1
|
Qureshi AI, Lodhi A, Ma X, Ahmed R, Kwok CS, Maqsood H, Liaqat J, Hassan AE, Siddiq F, Gomez CR, Suri MFK. Self-expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta-analysis. J Neuroimaging 2024; 34:295-307. [PMID: 38225680 DOI: 10.1111/jon.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND AND PURPOSE There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. METHODS We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity of postprocedure stenosis, technical success, 30-day stroke and/or death, cumulative clinical endpoints, and restenosis rates. RESULTS A total of 20 studies were included. The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30-day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50-0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow-up were nonsignificantly lower (OR 0.64, 95% CI: 0.30-1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow-up were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = .004, 13 studies involving 1115 patients) with BES. CONCLUSIONS Compared with SES, BES were associated with lower rates of postprocedure 30-day stroke and/or death with lower rates of restenosis during follow up and the treatment of symptomatic intracranial arterial stenosis.
Collapse
Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Abdullah Lodhi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Xiaoyu Ma
- Department of Biostatistics, University of Missouri, Columbia, Missouri, USA
| | - Rehan Ahmed
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Chun Shing Kwok
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Hamza Maqsood
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Jahanzeb Liaqat
- Department of Neurology, Pak Emirates Military Hospital Rawalpindi, Rawalpindi, Pakistan
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - M Fareed K Suri
- Stroke Program, St. Cloud Hospital, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Lu T, Zou Y, Jiang T, Yang Y, Wu A, Chen H, Kang Z, Lin X, Fang Y, Lu Z. Intracranial Artery Injury in HIV-negative Tuberculous Meningitis : A High-Resolution Vessel Wall Imaging Study. Clin Neuroradiol 2019; 30:381-388. [PMID: 31053877 DOI: 10.1007/s00062-019-00766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The features of intracranial arterial injury in tuberculous meningitis (TBM) are of important diagnostic and prognostic value. The study aimed to elucidate the high-resolution vessel wall imaging (HR-VWI) manifestations of intracranial arterial insults in TBM. METHODS The clinical data, routine cranial magnetic resonance imaging, magnetic resonance angiography (MRA) and HR-VWI before and after contrast enhancement of intracranial arteries in clinically diagnosed TBM patients were retrospectively analyzed. RESULTS In this study 27 TBM patients were included. Abnormalities in the intracranial arteries were detected in all patients using HR-VWI. Typical vessel insults included nodular or granular lesions, related thickness and prominent enhancement in the wall, and lumen narrowing or occlusion. The most frequently involved arteries were the C4 segment of the internal carotid artery and the P1 segment of the posterior cerebral artery. The lesions were consistent with disease stage and disease duration and correlated with infarction. CONCLUSION The use of HR-VWI revealed that cerebral artery involvement in patients with TBM is much more common and extensive than in previous radiological reports. The use of HR-VWI improves recognition of arterial pathologies and has diagnostic value in patients with TBM.
Collapse
Affiliation(s)
- Tingting Lu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Zou
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ting Jiang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Yang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Aimin Wu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yimin Fang
- Guangzhou Chest Hospital, Guangzhou, China.
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
3
|
Jann K, Hauf M, Kellner Weldon F, El Koussy M, Kiefer C, Federspiel A, Schroth G. Implication of cerebral circulation time in intracranial stenosis measured by digital subtraction angiography on cerebral blood flow estimation measured by arterial spin labeling. Diagn Interv Radiol 2017; 22:481-8. [PMID: 27411297 DOI: 10.5152/dir.2016.15204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) magnetic resonance imaging to assess cerebral blood flow (CBF) is of increasing interest in basic research and in diagnostic applications, since ASL provides similar information to positron emission tomography about perfusion in vascular territories. However, in patients with steno-occlusive arterial disease (SOAD), CBF as measured by ASL might be underestimated due to delayed bolus arrival, and thus increased spin relaxation. We aimed to estimate the extent to which bolus arrival time (BAT) was delayed in patients with SOAD and whether this resulted in underestimation of CBF. METHODS BAT was measured using digital subtraction angiography (DSA) in ten patients with high-grade stenosis of the middle carotid artery (MCA). Regional CBF was assessed with pseudocontinuous ASL. RESULTS BATs were nonsignificantly prolonged in the stenotic hemisphere 4.1±2.0 s compared with the healthy hemisphere 3.3±0.9 s; however, there were substantial individual differences on the stenotic side. CBF in the anterior and posterior MCA territories were significantly reduced on the stenotic hemisphere. Severe stenosis was correlated with longer BAT and lower quantified CBF. CONCLUSION ASL-based perfusion measurement involves a race between the decay of the spins and the delivery of labeled blood to the region of interest. Special caution is needed when interpreting CBF values quantified in individuals with altered blood flow and delayed circulation times. However, from a clinician's point of view, an accentuation of hypoperfusion (even if caused by underestimation of CBF due to prolonged BATs) might be desirable since it indexes potentially harmful physiologic deficits.
Collapse
Affiliation(s)
- Kay Jann
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry and University of Bern, Bern, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
4
|
Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery for Refractory Symptomatic Intracranial Atherosclerotic Stenosis. World Neurosurg 2017; 104:74-81. [PMID: 28434956 DOI: 10.1016/j.wneu.2017.04.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate blood flow changes after bypass surgery for refractory symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS We examined a cohort of consecutive patients with symptomatic ICAS. Superficial temporal artery-middle cerebral artery (MCA) bypass was performed in refractory patients with poor perfusion. Angiograms were graded systematically for antegrade, collateral, and bypass flow, and clinical variables were collected preoperatively, at 7 days postoperatively, and 3, 6, and 12 months postoperatively. RESULTS Among 185 consecutive cases with ICAS, 15 patients who were unsuitable for or did not respond to the best medical therapy or stenting underwent bypass surgery. No patients had new ischemic deficits within 7 days postoperatively. The mean follow-up period was 30.2 ± 12.3 months. Within this period, all anastomoses were patent by methods of ultrasound or computed tomography angiography. In 2 patients, stenotic lesions exhibited early postoperative occlusion conversion at 7 days on digital subtraction angiography. In 2 patients, stenotic lesions showed progression of occlusion at 6 and 8 months. The 2 lesions with early occlusion were both located in the MCA. The extent of retrograde blood flow via bypass anastomosis was correlated with early occlusion conversion. CONCLUSIONS For refractory ICAS in patients with compromised hemodynamics, direct bypass might induce early occlusion of a stenotic area. MCA lesions may have a greater tendency toward early occlusion conversion.
Collapse
|
5
|
Hwang YH, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of Target Arterial Residual Stenosis on Outcome After Endovascular Revascularization. Stroke 2016; 47:1850-7. [PMID: 27174525 DOI: 10.1161/strokeaha.116.013046] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute intracranial occlusion can be associated with in situ thrombo-occlusion in relation to preexisting intracranial atherosclerotic disease. We aimed to assess residual stenosis at the site of a target arterial lesion (TAL) to determine whether residual stenosis at the TAL is associated with underlying intracranial atherosclerotic disease. METHODS One hundred and sixty-three patients who underwent endovascular therapy for M1 middle cerebral artery occlusion and achieved angiographic reperfusion were selected for analysis. The presence of residual stenosis at the TAL was classified using the Arterial Occlusive Lesion (AOL) scale at postprocedural angiography, and the severity of stenosis was grouped into none, mild (<50%), moderate (50%-69%), severe (70%-99%), and occlusion on postprocedural and follow-up angiography. We also recorded the incidence of instant reocclusion occurring during the procedure and delayed reocclusion detected on follow-up angiography. RESULTS Seventy-four patients (45.5%) showed target arterial residual stenosis (AOL 2). As to the TAL pathogenesis, 40 patients were classified into in situ thrombo-occlusion (54.1% of AOL 2 and 24.5% of M1 occlusion). The occurrence of instant or delayed reocclusion was independently associated with a low chance of favorable 3-month outcome. Furthermore, the occurrence of delayed reocclusion was associated with excellent pretreatment collateral flow and early neurological worsening, but not the severity of residual stenosis at the TAL. CONCLUSIONS In population with a high prevalence of intracranial atherosclerotic disease, residual stenosis may be attributed to in situ thrombo-occlusion with underlying intracranial atherosclerotic disease in ≈25% of cases, hindering functional recovery via the occurrence of instant or delayed reocclusion.
Collapse
Affiliation(s)
- Yang-Ha Hwang
- From the Department of Neurology (Y.-H.H., Y.-W.K.), Department of Neurosurgery (D.-H.K.), Department of Radiology (Y.-W.K., D.-H.K., Y.-S.K.), and Cerebrovascular Center (Y.-H.H., Y.-W.K., D.-H.K., Y.-S.K.), Kyungpook National University School of Medicine and Hospital, Daegu, South Korea; and UCLA Stroke Center (D.S.L.), University of California, Los Angeles
| | - Yong-Won Kim
- From the Department of Neurology (Y.-H.H., Y.-W.K.), Department of Neurosurgery (D.-H.K.), Department of Radiology (Y.-W.K., D.-H.K., Y.-S.K.), and Cerebrovascular Center (Y.-H.H., Y.-W.K., D.-H.K., Y.-S.K.), Kyungpook National University School of Medicine and Hospital, Daegu, South Korea; and UCLA Stroke Center (D.S.L.), University of California, Los Angeles
| | - Dong-Hun Kang
- From the Department of Neurology (Y.-H.H., Y.-W.K.), Department of Neurosurgery (D.-H.K.), Department of Radiology (Y.-W.K., D.-H.K., Y.-S.K.), and Cerebrovascular Center (Y.-H.H., Y.-W.K., D.-H.K., Y.-S.K.), Kyungpook National University School of Medicine and Hospital, Daegu, South Korea; and UCLA Stroke Center (D.S.L.), University of California, Los Angeles
| | - Yong-Sun Kim
- From the Department of Neurology (Y.-H.H., Y.-W.K.), Department of Neurosurgery (D.-H.K.), Department of Radiology (Y.-W.K., D.-H.K., Y.-S.K.), and Cerebrovascular Center (Y.-H.H., Y.-W.K., D.-H.K., Y.-S.K.), Kyungpook National University School of Medicine and Hospital, Daegu, South Korea; and UCLA Stroke Center (D.S.L.), University of California, Los Angeles
| | - David S Liebeskind
- From the Department of Neurology (Y.-H.H., Y.-W.K.), Department of Neurosurgery (D.-H.K.), Department of Radiology (Y.-W.K., D.-H.K., Y.-S.K.), and Cerebrovascular Center (Y.-H.H., Y.-W.K., D.-H.K., Y.-S.K.), Kyungpook National University School of Medicine and Hospital, Daegu, South Korea; and UCLA Stroke Center (D.S.L.), University of California, Los Angeles.
| |
Collapse
|
6
|
Han X, Ouyang L, Zhang C, Ma H, Qin J. Relationship between deep medullary veins in susceptibility-weighted imaging and ipsilateral cerebrovascular reactivity of middle cerebral artery in patients with ischemic stroke. Exp Ther Med 2016; 11:2217-2220. [PMID: 27284303 PMCID: PMC4887931 DOI: 10.3892/etm.2016.3198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/28/2016] [Indexed: 12/01/2022] Open
Abstract
Deep cerebral veins have been recently associated with the severity of hemodynamic impairment in moyamoya disease. The aim of the current study was to determine the correlation of deep medullary veins (DMVs) in susceptibility-weighted imaging (SWI) with ipsilateral cerebrovascular reactivity (CVR) of and anterior cecebrocervical artery stenosis in patients with ischemic stroke. Patients with unilateral TIA or infarction who underwent 3.0 T magnetic resonance imaging SWI, digital subtraction angiography and transcranial Doppler with CO2 stimulation within the first 7 days of hospitalization were retrospectively selected. CVR and stenosis of anterior cerebrocervical arteries were compared between different DMVs stages in symptomatic hemispheres (SHs) and asymptomatic hemispheres (AHs). A total of 61 patients were subsequently included in the present study. A univariate analysis was conducted and results for age (PAHs=0.004, PSHs=0.006), hypertension (PAHs=0.008, PSHs=0.020), current smoking (PAHs=0.006, PSHs=0.021), CVR (PAHs=0.000, PSHs=0.000), and artery stenosis (PAHs=0.000, PSHs=0.000) were obtained. The results suggested statistically significant differences between DMVs grades in SHs and AHs. A subsequent multivariate analysis revealed that CVR (ORAHs=0.925, 95% CIAHs: 0.873–0.981; ORSHs=0.945, 95% CISHs: 0.896–0.996), and artery stenosis (ORAH=3.147, 95% CIAH: 1.010–9.806; ORSHs=2.882, 95% CISHs: 1.017–8.166) were independent risk factors of DMVs. In conclusion, 3.0 T SWI was useful in detecting the DMVs around the lateral ventricle in patients with atherosclerotic ischemic stroke. CVR and stenosis of anterior cerebrocervical arteries were independent risk factors for ipsilateral DMVs in SHs and AHs.
Collapse
Affiliation(s)
- Xianjun Han
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Linhui Ouyang
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Chunning Zhang
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Hailing Ma
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Jingcui Qin
- Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| |
Collapse
|
7
|
Umemura T, Kawamura T, Mashita S, Kameyama T, Sobue G. Higher Levels of Cystatin C Are Associated with Extracranial Carotid Artery Steno-Occlusive Disease in Patients with Noncardioembolic Ischemic Stroke. Cerebrovasc Dis Extra 2016; 6:1-11. [PMID: 26997949 PMCID: PMC4772640 DOI: 10.1159/000443338] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 12/09/2015] [Indexed: 11/26/2022] Open
Abstract
Background Large artery atherosclerosis is a major cause of ischemic stroke worldwide. Differential biomarker profiles associated with extra- and intracranial atherosclerosis are a topic of considerable interest. Cystatin C (CysC), a marker of renal function, is a risk factor for cardiovascular disease. Aim We sought to determine whether CysC levels were associated with extra- and intracranial large artery stenosis (LAS) in patients with acute ischemic stroke. Methods We retrospectively analyzed data of acute noncardioembolic ischemic stroke patients who were admitted to our stroke center within 5 days from symptom onset. Serum CysC levels were measured using latex agglutination turbidimetric immunoassay. Extra- and intracranial LAS were defined as ≥50% diameter stenosis or occlusion of the relevant internal carotid artery (ICA) and/or middle cerebral artery (MCA) using carotid echography and volume rendering on magnetic resonance angiography. Multivariate logistic analyses were used to assess the association between CysC levels and LAS after adjustment for potential confounders. Results Of 205 patients (mean age 70.2 years), 76 (37.1%) had LAS. The distribution of LAS was 29 extracranial ICA, 34 intracranial ICA/MCA (8 ICA only, 25 MCA only, 1 ICA+MCA) and 13 tandem stenosis (both extracranial ICA and intracranial ICA/MCA). Levels of CysC were higher in patients with extracranial ICA stenosis than in those with intracranial ICA/MCA stenosis (1.23 ± 0.33 vs. 0.97 ± 0.21 mg/l, p < 0.001). In multivariate analysis, the highest CysC tertile (>1.04 mg/l) was significantly associated with extracranial ICA stenosis (adjusted odds ratio [OR] 5.01, 95% confidence interval [CI] 1.51-16.63, p = 0.009) after adjustment for age, sex, diabetes, chronic kidney disease, current smoking, systolic blood pressure, HDL cholesterol, high-sensitivity C-reactive protein (hs-CRP) and premorbid lipid-lowering drugs use. When CysC was considered as a continuous variable, 1 SD increase in CysC was significantly associated with extracranial ICA stenosis (adjusted OR 3.01, 95% CI 1.58-5.72, p = 0.001). However, there were no significant associations between CysC levels and intracranial ICA/MCA stenosis. In addition, CysC levels showed a weak but statistically significant correlation with hs-CRP levels (r = 0.195, p = 0.021). Using receiver operating characteristic curve analysis, CysC value displayed good performance in discriminating extracranial ICA stenosis (c-statistic 0.79, 95% CI 0.69-0.89, p < 0.001). Conclusions This preliminary study suggests that higher levels of CysC were independently associated with symptomatic extracranial ICA stenosis, but not with intracranial ICA/MCA stenosis in patients with noncardioembolic stroke. Our findings provide new insights into the link between serum CysC and carotid atherosclerosis.
Collapse
Affiliation(s)
| | - Takahiko Kawamura
- Department of Diabetes and Endocrine Internal Medicine, Preventive Medical Center, Nagoya, Japan
| | | | - Takashi Kameyama
- Department of Neurology, Preventive Medical Center, Nagoya, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
8
|
Ma N, Xu Z, Mo D, Gao F, Gao K, Sun X, Xu X, Liu L, Song L, Wang T, Zhao X, Wang Y, Wang Y, Miao Z. Safety of low-dose aspirin in endovascular treatment for intracranial atherosclerotic stenosis. PLoS One 2014; 9:e105252. [PMID: 25144449 PMCID: PMC4140744 DOI: 10.1371/journal.pone.0105252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/22/2014] [Indexed: 11/20/2022] Open
Abstract
Objectives To evaluate the safety of low-dose aspirin plus clopidogrel versus high-dose aspirin plus clopidogrel in prevention of vascular risk within 90 days of duration of dual antiplatelet therapy in patients treated with intracranial endovascular treatment. Methods From January 2012 to December 2013, this prospective and observational study enrolled 370 patients with symptomatic intracranial atherosclerotic stenosis of ≥70% with poor collateral undergoing intracranial endovascular treatment. Antiplatelet therapy consists of aspirin, at a low-dose of 100 mg or high-dose of 300 mg daily; clopidogrel, at a dose of 75 mg daily for 5 days before endovascular treatment. The dual antiplatelet therapy continued for 90 days after intervention. The study endpoints include acute thrombosis, subacute thrombosis, stroke or death within 90 days after intervention. Results Two hundred and seventy three patients received low-dose aspirin plus clopidogrel and 97 patients received high-dose aspirin plus clopidogrel before intracranial endovascular treatment. Within 90 days after intervention, there were 4 patients (1.5%) with acute thrombosis, 5 patients (1.8%) with subacute thrombosis, 17 patients (6.2%) with stroke, and 2 death (0.7%) in low-dose aspirin group, compared with no patient (0%) with acute thrombosis, 2 patient (2.1%) with subacute thrombosis, 6 patients (6.2%) with stroke, and 2 death (2.1%) in high-dose aspirin group, and there were no significant difference in all study endpoints between two groups. Conclusion Low-dose aspirin plus clopidogrel is comparative in safety with high-dose aspirin plus clopidogrel within 90 days of duration of dual antiplatelet therapy in patients treated with intracranial endovascular treatment.
Collapse
Affiliation(s)
- Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziqi Xu
- Department of Neurology, the First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lian Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tiejun Wang
- Department of Neurology, the Daxing District Hospital of Beijing, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
| |
Collapse
|
9
|
Cai Q, Li Y, Xu G, Sun W, Xiong Y, Sun W, Bao Y, Huang X, Zhang Y, Zhou L, Zhu W, Liu X. Learning curve for intracranial angioplasty and stenting in single center. Catheter Cardiovasc Interv 2013; 83:E94-100. [PMID: 23729240 DOI: 10.1002/ccd.25038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 05/15/2013] [Accepted: 05/19/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Qiankun Cai
- Department of Neurology, Jinling Hospital; Southern Medical University; Nanjing Jiangsu China
| | - Yongkun Li
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
- Department of Neurology; Provincial Clinical Department of Fujian Medical University; Fuzhou Fujian China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital; Southern Medical University; Nanjing Jiangsu China
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Wen Sun
- Department of Neurology, Jinling Hospital; Southern Medical University; Nanjing Jiangsu China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Wenshan Sun
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Yuanfei Bao
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Xianjun Huang
- Department of Neurology; Yijishan Hospital, Wannan Medical College; Wuhu Anhui China
| | - Yao Zhang
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Lulu Zhou
- Department of Neurology, Jinling Hospital; Southern Medical University; Nanjing Jiangsu China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital; Southern Medical University; Nanjing Jiangsu China
- Department of Neurology, Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| |
Collapse
|
10
|
Seo KD, Lee KO, Choi YC, Kim WJ, Lee KY. Fluid-attenuated inversion recovery hyperintense vessels in posterior cerebral artery infarction. Cerebrovasc Dis Extra 2013; 3:46-54. [PMID: 24052794 PMCID: PMC3776708 DOI: 10.1159/000350459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are known to reflect stagnant or slow blood flow within the cerebral artery. FHVs are frequently observed in patients with acute cerebral infarction accompanied by arterial occlusion or significant stenosis of the anterior cerebral circulation. However, FHVs have not been studied in the context of posterior cerebral circulation. Thus, we investigated the prevalence of FHVs and its clinical significance in patients with acute posterior cerebral artery (PCA) territory infarction. Methods In this retrospective study, consecutive patients with PCA territory infarction who underwent MRI within 1 week after symptom onset were enrolled. Two neurologists who were blinded to the angiographic findings read the images and determined the presence of FHVs. Afterwards, FHVs were graded according to the extent (subtle or prominent) and location (proximal or distal) of the hyperintense vessels. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) upon admission and after 5 days. The clinical outcome between patient groups based on FHVs grading was compared using the NIHSS. Among the patients with PCA occlusion, infarction volume on the diffusion-weighted image was compared between the two groups with and without distal FHVs. Results FHVs were observed in 25 of the 87 patients (28.7%) with PCA territory infarction and in 65.7% of the 35 patients with significant arterial stenosis (10 patients) or occlusion (25 patients) in the posterior cerebral circulation. Among the 18 patients with PCA occlusion, the NIHSS score was significantly improved in patients with distal FHVs compared to the others (2.00 ± 2.18 vs. 0.56 ± 1.01, p = 0.04). The infarction volume was smaller in the distal FHV group than in the others (8.3 ± 8.7 vs. 16.8 ± 17.6 ml), but the difference was not statistically significant. Conclusions FHVs are detected in patients with PCA territory infarction, especially in those with an occlusive lesion in the PCA. FHVs can be used as an imaging marker of PCA occlusion. Although this study showed a better clinical improvement in patients with distal FHVs, further study is needed to elucidate the clinical meaning of FHVs in PCA infarction.
Collapse
Affiliation(s)
- Kwon-Duk Seo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Daejeon, Korea
| | | | | | | | | |
Collapse
|
11
|
Liu X, Xiong Y, Zhou Z, Niu G, Wang W, Xiao G, Lin M, Leung TW, Liu D, Liu W, Fan X, Yin Q, Zhu W, Ma M, Zhang R, Xu G. China Interventional Stroke Registry: Rationale and Study Design. Cerebrovasc Dis 2013; 35:349-54. [DOI: 10.1159/000350210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/25/2013] [Indexed: 11/19/2022] Open
|
12
|
Acute intracranial in-stent thrombosis after angioplasty of middle cerebral artery symptomatic stenosis: a case report. Neurologist 2012; 18:290-5. [PMID: 22931736 DOI: 10.1097/nrl.0b013e318266f5ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intracranial atherosclerotic disease is one of the major risk factors of ischemic stroke. Percutaneous transluminal angioplasty with stent deployment may be effective for the treatment of symptomatic intracranial stenosis, however its value is yet to be determined. High possibility of serious periprocedural complications, such as acute in-stent thrombosis or stroke, narrows the current recommendations for this treatment to patients with high-grade stenosis (>70%), and to experienced neurointerventional centers. CASE REPORT We present a 44-year-old male with symptomatic high-grade stenosis of the M1 segment of left middle cerebral artery, treated with percutaneous transluminal angioplasty with stenting. The procedure was complicated with acute in-stent thrombosis treated with intra-arterial thrombolysis, which resulted in a nondisabling stroke. CONCLUSIONS The procedure-related stroke in this patient was probably caused by middle cerebral artery perforator ostium occlusion with balloon predilatation and transient in-stent thrombosis related to insufficient antiplatelet pretreatment. Exhausted cerebrovascular reserve due to long-lasting high-grade intracranial stenosis should also be considered as a factor contributing to ischemic complications.
Collapse
|
13
|
Qureshi AI. Interpretation and implications of the prematurely terminated Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in the Intracranial Stenosis (SAMMPRIS) trial. Neurosurgery 2012; 70:E264-8. [PMID: 21964627 DOI: 10.1227/neu.0b013e318239f318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
14
|
Abstract
This article outlines the roles of the anesthesiologist in the management of patients undergoing invasive endovascular procedures to treat vascular diseases, primarily of the central nervous system. This practice is usually termed interventional neuroradiology or endovascular neurosurgery. The article emphasizes perioperative and anesthetic management strategies to prevent complications and minimize their effects if they occur. Planning the anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems.
Collapse
|
15
|
Value of imaging lenticulostriate arteries before middle cerebral artery stenting for the prevention of perforator stroke. Neuroradiology 2012; 55:57-64. [PMID: 22777193 DOI: 10.1007/s00234-012-1064-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In this study, we investigated whether pre-procedural imaging of LSAs would potentially be helpful for preventing LSAs from being covered. METHODS We retrospectively evaluated the LSAs of 15 consecutive patients who underwent revascularization for symptomatic middle cerebral artery (MCA) stenosis. All patients underwent two- (2D) and three-dimensional (3D) digital subtraction angiography. RESULTS We found that 46.7 (7/15), 40 (6/15), and 13.3 % (2/15) of patients had stenotic lesions in the proximal, middle, and distal third of the M1 segment, respectively. There was a total of 32 LSAs that originated from the lesioned MCAs. Seven (21.9 %), 10 (31.3 %), 11 (34.4 %), and 4 (12.5 %) LSAs originated from the proximal third of the M1 segment, middle third of the M1 segment, distal third of the M1 segment, and starting segment of the superior M2 segment, respectively. Sixteen (76.2 %) of 22 LSAs in 13 patients were covered by stents. It would have been possible to avoid covering 43.8 % (7/16) of these LSAs with stents if they had been evaluated before stenting, and the stents had been accurately deployed. Among 16 LSAs which were covered by stent, only one (6.25 %) was occluded after coverage. CONCLUSION Our data suggest that evaluation of LSAs during MCA stenting would be potentially helpful for preventing LSAs from being covered and subsequently occluded by stents.
Collapse
|
16
|
Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent: procedural safety, efficacy and mid-term patency. Clin Neuroradiol 2012; 22:227-33. [PMID: 22252289 PMCID: PMC3432207 DOI: 10.1007/s00062-011-0125-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/16/2011] [Indexed: 11/20/2022]
Abstract
Purpose Procedural safety and high rates of in-stent recurrent stenotic lesions (ISR) remain a concern in the endovascular treatment of intracranial atherosclerotic disease (ICAD). In the present study technical feasibility, safety and efficacy of the paclitaxel eluting balloon-expandable coronary stent Coroflex® Please was assessed in the treatment of ICAD. Methods A total of 95 patients (79 male; median age 68 years) with 106 intracranial atherosclerotic stenotic lesions underwent endovascular treatment using Coroflex® Please stents (B. Braun, Melsungen, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Post-procedural medication included 100 mg acetylsalicylic acid (ASA) and 75 mg clopidogrel for 1 year. Angiographic follow-up was scheduled for 6, 12, 26 and 52 weeks after the treatment. Results The lesion locations were as follows: internal carotid artery (ICA) petrous (n = 44, 42%), ICA cavernous (n = 43, 41%), ICA paraclinoid (n = 4, 4%), intradural vertebral artery (VA; n = 11, 10%) and basilar artery (BA; n = 4, 4%). Of the lesions seven could not be treated due to difficult anatomy and stent stiffness (7% technical failure rate). The combined post-interventional neurological morbidity and mortality rate, including stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and carotid cavernous fistula (CCF) was n = 4 (3.7%) within and n = 1 (0.9%) at and beyond 30 days, respectively. Angiographic and clinical follow-up examinations were carried out for 78 (78%) of the lesions (mean 16.1 months, maximum 48 months). Asymptomatic recurrent stenosis was seen in 3 out of 78 (3.8%) lesions and there was 1 case of late stent thrombosis (0.9%). Conclusions Treatment of ICAD using drug-eluting coronary stents is safe and effective but technical failure due to stent stiffness remains a problem. Application of the more flexible, newest generation thin-strut stents, however, shows promising results.
Collapse
|
17
|
Qureshi AI, Al-Senani FM, Husain S, Janjua NA, Lanzino G, Lavados PM, Nguyen T, Raymond J, Shah QA, Suarez JI, Suri MFK, Tolun R. Intracranial Angioplasty and Stent Placement After Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial: Present State and Future Considerations⋆. J Neuroimaging 2012; 22:1-13. [DOI: 10.1111/j.1552-6569.2011.00685.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
18
|
Ansari S, McConnell DJ, Velat GJ, Waters MF, Levy EI, Hoh BL, Mocco J. Intracranial stents for treatment of acute ischemic stroke: evolution and current status. World Neurosurg 2012; 76:S24-34. [PMID: 22182268 DOI: 10.1016/j.wneu.2011.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 02/07/2011] [Accepted: 02/12/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Intravascular stents have been applied to treat a variety of pathophysiologic conditions. With advances in stent design and delivery, stenting has become a viable treatment option in neurovascular disease. Recently, intracranial arterial stenting has received increasing interest as a modality to rapidly and effectively recanalize affected vessels in the setting of acute ischemic stroke. METHODS To examine the potential of stenting procedures for stroke, we compiled and analyzed relevant experimental and clinical studies in the available databases. RESULTS Our resulting discussion covers the brief history of stents, from their initial inception in the 1960s, to the developments of interventional cardiology, and finally to the treatment of acute occlusions of the neurovasculature. We also detail technological advances that have improved stent delivery to intracranial arteries and review the several clinical studies that feature stenting for the treatment of acute ischemic stroke. CONCLUSION Numerous clinical studies have revealed that stents are a quick and efficacious endovascular tool for acute ischemic stroke treatment. It appears likely that issues regarding design, safety, and feasibility of stent-based devices will experience further improvement and refinement, and from fruitful criticism of existing technologies and techniques, along with lessons from past mistakes, will arise safer and more effective devices.
Collapse
Affiliation(s)
- Saeed Ansari
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Hussein HM, Georgiadis AL, Qureshi AI. Point-of-care testing for anticoagulation monitoring in neuroendovascular procedures. AJNR Am J Neuroradiol 2011; 33:1211-20. [PMID: 21920856 DOI: 10.3174/ajnr.a2621] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
POC testing is defined as diagnostic testing at or near the site of patient care. Rapid measurement of the intensity of anticoagulation and, more recently, platelet inhibition allows dose titration of adjuvant medications such a heparin and antiplatelet agents during neuroendovascular procedures. However, knowledge among practicing physicians regarding the pathophysiologic basis of these measurements and variations in knowledge about the differences among devices is often limited. This review discusses the role of anticoagulation in endovascular procedures and the currently available POC tests for anticoagulation monitoring.
Collapse
Affiliation(s)
- H M Hussein
- Department of Neurology, Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA.
| | | | | |
Collapse
|
20
|
Tang CW, Chang FC, Chern CM, Lee YC, Hu HH, Lee IH. Stenting versus medical treatment for severe symptomatic intracranial stenosis. AJNR Am J Neuroradiol 2011; 32:911-6. [PMID: 21393399 DOI: 10.3174/ajnr.a2409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is especially prevalent in Asians, but intracranial stent placement and medical treatment for severe intracranial stenosis are controversial. Thus, we compared long-term outcomes of these 2 therapeutic approaches in an Asian population. MATERIALS AND METHODS Patients with angiographically proved severe (≥70%) symptomatic intracranial atherosclerosis, with or without stent placement, were retrospectively reviewed at a single center between 2002 and 2009, with adjustments for age, sex, vascular risk factors, degree of baseline stenosis, and baseline functional status. RESULTS Of the 114 patients followed from 3 to 36 months (mean, 17.3 months) after initial diagnosis, 53 received 56 stents in addition to medical treatment (stent-placement group), and 61 matched patients received only medical treatment (medical group). Total clinical events, including stroke, TIA, and vascular death, were 12 (22.6%) and 15 (24.6%) in the stent-placement and medical groups, respectively (P = .99). The stent-placement group had significantly better functional outcomes than the medical group (94.3% versus 78.7% for mRS scores of 0-3, P = .045). Most events in the stent-placement group occurred within the first week of the periprocedural period (17.0%) as minor embolic or perforator infarctions, and the rate of events decreased thereafter (5.7%, P = .07). Stent placement over the perforator-rich MCA and BA independently predicted periprocedural events on multivariate regression analysis. In the medical group, events increased in frequency (21.7%) and severity with time. CONCLUSIONS Although the total ischemic event rate was similar in the 2 groups during a 3-year follow-up, the stent-placement group had a more favorable functional outcome despite minor periprocedural strokes.
Collapse
Affiliation(s)
- C-W Tang
- Department of Neurology, Suao Veterans Hospital, Yilan County, Taiwan
| | | | | | | | | | | |
Collapse
|
21
|
Rhoney DH. Contemporary Management of Transient Ischemic Attack: Role of the Pharmacist. Pharmacotherapy 2011; 31:193-213. [DOI: 10.1592/phco.31.2.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
22
|
Liu W, Xu G, Yue X, Wang X, Ma M, Zhang R, Wang H, Zhou C, Liu X. Hyperintense vessels on FLAIR: a useful non-invasive method for assessing intracerebral collaterals. Eur J Radiol 2010; 80:786-91. [PMID: 21067881 DOI: 10.1016/j.ejrad.2010.09.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 09/27/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study was aimed to evaluate relationship between hyperintense vessels (HV) on fluid-attenuated inversion recovery (FLAIR) and artery steno-occlusion related intracerebral collaterals. MATERIALS AND METHODS A total of 233 patients with 260 atherosclerotic lesions in the M1 segment of the middle cerebral artery (MCA) were examined with FLAIR and digital subtraction angiography (DSA). HV were graded as 0, 1, 2 and 3 by its distributions in the MCA territory. Grade 0 indicated no HV; Grade 1 indicated the HV limited in Sylvian fissure; Grade 2 indicated the HV limited in Sylvian fissure and the temporal-occipital junction; Grade 3 indicated the HV extended to frontal-parietal lobes. Collateral blood flows were classified by DSA results. The relationship between HV grades and patterns of collateral flows was analyzed. RESULTS HV were observed in 76 out of 260 hemispheres. For patients with Grade 1 HV, most of their collateral flows (80.8%) were antegrade; for patients with Grade 2, the retrograde leptomeningeal flows were commonly manifested as anterior cerebral artery to MCA (75%); for patients with Grade 3 HV, most of the retrograde leptomeningeal flows were manifested as posterior cerebral artery to MCA (81.8%). As the grade HV increased, the frequency of retrograde leptomeningeal collateral from ACA to MCA decreased (100% to 75% and to 18.2%), and increased (0% to 25% and to 81.8%) for the retrograde leptomeningeal collateral via PCA to MCA (P<0.001). CONCLUSIONS The HV could assess non-invasively intracerebral collaterals in patients with steno-occlusive lesions of M1 segment of MCA.
Collapse
Affiliation(s)
- Wenhua Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, 210002 Nanjing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- Matthew J. Gounis
- From the Department of Radiology and New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Mass
| | - Michael J. De Leo
- From the Department of Radiology and New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Mass
| | - Ajay K. Wakhloo
- From the Department of Radiology and New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Mass
| |
Collapse
|
24
|
Vajda Z, Miloslavski E, Güthe T, Schmid E, Schul C, Albes G, Henkes H. Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency. Neuroradiology 2009; 52:645-51. [PMID: 19921164 DOI: 10.1007/s00234-009-0615-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/07/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Zsolt Vajda
- Klinik für Neuroradiologie, Katharinenhospital-Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | | | | | | | | | | | | |
Collapse
|
25
|
Recanalization Results After Intracranial Stenting of Atherosclerotic Stenoses. Cardiovasc Intervent Radiol 2009; 33:914-20. [DOI: 10.1007/s00270-009-9744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
|
26
|
Marazziti D, Golia F, Picchetti M, Pioli E, Mannari P, Lenzi F, Conversano C, Carmassi C, Catena Dell'Osso M, Consoli G, Baroni S, Giannaccini G, Zanda G, Dell'Osso L. Decreased density of the platelet serotonin transporter in pathological gamblers. Neuropsychobiology 2008; 57:38-43. [PMID: 18451636 DOI: 10.1159/000129665] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Accepted: 01/22/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate the serotonin transporter (SERT), by means of the 3H-paroxetine ([3H]-Par) binding to platelet membranes, in patients affected by pathological gambling (PG), as compared with a similar group of healthy control subjects. METHODS Seventeen PG patients were selected amongst those who were drug-free and at the first psychiatric interview in a Department of Addiction. The diagnosis was assessed according to DSM-IV criteria and PG severity was measured by means of the South Oaks Gambling Screen. The platelet [3H]-Par binding was carried out according to a standardized method. The binding parameters, the maximum binding capacity (B(max)) and the dissociation constant (K(d)), were obtained by means of the Scatchard analysis. RESULTS The B(max) values of PG patients were significantly lower than that of healthy subjects, while the K(d) values were not different in the two groups. No significant effect of age, sex or psychiatric comorbidity on B(max) or K(d) was observed; there were also no correlations between clinical and biological variables. CONCLUSIONS PG patients showed a dysfunction at the level of the platelet SERT that would suggest the involvement of the 5-HT system in this condition.
Collapse
Affiliation(s)
- Donatella Marazziti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|