p = 0.167, respectively). A positive correlation existed between the number of macroinfarcts and CMIs (p < 0.05). In patients with macroinfarcts, we found more concentric (p < 0.01) and diffuse (p < 0.05) type of ICAS lesions. A high prevalence of brain tissue lesions, both macroinfarcts and CMIs, were found in patients with ICAS. Macroinfarcts were found to be related to specific ICAS lesion types. The type of ICAS lesion seems to be promising as a marker for ICAS patients at higher risk of future infarcts.
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Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | | | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, the Netherlands Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Geert J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, the Netherlands Philips Healthcare, Best, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, the Netherlands
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Zhao T, Zhu WY, Xiong XY, Li J, Wang L, Ding HY, Wei F, Zhou Y, Gong ZL, Cheng SY, Liu Y, Shuai J, Yang QW. Safety and Efficacy of Wingspan Stenting for Severe Symptomatic Atherosclerotic Stenosis of the Middle Cerebral Artery: Analysis of 278 Continuous Cases. J Stroke Cerebrovasc Dis 2016; 25:2368-72. [PMID: 27324301 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/06/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Our objective is to investigate the safety and long-term efficacy of the Wingspan stent (Boston Scientific, Natick, MA, USA) for treating severe atherosclerotic stenosis of the middle cerebral artery (MCA). METHODS A total of 278 consecutive patients from our stroke database with clinical symptoms within the prior 90 days and intracranial atherosclerotic stenosis of 70% or above of the MCA were enrolled in this study between September 2012 and November 2014, and these patients were followed until the end of June 2015. The endpoint events included any stroke or death within 30 days after stenting and any subsequent ipsilateral ischemic stroke. RESULTS Among the 278 enrolled patients, 277 patients (99.6%) successfully underwent stenting. The mean rate of stenosis decreased from 82.5 ± 7.9% to 9.0 ± 3.2% following treatment. Within 30 days after stenting, 12 patients (4.3%) experienced endpoint events, including 8 cases (2.9%) of hemorrhagic stroke and 4 cases (1.4%) of ischemic stroke; 2 perioperative deaths occurred. During 8-33 months of follow-up, 19 patients developed endpoint events. The 1- and 2-year endpoint event rates were 5.8% (95% confidence interval [CI], 5.0%-15.7%) and 7.2% (95% CI, 4.3%-10.1%), respectively. CONCLUSIONS From this study, we can conclude that the treatment of severe symptomatic atherosclerotic stenosis of the MCA using the Wingspan stent was safe and effective and that the long-term stroke recurrence rate after stenting was low.
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Affiliation(s)
- Ting Zhao
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Wen-Yao Zhu
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiao-Yi Xiong
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Li
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Wang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Hui-Yan Ding
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Fei Wei
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yu Zhou
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zi-Li Gong
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Sai-Yu Cheng
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yong Liu
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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Kitazono T. [Pathogenetic mechanism of brain infarction]. Nihon Rinsho 2016; 74:546-548. [PMID: 27333737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Tuttolomondo A, Di Raimondo D, Pecoraro R, Maida C, Arnao V, Della Corte V, Simonetta I, Corpora F, Di Bona D, Maugeri R, Iacopino DG, Pinto A. Early High-dosage Atorvastatin Treatment Improved Serum Immune-inflammatory Markers and Functional Outcome in Acute Ischemic Strokes Classified as Large Artery Atherosclerotic Stroke: A Randomized Trial. Medicine (Baltimore) 2016; 95:e3186. [PMID: 27043681 PMCID: PMC4998542 DOI: 10.1097/md.0000000000003186] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Statins have beneficial effects on cerebral circulation and brain parenchyma during ischemic stroke and reperfusion. The primary hypothesis of this randomized parallel trial was that treatment with 80 mg/day of atorvastatin administered early at admission after acute atherosclerotic ischemic stroke could reduce serum levels of markers of immune-inflammatory activation of the acute phase and that this immune-inflammatory modulation could have a possible effect on prognosis of ischemic stroke evaluated by some outcome indicators. We enrolled 42 patients with acute ischemic stroke classified as large arteries atherosclerosis stroke (LAAS) randomly assigned in a randomized parallel trial to the following groups: Group A, 22 patients treated with atorvastatin 80 mg (once-daily) from admission day until discharge; Group B, 20 patients not treated with atorvastatin 80 mg until discharge, and after discharge, treatment with atorvastatin has been started. At 72 hours and at 7 days after acute ischemic stroke, subjects of group A showed significantly lower plasma levels of tumor necrosis factor-α, interleukin (IL)-6, vascular cell adhesion molecule-1, whereas no significant difference with regard to plasma levels of IL-10, E-Selectin, and P-Selectin was observed between the 2 groups. At 72 hours and 7 days after admission, stroke patients treated with atorvastatin 80 mg in comparison with stroke subjects not treated with atorvastatin showed a significantly lower mean National Institutes of Health Stroke Scale and modified Rankin scores. Our findings provide the first evidence that atorvastatin acutely administered immediately after an atherosclerotic ischemic stroke exerts a lowering effect on immune-inflammatory activation of the acute phase of stroke and that its early use is associated to a better functional and prognostic profile.
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Affiliation(s)
- Antonino Tuttolomondo
- From the Internal Medicine and Cardioangiology Ward (AT, DDR, RP, CM, VDC, IS, FC, AP), Dipartimento Biomedico di Medicina Interna e Specialistica; Department of Experimental Medicine and Clinical Neurosciences (VA), Clinical Neurology ward; Department of Experimental Medicine and Clinical Neurosciences (RM, DGI), Neurosurgical Section, University of Palermo; and School and Chair of Allergology, Dipartimento delle Emergenze e Trapianti d'Organo (DDB), University of Bari, Bari Italy
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106
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Kang K. Low bone mineral density is associated with intracranial posterior circulation atherosclerosis in women. Bone 2015; 81:669-674. [PMID: 26431918 DOI: 10.1016/j.bone.2015.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/14/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
Low bone mineral density (BMD) is associated with carotid atherosclerosis and the incidence of stroke. However, there are no data on the association of BMD with intracranial atherosclerosis. The study population consisted of 357 participants who underwent dual energy x-ray absorptiometric scanning of the lumbar spine and brain 3D time of flight magnetic resonance angiography as part of their voluntary health checks. The basilar, middle cerebral, intracranial internal carotid and intracranial vertebral arteries were evaluated. Low BMD was defined as a T-score of less than -1. All analyses were stratified by sex and intracranial atherosclerosis location. One hundred seventy-six women (53 years; 66.9% postmenopausal; 33.5% low BMD; 60.2% intracranial atherosclerosis in the anterior circulation (AC); 60.2% intracranial atherosclerosis in the posterior circulation (PC)) and 181 men (51 years; 28.7% low BMD; 61.9% intracranial atherosclerosis in the AC; 55.8% intracranial atherosclerosis in the PC) were included. In women, low BMD was significantly associated with intracranial atherosclerosis in the PC with the odds ratio of 2.57 (95% confidence interval 1.11-5.99). However, intracranial atherosclerosis in the AC was not associated with BMD in women. In men, there were no significant associations between BMD and intracranial atherosclerosis. In conclusion, this study shows that low BMD is associated with subclinical intracranial PC atherosclerosis in women but not in men.
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Affiliation(s)
- K Kang
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea.
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Abstract
The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis.Fifty-seven patients with asymptomatic mild, moderate, and severe unilateral MCA stenosis and 8 patients with symptomatic severe unilateral MCA stenosis diagnosed by transcranial Doppler were enrolled. Twenty-four healthy volunteers served as controls. The noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each subject in the supine position. Transfer function analysis was applied to determine the autoregulatory parameters (phase difference [PD] and gain).The PD values in the severe stenosis groups were significantly lower than those of the control group (60.71 ± 18.63°), the asymptomatic severe stenosis group was impaired ipsilaterally (28.94 ± 27.43°, P < 0.001), and the symptomatic severe stenosis group was impaired bilaterally (13.74 ± 19.21°, P < 0.001; 19.68 ± 14.50°, P = 0.006, respectively). The PD values in the mild and moderate stenosis groups were not significantly different than the controls (44.49 ± 27.93°; 48.65 ± 25.49°, respectively). The gain values in the mild and moderate groups were higher than in the controls (1.00 ± 0.58 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, and 1.20 ± 0.59 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, respectively). The gain values in the severe stenosis groups were significantly lower than that in the control group: the asymptomatic severe stenosis group was lower bilaterally (0.56 ± 0.32 cm/s/mm Hg, P = 0.003; 0.60 ± 0.32 cm/s/mm Hg, P < 0.05, respectively), whereas the symptomatic severe group was lower unilaterally (on the contralateral side) (0.53 ± 0.43 cm/s/mm Hg, P < 0.05).In asymptomatic patients with unilateral MCA stenosis, only the dCA of the severe stenosis was ipsilaterally impaired. Acute stroke may aggravate the impaired dCA and even spread contralaterally.
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Affiliation(s)
- Shuang Wang
- From the Stroke Center, Department of Neurology (SW, HM, HJ, YY); Neuroscience Center, Department of Neurology (Z-NG); Center for Neurovascular ultrasound (Y X), the First Hospital of Jilin Universit, Changchun, China and Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Xueyuan Avenue, Shenzhen University Town, Shenzhen, China (JL)
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Song Y, Liu H, Long L, Zhang N, Liu Y. TLR4 rs1927911, but not TLR2 rs5743708, is associated with atherosclerotic cerebral infarction in the Southern Han population: a case-control study. Medicine (Baltimore) 2015; 94:e381. [PMID: 25590839 PMCID: PMC4602557 DOI: 10.1097/md.0000000000000381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The objective of this study was to explore the association of toll-like receptor (TLR) 4 rs1927911 and TLR2 rs5743708 with atherosclerotic cerebral infarction (ACI) and their effects on blood pressure, fasting blood glucose, and blood lipids in the Han population of Hunan Province. TLR4 rs1927911 and TLR2 rs5743708 were detected by polymerase chain reaction and restriction fragment length polymorphism in 170 patients with ACI and 149 healthy controls. Our results indicated that the genotype and allele frequencies of TLR4 rs1927911 were significantly different between ACI patients and controls, whereas those of TLR2 rs5743708 were not significantly different between the 2 groups. For TLR4 rs1927911, blood pressure, fasting blood sugar, and serum lipid levels were not significantly different among different genotypes in the ACI and control groups. The rs1927911 polymorphism of the TLR4 gene may be a risk factor for ACI in the Southern Han population of Hunan Province; however, it may not be associated with blood pressure, fasting blood sugar, or blood lipids.
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Affiliation(s)
- Yanmin Song
- From the Department of Neurology (YS, HL, LL, NZ, YL), Xiangya Hospital, Central South University, Changsha, China
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Duan JG, Chen XY, Lau A, Wong A, Thomas GN, Tomlinson B, Liu R, Chan JCN, Leung TW, Mok V, Wong KS. Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study. PLoS One 2014; 9:e106623. [PMID: 25192283 PMCID: PMC4156359 DOI: 10.1371/journal.pone.0106623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/29/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes. METHODS In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death. RESULTS Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03). CONCLUSIONS Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.
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Affiliation(s)
- Jian Gang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Alex Lau
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Adrian Wong
- Department of Psychological Studies and Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong SAR, China
| | - G. Neil Thomas
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Roxanna Liu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Thomas W. Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Leng X, Scalzo F, Ip HL, Johnson M, Fong AK, Fan FSY, Chen X, Soo YOY, Miao Z, Liu L, Feldmann E, Leung TWH, Liebeskind DS, Wong KS. Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence. PLoS One 2014; 9:e97531. [PMID: 24818753 PMCID: PMC4018340 DOI: 10.1371/journal.pone.0097531] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/21/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with symptomatic intracranial atherosclerosis (ICAS) of ≥ 70% luminal stenosis are at high risk of stroke recurrence. We aimed to evaluate the relationships between hemodynamics of ICAS revealed by computational fluid dynamics (CFD) models and risk of stroke recurrence in this patient subset. METHODS Patients with a symptomatic ICAS lesion of 70-99% luminal stenosis were screened and enrolled in this study. CFD models were reconstructed based on baseline computed tomographic angiography (CTA) source images, to reveal hemodynamics of the qualifying symptomatic ICAS lesions. Change of pressures across a lesion was represented by the ratio of post- and pre-stenotic pressures. Change of shear strain rates (SSR) across a lesion was represented by the ratio of SSRs at the stenotic throat and proximal normal vessel segment, similar for the change of flow velocities. Patients were followed up for 1 year. RESULTS Overall, 32 patients (median age 65; 59.4% males) were recruited. The median pressure, SSR and velocity ratios for the ICAS lesions were 0.40 (-2.46-0.79), 4.5 (2.2-20.6), and 7.4 (5.2-12.5), respectively. SSR ratio (hazard ratio [HR] 1.027; 95% confidence interval [CI], 1.004-1.051; P = 0.023) and velocity ratio (HR 1.029; 95% CI, 1.002-1.056; P = 0.035) were significantly related to recurrent territorial ischemic stroke within 1 year by univariate Cox regression, respectively with the c-statistics of 0.776 (95% CI, 0.594-0.903; P = 0.014) and 0.776 (95% CI, 0.594-0.903; P = 0.002) in receiver operating characteristic analysis. CONCLUSIONS Hemodynamics of ICAS on CFD models reconstructed from routinely obtained CTA images may predict subsequent stroke recurrence in patients with a symptomatic ICAS lesion of 70-99% luminal stenosis.
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Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Fabien Scalzo
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Mark Johnson
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Albert K. Fong
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Florence S. Y. Fan
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Xiangyan Chen
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Zhongrong Miao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Edward Feldmann
- Department of Neurology, Tufts University, Boston, Massachusetts, United States of America
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | | | - Ka Sing Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- * E-mail:
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Abstract
Atherosclerotic disease often involves the intracranial arteries including those encased by cranial bones and dura, and those located in the subarachnoid space. Age, hypertension, and diabetes mellitus are independent risk factors for intracranial atherosclerosis. Intracranial atherosclerosis can result in thromboembolism with or without hypoperfusion leading to transient or permanent cerebral ischaemic events. High rates of recurrent ischaemic stroke and other cardiovascular events mandate early diagnosis and treatment. Present treatment is based on a combination of antiplatelet drugs, optimisation of blood pressure and LDL cholesterol values, and intracranial angioplasty or stent placement, or both, in selected patients.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and CentraCare Health, St Cloud, MN, USA.
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Turan TN, Cotsonis G, Lynn MJ, Wooley RH, Swanson S, Williams JE, Stern BJ, Derdeyn CP, Fiorella D, Chimowitz MI. Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists. Cerebrovasc Dis 2014; 37:203-11. [PMID: 24557055 PMCID: PMC3991561 DOI: 10.1159/000358120] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multicenter randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). METHODS Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial (pre-WASID survey, 2004), 1 year after WASID publication (post-WASID survey, 2006) and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial (post-SAMMPRIS survey, 2012). Neurologists were invited to participate in the pre-WASID survey (n=525). Neurologists and neurointerventionists were invited to participate in the post-WASID (n=598) and post-SAMMPRIS (n=2,080) surveys. The 3 surveys were conducted using web-based survey tools delivered by E-mail, and a fax-based response form delivered by E-mail and conventional mail. Data were analyzed using the χ2 test. RESULTS Before WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID=44%, post-WASID=85%, post-SAMMPRIS=94%) and posterior circulation (pre-WASID=36%, post-WASID=74%, post-SAMMPRIS=83%). The antiplatelet agent most commonly recommended after WASID was aspirin, but after SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in >25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID surveys (12%), but then decreased again after SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in >25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS surveys (17%). CONCLUSIONS The surveyed US physicians' recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the USA.
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Affiliation(s)
- Tanya N Turan
- Medical University of South Carolina, Charleston, S.C., USA
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Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS, Montgomery J, Nizam A, Lane BF, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Lynch JR, Zaidat OO, Rumboldt Z, Cloft HJ. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 2014; 383:333-41. [PMID: 24168957 PMCID: PMC3971471 DOI: 10.1016/s0140-6736(13)62038-3] [Citation(s) in RCA: 536] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early results of the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis trial showed that, by 30 days, 33 (14·7%) of 224 patients in the stenting group and 13 (5·8%) of 227 patients in the medical group had died or had a stroke (percentages are product limit estimates), but provided insufficient data to establish whether stenting offered any longer-term benefit. Here we report the long-term outcome of patients in this trial. METHODS We randomly assigned (1:1, stratified by centre with randomly permuted block sizes) 451 patients with recent transient ischaemic attack or stroke related to 70-99% stenosis of a major intracranial artery to aggressive medical management (antiplatelet therapy, intensive management of vascular risk factors, and a lifestyle-modification programme) or aggressive medical management plus stenting with the Wingspan stent. The primary endpoint was any of the following: stroke or death within 30 days after enrolment, ischaemic stroke in the territory of the qualifying artery beyond 30 days of enrolment, or stroke or death within 30 days after a revascularisation procedure of the qualifying lesion during follow-up. Primary endpoint analysis of between-group differences with log-rank test was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00576693. FINDINGS During a median follow-up of 32·4 months, 34 (15%) of 227 patients in the medical group and 52 (23%) of 224 patients in the stenting group had a primary endpoint event. The cumulative probability of the primary endpoints was smaller in the medical group versus the percutaneous transluminal angioplasty and stenting (PTAS) group (p=0·0252). Beyond 30 days, 21 (10%) of 210 patients in the medical group and 19 (10%) of 191 patients in the stenting group had a primary endpoint. The absolute differences in the primary endpoint rates between the two groups were 7·1% at year 1 (95% CI 0·2 to 13·8%; p=0·0428), 6·5% at year 2 (-0·5 to 13·5%; p=0·07) and 9·0% at year 3 (1·5 to 16·5%; p=0·0193). The occurrence of the following adverse events was higher in the PTAS group than in the medical group: any stroke (59 [26%] of 224 patients vs 42 [19%] of 227 patients; p=0·0468) and major haemorrhage (29 [13%]of 224 patients vs 10 [4%] of 227 patients; p=0·0009). INTERPRETATION The early benefit of aggressive medical management over stenting with the Wingspan stent for high-risk patients with intracranial stenosis persists over extended follow-up. Our findings lend support to the use of aggressive medical management rather than PTAS with the Wingspan system in high-risk patients with atherosclerotic intracranial arterial stenosis. FUNDING National Institute of Neurological Disorders and Stroke (NINDS) and others.
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Affiliation(s)
- Colin P Derdeyn
- Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery, Washington University School of Medicine, St Louis, MO, USA.
| | - Marc I Chimowitz
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - David Fiorella
- Department of Neurosurgery, State University of New York, Stony Brook, NY, USA
| | - Tanya N Turan
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - L Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Jean Montgomery
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Bethany F Lane
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public, Health, Atlanta, GA, USA
| | - Helmi L Lutsep
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Stanley L Barnwell
- Department of Neurological Surgery and the Dotter Interventional Institute, Oregon Health Sciences University, Portland, OR, USA
| | - Michael F Waters
- Departments of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Elad I Levy
- Department of Neurosurgery, University of Buffalo, NY, USA
| | | | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - David Chiu
- Department of Neurology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Joni M Clark
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Mark D Johnson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - G Lee Pride
- Departments of Radiology and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John R Lynch
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Osama O Zaidat
- Departments of Neurology, Radiology, and Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Zoran Rumboldt
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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115
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Galkin PV, Gushcha AO, Antonov GI. [Surgical treatment of the internal carotid artery atherosclerotic occlusion]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:67-72. [PMID: 25202786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Internal carotid artery occlusion is the cause of carotid territory transient ischemic attacks or infarction approximately in 15% of patients. Extracranial-lntracranial (EC-IC) Bypass Study and Carotid Occlusion Surgery Study (COSS) failed to show a benefit of EC-IC bypass over medical therapy in patients with symptomatic carotid artery occlusion. Weak sides of COSS were investigators reliance on post hoc analysis, use of specific thresholds in the definition of impaired cerebral hemodynamics and high perioperative morbidity. In selected subset of patients with medically refractory ischemic symptoms, EC-IC bypass, can provide benefit from surgery performed with sufficiently low perioperative morbidity. The potential of functional and cognitive improvement after cerebral revascularization needs further investigation.
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116
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Grudianov AI, Krechina EK, Mustafina FN, Avraamova TV. [Computer capillaroscopy for periodontal microcirculation assessment in patients with early atherosclerotic lesions]. Stomatologiia (Mosk) 2014; 93:24-26. [PMID: 25377575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The study of gingival microvessels was carried out by means of computer capillaroscopy in patients with moderate periodontal disease and early symptoms of atherosclerosis of extracranial portions of cephalic arteries. The results proved the decreased density of the capillar network in the marginal gingiva, as well as of linear and volumetric blood flow velocities drop in the arterial and venular portions of capillaries in patients with periodontal diseases combined with early atherosclerosis.
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Vakil P, Vranic J, Hurley MC, Bernstein RA, Korutz AW, Habib A, Shaibani A, Dehkordi FH, Carroll TJ, Ansari SA. T1 gadolinium enhancement of intracranial atherosclerotic plaques associated with symptomatic ischemic presentations. AJNR Am J Neuroradiol 2013; 34:2252-8. [PMID: 23828109 DOI: 10.3174/ajnr.a3606] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease. MATERIALS AND METHODS We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (>70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1-5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion. RESULTS Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant (P = .001, t test). CONCLUSIONS In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.
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Abstract
Patients with symptomatic intracranial atherosclerotic disease have a high risk of recurrent stroke, and secondary prevention in these patients remains a challenge. Aggressive medical management of vascular risk factors is safe and effective for most high risk patients, but the role of endovascular and surgical therapies still remain uncertain. Future studies may identify novel therapeutic strategies for patients with intracranial atherosclerotic disease, but aggressive risk factor control remains the mainstay of evidenced-based treatment at this time.
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Affiliation(s)
- Tanya N Turan
- MUSC Stroke Program, Suite 501, Harborview Office Tower, 19 Hagood Ave, Charleston, SC, 29425, USA,
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119
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Ataman OV, Polonikov OV, Harbuzova VI, Ataman IO, Matlaĭ OI. [Analysis of matrix Gla-protein (MGP) G-7A polymorphism association with ischemic atherothrombotic stroke in persons with risk factors]. Tsitol Genet 2013; 47:33-40. [PMID: 24228496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
G-7A polymorphism (rs1800801) of matrix Gla protein (MGP) gene in 170 patients with ischemic atherothrombotic stroke (IATS) and in 124 persons of the control group was determined. It was shown that in patients with IATS the distribution of the major allele homozygotes, heterozygotes and minor allele homozygotes was 35.9; 48.8; 15.3% (in control--43.5; 50.0; 6.5%, P = 0.051 by chi2-test). Significant differences in the distribution of genotypes were revealed only in women (P = 0.022). Odds ratio for minor allele homozygotes (A/A) versus major allele carriers (G/A+G/G) was 2,618 (P = 0.023), while in women it was equal to 6,645 (P = 0.015). In patients with A/A genotype the values of blood coagulation parameters (prothrombin time) indicated increased predisposition to hypercoagulability. The results obtained suggest that the A/A-variant of MGP gene is associated with an increased risk of IATS in female persons of the Ukrainian population and may be related to blood hypercoagulability and thrombi formation.
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120
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Zhu SG, Zhu YL, Huang ZF, Zhai DY, Zhang TT, Zhou Q, Mu YF, Liu DZ, Liu WH, Xu GL, Liu XF. [Effects of metabolic syndrome on multi-vessel lesions of symptomatic intracranial atherosclerosis]. Zhonghua Yi Xue Za Zhi 2013; 93:1622-1625. [PMID: 24125668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the effects of metabolic syndrome (MS) on multi-vessel lesions of symptomatic intracranial atherosclerosis. METHODS During April 2009 and October 2010, a total of 139 consecutive hospitalized patients with symptomatic intracranial atherosclerosis were recruited to undergo magnetic resonance angiography (MRA) or/and CT angiography (CTA) or/and digital subtraction angiography (DSA) to measure the stenotic degree and numbers of intracranial atherosclerosis. They were divided into 2 groups according to lesion numbers: single and multi-vessel lesions. MS was defined by the criteria of the Adult Treatment Panel III to examine the incidences of MS. The risk factors were analyzed for multi-vessel lesions of symptomatic intracranial atherosclerosis to explore the relationship between MS and multi-vessel lesions. RESULTS Among them, 210 intracranial atherosclerotic lesions were documented. Fifty-nine (42.4%) patients had two or more lesions (group with multi-vessel lesions). The incidence of MS was 70.5%. The rates of MS in groups of single and multi-vessel lesions were 56.3% and 89.8% respectively. And statistical significance existed between two groups (P < 0.001). Moreover, the number of MS components increased gradually with the number of lesions (P < 0.001). For the analysis of individual criteria for MS, only abnormal glycemia was found to be associated with multi-vessel lesions (P = 0.002). And multiple Logistic regression analysis showed that MS was associated with multi-vessel lesions of intracranial atherosclerosis (P = 0.001). CONCLUSIONS MS is an independent predictor for multi-vessel lesions of intracranial atherosclerosis. And its intervention may be an important preventive strategy for intracranial multi-vessel atherosclerosis.
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Affiliation(s)
- Shuang-gen Zhu
- Department of Neurology, Third Affiliated Hospital, Anhui Medical University, Hefei 230061, China
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Wadiwala MF, Kamal AK. My patient has intracranial stenosis, does he need an intracerebral stent? Results of the SAMMPRIS study. J PAK MED ASSOC 2013; 63:654-655. [PMID: 23758002 PMCID: PMC4185064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Yu SCH, Cheng HKM, Cheng PW, Lui WM, Leung KM, Tan CB, Pang KY, Wong GKC, Cheung YL, Lee R, Wong YC, Wong CK, Kwok JCK. Angioplasty and stenting for intracranial atherosclerotic stenosis: position statement of the Hong Kong Society of Interventional and Therapeutic Neuroradiology. Hong Kong Med J 2013; 19:69-73. [PMID: 23378358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
As a means of preventing secondary ischaemic stroke, angioplasty and stenting are considered potentially beneficial for patients with severe intracranial atherosclerotic stenosis. However, the role of stenting has been challenged since the publication of the first randomised controlled trial on Stenting versus Aggressive Medical Management for Preventing Recurrent stroke in Intracranial arterial Stenosis (SAMMPRIS). This indicated that aggressive medical management was superior to stenting using Wingspan to prevent recurrent stroke, because stenting has a high peri-procedural stroke and death rate. In this paper, we review the management of intracranial atherosclerosis, revisit the skepticism on stenting, and state our position on the topic in the form of recommendations. These are based on the prevalence of the disease in Hong Kong, the high risk of recurrent stroke despite medical therapy in the presence of haemodynamic intracranial stenosis without sufficient collaterals, an analysis of the weak points of SAMMPRIS, and results of clinical studies in Hong Kong.
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Affiliation(s)
- Simon C H Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Kim YJ, Lee SM, Cho HJ, Do HJ, Hong CH, Shin MJ, Kim YS. Plasma Levels of Apolipoprotein E and Risk of Intracranial Artery Stenosis in Acute Ischemic Stroke Patients. Ann Nutr Metab 2013. [PMID: 23208293 DOI: 10.1159/000343789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yong-Jae Kim
- Department of Neurology, Ewha Womans University, Seoul, Republic of Korea
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124
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Fedin AI, Starykh EP, Parfenov AS, Mironova OP, Abdrakhmanova EK, Starykh EV. [Pharmacotherapy of endothelial dysfunction in patients with atherosclerotic brain ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113:45-48. [PMID: 24300805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We studied the effect of deproteinized hemoderivative of calf blood, thioctic acid and vinpocetine with piracetam on the endothelial function in patients with chronic cerebral ischemia stage III. After pharmacological treatment, there was the improvement in the endothelium properties of both large and small blood vessels. The index of occlusion that characterized the function of small vessels reached normal values while the phase shift did not approach to the reference values. This notion indicates that in cerebral atherosclerosis small arteries initially are subject to alterations to a lesser extent compared to the arteries of large and medium caliber. The most effective medicines of those used for the correction of endothelial dysfunction are deproteinized hemoderivative of calf blood and thioctic acid.
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125
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Shishkova VN, Zotova LI, Fukalov IA, Shklovskiĭ VM. [The problem of cerebrovascular complications in patients with high risk of cardiovascular diseases: focus on diabetes]. Kardiologiia 2013; 53:52-57. [PMID: 24800482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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126
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Mi D, Zhang L, Wang C, Liu L, Pu Y, Zhao X, Wang Y, Wang Y. Impact of metabolic syndrome on the prognosis of ischemic stroke secondary to symptomatic intracranial atherosclerosis in Chinese patients. PLoS One 2012; 7:e51421. [PMID: 23251528 PMCID: PMC3519650 DOI: 10.1371/journal.pone.0051421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 11/01/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To analyze the effect of metabolic syndrome (MetS) on prognosis of ischemic stroke secondary to intracranial stenosis in Chinese patients. METHODS A prospective cohort of 701 patients with ischemic stroke, caused by intracranial stenosis, were followed at 3-month intervals for 1 year to monitor development of recurrent stroke or death. Imaging was performed using magnetic resonance angiography. MetS was defined using International Diabetes Federation (IDF) criteria. RESULTS MetS was identified in 26.0% of the cohort of stroke patients. Patients with MetS were more likely to be female, nonsmokers, and more likely to have a prior history of diabetes mellitus, high blood glucose and a family history of stroke than patients without MetS. During 1-year follow-up, patients with MetS had a non-significantly higher rate of stroke recurrence (7.1%) than patients without MetS (3.9%; P = 0.07). There was no difference in mortality (3.3% versus 3.5%, respectively). Multivariate Cox proportional hazards analysis (adjusting for gender, BMI, smoking, diabetes, and LDL-C) identified an association between that 1-year stroke recurrence and the presence of MetS (hazard ratio 2.30; 95% CI: 1.01-5.22) and large waist circumference (hazard ratio: 2.39; 95% CI: 1.05-5.42). However, multivariable analysis adjusting for the individual components of MetS found no significant associations between MetS and stroke recurrence. There were no associations between these parameters and mortality. CONCLUSIONS Chinese patients with symptomatic intracranial atherosclerosis who have MetS, are at higher risk of recurrent stroke than those without MetS. However, MetS was not predictive of stroke recurrence beyond its individual components and one-year mortality.
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Affiliation(s)
- Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
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128
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Turan TN, Lynn MJ, Nizam A, Lane B, Egan BM, Le NA, Lopes-Virella MF, Hermayer KL, Benavente O, White CL, Brown WV, Caskey MF, Steiner MR, Vilardo N, Stufflebean A, Derdeyn CP, Fiorella D, Janis S, Chimowitz MI. Rationale, design, and implementation of aggressive risk factor management in the Stenting and Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. Circ Cardiovasc Qual Outcomes 2012; 5:e51-60. [PMID: 22991350 PMCID: PMC3500085 DOI: 10.1161/circoutcomes.112.966911] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tanya N Turan
- Medical University of South Carolina, Charleston, SC 29425, USA.
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Statins may help lower depression risk. The key could be that the medication reduces atherosclerosis in the brain. Duke Med Health News 2012; 18:7. [PMID: 22649833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
PURPOSE OF REVIEW Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. RECENT FINDINGS We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. SUMMARY Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
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Affiliation(s)
- Shyam Prabhakaran
- Department of Neurological Sciences, Head, Cerebrovascular Disease & Neurocritical Care, Rush University Medical Center, 1725 W. Harrison St. Suite 1121, Chicago, IL 60612, Tel: 312-563-2518 Fax: 312-563-2206
| | - Jose G. Romano
- Cerebrovascular Division, University of Miami, Miller School of Medicine, 1120 NW 14 St. Suite 1357, Miami FL 33136, Tel: 305-243-2336, Fax: 305-243-7081
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131
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Kim JS. [Branch atheromatous disease: an important cause of small subcortical infarction in Asia]. Rinsho Shinkeigaku 2011; 51:882. [PMID: 22277401 DOI: 10.5692/clinicalneurol.51.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Chen SY, Huang E, Wang V, Fan YM, Ho CF, Yip PK. Improvement of clinical outcome and cerebral perfusion in a patient of atherosclerotic cerebral infarction after repetitive hyperbaric oxygen treatment--a case report and literature review. Undersea Hyperb Med 2011; 38:375-379. [PMID: 22013763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is a case report of hyperbaric oxygen therapy (HBO2T) for ischemic stroke. HBO2T should be the potential or additional treatment (with thrombolytic therapy) for ischemic stroke according to the preclinical and clinical studies. Hereby, we present a 56-year-old Chinese man with vascular risk factors. He had an acute ischemic stroke on the left corona radiata, with right hemiparesis and dysarthria resulting from atherosclerosis. The patient could not get thrombolytic treatment because the time to ER was in excess of five hours. He experienced great improvement after the general course of HBO2T; this was evaluated with standard rating scales for stroke research and cerebral perfusion images, including brain-computed tomography perfusion (CTP) and single-photon emission computed tomography (SPECT). Although few clinical trials showed a negative result, we suggest that further trials on HBO2T are still needed. Meanwhile, we emphasize the importance of HBO2T protocol and the selection of a suitable patient, which may influence the outcome.
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133
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Yamauchi H. [Ischemic cortical neuronal damage and cognitive impairments in atherosclerotic occlusive disease of the major cerebral artery: a PET study]. Brain Nerve 2011; 63:945-953. [PMID: 21878696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) disease, selective neuronal damage can be detected as a decrease in central benzodiazepine receptors (BZRs) in an apparently normal cerebral cortex. To investigate the association between cortical BZRs decreases and executive dysfunctions, we measured BZRs using positron emission tomography (PET) and (11)C-flumazenil in 60 non-disabled patients with unilateral atherosclerotic ICA or MCA disease and no cortical infarction. Using 3-dimensional stereotactic surface projections, we calculated the BZR index, a measure of abnormally decreased BZRs in the cerebral cortex within the anterior cerebral artery (ACA) or MCA territory, and found that it to be correlated with the patient's score on the Wisconsin Card Sorting Test (WCST). Based on the WCST results, 39 patients were considered abnormal (low categories achieved) for their age. The BZR index of the ACA territory in the hemisphere affected by arterial disease was significantly higher in abnormal patients than in normal patients. The BZR index of the MCA territory differed significantly between the 2 groups when patients with left arterial disease (n = 28) were analyzed separately. The BZR indices of the anterior cingulate gyrus and the middle frontal gyrus carrelated significantly and positively with the total number of WCST errors. In atherosclerotic ICA or MCA disease, selective neuronal damage that is manifested as a decrease in BZRs in the non-infarcted cerebral cortex is associated with executive dysfunction. PET imaging of BZRs is useful as an objective measure of cognitive impairments in atherosclerotic occlusive disease of the major cerebral artery.
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Affiliation(s)
- Hiroshi Yamauchi
- Division of PET Imaging, Shiga Medical Center Research Institute, Shiga, Japan
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134
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Doi K, Yaku H. Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke. Eur J Cardiothorac Surg 2011; 38:568-72. [PMID: 20399676 DOI: 10.1016/j.ejcts.2010.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/27/2010] [Accepted: 03/08/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cerebrovascular atherosclerotic disease is a widely known risk factor for stroke after conventional coronary artery bypass grafting (CABG). The aim of this study is to evaluate the incidence of stroke in patients with significant cerebrovascular disease after off-pump CABG. METHODS In this retrospective study, 611 patients, who underwent off-pump CABG, were divided into high-risk (n=196) and low-risk groups (n=415) for perioperative stroke using preoperative brain magnetic resonance angiography/imaging and cervical Doppler sonography, and the incidence of stroke in the two groups was compared. RESULTS No 'intra-operative' stroke was observed. However, seven patients (3.6%) in the high-risk group and one patient (0.2%) in the low-risk group developed 'delayed stroke' between the day of surgery and postoperative day 18 (mean postoperative day 8.8). The predominant aetiology of delayed stroke was thrombo-embolism. Assignment to the high-risk group had a significant association with the occurrence of delayed stroke (p=0.011). The person-time incidence rate of stroke in the high-risk group was much higher within 1 month (3.57) after CABG than beyond 1 month (0.14). CONCLUSIONS Patients with significant cerebrovascular disease did not develop intra-operative stroke after off-pump CABG. However, these patients were likely to suffer from delayed stroke within 30 days of surgery.
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Affiliation(s)
- Kiyoshi Doi
- Department of Cardiovascular Surgery, Koto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan.
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135
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Affiliation(s)
- Tanya N Turan
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA.
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136
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Khan M, Kamal AK. What are the therapeutic options for strokes secondary to intracranial large artery stenosis? J PAK MED ASSOC 2011; 61:194-195. [PMID: 21375179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Maria Khan
- Stroke Service and Vascular Fellowship Program, Aga Khan University Hospital, Karachi, Pakistan
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137
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Dabus G, Bendok BR, Walker MT. Asymptomatic distal plaque migration after angioplasty of atherosclerotic middle cerebral artery stenosis. J Neuroimaging 2010; 23:152-3. [PMID: 20977530 DOI: 10.1111/j.1552-6569.2010.00522.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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138
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139
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Azovtsev RA, Morozov VP, Pudiakov PS. [Strategy of treatment of patients with a combination of esophagus cancer and atherosclerotic lesions of coronary and cerebral arteries]. Vestn Khir Im I I Grek 2010; 169:124-126. [PMID: 20387622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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140
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Rafael H. Cerebral atherosclerosis causes neurodegenerative diseases. Med Sci Monit 2010; 16:LE1-LE2. [PMID: 20037498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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141
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Abstract
INTRODUCTION With mounting evidence underscoring the multifactorial pathogenesis of atherothrombotic cerebrovascular disease, it is becoming increasingly obvious that an early and aggressive multimodal treatment of the underlying atherosclerotic disease process is the most effective approach towards preventing recurrent vascular events in the majority of ischemic stroke patients. Knowledge of the evidence behind this strategy and the effective means for implementing it could be useful to the healthcare practitioner caring for stroke and transient ischemic attack (TIA) patients. REVIEW SUMMARY This review presents the evidence behind the broadening therapeutic options for recurrent vascular event prevention in ischemic stroke patients whose underlying stroke pathophysiologic mechanism is presumed to be due to atherosclerosis. The paper identifies modifiable vascular risk factors associated with recurrent stroke, as well as the clinical trial data on which the latest clinical practice guidelines on recurrent stroke prevention have been based. Therapies discussed include antithrombotics, statins, antihypertensives, revascularization procedures and lifestyle modification (smoking cessation, exercise and diet education). Finally, successful hospital-based quality improvement programs for initiating and maintaining these evidence-based recurrent stroke prevention treatments are also described. CONCLUSIONS A timely, systematic, evidence-based multimodal preventive approach to atherothrombotic disease in ischemic stroke and TIA patients that transcends the continuum of care will enhance treatment rates and improve clinical outcomes.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center and Department of Neurology, Medical Center, University of California at Los Angeles, Los Angeles, CA 90095, USA. ovibes@ mednet.ucla.edu
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142
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Stroganova IM, Kiparisov MA. [Omaron in the restorative treatment of patients with chronic cerebrovascular insufficiency]. Zh Nevrol Psikhiatr Im S S Korsakova 2010; 110:70-72. [PMID: 20443242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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143
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Uzawa A, Aotsuka A, Terano T. Posterior cerebral artery territory infarction associated with persistent primitive hypoglossal artery with internal carotid artery atherosclerosis. Intern Med 2010; 49:515-6. [PMID: 20190498 DOI: 10.2169/internalmedicine.49.3075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akiyuki Uzawa
- Department of Neurology, Chiba Municipal Aoba Hospital.
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144
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Drinka P. Letter by Drinka regarding article, "Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study". Circulation 2009; 120:e293. [PMID: 20026790 DOI: 10.1161/circulationaha.109.883686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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145
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Birns J, Morris R, Jarosz J, Markus HS, Kalra L. Hypertension-related cognitive decline: is the time right for intervention studies? Minerva Cardioangiol 2009; 57:813-830. [PMID: 19942849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The importance of lowering blood pressure in hypertensive subjects is well known but the relationship between hypertension and cognitive function has been a subject of considerable controversy. Cross-sectional studies investigating the relationship between blood pressure and cognition have shown conflicting relationships whilst the majority of longitudinal studies have demonstrated elevated blood pressure to be associated with cognitive decline. Randomised studies have demonstrated heterogeneous and sometimes conflicting effects of blood pressure lowering on cognitive function and suggested reasons include multiple mechanisms by which hypertension affects the brain, the variety of cognitive instruments used for assessment and differences in antihypertensive treatments. Chronic hypertension accelerates arteriosclerotic changes in the brain with a disproportionate effect on subcortical circuits associated with cerebral small vessel disease. Randomised clinical trials assessing the cognitive consequences of blood pressure reduction in people with small vessel disease are lacking and many of the existing controversies on the cognitive consequences of blood pressure lowering, especially in older people, arise from the design limitations of studies. This article describes the methodological issues in designing such a trial and the results of a pilot evaluation to see if careful selection of subjects and measurements would make undertaking intervention studies feasible. Given the predicted upswing in people with cognitive impairments, the time is right for randomised clinical trials with specific cognitive end-points to examine the relationship between cognitive function and hypertension and guide practice.
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Affiliation(s)
- J Birns
- Department of Ageing and Health, 9th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK2.
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146
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He YL, Zhu M, Jin XP, Zhou YL. [Relationship of polymorphism of SG13S114A/T in ALOX5AP gene with atherosclerotic cerebral infarction]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2009; 38:630-633. [PMID: 20014490 DOI: 10.3785/j.issn.1008-9292.2009.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the relationship of the polymorphism of SG13S114A/T in ALOX5AP gene with atherosclerotic cerebral infarction (ACI). METHODS By polymerase chain reaction and restriction fragment length polymorphism, polymorphism of SG13S114A/T in ALOX5AP gene in 412 cases with ACI and 368 non-ACI controls were analyzed. RESULT There were no statistically significant differences in the ALOX5AP gene SG13S114 AA genotype and A allele frequencies between ACI group and control group (P>0.05). CONCLUSION The results do not support genotype SG13S114 A allele as the risk gene for ACI.control group.
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Affiliation(s)
- Ying-Lei He
- Department of Neurology, Taizhou Hospital, Wenzhou Medical College, Taizhou 317000, China.
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147
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Vibo R, Kõrv J, Roose M, Kampus P, Muda P, Zilmer K, Zilmer M. Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome. Free Radic Res 2009; 41:282-7. [PMID: 17364956 DOI: 10.1080/10715760601083235] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The goal of our study was to investigate the associations of oxidized LDL (apoB100 aldehyde-modified form) and acute phase proteins (fibrinogen, CRP) with acute ischemic stroke severity and outcome. MATERIALS AND METHODS The study included 61 ischemic stroke patients and 64 controls. Strokes were subtyped according to TOAST criteria, the severity and outcome of stroke (at 1 year) were measured. RESULTS The mean triglyceride, fibrinogen, CRP and glucose values were significantly higher among cases. The median oxLDL value for patients with large artery atherosclerosis (LAA) type of stroke was significantly higher than for other subtypes. The oxLDL values did not correlate with age, stroke severity and outcome. CONCLUSIONS Inflammatory markers (fibrinogen and CRP) predicted the stroke severity and outcome whereas elevation of oxLDL levels did not. Our data refer to possibility that there may exist some links between the LAA subtype of stroke and elevated oxLDL (apoB100 aldehyde-modified form).
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Affiliation(s)
- Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Estonia.
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148
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Abstract
Residual coronary heart disease remains a significant problem even after adequate statin therapy for cardiovascular risk reduction as currently recommended by the Adult Treatment Panel III (ATP-III) of the National Cholesterol Education Program (NCEP). This is particularly true for the high risk patients as defined by ATP-III that includes those patients who have a greater than 20% 10-year risk of adverse cardiac events. For such patients the current goal of a low-density lipoprotein cholesterol (LDL-cholesterol) maintenance level of < or =100 mg/dL plasma appears to be suboptimal. Accumulating data from several recent randomized studies of more aggressive LDL-cholesterol reduction to levels below 70 mg/dL in the high risk patients favor acceptance of such a new lower target for LDL-cholesterol using more intensive statin therapy which would affect the treatment strategy for patients with coronary heart disease pre-percutaneous intervention, metabolic syndrome, diabetes mellitus, congestive heart failure, cerebrovascular disease and chronic kidney disease.
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Affiliation(s)
- Vibhuti Singh
- University of South Florida College of Medicine, and Suncoast Cardiovascular Center, St. Petersburg, Florida, USA
| | - Prakash Deedwania
- Cardiology Division, VACCHCS/UCSF, Fresno, CA, and UCSF School of Medicine, San Francisco, CA, USA
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149
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Saidi S, Mallat SG, Almawi WY, Mahjoub T. Association between renin-angiotensin-aldosterone system genotypes and haplotypes and risk of ischemic stroke of atherosclerotic etiology. Acta Neurol Scand 2009; 119:356-63. [PMID: 19473121 DOI: 10.1111/j.1600-0404.2008.01105.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The association of renin C-4063T and angiotensinogen (AGT) T174M, AGT M235T and AGT A-6G polymorphisms with ischemic stroke of atherosclerotic etiology was investigated in 329 Tunisian patients with stroke and 444 controls. MATERIALS AND METHODS Genotyping was performed using PCR-RFLP and the contributions of polymorphisms to the risk of stroke were analyzed using haplotype and multivariate regression analysis. RESULTS AGT 235T and AGT-6G allele and AGT 235T/T, AGT-6A/G and AGT-6G/G genotype frequencies were higher in patients. Linkage disequilibrium (LD) was noted for AGT174T with AGT235M and AGT(-6)A in patients, while AGT235M was in LD with AGT(-6)A in controls and AGT235T was in LD with AGT(-6)G in both groups. The AGT 174T/235T/-6A and AGT 174T/235M/-6G haplotypes were positively and negatively associated with stroke respectively. Multivariate regression analysis identified AGT 174T/235M/-6A, AGT 174T/235T/-6G, AGT 174T/235T/-6A and AGT 174M/235T/-6A haplotypes to be significantly associated with an increased risk of stroke. CONCLUSIONS Renin-angiotensin-aldosterone system polymorphisms influence the risk of atherosclerotic stroke in Tunisians.
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Affiliation(s)
- S Saidi
- Research Unit of Hematological and Autoimmune Diseases, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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150
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