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Thiankhaw K, Ozkan H, Ambler G, Werring DJ. Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis. J Neurol 2024; 271:772-781. [PMID: 38019295 PMCID: PMC10827828 DOI: 10.1007/s00415-023-12094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke. METHODS We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%). CONCLUSIONS In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.
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Affiliation(s)
- Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Hatice Ozkan
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gareth Ambler
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.
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Fanji K, Jianfeng Y, Li L, Xiaolong Y, Jun L. Study on the relationship between vertebrobasilar dolichoectasia and posterior cranial fossa space. Heliyon 2023; 9:e18470. [PMID: 37576277 PMCID: PMC10412902 DOI: 10.1016/j.heliyon.2023.e18470] [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: 01/25/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To investigate the correlation between vertebrobasilar dolichoectasia (VBD) and posterior cranial fossa (PCF) space. Methods The medical records and imaging data of patients with VBD and control group were collected from June 2021 to June 2022 in the Third People's Hospital of Hubei Province. All patients with VBD were graded by head and neck CTA. The grading index was divided into two parts, including vertebral artery bifurcation height and offset degree. Taking the healthy adult subjects of matched age as the control group. The linear volume of posterior cranial fossa was measured by median sagittal CTA images. Middle clivus length, transverse diameter of occipital foramen, supraoccipital length, sagittal diameter of posterior cranial fossa and height diameter of posterior cranial fossa was measured. The volume of the PCF was calculated by 3Dslice software. The relationship between VBD and the volume of PCF was analyzed by SPSS23.0. Results The height diameter of posterior cranial fossa, sagittal diameter of posterior cranial fossa, transverse diameter of occipital foramen, clival length, supraoccipital length and space volume of PCF were 34.78 ± 3.67 mm, 85.49 ± 4.15 mm, 30.89 ± 3.94 mm, 44.53 ± 5.36 mm, 45.21 ± 6.45 mm, 171.08 ± 15.81 cm3 in the case group. The linear volume of PCF and space volume of PCF were significantly lower than those in the control group (P < 0.05). Binary logistic regression analysis showed that the independent risk factors of VBD were height diameter of PCF, sagittal diameter of PCF, transverse diameter of occipital foramen, clival length, supraoccipital length and space volume of posterior cranial fossa. According to the classification, the height and diameter of PCF in grade 1 was significantly smaller than that in grade 2 VBD (P < 0.05). Under the standard of BA bifurcation degree, there were significant differences between different grades of VBD patients and age (P < 0.05). Conclusion The smaller volume of PCF may leading the greater possibility of VBD. Under the classification of VBD, the older, the longer the course of disease is, the higher degree of VBD classification is.
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Affiliation(s)
- Kong Fanji
- Xianning Central Hospital, No.228 Jingui Road, Xianan District, Xianning, 437000, Hubei, China
- Medical School of Jianghan University, Wuhan, 430000, Hubei, China
| | - Ye Jianfeng
- The Third People's Hospital of Hubei Province, No. 26 Zhongshan Avenue, Qiaokou District, Wuhan, 430000, Hubei, China
| | - Lai Li
- The Third People's Hospital of Hubei Province, No. 26 Zhongshan Avenue, Qiaokou District, Wuhan, 430000, Hubei, China
- Medical School of Jianghan University, Wuhan, 430000, Hubei, China
| | - Yao Xiaolong
- The Third People's Hospital of Hubei Province, No. 26 Zhongshan Avenue, Qiaokou District, Wuhan, 430000, Hubei, China
| | - Li Jun
- The Third People's Hospital of Hubei Province, No. 26 Zhongshan Avenue, Qiaokou District, Wuhan, 430000, Hubei, China
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Fitzhugh N, Rasmussen LR, Simoni AH, Valentin JB. Misuse of multinomial logistic regression in stroke related health research: A systematic review of methodology. Eur J Neurosci 2023; 58:3116-3131. [PMID: 37442794 DOI: 10.1111/ejn.16084] [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: 10/03/2022] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023]
Abstract
Multinomial logistic regression (MLR) is often used to model the association between a nominal outcome variable and one or more covariates. The results of MLR are interpreted as relative risk ratios (RRR) and warrant a more coherent interpretation than ordinary logistic regression. Some authors compare the results of MLR to ordinal logistic regression (OLR), irrespective of the fact that these estimate different quantities. We aim to investigate the time trends in the use and misuse of MLR in studies including stroke patients, specifically the extent to which (1) the results are denoted as anything other than RRR, (2) comparisons are made of results with results of OLR and (3) results have been interpreted coherently. Secondarily, we examine the use of model validation techniques in studies with predictive aims. We searched EMBASE and PubMed for articles using MLR on populations of stroke patients. Identified studies were screened, and information pertaining to our aims was extracted. A total of 285 articles were identified through a systematic literature search, and 68 of these were included in the review. Of these, 60 articles (88%) did not denote exponentiated coefficients of MLR as relative risk ratios but rather some other measure. Additionally, 63 articles (93%) interpreted the results of MLR in a non-coherent manner. Two articles attempted to compare MLR results with those of OLR. Nine studies attempted to use MLR for predictive means, and three used relevant validation techniques. From these findings, it is clear that the interpretation of MLR is often suboptimal.
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Affiliation(s)
- Nicholas Fitzhugh
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Danish Health Technology Council (Behandlingsrådet), Aalborg, Denmark
| | - Line Ryberg Rasmussen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Amalie Helme Simoni
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
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Del Brutto VJ, Khasiyev F, Omran SS, Purohit M, Liu M, Wright C, Rundek T, Elkind MSV, Sacco RL, Gutierrez J. Association of Brain Arterial Elongation With Risk of Stroke and Death in Stroke-Free Individuals: Results From NOMAS. Arterioscler Thromb Vasc Biol 2023; 43:474-481. [PMID: 36727517 PMCID: PMC9974766 DOI: 10.1161/atvbaha.122.318819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brain arterial dilation and elongation characterize dolichoectasia, an arteriopathy associated with risk of stroke and death. We aim to determine whether brain arterial elongation increases the risk of stroke and death independent of brain arterial diameters. METHODS We analyzed 1210 stroke-free participants (mean age 71±9 years, 41% men, 65% Hispanic) with available time-of-flight magnetic resonance angiogram from the Northern Manhattan Study, a population-based cohort study across a multiethnic urban community. We obtained baseline middle cerebral artery M1-segment (MCA-M1) and basilar artery (BA) mean lengths and diameters using a semi-automated software. Cox proportional hazards models adjusted for brain arterial diameters and potential confounders yielded adjusted hazards ratios with 95% CIs for the primary outcomes of incident stroke and all-cause mortality, as well as secondary outcomes including noncardioembolic stroke, vascular death, and any vascular event. RESULTS Neither MCA-M1 nor BA lengths correlated with incident stroke or all-cause mortality. Both MCA-M1 and BA larger diameters correlated with all-cause mortality (MCA-M1 aHR, 1.52 [95% CI, 1.03-2.23], BA aHR, 1.28 [95% CI, 1.02-1.61]), as well as larger MCA-M1 diameters with vascular death (aHR, 1.84 [95% CI, 1.02-3.31]). Larger MCA-M1 and BA diameters did not correlate with incident stroke. However, larger BA diameters were associated with posterior circulation noncardioembolic stroke (aHR, 2.93 [95% CI, 1.07-8.04]). There were no statistical interactions between brain arterial lengths and diameters in relation to study outcomes. CONCLUSIONS In a multiethnic cohort of stroke-free adults, brain arterial elongation did not correlate with risk of stroke or death, nor influenced the significant association between brain arterial dilation and vascular risk.
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Affiliation(s)
- Victor J. Del Brutto
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meghan Purohit
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Minghua Liu
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Clinton Wright
- National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Osama A, Negm M, Mosallam W, Hegazy M, Elshamly S. Vertebrobasilar dolichoectasia in patients with cerebrovascular ischemic stroke: does it have a role in cerebral microbleeds? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00588-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Vertebrobasilar dolichoectasia (VBD) may account for cerebral microbleeds (CMBs) in ischemic cerebrovascular stroke.
Objectives
To examine whether VBD is associated with the involvement of CMBs in any region and, if so, whether it is associated with CMBs among ischemic stroke patients located in posterior circulation territory. For patients with VBD, we also studied ischemic stroke subtypes, and checked whether dolichoectasia was linked to vascular risk factors.
Methods
Two hundred ischemic stroke patients in whom detailed clinical data and brain MRI sequences were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed.
Results
The mean age of patients was (65.22 ± 12.88), male patients were more frequent (67.5%); dyslipidemia was the most frequent risk factor (55%). Cardio-embolic stroke subtype was the most frequent (37%) and (71.5%) of patients had no history of previous use of antithrombotic drugs. Ectasia was found in 28 (14%), dolichosis was found in 50 (25%) and vertebrobasilar dolichoectasia was found in 19 (9.5%) of patients. Cerebral microbleeds were detected in 114 (57%) patients. Mild degree CMBs was the most prevalent among patients 69 (61%) and were located predominantly in both anterior and posterior territories 41 (36%). CMBs were significantly more frequent in hypertensive and older patients.
Conclusions
In patients with VBD, severe degree CMBs were more common and were located as a vascular territory supplied by vessels originating from dolichoectatic parent vessels in the posterior region.
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Xu SY, Wang RJ, Zhang L, Li CX. Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities: A case report. Medicine (Baltimore) 2021; 100:e27022. [PMID: 34414996 PMCID: PMC8376391 DOI: 10.1097/md.0000000000027022] [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] [Received: 06/25/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment. PATIENT CONCERNS A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension. DIAGNOSES An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall. INTERVENTIONS Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug. OUTCOMES The patient had no symptoms of neurological damage during 3-month follow-up. LESSONS Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.
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Affiliation(s)
- Sui-yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruo-jun Wang
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Zhang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chang-xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
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Del Brutto VJ, Gutierrez J, Goryawala MZ, Sacco RL, Rundek T, Romano JG. Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke. Stroke 2021; 52:2311-2318. [PMID: 33980042 DOI: 10.1161/strokeaha.120.032225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Victor J Del Brutto
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose Gutierrez
- Department of Neurology, Mailman School of Public Health, Columbia University (J.G.)
| | - Mohammed Z Goryawala
- Departments of Radiology (M.Z.G.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
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Del Brutto VJ, Prabhakaran S, Liebeskind DS, Campo-Bustillo I, Cotsonis G, Nizam A, Romano JG. Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease: Results from the MYRIAD study. J Neuroimaging 2021; 31:931-939. [PMID: 33942908 DOI: 10.1111/jon.12872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. METHODS We analyzed 98 participants (mean age 63.8 ± 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. RESULTS IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. CONCLUSIONS IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | | | - Iszet Campo-Bustillo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between Internal Carotid Artery Tortuosity and Imaging of Cerebral Small Vessel Disease. Front Neurol 2020; 11:567232. [PMID: 33193005 PMCID: PMC7642469 DOI: 10.3389/fneur.2020.567232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose: An association between artery tortuosity and neuroimaging of cerebral small vessel disease (SVD) has been reported, especially in the posterior circulation. However, few studies involved the whole magnetic resonance imaging (MRI) spectrum of SVD in association with anterior circulation arterial tortuosity. This study aimed to investigate the relationship between internal carotid artery (ICA) tortuosity and the neuroimaging of SVD. Methods: Data of 1,264 consecutive patients in whom cerebral vessel diseases were suspected and who underwent both MRI and computed tomography angiography were reviewed from a prospective registry. Internal carotid artery tortuosity was evaluated using the tortuosity index (TI), which was defined as the ratio of the vessel centerline length divided by the straight length. Magnetic resonance imaging was used to assess cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. Results: The TIs of the ICA for patients with and without SVD MRI markers were 1.81 ± 0.42 and 1.72 ± 0.33, respectively (P < 0.001). Univariate analysis showed that the ICA TI were positively correlated with each SVD MRI marker (P < 0.001), and the correlation coefficients (rs) were 0.57, 0.42, 0.30, and 0.26 for EPVSs, WMHs, CMBs, and lacunes, respectively. The adjusted ORs of the ICA TI were 1.52 (95% CI 1.44–1.60, P < 0.001) for EPVS grade 1, 2.05 (95% CI 1.93–2.18, P < 0.001) for EPVS grades 2–4, and 1.09 (95% CI 1.03–1.15, P = 0.004) for WMH grade 3. Conclusions: The TI of ICA was higher in patients with neuroimaging of SVD. Internal carotid arteries tortuosity was associated with MRI-defined markers of SVD, including EPVS and high-grade WMH, and positively correlated with EPVS severity. Arterial tortuosity might be a risk factor for SVD. This finding may have potential clinical significance for identifying patients with suspected SVD.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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10
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Chen Z, Li H, Wu M, Chang C, Fan X, Liu X, Xu G. Caliber of Intracranial Arteries as a Marker for Cerebral Small Vessel Disease. Front Neurol 2020; 11:558858. [PMID: 33071944 PMCID: PMC7542665 DOI: 10.3389/fneur.2020.558858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The dilation of intracranial large arteries caliber, may transfer more hemodynamic burden to the downstream brain capillaries, which, in the long run, results in cerebral small vessel disease (CSVD). This study aimed to investigate the relationship between intracranial artery calibers and small vessel disease. Methods: Patients with first-ever ischemic stroke of lacunar infarction subtype were enrolled via Nanjing Stroke Registry Program. An intracranial arterial Z-score, named the brain arterial remodeling (BAR) score, was calculated by averaging the calibers of the seven main intracranial arteries. Among the enrolled patients, those with a BAR score < −1 SD were deemed to have small intracranial artery calibers; those with a BAR score >1 SD were deemed to have large intracranial artery calibers and those with a between BAR score were deemed to have normal intracranial artery calibers. Imaging markers of CSVD, including lacuna, white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS) and cerebral microbleeds (CMBs) were rated and then summed to obtain a total CSVD score. Results: A total of 312 patients were involved in this study, patients with BAR score >1 SD were older (P = 0.039), and more prone to having a history of myocardial infarction (P = 0.033). The Spearman's rank correlation coefficient between the BAR score and total CSVD score is 0.320 (P < 0.001). Binary logistic regression found that BAR score >1 SD was correlated with lacuna (OR = 1.987; 95% CI, 1.037–3.807; P = 0.039); severe WMH (OR = 1.994; 95% CI, 1.003–3.964; P = 0.049); severe EPVS (OR = 2.544; 95% CI, 1.299–4.983; P = 0.006) and CSVD (OR = 2.997; 95% CI 1.182–7.599; P = 0.021). Ordinal logistic regression analysis found that age (OR = 1.028; 95% CI, 1.007–1.049; P = 0.009), hypertension (OR = 3.514; 95% CI, 2.114–5.769; P < 0.001) and BAR score >1 SD (OR = 2.418; 95% CI, 1.350–4.330; P = 0.003) were correlated with the total CSVD score. Conclusions: Patients with large intracranial arterial calibers may have heavier CSVD burden. The mechanisms of this association warrant further study.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Hui Li
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Chang
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
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11
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Liu Y, Zhu J, Deng X, Yang Z, Chen C, Huang S, Chen L, Ma Y, Lin W, Zhu F. Serum level of lipoprotein-associated phospholipase A2 is a potential biomarker of vertebrobasilar dolichoectasia and its progression to cerebral infarction. Neurol Sci 2020; 42:599-605. [PMID: 32648046 DOI: 10.1007/s10072-020-04563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are no effective therapies to prevent the occurrence and progression of vertebrobasilar dolichoectasia (VBD). In this study, we investigated the relationship between serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) and the occurrence and progression of VBD. METHODS Sixty (60) cases without VBD and ischemia stroke were considered as Group A, 100 cases with VBD were further divided into Group B (VBD without ischemic stroke, n = 54) and Group C (VBD with first ever acute posterior circulation ischemic stroke, n = 46). Demographic data (such as gender and age) and past medical history (such as hypertension, diabetes, and smoking history) were collected. The levels of serum low-density lipoprotein cholesterol (LDL-C), hypersensitivity C reactive protein (hs-CRP), glycosylated hemoglobin (HbAlc), homocysteine (HCY), uric acid (UA), fibrinogen (Fib), and Lp-PLA2, etc. were measured. Logistic regression analysis was used to assess the related factors of VBD and ischemic stroke secondary to VBD. RESULTS Logistic multivariate regression analysis showed that only age and the level of serum Lp-PLA2 were significantly higher in group B than those in group A (P < 0.012, P < 0.001, respectively), however, only the level of serum Lp-PLA2 was significantly higher in group C than those in group B (P < 0.001). CONCLUSIONS The serum marker Lp-PLA2 is an independent risk factor for the occurrence of VBD and the progression of VBD to posterior circulation ischemic stroke. Whether intervening on atherosclerosis could prevent the occurrence and development of VBD needs to be further studied.
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Affiliation(s)
- Yuan Liu
- Department of Neurology, The Affiliated Yue Bei People's Hospital of ShantouUniversity Medical College, Shaoguan, 512025, Guangdong, People's Republic of China.,Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yue Bei People's Hospital of ShantouUniversity Medical College, Shaoguan, 512025, Guangdong, People's Republic of China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yue Bei People's Hospital of ShantouUniversity Medical College, Shaoguan, 512025, Guangdong, People's Republic of China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yue Bei People's Hospital of ShantouUniversity Medical College, Shaoguan, 512025, Guangdong, People's Republic of China
| | - Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, the Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, 518001, Guangdong, People's Republic of China
| | - Shuxuan Huang
- Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Lue Chen
- Department of Neurology, Shunde Hospital of Southern Medical University, Shunde, Foshan, 528300, Guangdong, People's Republic of China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, 518001, Guangdong, People's Republic of China
| | - Weifeng Lin
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China
| | - Feiqi Zhu
- Department of Neurology, The Affiliated Yue Bei People's Hospital of ShantouUniversity Medical College, Shaoguan, 512025, Guangdong, People's Republic of China. .,Cognitive Impairment Ward of Neurology Department, the Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, 518001, Guangdong, People's Republic of China.
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12
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Lalla R, Raghavan P, Cole JW. Extracranial ectasia and embolic infarcts in HIV: two case reports and a clinical decision-making algorithm. J Neurovirol 2020; 26:474-481. [PMID: 32632673 DOI: 10.1007/s13365-020-00867-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/04/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
HIV is known to increase the risk of both ischemic and hemorrhagic strokes. There are many postulated mechanisms for this elevated risk including an HIV-induced vasculopathy and/or coagulopathy, opportunistic infections, and cardioembolic etiologies, among others. Regarding vasculopathy, prior reports have described the various changes to the arterial vasculature that can occur in the setting of HIV, yet the appropriate workup and management of this condition remains poorly defined. Here we describe two cases of patients with HIV presenting with large vessel intracranial occlusions in the setting of ectatic extracranial vasculature accompanied by intraluminal thrombus formation. One patient underwent thrombectomy, while the other improved after receiving IV-tPA. Inferring on these cases and the existing literature, a standardized workup and treatment algorithm is proposed, emphasizing the key management decisions that should be considered on a case-by-case basis.
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Affiliation(s)
- Rakhee Lalla
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Prashant Raghavan
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - John W Cole
- Departments of Neurology, Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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13
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Zhang DP, Yin S, Zhang HL, Li D, Song B, Liang JX. Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms. J Stroke 2020; 22:173-184. [PMID: 32635683 PMCID: PMC7341005 DOI: 10.5853/jos.2019.02985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/06/2020] [Indexed: 12/29/2022] Open
Abstract
Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IAD-Erelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry’s disease and late-onset Pompe’s disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (COL4A1/COL4A2) and forkhead box C1 (FOXC1) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.
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Affiliation(s)
- Dao Pei Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Suo Yin
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Dan Li
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jia Xu Liang
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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14
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Li B, Zhou B, Zhang MZ, Qin RQ, He Y. Extensive intracranial arterial dolichoectasia involving distal branches of intracranial arteries: two cases report and review of the literature. Int J Neurosci 2020; 131:1133-1138. [PMID: 32449866 DOI: 10.1080/00207454.2020.1774577] [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: 10/24/2022]
Abstract
With the rapid development of noninvasive angiography techniques such as Magnetic Resonance Angiography (MRA) and Computer Tomography Angiography (CTA), more and more patients with intracranial arterial dolichoectasia (IADE) have been found, and clinical studies on this kind of vascular abnormity have become hot subjects in neurology. We presented two young patients with IADE extensively involving the branches of intracranial arteries, which were different from patients described in other articles. A young male patient was diagnosed with IADE after examination on admission, and further detailed examination revealed that the patient had osteropathia striata. Another young woman had an arterial malformation that mainly affected the distal branch of the intracranial artery. These two cases give us another perspective to look into IADE.
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Affiliation(s)
- Bo Li
- Vascular Interventional Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Bing Zhou
- Vascular Interventional Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ming-Zhao Zhang
- Vascular Interventional Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Rong-Qing Qin
- Vascular Interventional Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Yang He
- Vascular Interventional Department, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
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15
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Fierini F, Poggesi A, Salvadori E, Acquafresca M, Fainardi E, Moretti M, Pantoni L. Cerebral small vessel disease and systemic arteriopathy in intracranial arterial dolichoectasia patients. Acta Neurol Scand 2019; 139:150-157. [PMID: 30338521 DOI: 10.1111/ane.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate clinical and demographic characteristics of patients with intracranial arterial dolichoectasia (IADE) and describe the possible coexistence of cerebral small vessel disease (SVD) and systemic arteriopathy. MATERIAL AND METHODS From January 2015 to March 2016, all the patients attending an outpatient service for chronic cerebrovascular diseases were screened for suspected IADE. Identified patients underwent a predefined protocol including: brain MR angiography for the diagnosis of IADE; brain MRI with visual rating of SVD features; whole-body CT angiography to assess signs of systemic arteriopathy; and neuropsychological examination. RESULTS Among the 251 patients screened, IADE was diagnosed in seven (mean age ± SD 68.8 ± 7.2 years, six males). Hypertension was the most frequent risk factor. All patients had basilar artery dolichoectasia, two also ectasia of a vessel of the anterior circulation. All patients had white matter hyperintensities that were moderate or severe in six, five had at least one lacune, and all had enlarged perivascular spaces. At least one microbleed was detected in six patients. A variable grade of global cortical atrophy was found in six patients. Systemic arterial ectasia was found in all but one patient. Neuropsychological examination showed a multidomain cognitive impairment in five patients. CONCLUSIONS Our study confirms the high prevalence of cerebral SVD in IADE. The involvement of the brain-supplying arteries is probably part of a systemic arteriopathy in IADE patients, thus suggesting the usefulness of assessing the whole arterial tree in clinical practice. Cognitive deterioration signs are frequent in these patients.
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Affiliation(s)
- Fabio Fierini
- Psychiatry Unit, Department of Health Sciences; University of Florence; Florence Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section; University of Florence; Florence Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section; University of Florence; Florence Italy
| | - Manlio Acquafresca
- Radiology Unit 4, Department of Diagnostic Imaging; Careggi University Hospital; Florence Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - Marco Moretti
- Neuroradiology Unit, Department of Diagnostic Imaging; Careggi University Hospital; Florence Italy
| | - Leonardo Pantoni
- 'L. Sacco' Department of Biomedical and Clinical Sciences; University of Milan; Milan Italy
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16
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Zhai FF, Yan S, Li ML, Han F, Wang Q, Zhou LX, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Intracranial Arterial Dolichoectasia and Stenosis. Stroke 2018; 49:1135-1140. [PMID: 29581240 DOI: 10.1161/strokeaha.117.020130] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial arterial dolichoectasia (IADE) is a poorly understood arteriopathy compared with intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of IADE and ICAS and their relationship with neuroimaging markers of cerebral small vessel disease in a population-based study.
Methods—
This study comprised 1237 participants (aged 57.2±9.4 years, 37.6% men) who underwent brain magnetic resonance imaging and magnetic resonance angiography. IADE was assessed based on basilar artery dolichoectasia (diameter, height of bifurcation, and laterality of basilar artery) and dilation of basilar artery and internal carotid artery (intracranial volume-adjusted diameter ≥2 SD). ICAS was defined as any degree of stenosis in at least 1 intracranial artery. The neuroimaging markers of cerebral small vessel disease, including lacunes, white matter hyperintensities, microbleeds, dilated perivascular spaces, and brain atrophy, were evaluated.
Results—
Basilar arterial dolichoectasia was observed in 3.6% (45/1237); intracranial arterial dilation in 5.9% (67/1142); and ICAS in 15.7% (194/1237). Older age, higher systolic blood pressure, diabetes mellitus, higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) were associated with the presence of ICAS (all
P
<0.001), whereas only older age was associated with IADE. ICAS was associated with lacunes (odds ratio, 2.91; 95% confidence interval, 1.96–4.34;
P
<0.001), increased white matter hyperintensities volume (β±SE, 0.54±0.13;
P
<0.001), and brain atrophy (β±SE, −1.16±0.21;
P
<0.001), whereas basilar arterial dolichoectasia was mainly associated with dilated perivascular spaces in basal ganglia (odds ratio, 2.20; 95% confidence interval, 1.20–4.02;
P
=0.01) and, to a lesser extent, associated with lacunes and microbleeds.
Conclusions—
IADE and ICAS had different risk factor profiles and associated with different imaging phenotypes of cerebral small vessel disease, suggesting different underlying mechanisms.
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Affiliation(s)
- Fei-Fei Zhai
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shuang Yan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Fei Han
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Quan Wang
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Li-Xin Zhou
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Jun Ni
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Ming Yao
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.-Y.Z.)
| | - Li-Ying Cui
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Yi-Cheng Zhu
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
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17
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Förster A, Wenz R, Maros ME, Böhme J, Al-Zghloul M, Alonso A, Groden C, Wenz H. Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia. PLoS One 2018; 13:e0196149. [PMID: 29672624 PMCID: PMC5908155 DOI: 10.1371/journal.pone.0196149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/07/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Vertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy associated with intracerebral hemorrhage. In the present study, we sought to evaluate the frequency and anatomical distribution of cerebral microbleeds (cMBs) and intracerebral hemorrhage (ICH) in VBD. METHODS From a MRI database 94 VBD patients were identified and analyzed with special emphasis on cMBs and ICH on T2*-weighted gradient echo images (GRE) in relation to the established diagnostic MRI criteria of VBD (diameter, height, and lateral position). cMBs/ICH location was categorized into anterior/posterior circulation. Clinical information like demographic details, clinical symptoms, and comorbidities were abstracted from the case records. An extensive modelling approach using generalized linear mixed-effects models was used. RESULTS Overall, 79 (84.0%) patients (mean age 72.1±10.0 years, 74.7% male) with a standard stroke MRI protocol including T2*-weighted images were included in the analysis. cMBs were observed in 38/79 (48.1%) patients, ranging from 1 to 84 cMBs per patient. In the posterior circulation cMBs were observed more frequently (34/38 (89.5%)) in comparison to the anterior circulation (24/38 (63.2%)). cMBs were observed in the thalamus in 20/38 (52.6%), hippocampus in 1/38 (2.6%), occipital lobe in 18/38 (47.4%), pons in 6/38 (15.8%), medulla oblongata in 2/38 (5.2%), and cerebellum in 14/38 (36.8%) patients. ICH was observed in only 6/79 (7.6%) patients. There were significantly more cMBs in the posterior- (NCMBs-PC = 1.717, 95%CI: 1.336-2.208, p = 0.0315) than in the anterior circulation. Logistic regression model showed a significant positive effect of clinical symptoms such as ischemic, TIA and hemorrhagic stroke on the presence of cMBs (OR = 3.34, 95%CI [2.0-5.57], p = 0.0184; ndf = 78, AIC = 107.51). General linear model showed that clinical symptoms have a highly significant effect on the number of cMBs (N = 2.78, 95%CI [2.51-3.07], p<2*10-16; ndf = 78, AIC = 1218). CONCLUSION cMBs and ICH may be observed in the anterior and posterior circulation in VBD but they occur more frequently in the posterior circulation. Most common anatomical locations of cMBs in VBD were the thalamus, occipital lobe and cerebellum. This posterior dominance of cMBs and ICH in VBD might reflect a specific underlying vascular pathology.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf Wenz
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
| | - Máté Elöd Maros
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- * E-mail:
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18
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Zhang X, Jing J, Zhao X, Liu L, Meng X, Wang A, Pan Y, Wang D, Wang Y, Wang Y. Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke. Neurol Res 2018; 40:452-458. [PMID: 29600887 DOI: 10.1080/01616412.2018.1451016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives This study aimed to estimate the prognosis of dolichoectasia in non-cardioembolic transient ischemic attack (TIA) and minor stroke patients. Methods Data were derived from the imaging subgroup of patients in the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Dolichoectasia was defined as ectasia (basilar artery diameter >4.5 mm) and dolichosis (either basilar artery bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae). The prognosis included ischemic stroke recurrence and poor functional outcome (modified Rankin scale 2-6) at 12-month follow-up. The association of dolichoectasia with risk factors and prognosis of patients were assessed using multivariable Cox regression models. Results Overall, 1089 patients with magnetic resonance images in the CHANCE trial were included in this subanalysis. A total of 98 (9.0%) patients were detected with dolichoectasia, and 106 (9.7%) patients had a recurrent ischemic stroke at 12 months. Small artery occlusion (SAO) was more prevalent in patients with dolichoectasia compared with those without dolichoectasia (29.6% vs. 22.7%, hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.59-5.17, p < 0.001). However, multivariate analysis showed no association of dolichoectasia with 12-month recurrent stroke (9.2% vs. 9.8%, HR, 1.15; 95%CI, 0.32-4.12; p = 0.83) and poor functional outcome (7.6% vs. 8.4%, odds ratio, 1.22; 95%CI, 0.24-6.08; p = 0.81) in the current subgroup analysis. Conclusions Dolichoectasia was significantly associated with SAO. There was no relationship between dolichoectasia and 12-month prognosis of patients with non-cardioembolic TIA or minor stroke.
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Affiliation(s)
- Xinmiao Zhang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Jing Jing
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Xingquan Zhao
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Liping Liu
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Xia Meng
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Anxin Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yuesong Pan
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - David Wang
- e Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System , University of Illinois College of Medicine , Peoria , IL , USA
| | - Yilong Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yongjun Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
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19
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Alabri H, Lewis WD, Manjila S, Alkhachroum AM, De Georgia MA. Acute Bilateral Ophthalmoplegia Due to Vertebrobasilar Dolichoectasia: A Report of Two Cases. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1302-1308. [PMID: 29213030 PMCID: PMC5729801 DOI: 10.12659/ajcr.904395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Case series Patient: Male, 52 • Female, 68 Final Diagnosis: VBD Symptoms: Ophthalmoplegia Medication: — Clinical Procedure: — Specialty: Neurology
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Affiliation(s)
- Haifa Alabri
- Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Whitfield D Lewis
- Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Sunil Manjila
- Department of Neurosurgery, West Side Medical Mall, Bay City, MI, USA
| | - Ayham M Alkhachroum
- Neurocritical Care, New York Presbyterian Columbia and Cornell, New York, NY, USA
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Del Brutto OH, Mera RM, Del Brutto VJ, Costa AF, Zambrano M, Brorson J. Basilar Artery Dolichoectasia: Prevalence and Correlates With Markers of Cerebral Small Vessel Disease in Community-Dwelling Older Adults. J Stroke Cerebrovasc Dis 2017; 26:2909-2914. [PMID: 28869136 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Basilar artery (BA) dolichoectasia has been associated with cerebral small vessel disease (SVD). However, studies have focused on stroke patients, and results cannot be extrapolated to the population at large. In this study, we aimed to assess prevalence of BA dolichoectasia and its association with SVD in community-dwelling older adults living in rural Ecuador. METHODS Atahualpa residents aged ≥60 years underwent brain magnetic resonance imaging and magnetic resonance angiography of intracranial vessels. Following Smoker's criteria, the mean BA diameter plus 2 standard deviation defined ectasia. In addition, a location lateral to the lateral margin of the clivus of dorsum sellae or a bifurcation at the third ventricle floor or higher defined dolichosis. Associations between BA abnormalities and imaging markers of SVD were assessed by the use of regression models adjusted for demographics and cardiovascular risk factors. RESULTS Of 346 participants, 11 (3.2%) had ectasia, 40 (11.6%) had dolichosis, and 47 (13.6%) had dolichoectasia (ectasia, dolichosis, or both). BA diameter was only associated with severity of white matter hyperintensities (P = .038). Dolichosis was associated with deep cerebral microbleeds (P = .002) but not with white matter hyperintensities. Dolichoectasia was associated with both white matter hyperintensities (P = .031) and cerebral microbleeds (P = .001). There were no associations with lacunar infarcts or enlarged perivascular spaces in any model. CONCLUSIONS Prevalence of BA dolichoectasia in this rural setting is similar to that reported in other populations. Associations with imaging markers of SVD differ according to whether the subject has ectasia or dolichosis.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
| | | | | | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador
| | | | - James Brorson
- Department of Neurology, University of Chicago, Chicago, Illinois
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Thijs V, Grittner U, Fazekas F, McCabe DJH, Giese AK, Kessler C, Martus P, Norrving B, Ringelstein EB, Schmidt R, Tanislav C, Putaala J, Tatlisumak T, von Sarnowski B, Rolfs A, Enzinger C. Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke. Stroke 2017; 48:2361-2367. [PMID: 28754833 DOI: 10.1161/strokeaha.117.017406] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. METHODS We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) transient ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. RESULTS Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P=0.065; 29.1% versus 16.5% for old lesions, P<0.001), infarct location in the brain stem (12.4% versus 6.9%, P<0.001), and in white matter (27.8% versus 21.1%, P=0.001). Microbleeds (16.3% versus 4.7%, P=0.001), higher grades of white matter hyperintensities (P<0.001), and small vessel disease subtype (18.1% versus 12.4%, overall P for differences in TOAST (P=0.018) were more often present in patients with dolichoectasia. CONCLUSIONS Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with transient ischemic attack and ischemic stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.
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Affiliation(s)
- Vincent Thijs
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
| | - Ulrike Grittner
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Franz Fazekas
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Dominick J H McCabe
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Anne-Katrin Giese
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Christof Kessler
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Peter Martus
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Bo Norrving
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Erich Bernd Ringelstein
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Reinhold Schmidt
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Christian Tanislav
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Jukka Putaala
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Turgut Tatlisumak
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Bettina von Sarnowski
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Arndt Rolfs
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Christian Enzinger
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.); Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.); Center for Stroke Research and Department of Biostatistics and Clinical Epidemiology, Charité - University Medical Centre Berlin, Germany (U.G.); Department of Neurology (F.F., R.S., C.E.) and Division of Neuroradiology, Department of Radiology (C.E.), Medical University of Graz, Austria; Department of Neurology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Republic of Ireland (D.J.H.M.); Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom (D.J.H.M.); Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland (D.J.H.M.); Albrecht-Kossel-Institute for Neuroregeneration (AKos) Centre for Mental Health Disease University of Rostock, Germany (A.-K.G., A.R.); Department of Neurology, University Medicine Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany (C.K., B.v.S.); Institut für Klinische Epidemiologie und Angewandte Biometrie (IKEaB), Tübingen, Germany (P.M.); Department of Clinical Sciences Neurology, Lund University, Sweden (B.N.); Wilhelms University of Muenster, Germany (E.B.R.); Department of Neurology, Justus Liebig University Giessen, Germany (C.T.); Department of Neurology, Helsinki University Central Hospital, Finland (J.P., T.T.); Clinical Neurosciences, University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
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Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol 2017; 8:344. [PMID: 28769872 PMCID: PMC5511833 DOI: 10.3389/fneur.2017.00344] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
Abstract
An increased diameter (ectasis) and/or long and tortuous course (dolichosis) of at least one cerebral artery define intracranial arterial dolichoectasia (IADE). IADE could be detected incidentally or may give rise to an array of neurological complications including ischemic stroke, intracranial hemorrhage, or compression of surrounding neural structures. The basilar artery is preferentially affected and has been studied in more detail, mainly due to the presence of accepted diagnostic criteria proposed by Smoker and colleagues in 1986 (1). Criteria for the diagnoses of dolichoectasia in other cerebral arteries have been suggested. However, they lack validation across studies. The prevalence of IADE is approximately 0.08–6.5% in the general population, while in patients with stroke, the prevalence ranges from 3 to 17%. Variations among case series depend on the characteristics of the studied population, diagnostic tests used, and diagnostic criteria applied. In rare instances, an underlying hereditary condition, connective tissue disorder, or infection predispose to the development of IADE. However, most cases are sporadic and associated with traditional vascular risk factors including advanced age, male gender, and arterial hypertension. The link between this dilative arteriopathy and other vascular abnormalities, such as abdominal aortic aneurysm, coronary artery ectasia, and cerebral small vessel disease, suggests the underlying diffuse vascular process. Further understanding is needed on the physiopathology of IADE and how to prevent its progression and clinical complications.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jorge G Ortiz
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Abstract
Background Cerebrovascular disease is the most common cause of death worldwide, with millions of deaths annually. Interest is increasing toward understanding the geometric factors that influence cerebrovascular diseases, such as stroke. Cerebrovascular shape analyses are essential for the diagnosis and pathological identification of these conditions. The current study aimed to provide a stable and consistent methodology for quantitative Circle of Willis (CoW) analysis and to identify geometric changes in this structure. Method An entire pipeline was designed with emphasis on automating each step. The stochastic segmentation was improved and volumetric data were obtained. The L1 medial axis method was applied to vessel volumetric data, which yielded a discrete skeleton dataset. A B-spline curve was used to fit the skeleton, and geometric values were proposed for a one-dimensional skeleton and radius. The calculations used to derive these values were illustrated in detail. Result In one example(No. 47 in the open dataset) all values for different branches of CoW were calculated. The anterior communicating artery(ACo) was the shortest vessel, with a length of 2.6mm. The range of the curvature of all vessels was (0.3, 0.9) ± (0.1, 1.4). The range of the torsion was (−12.4,0.8) ± (0, 48.7). The mean radius value range was (3.1, 1.5) ± (0.1, 0.7) mm, and the mean angle value range was (2.2, 2.9) ± (0, 0.2) mm. In addition to the torsion variance values in a few vessels, the variance values of all vessel characteristics remained near 1. The distribution of the radii of symmetrical posterior cerebral artery(PCA) and angle values of the symmetrical posterior communicating arteries(PCo) demonstrated a certain correlation between the corresponding values of symmetrical vessels on the CoW. Conclusion The data verified the stability of our methodology. Our method was appropriate for the analysis of large medical image datasets derived from the automated pipeline for populations. This method was applicable to other tubular organs, such as the large intestine and bile duct. Electronic supplementary material The online version of this article (doi:10.1186/s12880-016-0170-8) contains supplementary material, which is available to authorized users.
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Matsukawa H, Shinoda M, Fujii M, Uemura A, Takahashi O, Niimi Y. Basilar dolichoectasia and the spontaneous intradural vertebral artery dissection. Brain Inj 2016; 30:90-4. [DOI: 10.3109/02699052.2015.1113562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hemifacial spasm due to vertebrobasilar dolichoectasia: a case report. Radiol Case Rep 2015; 10:65-7. [PMID: 26649123 PMCID: PMC4661493 DOI: 10.1016/j.radcr.2015.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/29/2015] [Indexed: 11/21/2022] Open
Abstract
Hemifacial spasm (HFS) happens because of vascular compression of the facial nerve at the root exit zone. Vertebrobasilar dolichoectasia (VBD) is a very rare cause of HFS. VBD is diagnosed by computed tomography angiography and magnetic resonance imaging. Here, we report a case of 65-year-old female patient with HFS due to VBD. We discuss the complications and the treatment options for the case.
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Pico F, Labreuche J, Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol 2015. [PMID: 26194931 DOI: 10.1016/s1474-4422(15)00089-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Up to 12% of patients with stroke have intracranial arterial dolichoectasia (IADE) and the basilar artery is affected in 80% of these cases. Diagnostic criteria and prognosis studies of IADE are based on basilar artery diameter, which is a good quantitative marker for the severity of the disease. The pathophysiology is largely unknown, but IADE can be viewed as a common final pathway of arterial wall response or damage in the tunica media due to various mechanisms, such as matrix metalloproteinase dysfunction or muscle cell or elastic fibre injury. No randomised controlled trials have been undertaken in IADE and thus little high-level evidence is available on which to base treatment guidelines. IADE management depends on clinical presentation and disease severity, and includes blood pressure control, antithrombotic treatments, endovascular procedures, and surgery. Further studies are needed to better define IADE in the general population, to establish its prevalence and pathophysiology, to identify subgroups at risk of life-threatening complications, and to offer effective treatment options.
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Affiliation(s)
- Fernando Pico
- Neurology Department and Stroke Centre, Centre Hospitalier de Versailles, Le Chesnay and Université de Versailles Saint-Quentin-en-Yvelines, Île-de-France, France; INSERM Laboratory for Vascular Translational Science, Paris, France
| | - Julien Labreuche
- Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France
| | - Pierre Amarenco
- INSERM Laboratory for Vascular Translational Science, Paris, France; Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France.
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Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis 2015; 24:1052-8. [PMID: 25817614 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/15/2014] [Accepted: 12/31/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The clinical implications of vertebrobasilar ectasia (VBE) in patients with cerebral small-artery disease are not well defined. We investigated whether VBE is associated with recurrent stroke, major hemorrhage, and death in a large cohort of patients with recent lacunar stroke. METHODS Maximum diameters of the vertebral and basilar arteries were measured by magnetic resonance angiography and computed tomographic angiography in 2621 participants in the Secondary Prevention of Small Subcortical Strokes trial. VBE was defined a priori as basilar artery greater than 4.5 mm and/or vertebral artery greater than 4.0 mm. Patient characteristics and risks of stroke recurrence and mortality during follow-up (median, 3.5 years) were compared between patients with and without VBE. RESULTS VBE affecting 1 or more arteries was present in 200 (7.6%) patients. Patient features independently associated with VBE were increasing age, male sex, white race ethnicity, hypertension, and higher baseline diastolic blood pressure. Baseline systolic blood pressure was inversely associated with VBE. After adjustment for other risk factors, VBE was not predictive of recurrent stroke (hazard ratio [HR], 1.3; 95% confidence interval [CI], .85-1.9) or major hemorrhage (HR, 1.5; CI, .94-2.6), but was of death (HR, 1.7; CI, 1.1-2.7). CONCLUSIONS In this large well-characterized cohort of patients with recent lacunar stroke, VBE was predictive of death but not of recurrent stroke or major hemorrhage. In these exploratory analyses, the frequency of VBE was directly related to diastolic blood pressure but inversely related to systolic blood pressure.
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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