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Sui Y, Sun J, Chen Y, Wang W. Multimodal MRI study of the relationship between plaque characteristics and hypoperfusion in patients with transient ischemic attack. Front Neurol 2023; 14:1242923. [PMID: 37840913 PMCID: PMC10568067 DOI: 10.3389/fneur.2023.1242923] [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: 06/20/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Transient ischemic attack is a significant risk factor for acute cerebral infarction. Previous studies have demonstrated that hypoperfusion in patients with transient ischemic attack was associated with the recurrence of transient ischemic attack, stroke, and persistent worsening of neurological symptoms. Moreover, transient ischemic attack patients classified as high-risk group according to the ABCD2 score have a higher incidence of stroke. Therefore, the objective of this study was to investigate the plaque characteristics of transient ischemic attack patients with concomitant cerebral hypoperfusion using multimodal MRI, as well as hemodynamic changes in the high-risk group with transient ischemic attack patients. Materials and methods A total of 151 patients with transient ischemic attack were prospectively recruited for this study. All enrolled patients underwent multimodal MRI, including DWI, TOF-MRA, HR-VWI, and DSC-PWI. Finally, 56 patients met the inclusion criteria. Based on DSC-PWI images, patients were divided into two groups: hypoperfusion (n = 41) and non-hypoperfusion (n = 15). Clinical baseline characteristics and plaque characteristics were analyzed between the two groups. Furthermore, within the hypoperfusion group, patients were further classified into low-risk (n = 11) and high-risk (n = 30) subgroups based on the ABCD2 score. Hemodynamic differences between these subgroups were also analyzed. Results Compared with the non-hypoperfusion group, the hypoperfusion group had a significantly higher prevalence of hypertension (68.3% vs. 33.3%, p = 0.019) and hyperhomocysteinemia (65.9% vs. 33.3%, p = 0.029). Moreover, the hypoperfusion group exhibited more significant luminal stenosis degree [41.79 ± 31.36 vs. 17.62± 13.62, p = 0.006] and greater NWI (57.1%± 20.47% vs. 40.21%± 21.56%, p = 0.009) compared to the non-hypoperfusion group. In addition, the high-risk group identified by the ABCD2 score had a higher rMTT [117.6(109.31-128.14) vs. 108.36(100.67-119.92), p = 0.037]. Conclusion Transient ischemic attack patients with hypoperfusion exhibited a higher prevalence of hypertension and hyperhomocysteinemia, as well as higher luminal stenosis degree, and greater NWI. Furthermore, Transient ischemic attack patients in the high-risk group demonstrated higher MTT.
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Affiliation(s)
| | | | | | - Wei Wang
- Department of MRI, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Qin H, Du H, Wang H, Li S. Analysis on application effect and prognostic factors of medical care combined with nursing in the elderly with T2DM and Cerebral Infarction based on targeted management mode. Biotechnol Genet Eng Rev 2023:1-12. [PMID: 37171373 DOI: 10.1080/02648725.2023.2207935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
To explore the analysis on application effect and prognostic factors of medical care combined with nursing in the elderly with type 2 diabetes mellitus (T2DM) and cerebral infraction (CI) based on targeted management mode. The clinical data of 180 elderly patients with T2DM and CI in our hospital from August 2017 to August 2019 were selected for retrospective analysis. Their cognitive function and daily living ability before and after intervention were evaluated, using the National Institutes of Health Stroke Scale (NIHSS) to evaluate their prognosis. They were divided into good prognosis group (n = 134) and poor prognosis group (n = 46) according to the score. Binary Logistic regression analysis was adopted to analyze the prognostic factors of such patients. After intervention, patients had visibly lower indexes of blood glucose fluctuation and lower average scores of ADL and MMSE (P < 0.001), with differences in body mass index, systolic pressure, diastolic pressure, fasting blood glucose and triglyceride in both groups (P < 0.001). Binary Logistic regression analysis showed that systolic pressure, diastolic pressure and triglyceride were risk factors affecting patients' prognosis (P < 0.05). Medical care combined with nursing based on targeted management mode has a remarkable control effect on blood glucose, and has a positive effect on improving cognitive function and living ability of elderly patients with T2DM and CI. In addition, attention should be paid to monitoring systolic and diastolic blood pressures, and triglyceride in patients to improve the prognosis.
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Affiliation(s)
- Hongyan Qin
- Medical Records Room, Jinan Authority Hospital, Jinan, Shandong, China
| | - Haiyan Du
- Community Health Service Center, Qingdao, Shandong, China
| | - Haizhen Wang
- Cadre Ward Section 1, The 960th Hospital of the People's Liberation Army, Jinan, Shandong, China
| | - Shan Li
- Health Section II, Weifang People's Hospital, Weifang, Shandong, China
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Lin J, Jiang M, Liu J, Yao L. The efficacy of transitional care services in patients with transient ischemic attack: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e30872. [PMID: 36181073 PMCID: PMC9524928 DOI: 10.1097/md.0000000000030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Transient ischemic attack (TIA) carries a particularly high short-term risk of stroke, which is associated with brain dysfunction caused by a regional reduction in blood flow. Transitional care services present benefits in improving ischemic neurological function and decreasing the recurrence in patients with TIA. The purpose of this study was to investigate the effects of transitional care on clinical outcomes in patients hospitalized for TIA. We retrospectively collected data about 1288 patients with TIA from May 2017 to June 2019. Patients were divided into mild (n = 438), moderate (n = 420) and severe group (n = 430) accessed by age, blood pressure, type of TIA, and duration (ABCD2) score. Participants were patients hospitalized due to TIA, assigned to transitional care (n = 643) or usual care (n = 645), and followed up for 24 months. Physical function of patients was evaluated using the 6-minute walk test. We evaluated patient reach, implementation using hospital quality measures, hospital-level sustainability physical function, ischemic neurological score, composite quality indicator score, and recurrence of TIA between transitional care or usual care group. TIA patients in transitional care group had better physical function and quality indicator score, lower ischemic neurological score and recurrence of TIA, and shorter hospital stay than patients in usual care group. Results demonstrated that transitional care significantly improved the patients' satisfaction compared to usual care. Patients in mild, moderate, and severe group presented more benefits than usual care clinical outcomes in patients hospitalized for TIA. Transitional care is associated with better functional status for patients with TIA.
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Affiliation(s)
- Jing Lin
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Meiling Jiang
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Jinmiao Liu
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
| | - Lan Yao
- Second Department of Neurology, Department of Oncology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang 157001, China
- *Correspondence: Lan Yao, No. 5, Tongxiang Road, Aimin District, Mudanjiang City, Heilongjiang Province 157001, China (e-mail )
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Liu S, Tang R, Xie W, Chai S, Zhang Q, Luo Y, Guo Y, Chai C, Huang L, Zheng M, Zhu J, Chang B, Yang Q, Jin S, Fan Z, Xia S. Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack. Eur Radiol 2020; 31:2062-2072. [PMID: 32997174 DOI: 10.1007/s00330-020-07327-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to investigate differential characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), and to develop a predictive model for the presence of ischemic stroke and neurological impairment. METHODS Sixty-seven patients with acute ischemic events in MCA territory who underwent high-resolution vessel wall imaging between September 2016 and August 2018 were reviewed retrospectively. Patients were assigned to either the stroke group or TIA group, according to diffusion-weighted imaging and neurological examination. Plaque characteristics and anterograde score (AnS) were calculated. Tmax > 6.0-s volume was acquired by RApid Processing of perfusIon and Diffusion software. Multivariate logistic regression analysis and multiple linear regression analysis were performed to establish a predictive model for irreversible infarction occurrence and clinical severity. RESULTS Forty-five patients were assigned to the stroke group, and 22 were assigned to the TIA group. Plaque length, intraplaque hemorrhage (IPH), enhancement, AnS, and Tmax > 6.0-s volumes were significantly different between the two groups (p < 0.05). IPH and AnS were independent predictors for patients with stroke (p = 0.020 and 0.034, respectively). Tmax > 6.0-s volume, IPH, hypertension, and AnS were associated with high National Institutes of Health Stroke Scale (NIHSS) scores (all p < 0.05, R = 0.725, and adjusted R2 = 0.494). CONCLUSIONS IPH and AnS are useful in predicting stroke occurrence. Tmax > 6.0-s volume, IPH, hypertension, and AnS are associated with neurological impairment of the patients. KEY POINTS • Ischemic stroke and TIA patients have different plaque characteristics and hemodynamics. • Intraplaque hemorrhage and anterograde score have high diagnostic efficiency for ischemic stroke. • The combination of Tmax > 6.0-s volume, intraplaque hemorrhage, hypertension, and anterograde score can predict the National Institutes of Health Stroke Scale scores of patients.
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Affiliation(s)
- Song Liu
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Ruowei Tang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Weiwei Xie
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Shengting Chai
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Qingqing Zhang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200081, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Chao Chai
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Meizhu Zheng
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, 100102, China
| | - Binge Chang
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Qi Yang
- Department of Radiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Song Jin
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300192, China.
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Liu L, Huo C, Sun H, Yang H, Zhang R, Wang L, Xia Z. Vascular Morphology has No Direct Relationship with Atherosclerotic Plaque Burden in Patients with Symptomatic Middle Cerebral Artery Stenosis. Curr Neurovasc Res 2019; 16:224-231. [PMID: 31258086 DOI: 10.2174/1567202616666190618122746] [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: 04/27/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The vascular morphology and the characteristics of atherosclerotic plaques in the middle cerebral artery (MCA) have not been fully studied with high-resolution magnetic resonance imaging (HR-MRI). OBJECTIVE HR-MRI was applied to investigate vascular morphology and atherosclerotic plaque in patients with symptomatic MCA stenosis. MATERIALS AND METHODS A total of 343 patients with symptomatic MCA stenosis were enrolled in this study. All the patients were examined by HR-MRI to analyze the morphology of MCA and the M1 segment (MCA-M1), the characteristics and the location of the plaques. RESULTS The proportion of L-shaped MCA-M1 decreased, while the proportion of S-shaped MCAM1 increased with age. The anterior plaques were the most common in all the patients. The superior plaques were relatively common in patients with L-shaped and U-shaped MCA-M1, while the inferior plaques were relatively common in patients with inverted U-shaped and S-shaped MCAM1. Among all the plaques, the majority were isointense or heterogeneous. The MCA-M1 morphology had no direct relationship with the common risk factors of atherosclerosis and the clinical outcomes of the patients after 12 months of follow up. CONCLUSION The morphology of MCA-M1 is not directly related to the plaque burden or the degree of stenosis in patients with symptomatic MCA stenosis. The morphology of MCA-M1 is not associated with the risk factors of atherosclerosis, or the clinical outcomes of the patients.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Chengju Huo
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Hao Sun
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Hua Yang
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Rui Zhang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Lexin Wang
- Department of Cardiology, Liaocheng People's Hospital, Liaocheng, Shandong, 252000, China.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Zhangyong Xia
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
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