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Ntaios G, Baumgartner H, Doehner W, Donal E, Edvardsen T, Healey JS, Iung B, Kamel H, Kasner SE, Korompoki E, Navi BB, Pristipino C, Saba L, Schnabel RB, Svennberg E, Lip GYH. Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC. Eur Heart J 2024; 45:1701-1715. [PMID: 38685132 PMCID: PMC11107123 DOI: 10.1093/eurheartj/ehae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.
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Affiliation(s)
- George Ntaios
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, Larissa 41132, Greece
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Wolfram Doehner
- Department of Cardiology (Campus Virchow), Center of Stroke Research Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health-Center for Regenerative Therapies, Deutsches Herzzentrum der Charité, Charité, Berlin, Germany
| | - Erwan Donal
- Service de Cardiologie et CIC-IT 1414, CHU Rennes, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Jeff S Healey
- Cardiology Division, McMaster University, Hamilton, Canada
| | - Bernard Iung
- Bichat Hospital, APHP and Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Scott E Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Pristipino
- Interventional and Intensive Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato, Cagliari, Italy
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Shen M, Gao P, Chen S, Zhao X, Li R, Du W, Yuan C, Hatsukami T, Sui B. Differences in distribution and features of carotid and middle cerebral artery plaque in patients with pial infarction and perforating artery infarction: A 3D vessel wall imaging study. Eur J Radiol 2023; 167:111045. [PMID: 37586303 DOI: 10.1016/j.ejrad.2023.111045] [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: 03/20/2023] [Revised: 05/31/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Atherosclerotic plaques of carotid artery (CA) and middle cerebral artery (MCA) are important causes of acute ischemic stroke (AIS). This study was designed to jointly assess the plaque distribution and features of CA and MCA in AIS patients with pial infarction (PI) and perforating artery infarction (PAI), and to investigate the associations between plaque characteristics and ischemic infarction patterns. METHODS Imaging data of sixty-five patients from a cross-sectional study were reviewed. All the patients had acute infarction in the MCA territory on diffusion weighted imaging (DWI) and underwent CA and MCA vessel wall imaging (VWI). The CA and MCA plaque presence and high-risk features on the ipsilateral side of infarction were analyzed. The brain infarction lesions were divided into PI group vs. non-PI group, and PAI group vs. non-PAI group. Different plaque distribution types and plaque features were compared in each two groups, and their associations were investigated using binary logistic regression. RESULTS Sixty-five patients (mean age, 54.6 ± 10.1 years; 61 men) were included. The CA high-risk plaque (OR: 5.683 [1.409-22.929], P = 0.015) and MCA plaque presence (OR: 3.949 [1.397-11.162], P = 0.010) were significantly associated with PI. MCA plaques that involved the orifice of the perforating arteries were significantly associated with PAI (OR: 15.167 [1.851-124.257], P = 0.011). CONCLUSION CA and MCA plaques show distinct distribution and high-risk features in patients with PI and PAI. Combined intracranial and extracranial arteries imaging should be considered for the evaluation of the symptomatic ischemic patients.
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Affiliation(s)
- Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Beijing, China.
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China; Department of Radiology, University of Washington, Seattle, WA, USA
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Binbin Sui
- Beijing Neurosurgical Institute, Beijing, China; Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China.
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Peret A, Romero-Sanchez G, Dabiri M, McNally JS, Johnson KM, Mossa-Basha M, Eisenmenger LB. MR Angiography of Extracranial Carotid Disease. Magn Reson Imaging Clin N Am 2023; 31:395-411. [PMID: 37414468 DOI: 10.1016/j.mric.2023.04.003] [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: 07/08/2023]
Abstract
Magnetic resonance angiography sequences, such as time-of-flight and contrast-enhanced angiography, provide clear depiction of vessel lumen, traditionally used to evaluate carotid pathologic conditions such as stenosis, dissection, and occlusion; however, atherosclerotic plaques with a similar degree of stenosis may vary tremendously from a histopathological standpoint. MR vessel wall imaging is a promising noninvasive method to evaluate the content of the vessel wall at high spatial resolution. This is particularly interesting in the case of atherosclerosis as vessel wall imaging can identify higher risk, vulnerable plaques as well as has potential applications in the evaluation of other carotid pathologic conditions.
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Affiliation(s)
- Anthony Peret
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P.14080, Ciudad de México, Mexico City, Mexico
| | - Mona Dabiri
- Radiology Department, Children's Medical Center, Tehran University of Medical Science, No 63, Gharib Avenue, Keshavarz Blv, Tehran 1419733151, Iran
| | - Joseph Scott McNally
- Department of Radiology, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53705, USA.
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Wang Y, Yin J, Meng Y, Wu L, Li X, Xu Y, Wei Y. Symptomatic free-floating thrombus in the vertebral artery: a case description. Quant Imaging Med Surg 2023; 13:4002-4006. [PMID: 37284108 PMCID: PMC10240024 DOI: 10.21037/qims-22-1064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/10/2023] [Indexed: 10/03/2023]
Affiliation(s)
| | | | - Yan Meng
- Department of Neurology, Xingtai Third Hospital, Xingtai, China
| | - Lijuan Wu
- Department of Neurology, Xingtai Third Hospital, Xingtai, China
| | - Xiaoqiang Li
- Department of Neurology, Xingtai Third Hospital, Xingtai, China
| | - Yingdong Xu
- Department of Neurology, Xingtai Third Hospital, Xingtai, China
| | - Yuqing Wei
- Department of Neurology, Xingtai Third Hospital, Xingtai, China
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Song X, Li S, Du H, Hu Q, Zhou L, Zhao J, Gu Y, Hu Y, Lu H, Wang G, Chen X, Wang Q. Association of Plaque Morphology With Stroke Mechanism in Patients With Symptomatic Posterior Circulation ICAD. Neurology 2022; 99:e2708-e2717. [PMID: 36220598 PMCID: PMC9757871 DOI: 10.1212/wnl.0000000000201299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the main mechanisms of stroke in patients with intracranial atherosclerotic disease (ICAD)-perforating artery occlusion (PAO) and artery-to-artery embolism (AAE)-have been identified and described, relatively little is known about the morphology of the symptomatic plaques and how they differ between these 2 mechanisms. METHODS We prospectively recruited patients with acute ischemic stroke in the posterior circulation that was attributable to ICAD. Fifty-one eligible patients were enrolled and underwent magnetic resonance imaging before being assigned to the PAO or AAE group according to probable stroke mechanism. Plaque morphological properties including plaque length, lumen area, outer wall area, plaque burden, plaque surface irregularity, vessel wall remodeling, and plaque enhancement were assessed using high-resolution MRI. Plaque morphological parameters of both PAO and AAE groups were compared using nonparametric tests. A binary logistic regression model was used to identify independent predictors while a receiver operating characteristic curve tested the sensitivity and specificity of the model. RESULTS Among patients who met the imaging eligibility criteria, 38 (74.5%) had PAO and 13 (25.5%) had AAE. Plaque length was shorter (6.39 interquartile range [IQR, 5.18-7.7]1 mm vs 10.90 [IQR, 8.18-11.85] mm, p < 0.01) in patients with PAO. Plaque burden was lower in PAO group (78.00 [IQR, 71.94-86.35] % vs 86.37 [IQR, 82.24-93.04] %, p = 0.04). The proportion of patients with plaque surface irregularity was higher in patients with AAE than in patients with PAO (19/38, 50.00% vs 12/13, 92.30%, p = 0.008). Plaque length was significantly associated with the PAO mechanism (adjusted OR 0.57, 95% CI, 0.41-0.79). DISCUSSION Intracranial atherosclerotic plaque morphology differs between patients with PAO and those with AAE. Plaque with shorter length, lower plaque burden, and regular surface is more likely to cause PAO.
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Affiliation(s)
- Xiaoyan Song
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Shuang Li
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Heng Du
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Qimin Hu
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Li Zhou
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Jinglong Zhao
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Yue Gu
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Yiming Hu
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Haiyan Lu
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Guodong Wang
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China.
| | - Xiangyan Chen
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Qiaoshu Wang
- From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China.
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Advances in Noninvasive Carotid Wall Imaging with Ultrasound: A Narrative Review. J Clin Med 2022; 11:jcm11206196. [PMID: 36294515 PMCID: PMC9604731 DOI: 10.3390/jcm11206196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Carotid atherosclerosis is a major cause for stroke, with significant associated disease burden morbidity and mortality in Western societies. Diagnosis, grading and follow-up of carotid atherosclerotic disease relies on imaging, specifically ultrasound (US) as the initial modality of choice. Traditionally, the degree of carotid lumen stenosis was considered the sole risk factor to predict brain ischemia. However, modern research has shown that a variety of other imaging biomarkers, such as plaque echogenicity, surface morphology, intraplaque neovascularization and vasa vasorum contribute to the risk for rupture of carotid atheromas with subsequent cerebrovascular events. Furthermore, the majority of embolic strokes of undetermined origin are probably arteriogenic and are associated with nonstenosing atheromas. Therefore, a state-of-the-art US scan of the carotid arteries should take advantage of recent technical developments and should provide detailed information about potential thrombogenic (/) and emboligenic arterial wall features. This manuscript reviews recent advances in ultrasonographic assessment of vulnerable carotid atherosclerotic plaques and highlights the fields of future development in multiparametric arterial wall imaging, in an attempt to convey the most important take-home messages for clinicians performing carotid ultrasound.
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Kim HW, Regenhardt RW, D'Amato SA, Nahhas MI, Dmytriw AA, Hirsch JA, Silverman SB, Martinez-Gutierrez JC. Asymptomatic carotid artery stenosis: a summary of current state of evidence for revascularization and emerging high-risk features. J Neurointerv Surg 2022:jnis-2022-018732. [DOI: 10.1136/jnis-2022-018732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
Carotid artery stenosis is a leading cause of ischemic stroke. While management of symptomatic carotid stenosis is well established, the optimal approach in asymptomatic carotid artery stenosis (aCAS) remains controversial. The rapid evolution of medical therapies within the time frame of existing landmark aCAS surgical revascularization trials has rendered their findings outdated. In this review, we sought to summarize the controversies in the management of aCAS by providing the most up-to-date medical and surgical evidence. Subsequently, we compile the evidence surrounding high-risk clinical and imaging features that might identify higher-risk lesions. With this, we aim to provide a practical framework for a precision medicine approach to the management of aCAS.
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Cheng SF, van Velzen TJ, Gregson J, Richards T, Jäger HR, Simister R, Kooi ME, de Borst GJ, Pizzini FB, Nederkoorn PJ, Brown MM, Bonati LH. The 2nd European Carotid Surgery Trial (ECST-2): rationale and protocol for a randomised clinical trial comparing immediate revascularisation versus optimised medical therapy alone in patients with symptomatic and asymptomatic carotid stenosis at low to intermediate risk of stroke. Trials 2022; 23:606. [PMID: 35897114 PMCID: PMC9328625 DOI: 10.1186/s13063-022-06429-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Carotid endarterectomy is currently recommended for patients with recently symptomatic carotid stenosis ≥50%, based on randomised trials conducted 30 years ago. Several factors such as carotid plaque ulceration, age and associated comorbidities might influence the risk-benefit ratio of carotid revascularisation. A model developed in previous trials that calculates the future risk of stroke based on these features can be used to stratify patients into low, intermediate or high risk. Since the original trials, medical treatment has improved significantly. Our hypothesis is that patients with carotid stenosis ≥50% associated with a low to intermediate risk of stroke will not benefit from additional carotid revascularisation when treated with optimised medical therapy. We also hypothesise that prediction of future risk of stroke in individual patients with carotid stenosis can be improved using the results of magnetic resonance imaging (MRI) of the carotid plaque. Methods Patients are randomised between immediate revascularisation plus OMT versus OMT alone. Suitable patients are those with asymptomatic or symptomatic carotid stenosis ≥50% with an estimated 5-year risk of stroke of <20%, as calculated using the Carotid Artery Risk score. MRI of the brain at baseline and during follow-up will be used as a blinded measure to assess the incidence of silent infarction and haemorrhage, while carotid plaque MRI at baseline will be used to investigate the hypotheses that plaque characteristics determine future stroke risk and help identify a subgroup of patients that will benefit from revascularisation. An initial analysis will be conducted after recruitment of 320 patients with baseline MRI and a minimum of 2 years of follow-up, to provide data to inform the design and sample size for a continuation or re-launch of the study. The primary outcome measure of this initial analysis is the combined 2-year rate of any clinically manifest stroke, new cerebral infarct on MRI, myocardial infarction or periprocedural death. Discussion ECST-2 will provide new data on the efficacy of modern optimal medical therapy alone versus added carotid revascularisation in patients with carotid stenosis at low to intermediate risk of future stroke selected by individualised risk assessment. We anticipate that the results of baseline brain and carotid plaque MRI will provide data to improve the prediction of the risk of stroke and the effect of treatment in patients with carotid stenosis. Trial registration ISRCTN registry ISRCTN97744893. Registered on 05 July 2012
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Affiliation(s)
- Suk Fun Cheng
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Twan J van Velzen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Toby Richards
- Faculty of Health and Medical Sciences, Surgery, University of Western Australia, Perth, Australia
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Simister
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.,Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Francesca B Pizzini
- Radiology, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
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9
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Carballo-Perich L, Puigoriol-Illamola D, Bashir S, Terceño M, Silva Y, Gubern-Mérida C, Serena J. Clinical Parameters and Epigenetic Biomarkers of Plaque Vulnerability in Patients with Carotid Stenosis. Int J Mol Sci 2022; 23:ijms23095149. [PMID: 35563540 PMCID: PMC9101730 DOI: 10.3390/ijms23095149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 12/24/2022] Open
Abstract
Atheromatous disease is the first cause of death and dependency in developed countries and carotid artery atherosclerosis is one of the main causes of severe ischaemic strokes. Current management strategies are mainly based on the degree of stenosis and patient selection has limited accuracy. This information could be complemented by the identification of biomarkers of plaque vulnerability, which would permit patients at greater and lesser risk of stroke to be distinguished, thus enabling a better selection of patients for surgical or intensive medical treatment. Although several circulating protein-based biomarkers with significance for both the diagnosis of carotid artery disease and its prognosis have been identified, at present, none have been clinically implemented. This review focuses especially on the most relevant clinical parameters to take into account in routine clinical practice and summarises the most up-to-date data on epigenetic biomarkers of carotid atherosclerosis and plaque vulnerability.
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Affiliation(s)
- Laia Carballo-Perich
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
| | - Dolors Puigoriol-Illamola
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
| | - Saima Bashir
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
| | - Mikel Terceño
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
| | - Yolanda Silva
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
- Correspondence: (Y.S.); (C.G.-M.); Tel.: +34-872-987-087 (C.G.-M.)
| | - Carme Gubern-Mérida
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
- Correspondence: (Y.S.); (C.G.-M.); Tel.: +34-872-987-087 (C.G.-M.)
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
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11
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Lyu Q, Zhang B, Tian X, Huang Y, Hui P. Association of Carotid Plaque Vulnerability and Cardiovascular Risk Factors in Patients Undergoing Carotid Endarterectomy. World Neurosurg 2021; 158:e778-e787. [PMID: 34838772 DOI: 10.1016/j.wneu.2021.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The association between high-risk cardiovascular factors and atherosclerotic is well established. However, whether plaque vulnerability is related to specific cardiovascular risk factors remains unknown. The association between plaque vulnerability and cardiovascular risk factors was evaluated in plaques removed in a carotid endarterectomy. METHODS Consecutive subjects scheduled for a carotid endarterectomy were recruited. All patients' baseline characteristics, risk factors, laboratory results, cardiovascular disease history, and medication use history were collected preoperatively. Histopathologic features within the vulnerable plaques were analyzed postoperatively. Risk factors for plaque vulnerability were assessed by univariate and multivariate analyses with adjustment for potential confounders. RESULTS A total of 128 carotid plaques were removed during the carotid endarterectomy. On multivariate analysis, hypertension (odds ratio [OR] 5.971, 95% confidence interval [CI] 1.959-18.203, P = 0.002) and dyslipidemia (OR 3.822, 95% CI 1.317-11.089, P = 0.014) were independently associated with plaque vulnerability. Hypertension was independently associated with the presence of a ruptured fibrous cap (OR 6.122, 95% CI 2.318-16.166, P < 0.001), intraplaque hemorrhage (OR 3.535, 95% CI 1.551-8.055, P = 0.003), and a large lipid core (OR 2.335, 95% CI 1.053-5.180, P = 0.037). The incidence of having a large lipid core was increased by 3.216-fold in patients with dyslipidemia (95% CI 1.409-7.340, P = 0.006). When the multivariate analysis was restricted to symptomatic patients, hypertension (OR 5.005, 95% CI 1.294-19.350, P = 0.020) was the most significant risk factor associated with vulnerable plaque. CONCLUSION The composition heterogeneity in the atherosclerotic plaque was significantly correlated to specific cardiovascular risk factors.
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Affiliation(s)
- Qi Lyu
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China; Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Bai Zhang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojie Tian
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yabo Huang
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China.
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12
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Hasan TF, Hasan H, Kelley RE. Overview of Acute Ischemic Stroke Evaluation and Management. Biomedicines 2021; 9:1486. [PMID: 34680603 PMCID: PMC8533104 DOI: 10.3390/biomedicines9101486] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Stroke is a major contributor to death and disability worldwide. Prior to modern therapy, post-stroke mortality was approximately 10% in the acute period, with nearly one-half of the patients developing moderate-to-severe disability. The most fundamental aspect of acute stroke management is "time is brain". In acute ischemic stroke, the primary therapeutic goal of reperfusion therapy, including intravenous recombinant tissue plasminogen activator (IV TPA) and/or endovascular thrombectomy, is the rapid restoration of cerebral blood flow to the salvageable ischemic brain tissue at risk for cerebral infarction. Several landmark endovascular thrombectomy trials were found to be of benefit in select patients with acute stroke caused by occlusion of the proximal anterior circulation, which has led to a paradigm shift in the management of acute ischemic strokes. In this modern era of acute stroke care, more patients will survive with varying degrees of disability post-stroke. A comprehensive stroke rehabilitation program is critical to optimize post-stroke outcomes. Understanding the natural history of stroke recovery, and adapting a multidisciplinary approach, will lead to improved chances for successful rehabilitation. In this article, we provide an overview on the evaluation and the current advances in the management of acute ischemic stroke, starting in the prehospital setting and in the emergency department, followed by post-acute stroke hospital management and rehabilitation.
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Affiliation(s)
- Tasneem F. Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA;
| | - Hunaid Hasan
- Hasan & Hasan Neurology Group, Lapeer, MI 48446, USA;
| | - Roger E. Kelley
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA;
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13
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Review of imaging biomarkers for the vulnerable carotid plaque. JVS Vasc Sci 2021; 2:149-158. [PMID: 34617065 PMCID: PMC8489200 DOI: 10.1016/j.jvssci.2021.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/23/2021] [Indexed: 12/26/2022] Open
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. As a result of the rapid technological evolution in medical imaging, several important steps have been taken in the field of carotid plaque imaging allowing us to visualize the carotid atherosclerotic plaque and its composition in great detail. For computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound scan, evidence has accumulated on novel imaging-based markers that confer information on carotid plaque vulnerability, such as intraplaque hemorrhage and lipid-rich necrotic cores. In terms of the imaging-based identification of individuals at high risk of stroke, routine assessments of such imaging markers are the way forward for improving current clinical practice. The current review highlights the main characteristics of the vulnerable plaque indicating their role in the etiology of ischemic stroke as identified by intensive plaque imaging.
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14
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Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke. Atherosclerosis 2020; 315:138-144. [PMID: 33183741 DOI: 10.1016/j.atherosclerosis.2020.10.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Carotid atherosclerosis is considered an important cause of ischemic stroke. Tthis study aimed to explore the relationship between plaque features and the severity of stroke, and to identify plaque risk factors for the assessment of the severity of ischemic stroke. METHODS Symptomatic patients with carotid atherosclerotic plaques were prospectively recruited and underwent high-resolution vessel wall magnetic resonance imaging (VW-MRI). Two trained MRI readers independently identified intraplaque hemorrhage (IPH), calcification (CA), surface CA, deep CA, and ulceration. They measured and calculated the maximum vessel diameter (Max VD), maximum wall thickness (Max WT), total vessel area, lumen area, normalized wall index (NWI), plaque volume, IPH volume, IPH proportion, CA volume, and CA proportion. Patients were divided into two groups according to their National Institutes of Health Stroke Scale (NIHSS) scores (NIHSS ≤1 vs. NIHSS >1). Clinical characteristics and carotid plaque features were compared using the Mann-Whitney U test or Chi-square test as appropriate. Odds ratio (OR) and corresponding 95% confidence interval (CI) of plaque features to distinguish patients with NIHSS >1 were calculated. Spearman's rank correlations or Pearson correlations were determined for plaque features and NIHSS scores. RESULTS Of the 97 included patients, 34 (35.05%) with NIHSS >1 had significantly greater NWI (p < 0.05), larger IPH volume (p < 0.01), and greater IPH proportion (p < 0.01), and higher prevalence of IPH (OR, 5.654; 95%CI, 2.272-14.070; p < 0.01) and ulceration (OR, 2.891; 95%CI, 1.090-7.667; p = 0.033) than patients with NIHSS ≤1. Max WT (r = 0.24, p = 0.018), NWI (r = 0.22, p = 0.032), IPH (r = 0.27, p = 0.007), IPH volume (r = 0.35, p < 0.01), IPH proportion (r = 0.28, p = 0.005), and ulceration (r = 0.35, p < 0.01) had positive correlations with NIHSS scores. CONCLUSIONS NWI, IPH, and ulceration of carotid atherosclerotic plaque based on high-resolution VW-MRI may be useful indicators for assessing the severity of ischemic stroke in patients with atherosclerosis. NIHSS score is related to max WT, NWI, IPH, IPH volume, IPH proportion, and ulceration.
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15
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Kassem M, Florea A, Mottaghy FM, van Oostenbrugge R, Kooi ME. Magnetic resonance imaging of carotid plaques: current status and clinical perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1266. [PMID: 33178798 PMCID: PMC7607136 DOI: 10.21037/atm-2020-cass-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
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Affiliation(s)
- Mohamed Kassem
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexandru Florea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, MUMC+, Maastricht, The Netherlands
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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16
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Liao Y, Guan M, Liang D, Shi Y, Liu J, Zeng X, Huang S, Xie X, Yuan D, Qiao H, Huang L. Differences in Pathological Composition Among Large Artery Occlusion Cerebral Thrombi, Valvular Heart Disease Atrial Thrombi and Carotid Endarterectomy Plaques. Front Neurol 2020; 11:811. [PMID: 32849244 PMCID: PMC7427050 DOI: 10.3389/fneur.2020.00811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose: Acute ischemic stroke (AIS) with large artery occlusion (LAO) may lead to severe disability or death if not promptly treated. To determine the source of cerebral artery occlusion thrombosis, we studied the pathological components of cerebral artery thrombosis with different etiological classifications to guide clinical formulation of preventive treatment. Materials and Methods: Eighty-eight thrombi from AIS patients with LAO, 12 atrial thrombi from patients with valvular heart disease (VHD), and 11 plaques obtained by carotid endarterectomy (CEA) from patients with carotid artery stenosis were included in this retrospective study. The hematoxylin and eosin–stained specimens were quantitatively analyzed for erythrocytes, white blood cells (WBCs) and fibrin; platelets were shown by immunohistochemistry for CD31. Results: The thrombi of VHD showed the highest percentage of fibrin, followed by those of cardioembolism (CE) and stroke of undetermined etiology (SUE), and these values were higher than those of the other groups. Plaques obtained by CEA showed the highest erythrocyte number, followed by the large artery atherosclerosis (LAA) thrombi, and showed significantly noticeable differences between other stroke subtypes. The proportions of fibrin and erythrocytes in the thrombi of CE and SUE were most similar to those in the thrombi of VHD, and the LAA thrombi were the closest to those obtained by CEA. CE thrombi and CEA plaques had a higher percentage of WBCs than thrombi of other stroke thrombus subtypes and VHD. Conclusions: CE and most cryptogenic thrombi may originate from the heart, and the formation of carotid atherosclerotic plaques may be related to atherosclerotic cerebral embolism. Inflammation may be involved in their formation.
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Affiliation(s)
- Yu Liao
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Pathology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Min Guan
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Dan Liang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yingying Shi
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jialin Liu
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiuli Zeng
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shengming Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xiaomei Xie
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Dingxin Yuan
- Department of Neurology, Beijiao Hospital, Foshan, China
| | - Hongyu Qiao
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Li'an Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
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17
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Rafailidis V, Li X, Sidhu PS, Partovi S, Staub D. Contrast imaging ultrasound for the detection and characterization of carotid vulnerable plaque. Cardiovasc Diagn Ther 2020; 10:965-981. [PMID: 32968654 DOI: 10.21037/cdt.2020.01.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Not only the degree of luminal narrowing but also the plaque morphology and composition play an important role in risk stratification of carotid atherosclerotic lesions. During the last few years, carotid contrast-enhanced ultrasound (CEUS) has emerged as a valuable imaging tool to assess such vulnerable carotid plaques. This review article discussed the use of CEUS for the detection of carotid plaque irregularities and ulcerations as well as the quantification of intraplaque neovascularization and its correlation with histology and inflammatory biomarkers. Apart from evaluating for markers of vulnerable carotid plaques, CEUS enhancement is directly associated with past cerebrovascular events. More importantly, preliminary evidence has shown that CEUS could be used to predict future cerebrovascular and cardiovascular events. Despite the progress in CEUS imaging for carotid atherosclerotic disease, past studies still suffer from the retrospective nature, small sample size, and a lack of matched, well controlled prospective studies. In the future, large multi-center prospective studies addressing the relationship between CEUS findings and patient clinical outcomes in carotid atherosclerotic disease are warranted.
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Affiliation(s)
| | - Xin Li
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
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18
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Oshida S, Mori F, Sasaki M, Sato Y, Kobayshi M, Yoshida K, Fujiwara S, Ogasawara K. Wall Shear Stress and T1 Contrast Ratio Are Associated With Embolic Signals During Carotid Exposure in Endarterectomy. Stroke 2019; 49:2061-2066. [PMID: 30354998 PMCID: PMC6116793 DOI: 10.1161/strokeaha.118.022322] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The frictional force because of blood flow may dislodge masses present on the surface of a plaque. Such frictional force is calculated as wall shear stress (WSS) using computational fluid dynamics. The aims of the present study were to determine whether, in addition to carotid plaque intensity on T1-weighted magnetic resonance (MR) imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy. Methods— One hundred patients with internal carotid artery stenosis (≥70%) underwent carotid plaque imaging with MR, and 54 patients with a vulnerable plaque (intraplaque hemorrhage or lipid/necrotic core) displayed as a high-intensity lesion underwent additional cervical 3-dimensional MR angiography. The maximum value of WSS within the most severe stenotic segment of the internal carotid artery was calculated using MR angiography. Transcranial Doppler monitoring of microembolic signals (MES) in the ipsilateral middle cerebral artery was performed during carotid endarterectomy. Results— Although none of the 46 patients with a nonvulnerable carotid plaque had MES during exposure of carotid arteries, 24 of the 54 patients with a vulnerable carotid plaque (44%) had MES. Logistic regression analysis showed that higher plaque intensity (P=0.0107) and higher WSS (P=0.0029) were significantly associated with the development of MES. When both cutoff points of plaque intensity and WSS in the receiver operating characteristic curves for predicting development of MES were combined, specificity (from 63% to 93%) and positive predictive value (from 66% to 90%) became greater than those for plaque intensity alone. Conclusions— In addition to carotid plaque intensity on T1-weighted MR imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy.
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Affiliation(s)
- Sotaro Oshida
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | - Futoshi Mori
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (F.M., M.S.), Iwate Medical University, Morioka, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (F.M., M.S.), Iwate Medical University, Morioka, Japan
| | - Yuiko Sato
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | | | - Kenji Yoshida
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
| | - Shunrou Fujiwara
- From the Department of Neurosurgery (S.O., Y.S., M.K., K.Y., S.F.)
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19
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Sui B, Gao P. High-resolution vessel wall magnetic resonance imaging of carotid and intracranial vessels. Acta Radiol 2019; 60:1329-1340. [PMID: 30727746 DOI: 10.1177/0284185119826538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Binbin Sui
- Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Radiology Department, Beijing Neurosurgical Institute, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Peiyi Gao
- Radiology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
- Radiology Department, Beijing Neurosurgical Institute, Beijing, PR China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
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20
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Yan L, Zhou X, Zheng Y, Luo W, Yang J, Zhou Y, He Y. Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases. Clinics (Sao Paulo) 2019; 74:e715. [PMID: 30864640 PMCID: PMC6438134 DOI: 10.6061/clinics/2019/e715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.
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Affiliation(s)
- Li Yan
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Xiaodong Zhou
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
- Corresponding author. E-mail:
| | - Yu Zheng
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Wen Luo
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China
| | - Junle Yang
- Department of CT & MRI, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Yin Zhou
- Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China
| | - Yang He
- Department of General Surgery, Xi'an Medical University, Xi'an, China
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21
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Kaczynski J, Home R, Shields K, Walters M, Whiteley W, Wardlaw J, Newby DE. Reproducibility of Transcranial Doppler ultrasound in the middle cerebral artery. Cardiovasc Ultrasound 2018; 16:15. [PMID: 30200977 PMCID: PMC6131943 DOI: 10.1186/s12947-018-0133-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcranial Doppler ultrasound remains the only imaging modality that is capable of real-time measurements of blood flow velocity and microembolic signals in the cerebral circulation. We here assessed the repeatability and reproducibility of transcranial Doppler ultrasound in healthy volunteers and patients with symptomatic carotid artery stenosis. METHODS Between March and August 2017, we recruited 20 healthy volunteers and 20 patients with symptomatic carotid artery stenosis. In a quiet temperature-controlled room, two 1-h transcranial Doppler measurements of blood flow velocities and microembolic signals were performed sequentially on the same day (within-day repeatability) and a third 7-14 days later (between-day reproducibility). Levels of agreement were assessed by interclass correlation co-efficient. RESULTS In healthy volunteers (31±9 years, 11 male), within-day repeatability of Doppler measurements were 0.880 (95% CI 0.726-0.950) for peak velocity, 0.867 (95% CI 0.700-0.945) for mean velocity, and 0.887 (95% CI 0.741-0.953) for end-diastolic velocity. Between-day reproducibility was similar but lower: 0.777 (95% CI 0.526-0.905), 0.795 (95% CI 0.558-0.913), and 0.674 (95% CI 0.349-0.856) respectively. In patients (72±11 years, 11 male), within-day repeatability of Doppler measurements were higher: 0.926 (95% CI 0.826-0.970) for peak velocity, 0.922 (95% CI 0.817-0.968) for mean velocity, and 0.868 (95% CI 0.701-0.945) for end-diastolic velocity. Similarly, between-day reproducibility revealed lower values: 0.800 (95% CI 0.567-0.915), 0.786 (95% CI 0.542-0.909), and 0.778 (95% CI 0.527-0.905) respectively. In both cohorts, the intra-observer Bland Altman analysis demonstrated acceptable mean measurement differences and limits of agreement between series of middle cerebral artery velocity measurements with very few outliers. In patients, the carotid stenoses were 30-40% (n = 9), 40-50% (n = 6), 50-70% (n = 3) and > 70% (n = 2). No spontaneous embolisation was detected in either of the groups. CONCLUSIONS Transcranial Doppler generates reproducible data regarding the middle cerebral artery velocities. However, larger studies are needed to validate its clinical applicability. TRIAL REGISTRATION ClinicalTrial.gov (ID NCT 03050567), retrospectively registered on 15/05/2017.
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Affiliation(s)
- Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Rachel Home
- College of Medicine and Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Karen Shields
- Stroke Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Matthew Walters
- College of Medical, Veterinary and Life Sciences, Wolfson Medical School Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - William Whiteley
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Joanna Wardlaw
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
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22
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Chen S, Zhao H, Li J, Zhou Z, Li R, Balu N, Yuan C, Chen H, Zhao X. Evaluation of carotid atherosclerotic plaque surface characteristics utilizing simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) technique. J Magn Reson Imaging 2018; 47:634-639. [PMID: 28766810 PMCID: PMC5796877 DOI: 10.1002/jmri.25815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) technique in identification of carotid plaque surface characteristics compared with the conventional multicontrast vessel wall imaging protocol. MATERIALS AND METHODS Thirty symptomatic patients with carotid plaque were recruited and underwent carotid artery magnetic resonance imaging (MRI) (3.0T) using a conventional multicontrast protocol and SNAP sequence. As an intrinsic multicontrast sequence, SNAP could generate a gray blood reference (Ref) image set, a black blood corrected real (CR) image set, and a bright blood MR angiography (MRA) image set. A bright blood SNAP Ref2 image was implemented by combining Ref and MRA images for facilitating plaque surface characteristics evaluation. The presence/absence of calcification (CA), juxtaluminal calcification (JCA), and ulceration was assessed. The agreement between SNAP and multicontrast vessel wall protocol in identifying CA, JCA, and ulceration was analyzed using Cohen's kappa analysis. The interreader and intrareader reproducibility of SNAP imaging in identifying plaque surface characteristics was also assessed. RESULTS Good to excellent agreement was found between SNAP and conventional multicontrast protocol in identifying CA (κ = 0.74, 95% confidence interval [CI]: 0.54-0.93), JCA (κ = 0.81, 95% CI: 0.66-0.97), and ulceration (κ = 0.82, 95% CI: 0.65-0.99). In addition, excellent intrareader and interreader reproducibility was found for SNAP imaging in identification of CA, JCA, and ulceration. CONCLUSION SNAP imaging showed excellent agreement with multicontrast imaging and high reproducibility in identification of both JCA and ulceration, suggesting that SNAP imaging may be a time-efficient, alternative tool in identification of plaque surface characteristics in carotid arteries. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:634-639.
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Affiliation(s)
- Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jifan Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Zechen Zhou
- Healthcare Department, Philips Research China, Shanghai, P.R. China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
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23
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Arias Lorza AM, van Engelen A, Petersen J, van der Lugt A, de Bruijne M. Maximization of regional probabilities using Optimal Surface Graphs: Application to carotid artery segmentation in MRI. Med Phys 2018; 45:1159-1169. [DOI: 10.1002/mp.12771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/21/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andres M. Arias Lorza
- Biomedical Imaging Group Rotterdam; Departments of Radiology and Medical Informatics; Erasmus MC; Rotterdam The Netherlands
| | - Arna van Engelen
- Biomedical Imaging Group Rotterdam; Departments of Radiology and Medical Informatics; Erasmus MC; Rotterdam The Netherlands
| | - Jens Petersen
- Department of Computer Science; University of Copenhagen; Copenhagen Denmark
| | | | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam; Departments of Radiology and Medical Informatics; Erasmus MC; Rotterdam The Netherlands
- Department of Computer Science; University of Copenhagen; Copenhagen Denmark
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24
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Cui H, Yan R, Zhai Z, Ren J, Li Z, Li Q, Wang S. Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis. Exp Ther Med 2018; 15:1654-1659. [PMID: 29434750 DOI: 10.3892/etm.2017.5548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to compare the diagnostic value of contrast-enhanced magnetic resonance angiography (CE MRA) with 3D time-resolved imaging of contrast kinetics, color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) in extracranial carotid stenosis (CS). A total of 54 patients with symptomatic CS were subjected to CDUS, CE MRA and DSA examination. Results of DSA were defined as the standard, and a total of 216 vessels were examined. In each patient four vessels were examined, namely the bilateral common carotid arteries and the bilateral internal carotid arteries. The sensitivities and specificities of CE MRA and CDUS for various degrees of CS were also determined. It was observed that the sensitivities to mild-level (1-49%), moderate-level (50-69%) and severe-level (70-99%) CS were 85.45, 100 and 100% for CE MRA, and 78.18, 50 and 100% for CDUS, respectively. The corresponding specificities were 95.27, 98.58 and 99.53% for CE MRA, and 79.05, 93.36 and 98.10% for CDUS, respectively. In addition, the carotid sinus plaque detection rate for CDUS was significantly higher than that of DSA and CE MRA (both P<0.001). Detection rates for common carotid artery plaques and internal carotid artery plaques did not significantly differ among the three examination methods (all P>0.05). These data demonstrate that CE MRA has higher sensitivity and specificity than CDUS for the diagnosis of CS, and that CDUS has a higher carotid sinus plaque detection rate than DSA and CE MRA. Therefore, the combination of MRI and CDUS may be a 'gold standard' diagnostic method for the detection of moderate and severe CS.
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Affiliation(s)
- Hongkai Cui
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Ruifang Yan
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zhansheng Zhai
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Jipeng Ren
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Zheng Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Qiang Li
- Center of Imaging, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, Henan 453100, P.R. China
| | - Shouying Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan 453000, P.R. China
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25
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Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
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Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
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26
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Smyth H, Byrne D, Hayden D, Kavanagh E, Murphy S. A cause of recurrent strokes: carotid webs detected by CT angiogram. BJR Case Rep 2018; 4:20170066. [PMID: 30363186 PMCID: PMC6159149 DOI: 10.1259/bjrcr.20170066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hannah Smyth
- Department of Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Danielle Byrne
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Derek Hayden
- Department of Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Department of Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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27
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Mitchell CC, Wilbrand SM, Kundu B, Steffel CN, Varghese T, Meshram NH, Li G, Cook TD, Salamat MS, Dempsey RJ. Transcranial Doppler and Microemboli Detection: Relationships to Symptomatic Status and Histopathology Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2017. [PMID: 28645797 PMCID: PMC5532746 DOI: 10.1016/j.ultrasmedbio.2017.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to determine the relationship between symptomatic status, transcranial Doppler (TCD) microemboli presence and plaque histopathology findings. TCD was performed on 60 patients (37 symptomatic, 23 asymptomatic) before undergoing clinically indicated carotid endarterectomy. The frequency of microemboli signals was not significantly different between symptomatic and asymptomatic subject groups (p = 0.88) and there were no differences observed in the macroscopic or histopathology scoring of these plaques (p-values all > 0.05). The presence of microemboli was associated with an ulceration score (regardless of symptomatic or asymptomatic status, p = 0.034), with a one-level increase in ulceration rating associated with an odds ratio of 5.86 (95% [CI] 1.55, 43.4). These findings suggest that both symptomatic and asymptomatic patients may have plaque with similar features of instability and ability to create emboli. Thus, identifying new ways to measure plaque instability may provide important information for optimizing treatment to prevent future stroke.
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Affiliation(s)
- Carol C Mitchell
- Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bornali Kundu
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catherine N Steffel
- Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Nirvedh H Meshram
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Geng Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Thomas D Cook
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M Shahriar Salamat
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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28
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Yuan J, Makris G, Patterson A, Usman A, Das T, Priest A, Teng Z, Hilborne S, Prudencio D, Gillard J, Graves M. Relationship between carotid plaque surface morphology and perfusion: a 3D DCE-MRI study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:191-199. [PMID: 28455630 PMCID: PMC5813060 DOI: 10.1007/s10334-017-0621-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/02/2022]
Abstract
Objective This study aims to explore the relationship between plaque surface morphology and neovascularization using a high temporal and spatial resolution 4D contrast-enhanced MRI/MRA sequence. Materials and methods Twenty one patients with either recent symptoms or a carotid artery stenosis ≥40% were recruited in this study. Plaque surface morphology and luminal stenosis were determined from the arterial phase MRA images. Carotid neovascularization was evaluated by a previously validated pharmacokinetic (PK) modeling approach. Ktrans (transfer constant) and vp (partial plasma volume) were calculated in both the adventitia and plaque. Results Image acquisition and analysis was successfully performed in 28 arteries. Mean luminal stenosis was 44% (range 11–82%). Both adventitial and plaque Ktrans in ulcerated/irregular plaques were significantly higher than smooth plaques (0.079 ± 0.018 vs. 0.064 ± 0.011 min−1, p = 0.02; 0.065 ± 0.013 vs. 0.055 ± 0.010 min−1, p = 0.03, respectively). Positive correlations between adventitial Ktrans and vp against stenosis were observed (r = 0.44, p = 0.02; r = 0.55, p = 0.01, respectively). Conclusion This study demonstrates the feasibility of using a single sequence to acquire both high resolution 4D CE-MRA and DCE-MRI to evaluate both plaque surface morphology and function. The results demonstrate significant relationships between lumen surface morphology and neovascularization.
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Affiliation(s)
- Jianmin Yuan
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - Gregory Makris
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Andrew Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ammara Usman
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Sarah Hilborne
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Dario Prudencio
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Martin Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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29
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Safouris A, Krogias C, Sharma VK, Katsanos AH, Faissner S, Roussopoulou A, Zompola C, Kneiphof J, Kargiotis O, Deftereos S, Giannopoulos G, Triantafyllou N, Voumvourakis K, Vadikolias K, Tsivgoulis G. Statin Pretreatment and Microembolic Signals in Large Artery Atherosclerosis. Arterioscler Thromb Vasc Biol 2017; 37:1415-1422. [PMID: 28450295 DOI: 10.1161/atvbaha.117.309292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although statin pretreatment (SP) is associated with better outcomes in patients with acute cerebral ischemia after an ischemic stroke/transient ischemic attack, data on the underlying mechanism of this beneficial effect are limited. APPROACH AND RESULTS We sought to evaluate the potential association between SP and microembolic signal (MES) burden in acute cerebral ischemia because of large artery atherosclerosis (LAA). We prospectively evaluated consecutive patients with first-ever acute cerebral ischemia because of LAA in 3 tertiary stroke centers over a 2-year period. All patients underwent continuous 1-hour transcranial Doppler monitoring of the relevant vessel at baseline (≤24 hours). SP was recorded and dichotomized as high dose or low-to-moderate dose. SP was documented in 43 (41%) of 106 LAA patients (mean age, 65.4±10.3 years; 72% men; low-to-moderate dose, 32%; high dose, 8%). There was a significant (P=0.022) dose-dependent effect between SP and MES prevalence: no SP (37%), SP with low-to-moderate dose (18%), and SP with high dose (0%). Similarly, a significant (P=0.045) dose-dependent effect was documented between SP and MES burden: no SP (1.1±1.8), SP with low-to-moderate dose (0.7±1.6), and SP with high dose (0±0). In multivariable logistic regression analysis adjusting for demographics, vascular risk factors, location of LAA, stroke severity, and other prevention therapies, SP was associated with lower likelihood of MES presence (odds ratio, 0.29; 95% confidence interval, 0.09-0.92; P=0.036). In addition, SP was found also to be independently related to higher odds of functional improvement (common odds ratio, 3.33; 95% confidence interval, 1.07-10.0; P=0.037). CONCLUSIONS We found that SP in patients with acute LAA is related with reduced MES presence and lower MES burden with an apparently dose-dependent association.
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Affiliation(s)
- Apostolos Safouris
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Christos Krogias
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Vijay K Sharma
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Aristeidis H Katsanos
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Simon Faissner
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Andromachi Roussopoulou
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Christina Zompola
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Janina Kneiphof
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Odysseas Kargiotis
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Spyridon Deftereos
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Georgios Giannopoulos
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Nikos Triantafyllou
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Konstantinos Voumvourakis
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Konstantinos Vadikolias
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.)
| | - Georgios Tsivgoulis
- From the Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (A.S., A.H.K., A.R., C.Z., K.V., G.T.); Acute Stroke Unit, Metropolitan Hospital, Pireus, Greece (A.S., O.K.); Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany (C.K., S.F., J.K.); Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.); Division of Neurology, National University Hospital, Singapore (V.K.S.); Department of Neurology, University Hospital of Ioannina, School of Medicine, University of Ioannina, Greece (A.H.K.); Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (S.D., G.G.); First Department of Neurology, University of Athens, School of Medicine, Eginition University Hospital, Greece (N.T.); and Department of Neurology, Alexandroupolis University Hospital, School of Medicine, Democritus University of Thrace, Greece (K.V.).
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Haq S, Mathur M, Singh J, Kaur N, Sibia RS, Badhan R. Colour Doppler Evaluation of Extracranial Carotid Artery in Patients Presenting with Acute Ischemic Stroke and Correlation with Various Risk Factors. J Clin Diagn Res 2017; 11:TC01-TC05. [PMID: 28511475 PMCID: PMC5427401 DOI: 10.7860/jcdr/2017/25493.9541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/18/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke. AIM To evaluate the role of carotid Doppler sonography in patients presenting with acute ischemic stroke and find association between carotid artery stenosis and risk factors such as diabetes mellitus, hypertension, hyperlipidemia, smoking and age. MATERIALS AND METHODS The present study was conducted on 50 patients. CT scan was done to diagnose acute ischemic stroke in patients who presented to emergency medicine with symptoms of acute ischemic stroke. Retrospectively CIMT and plaque characterization were done by gray scale ultrasound. Site and severity of stenosis were assessed on colour Doppler. All these findings were correlated with clinical presentation and risk factors. The collected data was statistically analyzed and multivariant logistic regression (R-value) test of significance was applied by using SPSS 16.0 version software. RESULTS On carotid Doppler, ICA/CCA PSV ratio was good predictor of stenosis and ratio above three indicates significant stenosis (>60%). Carotid bulb was most common location of plaque formation. Hypertension and diabetes were the most prevalent risk factors for cerebral ischemic stroke. Out of total 50 patients, 32 had hypertension (64%) and 22 had diabetes (44%). Hypertension and hyperlipidemia showed maximum mean R-values (0.275 and 0.048 respectively) and positive correlation with stenosis and increased CIMT in acute ischemic stroke patients. CONCLUSION The present study highlights the importance of Doppler sonography in acute ischemic stroke patients through surveillance of atherosclerosis.
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Affiliation(s)
- Samrin Haq
- Junior Resident, Department of Radiology, GMC, Patiala, Punjab, India
| | - Manoj Mathur
- Associate Professor, Department of Radiology, GMC, Patiala, Punjab, India
| | - Jasvir Singh
- Junior Resident, Department of Radiology, GMC, Patiala, Punjab, India
| | - Navkiran Kaur
- Associate Professor, Department of Medicine, GMC, Patiala, Punjab, India
| | | | - Rajesh Badhan
- Senior Resident, Department of Radiology, GMC, Patiala, Punjab, India
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Rafailidis V, Chryssogonidis I, Tegos T, Kouskouras K, Charitanti-Kouridou A. Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature. Insights Imaging 2017; 8:213-225. [PMID: 28160261 PMCID: PMC5359146 DOI: 10.1007/s13244-017-0543-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 02/01/2023] Open
Abstract
Abstract Carotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associated with the occurrence of neurologic symptoms. The delineation of the carotid plaque surface can be performed with virtually all imaging modalities including ultrasound, contrast-enhanced ultrasound, multi-detector computed tomography angiography, magnetic resonance angiography and the traditional reference method of angiography. These techniques have shown varying levels of diagnostic accuracy for the identification of ulcerated carotid plaques or plaque surface irregularities. As a consequence and given its high clinical significance, radiologists should be familiar with the various aspects of this entity, including its definition, classification, imaging findings on different imaging modalities and associations. The purpose of this review is to present the current literature regarding carotid plaque ulcerations and present illustrative images of ulcerated carotid plaques. Teaching Points • Plaque surface and ulceration represent risk factors for stroke in carotid disease. • Characterisation of the plaque surface and ulcerations can be performed with every modality. • US is the first-line modality for carotid disease and identification of ulcerations. • The administration of microbubbles increases US accuracy for diagnosis of carotid ulceration. • MDCTA and MRA are valuable for diagnosing ulceration and evaluating plaque composition.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hingwala DR, Chandrasekhakan K, Thomas B, Sylaja PN, Unnikrishnan M, Kapilamoorthy TR. Atherosclerotic Carotid Plaques: Multimodality Imaging with Contrast-enhanced Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. Ann Indian Acad Neurol 2017; 20:378-386. [PMID: 29184341 PMCID: PMC5682742 DOI: 10.4103/aian.aian_122_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The imaging of carotid plaques has undergone a paradigm shift increasing importance being given to plaque characterization. Patients with "vulnerable" plaques are more prone to develop future neurovascular events. Purpose The purpose of this study is to analyze the role of multimodality imaging techniques in the assessment of carotid atherosclerotic plaques. Materials and Methods Twenty-six patients were prospectively enrolled in the study. Patients underwent multidetector computed tomography (CT) angiography, ultrasound, contrast-enhanced ultrasound, and high-resolution magnetic resonance imaging (MRI) of the carotid arteries with special emphasis on the carotid bifurcation. Results The mean age of patients was 65.41 years. Twenty-one were males. Plaque neovascularization was seen in 10 of the 18 plaques studied (55.56%). Based on the predominant components of the plaque, plaques were characterized as lipid (3), lipid with recent hemorrhage (1), fibrous (7), fibrofatty (4), fibrofatty with some hemorrhagic components (3), and recent hemorrhage (2). Conclusions Together, contrast-enhanced ultrasound, CT, and MRI provide complete information about the plaque characteristics.
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Affiliation(s)
- Divyata R Hingwala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kesavadas Chandrasekhakan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M Unnikrishnan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - T R Kapilamoorthy
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Yuan J, Usman A, Das T, Patterson AJ, Gillard JH, Graves MJ. Imaging Carotid Atherosclerosis Plaque Ulceration: Comparison of Advanced Imaging Modalities and Recent Developments. AJNR Am J Neuroradiol 2016; 38:664-671. [PMID: 28007772 DOI: 10.3174/ajnr.a5026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Atherosclerosis remains the leading cause of long-term mortality and morbidity worldwide, despite remarkable advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary, and lower limb vessels. Carotid plaque ulceration is one of the key features associated with plaque vulnerability and is considered a notable indicator of previous plaque rupture and possible future cerebrovascular events. Multiple imaging modalities have been used to assess the degree of carotid plaque ulceration for diagnostic and research purposes. Early diagnosis and management of carotid artery disease could prevent further cerebrovascular events. In this review, we highlight the merits and limitations of various imaging techniques for identifying plaque ulceration.
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Affiliation(s)
- J Yuan
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - A Usman
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - T Das
- Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - A J Patterson
- Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - J H Gillard
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - M J Graves
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK.,Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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Wu XH, Chen XY, Fan YH, Leung TWH, Wong KS. High Extent of Intracranial Carotid Artery Calcification Is Associated with Downstream Microemboli in Stroke Patients. J Stroke Cerebrovasc Dis 2016; 26:442-447. [PMID: 27818028 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/07/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial arterial calcification (ICAC) is frequently detected on head computed tomography and has been found to be associated with ischemic stroke by recent clinical studies. AIMS Based on a hospital-based study, we aimed to compare the occurrence of cerebral microembolic signals (MES) among stroke patients with different degrees of ICAC, which may indicate the potential mechanisms linking ICAC and ischemic stroke in intracranial atherosclerosis patients. METHODS This is a post-hoc analysis of our previous clinical study in 2005-2007, recruiting consecutive ischemic stroke patients with middle cerebral artery territory infarctions and good temporal window for MES monitoring. The degrees of ICAC in the Circle of Willis, especially calcification in the ipsilateral intracranial internal carotid artery (iICA), were evaluated both qualitatively and quantitatively on unenhanced head computed tomography. RESULTS Among the 68 recruited patients, MES was detected in 26 patients (38.24%). The overall degree of ICAC in the Circle of Willis was similar between patients with and without MES. For calcification in ipsilateral iICA, the presence of MES was more frequent in the high extent group (widest arc of calcification ≥90°) than in the low extent group (54.2% versus 29.5%, P = .046). Logistic regression found that a high extent ipsilateral iICA calcification was an independent risk factor of MES (odds ratio: 3.134; 95% confidence interval, 1.029-9.543; P = .044). CONCLUSIONS MES is frequently detected in patients with a high extent of ipsilateral iICA calcification, which suggests that a high extent of iICA calcification indicates artery vulnerability and accounts for the occurrence of microemboli in the corresponding artery.
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Affiliation(s)
- Xiao-Hong Wu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiang-Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Yu-Hua Fan
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Thomas Wai-Hong Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka-Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
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Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy. Int J Mol Sci 2016; 17:ijms17111791. [PMID: 27801780 PMCID: PMC5133792 DOI: 10.3390/ijms17111791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.
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Axisa B, Naylor AR, London N, Bell PRF, Thompson MM. The Influence of Carotid Plaque Morphology on the Development of Cerebral Symptoms. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Large randomized trials such as the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have defined a role for carotid endarterectomy in symptomatic patients with severe carotid artery stenosis. Data from the same trials also shows that a subgroup of patients with less severe stenosis with a higher risk of stroke might benefit form carotid endarterectomy. In recent years, it has become apparent that besides the degree of stenosis, the morphology of the plaque itself plays a significant role in its potential for development of symptoms, and noninvasive methods of assessing plaque morphology are currently being developed. This paper reviews the literature regarding the relationship between carotid plaque morphology and the potential for development of clinical symptoms. Methods: A Medline search and a meta-analysis of the literature was carried out. Intraplaque hemorrhage and plaque ulceration were both found to be associated with a higher risk of stroke development (p = 0.001 and 0.0001, respectively). Intraluminal thrombus was not found to be associated with an increased risk of symptom development in the data analyzed. A possible explanation for this incongruous finding is discussed. In addition, the paper also discusses the role of noninvasive plaque characterization as a method of identifying unstable plaques in the future. Conclusion: Certain characteristics of plaque morphology correlate with a higher risk of development of symptoms and better noninvasive identification of plaque characterization will lead to better patient selection and may be especially useful identifying patients with lower degrees of stenosis but with potentially unstable plaques who might benefit from carotid endarterectomy but do not qualify for surgery using currently accepted criteria.
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Affiliation(s)
| | | | | | | | - M. M. Thompson
- Department of Surgery, Leicester Royal Infirmary, United Kingdom
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med 2016; 12:35-83. [PMID: 17451093 DOI: 10.1177/1358863x06076103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Irshad K, Millar S, Velu R, Reid AW, Diethrich EB, Reid DB. Virtual Histology Intravascular Ultrasound in Carotid Interventions. J Endovasc Ther 2016; 14:198-207. [PMID: 17488177 DOI: 10.1177/152660280701400212] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report early clinical experience with virtual histology intravascular ultrasound (VH IVUS) in carotid endoluminal repair. Technique: A 2.9-F, 20-MHz catheter that utilizes computer software to demonstrate the histological components of arteriosclerotic plaque was evaluated during carotid angioplasty and stenting. VH IVUS images were created following a pullback through the carotid stenosis and produced a color-coded map of the different histological constituents of the disease (dark green: fibrous, yellow/green: fibrofatty, white: calcified, and red: necrotic lipid core plaque). Conclusion: VH IVUS produces a color-coded map of the different histological components of artery plaque. It has the potential to predict how the plaque is likely to behave at the moment of endoluminal treatment.
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AbuRahma AF, Covelli MA, Robinson PA, Holt SM. The Role of Carotid Duplex Ultrasound in Evaluating Plaque Morphology: Potential Use in Selecting Patients for Carotid Stenting. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To study the role of duplex ultrasonography in evaluating plaque morphology and its correlation to neurological symptoms and cerebral infarctions on computed tomographic scans. Methods: The hospital records of 181 patients (107 males; average age 66 years, range 41 to 89) with > 50% carotid stenosis (29 bilateral lesions) who had undergone duplex ultrasonography, carotid arteriography, and cerebral computed tomography were studied retrospectively. Of 210 duplex examinations, 139 were appropriate for morphological analysis of surface characteristics and echogenicity. Results: Over half of the plaques examined had irregular surfaces (81, 58%) and displayed mixed (i.e., heterogeneous) echogenic patterns (74, 53%). Irregular (68 of 81, 84%) and heterogeneous (65 of 74, 88%) plaques were associated with ipsilateral neurological symptoms (p < 0.0001). Similarly, 44 (54%) of 81 irregular plaques and 42 (57%) of 74 heterogeneous plaques were found in patients with cerebral infarctions in the carotid territory (p < 0.0001). Conclusions: Heterogeneous and/or irregular plaques were more often associated with both neurological symptoms and infarctions than smooth or homogeneous plaques. These findings may have implications in patient selection for endoluminal therapy.
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Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity. Methods: The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity. Results: Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001). Conclusions: Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.
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Arias-Lorza AM, Petersen J, van Engelen A, Selwaness M, van der Lugt A, Niessen WJ, de Bruijne M. Carotid Artery Wall Segmentation in Multispectral MRI by Coupled Optimal Surface Graph Cuts. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:901-911. [PMID: 26595912 DOI: 10.1109/tmi.2015.2501751] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a new three-dimensional coupled optimal surface graph-cut algorithm to segment the wall of the carotid artery bifurcation from Magnetic Resonance (MR) images. The method combines the search for both inner and outer borders into a single graph cut and uses cost functions that integrate information from multiple sequences. Our approach requires manual localization of only three seed points indicating the start and end points of the segmentation in the internal, external, and common carotid artery. We performed a quantitative validation using images of 57 carotid arteries. Dice overlap of 0.86 ± 0.06 for the complete vessel and 0.89 ± 0.05 for the lumen compared to manual annotation were obtained. Reproducibility tests were performed in 60 scans acquired with an interval of 15 ± 9 days, showing good agreement between baseline and follow-up segmentations with intraclass correlations of 0.96 and 0.74 for the lumen and complete vessel volumes respectively.
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Sigala F, Savvari P, Liontos M, Sigalas P, Pateras IS, Papalampros A, Basdra EK, Kolettas E, Papavassiliou AG, Gorgoulis VG. Increased expression of bFGF is associated with carotid atherosclerotic plaques instability engaging the NF-κB pathway. J Cell Mol Med 2016; 14:2273-80. [PMID: 20455997 PMCID: PMC3822568 DOI: 10.1111/j.1582-4934.2010.01082.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Unstable atherosclerotic plaques of the carotid arteries are at great risk for the development of ischemic cerebrovascular events. The degradation of the extracellular matrix by matrix metalloproteinases (MMPs) and NO-induced apoptosis of vascular smooth muscle cells (VSMCs) contribute to the vulnerability of the atherosclerotic plaques. Basic fibroblast growth factor (bFGF) through its mitogenic and angiogenic properties has already been implicated in the pathogenesis of atherosclerosis. However, its role in plaque stability remains elusive. To address this issue, a panel of human carotid atherosclerotic plaques was analyzed for bFGF, FGF-receptors-1 and -2 (FGFR-1/-2), inducible nitric oxide synthase (iNOS) and MMP-9 expression. Our data revealed increased expression of bFGF and FGFR-1 in VSMCs of unstable plaques, implying the existence of an autocrine loop, which significantly correlated with high iNOS and MMP-9 levels. These results were recapitulated in vitro by treatment of VSMCs with bFGF. bFGF administration led to up-regulation of both iNOS and MMP-9 that was specifically mediated by nuclear factor-kappaB (NF-kappaB) activation. Collectively, our data demonstrate a novel NF-kappaB-mediated pathway linking bFGF with iNOS and MMP-9 expression that is associated with carotid plaque vulnerability.
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Affiliation(s)
- Fragiska Sigala
- Molecular Carcinogenesis Group, Laboratory of Histology and Embryology, Medical School, University of Athens, Athens, Greece
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Sato Y, Ogasawara K, Narumi S, Sasaki M, Saito A, Tsushima E, Namba T, Kobayashi M, Yoshida K, Terayama Y, Ogawa A. Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques. AJNR Am J Neuroradiol 2016; 37:1146-54. [PMID: 26846926 DOI: 10.3174/ajnr.a4674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy. MATERIALS AND METHODS Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity. RESULTS Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001). CONCLUSIONS Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid endarterectomy more accurately than other MR plaque imaging techniques.
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Affiliation(s)
- Y Sato
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Ogasawara
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - S Narumi
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - M Sasaki
- Division of Ultra-High Field MRI and Department of Radiology (M.S.), Iwate Medical University School of Medicine, Morioka, Japan
| | - A Saito
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - E Tsushima
- Graduate School of Health Sciences (E.T.), Hirosaki University, Hirosaki, Japan
| | - T Namba
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - M Kobayashi
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Yoshida
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - Y Terayama
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - A Ogawa
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
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Lu Z, Zhang Y, Maimaiti Y, Feng Y, Sun J, Zhuang J, Zeng L, Fu Y. Variants on Chromosome 9p21 Confer Risks of Noncardioembolic Cerebral Infarction and Carotid Plaque in the Chinese Han Population. J Atheroscler Thromb 2015; 22:1061-70. [PMID: 25958930 DOI: 10.5551/jat.28126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Considering that cerebral infarction (CI) may share a common etiological basis with coronary artery disease (CAD), we evaluated six CAD-related single-nucleotide polymorphisms (SNPs) on 9p21 for investigating the effect of 9p21 on CI or carotid plaque in the Chinese Han population. METHODS Altogether, 528 patients with noncardioembolic CI (375 with carotid plaque and 153 without carotid plaque) and 258 control subjects were genotyped. Six SNPs previously shown to be associated with CAD were sequenced and assessed for association with CI and carotid plaque using odds ratio (OR) and 95% confidence interval (CI) from logistic regression models. RESULTS The G allele frequencies of rs2383206 (OR=1.472, p=0.021) and rs4977574 (OR=1.519, p=0.013) significantly increased in patients with CI without carotid plaque compared with middle-aged patients in the control group. The CI risk was higher among the GG genotype carriers than among GA + AA genotype carriers (OR=1.794, 95% CI=1.059-3.039, p=0.030 for rs2383206; OR=1.866, 95% CI=1.088-3.201, p=0.023 for rs4977574). In comparison with the non-GG genotype, the GG genotype of rs2383206 and rs4977574 combined had a 1.733-fold greater risk of CI in the middle-aged group. SNPs rs2383206 and rs4977574 were also associated with a risk of carotid plaque among patients with CI aged > 65 years (OR=2.329, p=0.018 and OR=1.997, p=0.049, respectively). Moreover, six SNPs were strongly correlated with linkage disequilibrium. CONCLUSIONS Genetic variations of rs2383206 and rs4977574 on 9p21 are potentially associated with CI and carotid plaque in the Chinese Han population. Our results provide further evidence that the 9p21 region represents a major risk locus for cerebrovascular diseases.
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Affiliation(s)
- Zhongjiao Lu
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University
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Park JS, Kwak HS, Lee JM, Koh EJ, Chung GH, Hwang SB. Association of carotid intraplaque hemorrhage and territorial acute infarction in patients with acute neurological symptoms using carotid magnetization-prepared rapid acquisition with gradient-echo. J Korean Neurosurg Soc 2015; 57:94-9. [PMID: 25733989 PMCID: PMC4345200 DOI: 10.3340/jkns.2015.57.2.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 02/02/2023] Open
Abstract
Objective The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.
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Affiliation(s)
- Jung Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eun Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Gyung Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Müller HFG, Viaccoz A, Fisch L, Bonvin C, Lovblad KO, Ratib O, Lalive P, Pagano S, Vuilleumier N, Willi JP, Sztajzel R. 18FDG-PET-CT: an imaging biomarker of high-risk carotid plaques. Correlation to symptoms and microembolic signals. Stroke 2014; 45:3561-6. [PMID: 25370581 DOI: 10.1161/strokeaha.114.006488] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated whether uptake of (18)fluoro-2-deoxy-d-glucose (18FDG) positron emission tomography-computed tomography (PET-CT) correlated to clinical symptoms and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis. METHODS 18FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenoses. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the mean standardized uptake value of the jugular veins. End points for analysis were presence of symptoms and presence of MES. RESULTS We included 123 stenosis derived from 110 patients, 60 symptomatic and 63 asymptomatic. MES positive (+) lesions were found in 16%. TBR values were higher in symptomatic compared with asymptomatic (median 2.07 versus 1.78; P<0.0018) and in MES+ compared with MES- plaques (median 2.14 versus 1.86; P<0.008). TBR values were also higher in asymptomatic MES+ compared with MES- plaques (median 1.97 versus 1.76; P<0.03). The best TBR threshold value for symptomatic versus asymptomatic, for MES+ versus MES-, for symptomatic MES+ versus symptomatic or asymptomatic MES-, and for asymptomatic MES+ versus asymptomatic MES- plaques was 1.9. Sensitivity/specificity were, respectively, 56/77%, 73/63%, 79/64%, and 80/77%. We found a strong correlation between number of MES and TBR values (ρ 0.26; P=0.0043). CONCLUSIONS 18FDG-PET-CT accurately detected high-risk carotid plaques. Also given its strong correlation to MES, 18FDG-PET-CT may be a useful tool in clinical practice.
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Affiliation(s)
- Hubertus Fritz Georg Müller
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.).
| | - Aurélien Viaccoz
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Loraine Fisch
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Christophe Bonvin
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Karl-Olof Lovblad
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Osman Ratib
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Patrice Lalive
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Sabrina Pagano
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Nicolas Vuilleumier
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Jean-Pierre Willi
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
| | - Roman Sztajzel
- From the Department of Neurology (H.F.G.M., A.V., L.F., P.L., R.S.), Department of Neuroradiology (K.-O.L.), Department of Nuclear Medicine (O.R., J.-P.W.), and Department of Laboratory Medicine (S.P., N.V.), University Hospital of Geneva, Switzerland; and Department of Neurology, Hospital of Sion, Switzerland (C.B.)
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Grimm JM, Schindler A, Schwarz F, Cyran CC, Bayer-Karpinska A, Freilinger T, Yuan C, Linn J, Trelles M, Reiser MF, Nikolaou K, Saam T. Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques. J Cardiovasc Magn Reson 2014; 16:84. [PMID: 25315518 PMCID: PMC4189681 DOI: 10.1186/s12968-014-0084-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this prospective study was to perform a head-to-head comparison of the two methods most frequently used for evaluation of carotid plaque characteristics: Multi-detector Computed Tomography Angiography (MDCTA) and black-blood 3 T-cardiovascular magnetic resonance (bb-CMR) with respect to their ability to identify symptomatic carotid plaques. METHODS 22 stroke unit patients with unilateral symptomatic carotid disease and >50% stenosis by duplex ultrasound underwent MDCTA and bb-CMR (TOF, pre- and post-contrast fsT1w-, and fsT2w- sequences) within 15 days of symptom onset. Both symptomatic and contralateral asymptomatic sides were evaluated. By bb-CMR, plaque morphology, composition and prevalence of complicated AHA type VI lesions (AHA-LT6) were evaluated. By MDCTA, plaque type (non-calcified, mixed, calcified), plaque density in HU and presence of ulceration and/or thrombus were evaluated. Sensitivity (SE), specificity (SP), positive and negative predictive value (PPV, NPV) were calculated using a 2-by-2-table. RESULTS To distinguish between symptomatic and asymptomatic plaques AHA-LT6 was the best CMR variable and presence / absence of plaque ulceration was the best CT variable, resulting in a SE, SP, PPV and NPV of 80%, 80%, 80% and 80% for AHA-LT6 as assessed by bb-CMR and 40%, 95%, 89% and 61% for plaque ulceration as assessed by MDCTA. The combined SE, SP, PPV and NPV of bb-CMR and MDCTA was 85%, 75%, 77% and 83%, respectively. CONCLUSIONS Bb-CMR is superior to MDCTA at identifying symptomatic carotid plaques, while MDCTA offers high specificity at the cost of low sensitivity. Results were only slightly improved over bb-CMR alone when combining both techniques.
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Affiliation(s)
- Jochen M Grimm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
- Department of Medical Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Florian Schwarz
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Freilinger
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle, USA.
| | - Jennifer Linn
- Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Miguel Trelles
- Department of Radiology, University of Texas Medical Branch, Galveston, USA.
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
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Saksi J, Ijäs P, Mäyränpää MI, Nuotio K, Isoviita PM, Tuimala J, Lehtonen-Smeds E, Kaste M, Jula A, Sinisalo J, Nieminen MS, Lokki ML, Perola M, Havulinna AS, Salomaa V, Kettunen J, Jauhiainen M, Kovanen PT, Lindsberg PJ. Low-expression variant of fatty acid-binding protein 4 favors reduced manifestations of atherosclerotic disease and increased plaque stability. ACTA ACUST UNITED AC 2014; 7:588-98. [PMID: 25122052 DOI: 10.1161/circgenetics.113.000499] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatty acid-binding protein 4 (FABP4 or aP2 in mice) has been identified as a key regulator of core aspects of cardiometabolic disorders, including lipotoxic endoplasmic reticulum stress in macrophages. A functional promoter polymorphism (rs77878271) of human FABP4 gene has been described resulting in reduced FABP4 transcription. METHODS AND RESULTS We investigated the effects of this low-expression variant of FABP4 on cardiovascular morbidity and carotid atherosclerosis on a population level (n=7491) and in patient cohorts representing endarterectomized patients with advanced carotid atherosclerosis (n=92) and myocardial infarction (n=3432). We found that the low-expression variant was associated with decreased total cholesterol levels (P=0.006) with the largest reduction in variant allele homozygotes. Obese variant allele carriers also showed reduced carotid intima-media thickness (P=0.010) and lower prevalence of carotid plaques (P=0.060). Consistently, the variant allele homozygotes showed 8-fold lower odds for myocardial infarction (P=0.019; odds ratio, 0.12; 95% confidence interval, 0.003-0.801). Within the carotid plaques, the variant allele was associated with a 3.8-fold reduction in FABP4 transcription (P=0.049) and 2.7-fold reduction in apoptosis (activated caspase 3; P=0.043). Furthermore, the variant allele was enriched to patients with asymptomatic carotid stenosis (P=0.038). High FABP4 expression in the carotid plaques was associated with lipid accumulation, intraplaque hemorrhages, plaque ulcerations, and phosphoactivated endoplasmic reticulum stress markers. CONCLUSIONS Our results reveal FABP4 rs77878271 as a novel variant affecting serum total cholesterol levels and cardiovascular risk. A therapeutic regimen reducing FABP4 expression within the atherosclerotic plaque may promote lesion stability through modulation of endoplasmic reticulum stress signaling, and attenuation of apoptosis, lipid burden, and inflammation.
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Affiliation(s)
- Jani Saksi
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.).
| | - Petra Ijäs
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Mikko I Mäyränpää
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Krista Nuotio
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Pia M Isoviita
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Jarno Tuimala
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Erno Lehtonen-Smeds
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Markku Kaste
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Antti Jula
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Juha Sinisalo
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Markku S Nieminen
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Marja-Liisa Lokki
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Markus Perola
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Aki S Havulinna
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Veikko Salomaa
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Johannes Kettunen
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Matti Jauhiainen
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Petri T Kovanen
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
| | - Perttu J Lindsberg
- From the Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland (J.S., P.I., K.N., P.M.I., P.J.L.); HUSLAB, Division of Pathology (M.I.M.), Division of Cardiology, Department of Medicine (J.S., M.S.N.), Department of Neurology (P.I., K.N., M.K., P.J.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Pathology (M.I.M.), Transplantation Laboratory (M.-L.L.), Haartman Institute, Helsinki University, Helsinki, Finland; Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland (M.P., J.K.); Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (P.J.L.); Finnish Red Cross Blood Service, Helsinki, Finland (J.T.); Wihuri Research Institute, Helsinki, Finland (E.L.-S., P.T.K.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (A.J.); Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (A.J., M.P., A.S.H., V.S., J.K., M.J.); and The Estonian Genome Center, University of Tartu, Tartu, Estonia (M.P.)
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Saba L, Anzidei M, Piga M, Ciolina F, Mannelli L, Catalano C, Suri JS, Raz E. Multi-modal CT scanning in the evaluation of cerebrovascular disease patients. Cardiovasc Diagn Ther 2014; 4:245-62. [PMID: 25009794 DOI: 10.3978/j.issn.2223-3652.2014.06.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/07/2014] [Indexed: 11/14/2022]
Abstract
Ischemic stroke currently represents one of the leading causes of severe disability and mortality in the Western World. Until now, angiography was the most used imaging technique for the detection of the extra-cranial and intracranial vessel pathology. Currently, however, non-invasive imaging tool like ultrasound (US), magnetic resonance (MR) and computed tomography (CT) have proven capable of offering a detailed analysis of the vascular system. CT in particular represents an advanced system to explore the pathology of carotid arteries and intracranial vessels and also offers tools like CT perfusion (CTP) that provides valuable information of the brain's vascular physiology by increasing the stroke diagnostic. In this review, our purpose is to discuss stroke risk prediction and detection using CT.
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Affiliation(s)
- Luca Saba
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Michele Anzidei
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Mario Piga
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Federica Ciolina
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Lorenzo Mannelli
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Carlo Catalano
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Jasjit S Suri
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
| | - Eytan Raz
- 1 Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari) 09045, Italy ; 2 Departments of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 (Rome), Italy ; 3 Department of Radiology, University of Washington, Seattle, Washington, USA ; 4 Fellow AIMBE, CTO, AtheroPoint LLC, Roseville, CA, USA ; 5 Department of Biomedical Engineering, Idaho State University (Aff.), ID, USA ; 6 Department of Radiology, New York University School of Medicine, New York, USA ; 7 Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy
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Gunduz Y, Akdemir R, Ayhan LT, Keser N. Can Doppler flow parameters of carotid stenosis predict the occurrence of new ischemic brain lesions detected by diffusion-weighted MR imaging after filter-protected internal carotid artery stenting? AJNR Am J Neuroradiol 2014; 35:760-5. [PMID: 24651818 DOI: 10.3174/ajnr.a3904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid angioplasty and stent placement are increasingly being used for the treatment of symptomatic and asymptomatic carotid artery disease. Carotid angioplasty and stent placement carry an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on diffusion-weighted imaging after protected carotid angioplasty and stent placement and to determine the association of new lesions with ICA Doppler flow parameters. MATERIALS AND METHODS Fifty-two patients (mean age, 68 ± 11 years) with 50%-69% (n = 20, group 1) and ≥70% (n = 32, group 2) internal carotid artery stenosis underwent carotid angioplasty and stent placement with distal filter protection. DWI was performed before and 48 hours after carotid angioplasty and stent placement. RESULTS Thirty-three (63.4%) patients showed new lesions. The average number of new postprocedural lesions was 3.4 per patient. Most of the postprocedural lesions were <5 mm (range, 3-23 mm), cortical and corticosubcortical, and clinically silent. Group 2 had a significantly higher number of new lesions compared with group 1 (P < .001). A significant relationship was found between ICA Doppler flow parameters and the appearance of new lesions. CONCLUSIONS The appearance of new ischemic lesions was significantly related to the Doppler flow parameters, particularly peak systolic velocity.
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Affiliation(s)
- Y Gunduz
- From the Departments of Radiology (Y.G., L.T.A.)
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