1
|
Yuan C, Miller Z, Zhao XQ. Magnetic Resonance Imaging: Cardiovascular Applications for Clinical Trials. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
2
|
Gomez JR, Hobbs KS, Johnson LL, Vu QD, Bennett J, Tegeler C, Wolfe SQ, Sarwal A. The Clinical Contribution of Neurovascular Ultrasonography in Acute Ischemic Stroke. J Neuroimaging 2020; 30:867-874. [PMID: 32857913 DOI: 10.1111/jon.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with acute ischemic stroke receive computed tomography angiogram (CTA) and digital subtraction angiogram (DSA) for clinical evaluation. Current guidelines lack in defining indications for transcranial Doppler (TCD) and/or carotid duplex ultrasonography (CUS) in acute stroke evaluation or follow-up cerebrovascular imaging after reperfusion. We investigated the clinical utility of performing additional TCD/CUS after reperfusion in guiding postacute care stroke management. METHODS Retrospective review of acute ischemic stroke patients admitted to a comprehensive stroke center with CTA head and neck and/or DSA followed by TCD/CUS. Cases were reviewed by two authors to determine if TCD/CUS provided additional diagnostic information to aid management. A nominal group process, using a third author, achieved consensus in cases of disagreements. RESULTS Only 25 of 198 patients had CTA or DSA followed by TCD/CUS. Ten (40%) cases showed new clinical information from CUS aiding management. Of those with TCD, 5 patients (22.7%) had findings that impacted management. These clinical scenarios included detection of mobile thrombus requiring anticoagulation; distinguishing carotid near-occlusion from occlusion; confirming hemodynamic significance of intra/extracranial stenosis helping emergent stenting/endarterectomy; detecting hyperperfusion on TCDs causing symptoms; and establishing chronicity of carotid stenosis based on collateral flow patterns, which deferred further intervention. DISCUSSION Our experience shows that TCD/CUS may offer additional diagnostic information assisting postacute care management in small subset of patients with acute ischemic stroke. Larger studies are needed to research the clinical impact and cost-effectiveness of additional imaging and inform clinical guidelines for selecting patients who will benefit from these additional studies.
Collapse
Affiliation(s)
- Jonathan R Gomez
- Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD
| | - Kyle S Hobbs
- Neurocritical Care Section, Intermountain Medical Center, Salt Lake City, UT
| | - Leilani L Johnson
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Quang D Vu
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - John Bennett
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles Tegeler
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
3
|
Kim S, Kwak HS, Hwang SB, Chung GH. Dynamic change of carotid intraplaque hemorrhage volume in subjects with mild carotid stenosis. Eur J Radiol 2018; 105:15-19. [PMID: 30017272 DOI: 10.1016/j.ejrad.2018.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/16/2018] [Accepted: 05/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of intraplaque hemorrhage (IPH) in the carotid artery is important as it is correlated with an increased risk of cerebral ischemic events. We examined changes in IPH with magnetic resonance imaging (MRI) over an extended follow-up period in patients with mild carotid stenosis. MATERIALS AND METHODS From November 2013 to November 2015, we retrospectively reviewed cerebral MRI of 2036 patients, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequences obtained with a 3.0 T (T) MRI unit. An experienced neuroradiologist reviewed all studies and found 38 patients with carotid IPH and carotid stenosis that were categorized as mild (<30%), according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Twenty-five patients agreed to join this study and signed informed consent for (MPRAGE) sequence imaging. We used semi-automated software to measure IPH volume on both the initial and follow up scans. RESULTS The median follow-up time of patients with mild carotid stenosis and IPH was 33.3 months. IPH volume increased in 10 of 27 carotid arteries (37.0%), with a mean volume increase of 42.6 ± 44.0 mm3. IPH volume decreased in 17 of 27 carotid arteries (63%), with a mean volume decrease of 17.2 ± 22.8 mm3. Two patients without IPH at baseline showed IPH development on follow-up imaging. There were no significant differences in patient demographics between the two groups. CONCLUSIONS Carotid IPH volume in subjects with mild carotid stenosis can change over time and may not be correlated with any typical patient demographics.
Collapse
Affiliation(s)
- Sangheon Kim
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
| | - Hyo Sung Kwak
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea.
| | - Seung Bae Hwang
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
| | - Gyung-Ho Chung
- Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea
| |
Collapse
|
4
|
de Haro J, Rodriguez-Padilla J, Bleda S, Cañibano C, Michel I, Acin F. Carotid stenting with proximal cerebral protection in symptomatic low-grade vulnerable recurrent carotid stenosis. Ther Adv Chronic Dis 2018; 9:125-133. [PMID: 29854374 DOI: 10.1177/2040622318765727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
Background Although the management of carotid disease is well established for symptomatic lesions ⩾70%, carotid revascularization for symptomatic low-grade (⩽50%) stenosis is not actually supported by data from randomized clinical trials. Such patients may occasionally have recurrent neurological symptoms despite optimal medical treatment owing to vulnerable plaques. In such cases, carotid artery stenting (CAS) may represent an option for treatment but this has not been tested in clinical trials. This study analyzed early and long-term outcomes of CAS performed in patients with low-grade symptomatic recurrent carotid stenosis. Methods From a prospective registry of 322 carotid revascularization in symptomatic patients, 21 consecutive patients with low-grade symptomatic recurrent carotid stenosis who underwent CAS with proximal cerebral protection device Mo.Ma, after ruling out any other source of cerebral embolization, were involved in the study.All patients had suggestive evidence of unstable plaque or plaque ulceration. Results Procedural technical success rate was 100%. No 30-day stroke or death occurred, and no patients had recurrent neurological events related to the revascularized hemisphere during follow up. No 30-day local complications were reported. No late carotid occlusions were detected. There was one late death, and no stroke-related deaths. Survival rates were 100% at 1 year and 96% at 3 years. Conclusions This study shows that CAS is a well-tolerated, effective and durable treatment for patients with recurrent symptomatic low-grade carotid stenosis associated with a vulnerable plaque. Patients had excellent protection against further ischemic events and survived long enough.
Collapse
Affiliation(s)
- Joaquin de Haro
- Angiology and Vascular Surgery Department of Getafe University Hospital, Getafe, Madrid, Spain
| | | | - Silvia Bleda
- Vascular Surgery and Angiology Department, Hospital Universitario Getafe, Ctra Toledo Km 12,500, 28905 Madrid, Spain
| | - Cristina Cañibano
- Angiology and Vascular Surgery Department of Getafe University Hospital, Getafe, Madrid, Spain
| | - Ignacio Michel
- Angiology and Vascular Surgery Department of Getafe University Hospital, Getafe, Madrid, Spain
| | - Francisco Acin
- Angiology and Vascular Surgery Department of Getafe University Hospital, Getafe, Madrid, Spain
| |
Collapse
|
5
|
Skowronska M, Piorkowska A, Czlonkowska A. Differences in carotid artery atherosclerosis between men and women in the early phase after ischemic event. Neurol Neurochir Pol 2018; 52:162-167. [PMID: 28965666 DOI: 10.1016/j.pjnns.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Marta Skowronska
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland.
| | - Anna Piorkowska
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland.
| | - Anna Czlonkowska
- Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland.
| |
Collapse
|
6
|
Bulwa Z, Gupta A. Embolic stroke of undetermined source: The role of the nonstenotic carotid plaque. J Neurol Sci 2017; 382:49-52. [DOI: 10.1016/j.jns.2017.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
|
7
|
Konishi T, Funayama N, Yamamoto T, Morita T, Hotta D, Nomura R, Nakagaki Y, Murahashi T, Kamiyama K, Yoshimoto T, Aoki T, Nishihara H, Tanaka S. Pathological Quantification of Carotid Artery Plaque Instability in Patients Undergoing Carotid Endarterectomy. Circ J 2017; 82:258-266. [PMID: 28757518 DOI: 10.1253/circj.cj-17-0204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Unstable atherosclerotic carotid plaques cause cerebral thromboemboli and ischemic events. However, this instability has not been pathologically quantified, so we sought to quantify it in patients undergoing carotid endarterectomy (CEA).Methods and Results:Carotid plaques were collected during CEA from 67 symptomatic and 15 asymptomatic patients between May 2015 and August 2016. The specimens were stained with hematoxylin-eosin and elastica-Masson. Immunohistochemistry was performed using an endothelial-specific antibody to CD31, CD34 and PDGFRβ. The histopathological characteristics of the plaques were studied. By multiple-variable logistic regression analysis, plaque instability correlated with the presence of plaque rupture [odds ratio (OR), 9.75; P=0.013], minimum fibrous cap thickness (OR per 10 μm 0.70; P=0.025), presence of microcalcifications in the fibrous cap (OR 7.82; P=0.022) and intraplaque microvessels (OR 1.91; P=0.043). Receiver-operating characteristics analyses showed that these factors combined into a single score diagnosed symptomatic carotid plaques in patients with carotid artery stenosis with a high level of accuracy (area under the curve 0.92; 95% confidence interval 0.85-0.99 vs. asymptomatic). CONCLUSIONS This analysis of carotid plaque instability strongly suggested that the diagnostic scoring of carotid plaque instability improves the understanding and treatment of carotid artery disease in patients undergoing CEA.
Collapse
Affiliation(s)
- Takao Konishi
- Department of Cardiology, Hokkaido Cardiovascular Hospital.,Department of Cancer Pathology, Hokkaido University School of Medicine
| | | | | | - Tohru Morita
- Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Ryota Nomura
- Department of Neurosurgery, Nakamura Memorial Hospital
| | | | | | | | | | - Takeshi Aoki
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital
| | - Hiroshi Nishihara
- Department of Cancer Pathology, Hokkaido University School of Medicine
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University School of Medicine
| |
Collapse
|
8
|
Reynoso E, Rodriguez-Granillo GA, Capunay C, Deviggiano A, Meli F, Carrascosa P. Spectral Signal Density of Carotid Plaque Using Dual-Energy Computed Tomography. J Neuroimaging 2017; 27:511-516. [DOI: 10.1111/jon.12440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Exequiel Reynoso
- Department of Neuroradiology; Diagnóstico Maipú; Buenos Aires Argentina
| | | | - Carlos Capunay
- Department of Cardiovascular Imaging; Diagnóstico Maipú; Buenos Aires Argentina
| | | | - Francisco Meli
- Department of Neuroradiology; Diagnóstico Maipú; Buenos Aires Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging; Diagnóstico Maipú; Buenos Aires Argentina
| |
Collapse
|
9
|
Radu RA, Terecoasă EO, Băjenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand? Clin Neurol Neurosurg 2017; 159:93-106. [PMID: 28609703 DOI: 10.1016/j.clineuro.2017.05.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/06/2017] [Accepted: 05/18/2017] [Indexed: 12/25/2022]
Abstract
Despite major technological advances in ischemic stroke diagnostic techniques, our current understanding of stroke mechanisms and etiology continues to remain unclear in a significant percent of patients. As a result, several etiological ischemic stroke classifications have emerged during the last two decades but their reliability and validity is far from perfect and further world-wide research is needed in order to achieve the so much needed "standard reference language". An ideal ischemic stroke classification should both comprise all underlying pathologies that could potentially concur to an index event and emphasize the most likely etiological and pathophysiological mechanism. Currently available approaches to ischemic stroke classification are either phenotypic or causative in nature, a multitude of criteria being published by different authors. Phenotypic classifications are targeted towards describing the concurring underlying pathologies, without highlighting the most probable ischemic stroke etiology, while causative classifications focus on establishing the most likely cause, neglecting other associated diseases. A judicious use of this two different concepts might improve clinical research as well as daily clinical practice.
Collapse
Affiliation(s)
- Răzvan Alexandru Radu
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania
| | - Elena Oana Terecoasă
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Ovidiu Alexandru Băjenaru
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Tiu
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|