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Dimas GG, Zilakaki M, Giannopoulos A, Daios S, Kakaletsis N, Kaiafa G, Didangelos T, Savopoulos C, Ktenidis K, Tegos T. Assessment of Atherosclerosis in Ischemic Stroke by means of Ultrasound of Extracranial/Intracranial Circulation and Serum, Urine, and Tissue Biomarkers. Curr Med Chem 2023; 30:1107-1121. [PMID: 35980067 DOI: 10.2174/0929867329666220817123442] [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: 12/30/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
It is a common practice to take into consideration age, diabetes, smoking, treated and untreated systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol for the prediction of atherosclerosis and stroke. There are, however, ultrasound markers in use for the assessment of atherosclerosis and the evaluation of stroke risk. Two areas of investigation are of interest: the carotid artery and the intracranial arterial circulation. Again, within the domain of the carotid artery, two ultrasonic markers have attracted our attention: intima media thickness of the carotid artery and the presence of carotid plaque with its various focal characteristics. In the domain of intracranial circulation, the presence of arterial stenosis and the recruitment of collaterals are considered significant ultrasonic markers for the above-mentioned purpose. On the other hand, a series of serum, urine, and tissue biomarkers are found to be related to atherosclerotic disease. Future studies might address the issue of whether the addition of proven ultrasonic carotid indices to the aforementioned serum, urine, and tissue biomarkers could provide the vascular specialist with a better assessment of the atherosclerotic load and solidify their position as surrogate markers for the evaluation of atherosclerosis and stroke risk.
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Affiliation(s)
- Grigorios G Dimas
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Maria Zilakaki
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| | - Argyrios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki ,Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Kyriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Thomas Tegos
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
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Hernández Vara J, del Fueyo MR, Lorenzo Bosquet C, Castell Conesa J, Molina Cateriano CA, Miquel Rodríguez F. Utilidad de la sonografía del parénquima cerebral en la enfermedad de Parkinson: Estudio comparativo con 123I-FP-CIT SPECT. Med Clin (Barc) 2008. [DOI: 10.1016/s0025-7753(08)72259-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bartels E. The axial imaging plane--the main domain of the transcranial color-coded duplex ultrasonography? EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2002; 16:47-57. [PMID: 12470850 DOI: 10.1016/s0929-8266(02)00067-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transcranial color-coded duplex ultrasonography (TCCS) makes possible the visualization of basal cerebral arteries through color-coding the flow velocity information. This method is well established in the clinical routine for the diagnostics of pathological processes in cerebrovascular disease. The present review describes the examination technique, normal and pathological findings, such as stenosis and occlusion of intracranial arteries, as well as intracranial vascular malformations focussing on the advantages of the examination in the axial imaging planes.
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Affiliation(s)
- Eva Bartels
- Department of Clinical Neurophysiology, University Hospital, Georg-August University of Göttingen, Robert-Koch-Straase 40, D-37075, Göttingen, Germany.
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Schlachetzki F, Hoelscher T, Dorenbeck U, Greiffenberg B, Marienhagen J, Ullrich OW, Bogdahn U. Sonographic parenchymal and brain perfusion imaging: preliminary results in four patients following decompressive surgery for malignant middle cerebral artery infarct. ULTRASOUND IN MEDICINE & BIOLOGY 2001; 27:21-31. [PMID: 11295267 DOI: 10.1016/s0301-5629(00)00309-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To investigate new methods of diagnostic transcranial sonography for brain parenchymal, vascular and perfusion imaging, we performed 3-D native tissue harmonic transcranial sonography (3D-nthTCS), 3-D transcranial color-coded duplex sonography (3D-TCCS), and "loss-of-correlation" imaging (LOC-TCCS) in four patients following early hemicraniectomy due to space-occupying "malignant" middle cerebral artery infarction (MMCAI). Three-dimensional datasets, utilizing 3D-nthTCS and 3D-TCCS, were created and up to 10 axial 2-D B-mode image planes, similar to CCT, reconstructed in each patient. Three-dimensional reconstructions of the circle of Willis documented one persistent carotid-T occlusion and three recanalizations of the MCA. LOC-TCCS, based on stimulated acoustic emission from an ultrasound (US) contrast agent, demonstrated a perfusion deficit in 2 of 3 patients, with regard to their infarcts. Concluding, 3D-nthTCS, 3D-TCCS and LOC-TCCS are promising tools for bedside monitoring, early prognosis and treatment evaluation for MMCAI in the postoperative period. Further studies should be performed to standardize these new methods and evaluate their applications through the intact calvarina.
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Affiliation(s)
- F Schlachetzki
- Department of Neurology, University of Regensburg, Regensburg, Germany.
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Ringelstein EB. Echo-enhanced ultrasound for diagnosis and management in stroke patients. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1998; 7 Suppl 3:S3-15. [PMID: 9673329 DOI: 10.1016/s0929-8266(98)00027-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Early diagnosis of stroke and recognition of preceding transient ischemic attacks (TIAs) is important for clinical outcome. Better education of the signs and symptoms of TIA and stroke and improved diagnostic procedures will help to reduce the impact of stroke. Magnetic resonance imaging (MRI), computed tomography (CT) and single photon emission computed tomography (SPECT) are used to diagnose cerebral infarctions. MRI is the most effective diagnostic modality, however, MRI equipment is expensive and not always available. CT is therefore usually used but it has limitations, in detecting small infarctions, particularly in the posterior fossa. Ultrasound is a safe and inexpensive bedside diagnostic procedure. Ultrasound is often used in patients after TIA or stroke, however, it may be inadequate due to poor insonation conditions through the skull, or because the relevant vessel lies deep within the brain. Arteries with slow flowing blood are also difficult to image. The application of ultrasound has expanded with the development of two-dimensional transcranial color-coded sonography (TCCS) which provides both anatomical and functional information about the major cerebral vessels. In addition, the use of echo-enhancing agents now provides better images of vessels within the skull and enables ultrasound examinations to be performed even in patients with a poor transtemporal window. Echo-enhanced ultrasound can also provide images of vessels deep within the brain, which were previously non-evaluable. The echo-enhancing agent Levovist(R) has been extensively studied in patients undergoing ultrasound examination to detect cerebrovascular disease. Levovist improves diagnostic confidence without compromising safety. The improvement in images obtained of the cerebral vessels, including both arteries and veins, using echo-enhanced ultrasound may make this technique the future method of choice for patients with cerebrovascular disease.
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Affiliation(s)
- E B Ringelstein
- Klinik und Poliklinik fur Neurologie, Westfalische Wilhelms-Universitat Munster, Albert-schweitzer-strasse 33, D-48129 Munster, Germany
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de Bray JM, Daugy J, Legrand MS, Pulci S. Acute middle cerebral artery stroke and transcranial Doppler sonography. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1998; 7:31-6. [PMID: 9614288 DOI: 10.1016/s0929-8266(98)00021-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Five studies (Zanette et al., Stroke 1995;26:430-3; Pulci et al., JEMU 1991;12:190-5; Kuschner et al., Neurology 1991;41:109-13; Camerlingo et al., Acta Neurol Scand 1993;88:108-11; Kenton et al., Stroke 1997;28:1601-6) have validated the diagnostic and the prognostic value of Transcranial Doppler Sonography (TDS) at the onset of middle cerebral artery (MCA) strokes, but there is no large study and the interest of these investigations is often ignored. This report insists on the TDS methodological rules. It shows its value in the detection of MCA stenoses or occlusions (mainly from cardiac origin) and underlines its usefulness in evaluating therapeutical procedures and in defining hemodynamic consequences of tight internal carotid artery stenoses.
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Affiliation(s)
- J M de Bray
- Echographic Vascular Laboratory, CHU d'Angers, F-49033 Angers, France
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