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Yang H, Huang G, Li X, Wu M, Zhou W, Yin X, Zhang M, Chen Z. High-resolution magnetic resonance vessel wall imaging provides new insights into Moyamoya disease. Front Neurosci 2024; 18:1375645. [PMID: 38665292 PMCID: PMC11043609 DOI: 10.3389/fnins.2024.1375645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Moyamoya disease (MMD) is a rare condition that affects the blood vessels of the central nervous system. This cerebrovascular disease is characterized by progressive narrowing and blockage of the internal carotid, middle cerebral, and anterior cerebral arteries, which results in the formation of a compensatory fragile vascular network. Currently, digital subtraction angiography (DSA) is considered the gold standard in diagnosing MMD. However, this diagnostic technique is invasive and may not be suitable for all patients. Hence, non-invasive imaging methods such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are often used. However, these methods may have less reliable diagnostic results. Therefore, High-Resolution Magnetic Resonance Vessel Wall Imaging (HR-VWI) has emerged as the most accurate method for observing and analyzing arterial wall structure. It enhances the resolution of arterial walls and enables quantitative and qualitative analysis of plaque, facilitating the identification of atherosclerotic lesions, vascular entrapment, myofibrillar dysplasia, moyamoya vasculopathy, and other related conditions. Consequently, HR-VWI provides a new and more reliable evaluation criterion for diagnosing vascular lesions in patients with Moyamoya disease.
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Affiliation(s)
- Hui Yang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Guilan Huang
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xi Li
- Department of Neurology, University of California Irvine Medical Center, Irvine, CA, United States
| | - Moxin Wu
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Weixin Zhou
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Xiaoping Yin
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
| | - Manqing Zhang
- School of Basic Medicine, Jiujiang University, Jiujiang, China
| | - Zhiying Chen
- Department of Neurology, Clinical Medical School of Jiujiang University, Jiujiang, China
- Jiujiang Clinical Precision Medicine Research Center, Jiujiang, China
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Jia R, He Y, Liang J, Duan L, Ma C, Lu T, Liu W, Li S, Wu H, Cao H, Li T, He Y. Preparation of biocompatibility coating on magnesium alloy surface by sodium alginate and carboxymethyl chitosan hydrogel. iScience 2024; 27:109197. [PMID: 38433902 PMCID: PMC10904997 DOI: 10.1016/j.isci.2024.109197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Magnesium alloy is an excellent material for biodegradable cerebrovascular stents. However, the rapid degradation rate of magnesium alloy will make stent unstable. To improve the biocompatibility of magnesium alloy, in this study, biodegradable sodium alginate and carboxymethyl chitosan (SA/CMCS) was used to coat onto hydrothermally treated the surface of magnesium alloy by a dipping coating method. The results show that the SA/CMCS coating facilitates the growth, proliferation, and migration of endothelial cells and promotes neovascularization. Moreover, the SA/CMCS coating suppresses macrophage activation while promoting their transformation into M2 type macrophages. Overall, the SA/CMCS coating demonstrates positive effects on the safety and biocompatibility of magnesium alloy after implantation, and provide a promising therapy for the treatment of intracranial atherosclerotic stenosis in the future.
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Affiliation(s)
- Rufeng Jia
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Yanyan He
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Jia Liang
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Lin Duan
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
- Department of Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Chi Ma
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Taoyuan Lu
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Wenbo Liu
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Shikai Li
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
| | - Haigang Wu
- School of Life Sciences, Henan University, Kaifeng, Henan 475004, China
| | - Huixia Cao
- Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
- Department of Neurosurgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, Henan 450003, China
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Surgical Management of Intracranial Atherosclerotic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023. [DOI: 10.1007/s11936-022-00974-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Flat Detector CT with Cerebral Pooled Blood Volume Perfusion in the Angiography Suite: From Diagnostics to Treatment Monitoring. Diagnostics (Basel) 2022; 12:diagnostics12081962. [PMID: 36010312 PMCID: PMC9406673 DOI: 10.3390/diagnostics12081962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
C-arm flat-panel detector computed tomographic (CT) imaging in the angiography suite increasingly plays an important part during interventional neuroradiological procedures. In addition to conventional angiographic imaging of blood vessels, flat detector CT (FD CT) imaging allows simultaneous 3D visualization of parenchymal and vascular structures of the brain. Next to imaging of anatomical structures, it is also possible to perform FD CT perfusion imaging of the brain by means of cerebral blood volume (CBV) or pooled blood volume (PBV) mapping during steady state contrast administration. This enables more adequate decision making during interventional neuroradiological procedures, based on real-time insights into brain perfusion on the spot, obviating time consuming and often difficult transportation of the (anesthetized) patient to conventional cross-sectional imaging modalities. In this paper we review the literature about the nature of FD CT PBV mapping in patients and demonstrate its current use for diagnosis and treatment monitoring in interventional neuroradiology.
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Wang Y, Fan H, Duan W, Ren Z, Liu X, Liu T, Li Y, Zhang K, Fan H, Ren J, Li J, Li X, Wu X, Niu X. Elevated stress hyperglycemia and the presence of intracranial artery stenosis increase the risk of recurrent stroke. Front Endocrinol (Lausanne) 2022; 13:954916. [PMID: 36699024 PMCID: PMC9868694 DOI: 10.3389/fendo.2022.954916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Stress hyperglycemia has served as a reliable biomarker to predict poor outcomes after ischemic stroke. However, recent studies have reported some contrary conclusions. Different stroke subtypes may respond inconsistently to stress hyperglycemia. The progression of intracranial atherosclerotic stenosis (ICAS) is tightly related to hyperglycemia. Thus, this study aims to determine the relationship between stress hyperglycemia and recurrent stroke in ischemic stroke patients with or without intracranial atherosclerotic stenosis. METHODS This is a multicenter retrospective observational cohort study. Patients with acute minor ischemic stroke and eligible computed tomography and magnetic resonance imaging data were enrolled. The severity of stress hyperglycemia is measured by the stress hyperglycemia ratio (SHR). SHR was calculated based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels. The primary outcome was stroke recurrence during hospitalization. The interaction of SHR levels with the presence of ICAS on the primary outcome was investigated using univariable and multivariable Cox proportional hazards models. Restricted cubic splines were applied to determine the nonlinear relationship between SHR and primary outcome. A two-piecewise linear regression model was used to identify the threshold of SHR. RESULTS A total of 610 participants were included in the study. The average age of the patients was 61.4 ± 12.9 years old, and approximately 70% of participants were males. A total of 189 (30.98%) patients had ICAS. The patients were categorized into 3 groups based on the tertiles of SHR. Compared with the group with a lower SHR, a higher SHR was significantly associated with the risk of stroke recurrence in the ICAS group (hazard ratio [HR], 8.52, 95% confidence interval [CI], 3.16-22.96, P<0.001). When SHR was treated as a continuous variable, each 0.1-unit increase in SHR in the ICAS group was associated with a 1.63-fold increase in the risk of recurrence (HR, 1.63, 95% CI, 1.39-1.9, P<0.001) with a threshold of 0.75. FPG but not HbA1c was associated with stroke recurrence in ICAS patients (HR, 1.17, 95% CI, 1.08-1.26, P<0.001). Sensitive analyses showed consistent results after adjusting for previous diabetes mellitus, oral hypoglycemic agents and insulin injection. CONCLUSIONS SHR represents a better biomarker to predict the risk of stroke recurrence in patients with ICAS than FPG and HbA1c regardless of previous diabetes mellitus. TRIAL REGISTRATION https://www.chictr.org.cn/showproj.aspx?proj=125817; Identifier, [ChiCTR2100046958].
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Affiliation(s)
- Yongle Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongxuan Fan
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weiying Duan
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhaoyu Ren
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuchang Liu
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tingting Liu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanan Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Kaili Zhang
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Haimei Fan
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Jing Ren
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Juan Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinyi Li
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Xuemei Wu
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- *Correspondence: Xiaoyuan Niu,
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Nguyen L, Maingard J, Jhamb A, Brooks M, Barras C, Kok HK, Asadi H. Intracranial atherosclerotic disease and acute ischaemic stroke: A review of diagnosis and management. J Med Imaging Radiat Oncol 2021; 66:391-403. [PMID: 34894071 DOI: 10.1111/1754-9485.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
Intracranial atherosclerotic disease is highly prevalent and a common cause of ischaemic stroke globally. With the increasing use of endovascular treatment for acute stroke management, computed tomography and magnetic resonance imaging have become an essential part of patient selection. In this review, we present the typical imaging findings of intracranial atherosclerosis and an overview of management as relevant to diagnostic and interventional radiologists.
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Affiliation(s)
- Lauren Nguyen
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia
| | - Julian Maingard
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ashu Jhamb
- Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
| | - Mark Brooks
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
| | - Christen Barras
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
| | - Hong Kuan Kok
- Department of Radiology, Northern Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- NeuroInterventional Radiology Unit, Monash Health, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia.,Interventional Neuroradiology Service, Austin Health, Melbourne, Victoria, Australia
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Hurford R, Rothwell PM. Prevalence, prognosis, and treatment of atherosclerotic intracranial stenosis in Caucasians. Int J Stroke 2021; 16:248-264. [PMID: 33270537 PMCID: PMC8044631 DOI: 10.1177/1747493020974461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis is a highly prevalent cause of stroke worldwide with important ethnic disparities. Widely considered to be a common cause of stroke in Asian and Afro-Caribbean populations, relatively less is known about the burden and significance of intracranial atherosclerotic stenosis in Caucasians. AIMS We aim to highlight recent insights and advances into the prevalence, prognosis, and treatment of symptomatic and asymptomatic atherosclerotic intracranial atherosclerotic stenosis in Caucasian patients. SUMMARY OF REVIEW We identified 48 articles studying intracranial atherosclerotic stenosis in Caucasian patients with ischemic stroke or transient ischemic attack. Most studies were on hospital-based cohorts of consecutive patients and half were graded as "fair" quality. There was significant variation between studies in the definition of intracranial atherosclerotic stenosis and in the imaging modalities used to detect intracranial atherosclerotic stenosis. Overall, 12.1% of Caucasian patients were found to have any intracranial atherosclerotic stenosis, 6.4% symptomatic intracranial atherosclerotic stenosis and 11.1% asymptomatic intracranial atherosclerotic stenosis, with higher rates at older ages. In studies reporting prognosis, there were 61 and 10 same-territory ischemic strokes in 1000 person-years in patients with symptomatic and asymptomatic intracranial atherosclerotic stenosis, respectively. Percutaneous stenting and angioplasty have not proven superior to intensive medical management in patients with symptomatic intracranial atherosclerotic stenosis. CONCLUSIONS Intracranial atherosclerotic stenosis has previously been neglected as a cause of stroke in Caucasians but is highly prevalent at older ages and frequently discovered with the growing use of noninvasive angiography. Intensive medical therapy is the treatment of choice, but there is a need to develop novel treatments or therapeutic approaches to lower the risk of stroke in higher risk patients.
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Affiliation(s)
- Robert Hurford
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Fahmy EM, El Awady MAES, Sharaf SAA, Selim NM, Abdo HES, Mohammed SS. Apolipoproteins A1 and B and their ratio in acute ischemic stroke patients with intracranial and extracranial arterial stenosis: an Egyptian study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Apolipoprotein A1 and B and their ratio are considered a better biomarker for cardiovascular diseases than a lipid profile, but this previous finding is not proved to cerebrovascular ischemic diseases. The aim of this study is to assess the relation between apolipoprotien A1 and B and their ratio to intra- and extracranial carotid atherosclerosis in patients with ischemic acute stroke.
Methods
90 Egyptian patients with acute ischemic stroke are included in the study, and they have been classified into 3 groups: group 1 includes 30 patients with intracranial stenosis, group 2 includes 30 patients with extracranial arterial stenosis, and group 3 includes 30 patients with non-arterial stenosis. Patients were subjected to clinical assessment, routine laboratory measures, and Color-Coded Duplex Sonography for extracranial and intracranial arteries. The measurement of serum levels of apolipoproteins A1 and B was done using enzyme-linked immuno-sorbent assay (ELISA).
Results
A statistically significant difference was found between patient groups as regards the frequency of abnormal serum LDL-cholesterol (p = 0.04), being elevated in patients with extracranial stenosis (p = 0.01). There was a significant difference between patients groups as regards the frequency of abnormal serum HDL-cholesterol (p = 0.02), being lower in patients with extracranial stenosis. High Apo B/A1 ratio was an independent risk factor for intracranial arterial stenosis (p = 0.045). An abnormal elevation of serum LDL cholesterol was an independent risk factor of extracranial arterial stenosis (p = 0.021).
Conclusion
Apo B/A1 ratio is an independent risk factor for intracranial arterial stenosis, while serum LDL cholesterol is an independent risk factor for extracranial arterial stenosis. Apo B/A1 ratio and serum LDL cholesterol are reliable serum biomarkers for cranial arterial stenosis in acute ischemic stroke patients.
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Udani SD, Bhogal P. Black blood vessel wall MRI to identify vulnerable atherosclerotic plaque in a non-stenotic intracranial vertebral artery as a cause of acute ischaemia. BJR Case Rep 2020; 6:20200061. [PMID: 33299594 PMCID: PMC7709074 DOI: 10.1259/bjrcr.20200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/05/2022] Open
Abstract
Conventional neuroimaging techniques for investigating the cause of stroke are mainly centred on investigating luminal stenosis. The pathophysiology of intracranial atherosclerotic disease (ICAD) and stroke is complex and extends beyond just vessel narrowing. The concept of the vulnerable atherosclerotic plaque, that can result in acute coronary syndromes, has been well described in the cardiac literature1,2although this concept is less well accepted among stroke physicians. We describe a case of a 61-year-old male with acute neurological sequelae from a non-stenotic atherosclerotic plaque of the intracranial vertebral artery. This case report describes the additional use of vessel wall MRI techniques to aid the radiologist in identifying such vulnerable lesions and therefore helping to tailor management and prevent further clinical deterioration.
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Affiliation(s)
- Sundip Dhanvant Udani
- Department of Neuroradiology, The Royal London Hospital, Whitechapel Road, London, E1 1BB, United Kingdom
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Sarikaya B, Colip C, Hwang WD, Hippe DS, Zhu C, Sun J, Balu N, Yuan C, Mossa-Basha M. Comparison of time-of-flight MR angiography and intracranial vessel wall MRI for luminal measurements relative to CT angiography. Br J Radiol 2020; 94:20200743. [PMID: 33180559 DOI: 10.1259/bjr.20200743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess whether intracranial vessel wall (IVW) MRI luminal measurements are more accurate than non-contrast 3D-TOF-MRA measurements for intracranial atherosclerotic stenosis, relative to CTA. METHODS Consecutive patients with non-calcified intracranial atherosclerotic stenosis seen on CTA, who had non-contrast 3D-TOF-MRA and IVW performed between 1 January 2013 and 20 April 2014 were selected, and images with stenosis were pre-selected by a single independent rater. The pre-selected CTA, MRA, and IVW (T1-weighted) images were then reviewed by two independent raters blinded to the other measurements in random order. Measurements were made in a plane perpendicular to the lumen on each modality. MRA and IVW measurements were compared to CTA, to determine which more accurately matched the degree of stenosis. RESULTS 18 patients with 33 intracranial atherosclerotic stenoses were included. Relative to CTA, IVW had 40% less variance than MRA (p = .004). IVW had a significantly higher concordance correlation coefficient (CCC) relative to CTA than MRA (.87 vs .68, p = .002). IVW and MRA did not have significant bias relative to CTA, however, 8/33 lesions showed >20% overestimation of the degree of stenosis on MRA, compared to 1/33 for IVW. CCC between raters were 0.84 (95% CI 0.67-0.93) for CTA, 0.83 (0.67-0.93) for TOF-MRA, and 0.85 (0.71-0.94) for IVW. For stenosis >50% sensitivity was 82% for IVW and 64% for MRA, while specificity was 73% for both. CONCLUSION IVW provides more accurate stenosis measurements than MRA when compared to CTA. ADVANCES IN KNOWLEDGE Considering higher stenosis measurement accuracy of IVW, it can be more reliably used for quantitative evaluation relative to MRA.
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Affiliation(s)
- Basar Sarikaya
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Charles Colip
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - William D Hwang
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Jie Sun
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
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11
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Voigt S, van Os H, van Walderveen M, van der Schaaf IC, Kappelle LJ, Broersen A, Velthuis BK, de Jong PA, Kockelkoren R, Kruyt ND, Algra A, Wermer M. Sex differences in intracranial and extracranial atherosclerosis in patients with acute ischemic stroke. Int J Stroke 2020; 16:385-391. [PMID: 32878572 PMCID: PMC8193620 DOI: 10.1177/1747493020932806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background and aim To investigate sex differences with respect to presence and location of atherosclerosis in acute ischemic stroke patients. Methods Participants with acute ischemic stroke were included from the Dutch acute stroke trial, a large prospective multicenter cohort study performed between May 2009 and August 2013. All patients received computed tomography/computed tomography-angiography within 9 h of stroke onset. We assessed presence of atherosclerosis in the intra- and extracranial internal carotid and vertebrobasilar arteries. In addition, we determined the burden of intracranial atherosclerosis by quantifying internal carotid and vertebrobasilar artery calcifications, resulting in calcium volumes. Prevalence ratios between women and men were calculated with Poisson regression analysis and adjusted prevalence ratio for potential confounders (age, hypertension, hyperlipidemia, diabetes, smoking, and alcohol use). Results We included 1397 patients with a mean age of 67 years, of whom 600 (43%) were women. Presence of atherosclerosis in intracranial vessel segments was found as frequently in women as in men (71% versus 72%, adjusted prevalence ratio 0.95; 95% CI 0.89–1.01). In addition, intracranial calcification volume did not differ between women and men in both intracranial internal carotid (large burden 35% versus 33%, adjusted prevalence ratio 0.93; 95% CI 0.73–1.19) and vertebrobasilar arteries (large burden 26% versus 40%, adjusted prevalence ratio 0.69; 95% CI 0.41–1.12). Extracranial atherosclerosis was less common in women than in men (74% versus 81%, adjusted prevalence ratio 0.86; 95% CI 0.81–0.92). Conclusions In patients with acute ischemic stroke the prevalence of intracranial atherosclerosis does not differ between women and men, while extracranial atherosclerosis is less often present in women compared with men.
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Affiliation(s)
- S Voigt
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Hja van Os
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Maa van Walderveen
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - I C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L J Kappelle
- Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - A Broersen
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Kockelkoren
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - N D Kruyt
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - A Algra
- Department of Neurology and Neurosurgery, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mjh Wermer
- Department of Neurology, 4501Leiden University Medical Center, Leiden, the Netherlands
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Hongo H, Miyawaki S, Imai H, Shimizu M, Yagi S, Mitsui J, Ishiura H, Yoshimura J, Doi K, Qu W, Teranishi Y, Okano A, Ono H, Nakatomi H, Shimizu T, Morishita S, Tsuji S, Saito N. Comprehensive investigation of RNF213 nonsynonymous variants associated with intracranial artery stenosis. Sci Rep 2020; 10:11942. [PMID: 32686731 PMCID: PMC7371676 DOI: 10.1038/s41598-020-68888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
Intracranial artery stenosis (ICAS) is the most common cause of ischemic stroke worldwide. RNF213 single nucleotide variant c.14429G > A (p.Arg4810Lys, rs112735431) was recently reported to be associated with ICAS in East Asians. However, the disease susceptibility of other RNF213 variants has not been clarified. This study comprehensively investigated ICAS-associated RNF213 variants in a pool of 168 Japanese ICAS patients and 1,194 control subjects. We found 138 nonsynonymous germline variants by target resequencing of all coding exons in RNF213. Association study between ICAS patients and control subjects revealed that only p.Arg4810Lys had significant association with ICAS (P = 1.5 × 10-28, odds ratio = 29.3, 95% confidence interval 15.31-56.2 [dominant model]). Fourteen of 138 variants were rare variants detected in ICAS patients not harboring p.Arg4810Lys variant. Two of these rare variants (p.Cys118Arg and p.Leu2356Phe) consistent with variants previously reported in moyamoya disease patients characterized by stenosis of intracranial artery and association with RNF213, and three rare variants (p.Ser193Gly, p.Val1817Leu, and p.Asp3329Tyr) were found neither in control subjects and Single Nucleotide Polymorphism Database. The present findings may improve our understanding of the genetic background of intracranial artery stenosis.
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Affiliation(s)
- Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hideaki Imai
- Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | | | - Shinichi Yagi
- Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan
| | - Jun Mitsui
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Yoshimura
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan
| | - Koichiro Doi
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan.,School of Bioscience and Biotechnology, Tokyo University of Technology, Tokyo, Japan
| | - Wei Qu
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsushi Okano
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Shinichi Morishita
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan
| | - Shoji Tsuji
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,International University of Health and Welfare, Narita, Chiba, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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13
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Ibrahim AY, Amirabadi A, Shroff MM, Dlamini N, Dirks P, Muthusami P. Fractional Flow on TOF-MRA as a Measure of Stroke Risk in Children with Intracranial Arterial Stenosis. AJNR Am J Neuroradiol 2020; 41:535-541. [PMID: 32115418 DOI: 10.3174/ajnr.a6441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/04/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Conventional angiography is the criterion standard for measuring intracranial arterial stenosis. We evaluated signal intensity ratios from TOF-MRA as a measure of intracranial stenosis and infarct risk in pediatric stroke. MATERIALS AND METHODS A retrospective study was undertaken in children with intracranial arterial stenosis, who had TOF-MRA and conventional angiography performed within 6 months. Arterial diameters were measured for percentage stenosis. ROI analysis on TOF-MRA measured signal intensity in pre- and poststenotic segments, with post-/pre-signal intensity ratios calculated. The Pearson correlation was used to compare percentage stenosis on MRA with conventional angiography and signal intensity ratios with percentage stenosis; the point-biserial correlation was used for infarcts compared with percentage stenosis and signal intensity ratios. Sensitivity, specificity, and positive and negative predictive values were calculated for determining severe (≥70%) stenosis from MRA and signal intensity ratios against the criterion standard conventional angiography. P < .05 was considered statistically significant. RESULTS Seventy stenotic segments were found in 48 studies in 41 children (median age, 11.0 years; range, 5 months to 17.0 years; male/female ratio, 22:19): 20/41 (48.8%) bilateral, 11/41 (26.8%) right, and 10/41 (24.4%) left, with the most common site being the proximal middle cerebral artery (22/70, 31%). Moyamoya disease accounted for 27/41 (65.9%). Signal intensity ratios and conventional angiography stenosis showed a moderate negative correlation (R = -0.54, P < .001). Receiver operating characteristic statistics showed an area under the curve of 0.86 for using post-/pre-signal intensity ratios to determine severe (≥70%) carotid stenosis, yielding a threshold of 1.00. Sensitivity, specificity, and positive and negative predictive values for severe stenosis were the following-MRA: 42.8%, 58.8%, 30.0%, and 71.4%; signal intensity ratio >1.00: 97.1%, 77.8%, 71.7%, and 97.4%; combination: 75.5%, 100%, 100%, and 76.8%, respectively. Signal intensity ratios decreased with increasing grade of stenosis (none/mild-moderate/severe/complete, P < .001) and were less when associated with infarcts (0.81 ± 0.52 for arteries associated with downstream infarcts versus 1.31 ± 0.55 for arteries without associated infarcts, P < .001). CONCLUSIONS Signal intensity ratios from TOF-MRA can serve as a noninvasive measure of intracranial arterial stenosis and allow identification of high-risk lesions in pediatric stroke.
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Affiliation(s)
- A Y Ibrahim
- From the Department of Diagnostic Imaging (A.Y.I., A.A., M.M.S., P.M.)
- Department of Clinical Sciences (A.Y.I.), Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - A Amirabadi
- From the Department of Diagnostic Imaging (A.Y.I., A.A., M.M.S., P.M.)
| | - M M Shroff
- From the Department of Diagnostic Imaging (A.Y.I., A.A., M.M.S., P.M.)
| | | | - P Dirks
- Division of Neurosurgery (P.D.), Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - P Muthusami
- From the Department of Diagnostic Imaging (A.Y.I., A.A., M.M.S., P.M.)
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14
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Li M, Huang Y, Lin H, Chen Y. Association of uric acid with stenosis of intracranial and extracranial arteries in elderly patients with cerebral infarction. Neurol Sci 2019; 40:957-961. [PMID: 30747359 DOI: 10.1007/s10072-019-03737-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/23/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND To determine whether uric acid (UA) and intracranial and extracranial atherosclerosis stenosis of elderly patients suffering from ischaemic stroke are inter-related. METHODS Elderly patients with ischaemic stroke underwent computed tomography angiography (CTA) were enrolled between October 2015 and December 2017. We collected clinical assessment, image data, and laboratory tests, and divided patients into four groups: (1) intracranial stenosis atherosclerosis (ICAS) group, (2) combined intracranial and extracranial atherosclerosis stenosis (COAS) group, (3) extracranial carotid stenosis atherosclerosis (ECAS) group, and (4) non-cerebral stenosis atherosclerosis (NCAS) group. We used univariate and multiple logistic regression analyses to explore potential predictors. RESULTS We included 408 patients in this study, then divided them into elder group (n = 196) and young- and middle-aged group (n = 212). In old stroke patients, 72 cases (36.73%) were classified as the ICAS group, 45 cases (22.96%) as the COAS group, 21 cases (10.71%) as the ECAS group, and 58 cases (29.59%) as the NCAS group. The level of UA was comparatively higher (p = 0.033) in ICAS than in NCAS. Compared with the group which had only one stenosis artery, UA was substantially increased in patients with more than one stenosis intracranial artery (p < 0.001). With a multivariable analysis, UA was an independent predictor for intracranial stenosis of elderly patients (OR = 1.003, p = 0.042), but the relationship between extracranial artery stenosis and uric acid was negative. CONCLUSIONS Hyperuricaemia is a risk factor of intracranial artery stenosis rather than of ECAS in elderly patients with cerebral infarction.
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Affiliation(s)
- Mimi Li
- Department of Neurology, Second Affiliated Hospital of Fujian Medical University, Zhongshan North Road 34, Quanzhou, 362000, Fujan, China.
| | - Yinhui Huang
- Department of Neurology, Jinjiang Municipal Hospital, Jinjiang, 362200, Fujian, China
| | - Huasong Lin
- Department of Neurology, Second Affiliated Hospital of Fujian Medical University, Zhongshan North Road 34, Quanzhou, 362000, Fujan, China
| | - Yafang Chen
- Department of Neurology, Second Affiliated Hospital of Fujian Medical University, Zhongshan North Road 34, Quanzhou, 362000, Fujan, China
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15
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Intracranial atherosclerotic disease. Neurobiol Dis 2018; 124:118-132. [PMID: 30439443 DOI: 10.1016/j.nbd.2018.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is a progressive pathological process that causes progressive stenosis and cerebral hypoperfusion and is a major cause of stroke occurrence and recurrence around the world. Multiple factors contribute to the development of ICAS. Angiography imaging techniques can improve the diagnosis of and the selection of appropriate treatment regimens for ICAS. Neither aggressive medication nor endovascular interventions can eradicate stroke recurrence in patients with ICAS. Non-pharmacological therapies such as remote ischemic conditioning and hypothermia are emerging. Comprehensive therapy with medication in combination with endovascular intervention and/or non-pharmacological treatment may be a potential strategy for ICAS treatment in the future. We summarized the epidemiology, pathophysiological mechanisms, risk factors, biomarkers, imaging and management of ICAS.
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16
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Luo J, Wang T, Gao P, Krings T, Jiao L. Endovascular Treatment of Intracranial Atherosclerotic Stenosis: Current Debates and Future Prospects. Front Neurol 2018; 9:666. [PMID: 30186219 PMCID: PMC6110852 DOI: 10.3389/fneur.2018.00666] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Intracranial atherosclerotic stenosis (ICAS) is a common cause of transient ischemic attack (TIA) and ischemic stroke. Endovascular treatment, including balloon angioplasty alone, balloon-mounted stents, and self-expandable stent placement with or without prior angioplasty, is an alternative to medical treatment for the prevention of recurrent TIA or ischemic stroke in patients with ICAS. Although the SAMMPRIS and VISSIT trials supported medical management alone against endovascular treatments, both randomized controlled trials (RCT) were criticized due to flaws relating to patient-, intervention-, and operator-related factors. In this review, we discuss the current debate regarding these aspects and suggest approaches to solve current controversies in the future. In our opinion, endovascular treatment in carefully selected patients, individualized choice of endovascular treatment subtypes, and an experienced multidisciplinary team managing the patient in the pre-, peri- and post-procedural period have the potential to provide safe and efficious treatment of patients with symptomatic ICAS.
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Affiliation(s)
- Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Timo Krings
- UHN Joint Department of Medical Imaging Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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17
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Wang T, Wang X, Yang K, Zhang J, Luo J, Gao P, Ma Y, Jiao L, Ling F. Endovascular treatment for symptomatic intracranial artery stenosis: protocol for a systematic review and network meta-analysis. BMJ Open 2018; 8:e022359. [PMID: 29991634 PMCID: PMC6089297 DOI: 10.1136/bmjopen-2018-022359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/27/2018] [Accepted: 06/06/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Atherosclerotic intracranial artery stenosis (ICAS) is one of most common causes of stroke, which is the second-leading cause of death worldwide. Medical, surgical and endovascular therapy are three major treatments for ICAS. Currently, medical therapy is considered as the standard of care for most patients with ICAS, while extracranial to intracranial bypass is only used in rare situations. Balloon angioplasty alone, balloon-mounted stent and self-expanding stent, collectively called endovascular treatment, have shown promising potentials in treating specific subgroups of patients with symptomatic ICAS; however, their comparative safety and efficacy is still unclear. Therefore, a systematic review with network meta-analysis is needed to establish a hierarchy of these endovascular treatments. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was followed to establish this protocol. The search will be limited to studies published from 1 January 2000 to the formal search date. Major databases including Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, conference proceedings and grey literature database will be searched for clinical studies comparing at least two interventions for patients with symptomatic ICAS. Primary outcomes include short-term and long-term mortality or stroke rate. Random effects pairwise and network meta-analyses of included studies will be performed on STATA (V.14, StataCorp, 2015). The surface under the cumulative ranking curve and mean rank will be calculated in order to establish a hierarchy of the endovascular treatments. Evaluation of the risk of bias, heterogeneity, consistency, transitivity and quality of evidence will follow the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. ETHICS AND DISSEMINATION Ethics approval is not needed as systematic review is based on published studies. Study findings will be presented at international conferences and published on a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018084055; Pre-results.
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Affiliation(s)
- Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, UK
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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18
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Shi L, Yu J, Zhao Y, Xu K, Yu J. Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136 cases. Exp Ther Med 2018; 15:1647-1653. [PMID: 29434749 DOI: 10.3892/etm.2017.5525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/13/2017] [Indexed: 01/18/2023] Open
Abstract
It is widely acknowledged that arteriosclerosis and calcification of the parent artery and aneurysm neck make it difficult to clip posterior communicating artery (PCoA) aneurysms. A total of 136 cases of PCoA aneurysms accompanied by arteriosclerosis and calcification were collected and treated with clipping in the present study. Of the 136 patients, 112 were females (82.4%) and 24 were males (17.6%), with ages ranging from 37 to 76 years (mean age, 60.2 years). Rupture of a PCoA aneurysm was identified in 132 cases (97.1%), and there were 4 cases of unruptured PCoA aneurysms (2.9%). According to the severity of arteriosclerosis and calcification, the aneurysms were divided into type I, II or III. The treatment of type I aneurysms achieved the best curative effect. It is difficult to temporarily occlude type II and III aneurysms during surgery, and temporary occlusion failed in almost 50% of cases. Types II and III were prone to intraoperative aneurysm ruptures. A significantly higher rate of intraoperative aneurysm rupture was seen in type III compared with type II cases. Type II and III cases were more likely to be treated using a fenestrated clip for aneurysm clipping compared with type I cases, and fenestrated clips were used significantly more frequently in type III cases compared with type II cases. Arteriosclerosis and calcification were likely to affect the prognosis of patients, particularly in cases with type III arteriosclerosis and calcification of the parent artery and aneurysm neck. Therefore, the stratification of the arteriosclerosis and calcification of the parent artery and aneurysm neck into types I-III can guide the intraoperative aneurysm clipping strategy, aid in choosing the correct clips, and inform predictions of the occurrence of rupture and hemorrhage, as well as the prognosis for aneurysms.
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Affiliation(s)
- Lei Shi
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Yu
- Department of Operation, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ying Zhao
- Department of Training, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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19
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Rozell JM, Mtui E, Pan YN, Li S. Infectious and inflammatory diseases of the central nervous system-the spectrum of imaging findings and differential diagnosis. Emerg Radiol 2017; 24:619-633. [PMID: 28831608 DOI: 10.1007/s10140-017-1543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 12/30/2022]
Abstract
The infectious and inflammatory diseases of the central nervous system (CNS) including the brain and spine can present with a wide spectrum of clinical symptoms, locations, and appearance. The purpose of this exhibit is to review the different patterns of their presentations, to illustrate their imaging characteristics and techniques, and to discuss their clinical features and pathology so that the correct diagnosis can be made and prompt intervention can be initiated on a timely fashion.
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Affiliation(s)
- Joseph M Rozell
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Edward Mtui
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Yu-Ning Pan
- Department of Radiology, Ningbo First Hospital, Zhejiang University, 59 Liuting Road, Haishu District, Ningbo, 315010, Zhejiang, China
| | - Shan Li
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA.
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20
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Jiang Y, Peng W, Tian B, Zhu C, Chen L, Wang X, Liu Q, Wang Y, Xiang Z, Degnan AJ, Teng Z, Saloner D, Lu J. Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI. AJNR Am J Neuroradiol 2017; 38:1716-1722. [PMID: 28684455 DOI: 10.3174/ajnr.a5266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/23/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE High-resolution 3T MR imaging can visualize intracranial atherosclerotic plaque. However, histologic validation is still lacking. This study aimed to evaluate the ability of 3T MR imaging to identify and quantitatively assess intracranial atherosclerotic plaque components ex vivo with histologic validation. MATERIALS AND METHODS Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR imaging with T1, T2, and proton-density-weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. Fibrous cap thickness and maximum wall thickness were also quantified. The percentage of areas of the main plaque components, the ratio of fibrous cap thickness to maximum wall thickness, and plaque burden were calculated and compared. RESULTS The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences (P < .01) and was comparable on T1-weighted sequences (P = 1.00). Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Plaque component mean percentages were comparable between MR imaging and histology: fibrous component (81.86% ± 10.59% versus 81.87% ± 11.59%, P = .999), lipid core (19.51% ± 10.76% versus 19.86% ± 11.56%, P = .863), and fibrous cap (31.10% ± 11.28% versus 30.83% ± 8.51%, P = .463). However, MR imaging overestimated mean calcification (9.68% ± 5.21% versus 8.83% ± 5.67%, P = .030) and plaque burden (65.18% ± 9.01% versus 52.71% ± 14.58%, P < .001). CONCLUSIONS Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.
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Affiliation(s)
- Y Jiang
- From the Department of Radiology (Y.J.), Wuhan General Hospital of the People's Liberation Army, Wuhan, China.,Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - W Peng
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - B Tian
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - L Chen
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - X Wang
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Q Liu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Y Wang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - Z Xiang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Z Teng
- Department of Radiology (Z.T.), University of Cambridge, Cambridge, UK
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
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21
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van den Wijngaard IR, Holswilder G, van Walderveen MAA, Algra A, Wermer MJH, Zaidat OO, Boiten J. Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 2016; 6:e00536. [PMID: 27843693 PMCID: PMC5102638 DOI: 10.1002/brb3.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is a common cause of stroke worldwide. It results in ischemic stroke due to different mechanisms including artery-to-artery embolism, in situ thrombo-occlusion, occlusion of perforating arteries, and hemodynamic failure. In this review, we present an overview of current treatment and imaging modalities in intracranial atherosclerotic stenosis. METHODS PubMed was searched for relevant articles in English that evaluated the treatment and imaging of intracranial atherosclerotic stenosis (ICAS). RESULTS Aggressive medical management, consisting of dual antiplatelet therapy and intensive risk factor management, is important in patients with ICAS because of a substantial risk of recurrent stroke, approximately 20% in the first year, in patients on aspirin or warfarin alone. Recent trials have suggested that, aggressive medical therapy results in better outcome as compared with intracranial stenting. However, the question remains what the optimal treatment strategy would be in patients with recurrent strokes in the setting of failed aggressive medical therapy. Moreover, controversy exists whether a subgroup of patients with symptomatic ICAS could benefit from intracranial stenting if selection is based on radiological evidence of hemodynamic failure. With regard to imaging, transcranial Doppler ultrasound and magnetic resonance angiography are useful screening tests for exclusion of ICAS, but need confirmation by other imaging modalities when stenosis is suggested. Computed tomography angiography has a high positive and negative predictive value for detection of intracranial luminal stenosis of 50% or higher, but performs worse than digital subtraction angiography with regard to establishing the exact degree of luminal stenosis. Novel imaging techniques including high-resolution CT and MRI better identify plaque characteristics than conventional imaging methods. CONCLUSIONS Currently, aggressive medical management remains the standard of care for patients with ICAS. Further research is needed to identify high-risk subgroups and to develop more effective treatments for ICAS patients.
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Affiliation(s)
- Ido R. van den Wijngaard
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
| | | | | | - Ale Algra
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Osama O. Zaidat
- Department of NeurologyMedical College of Wisconsin/Froedtert HospitalMilwaukeeWIUSA
| | - Jelis Boiten
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
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