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Li L, Yang B, Dmytriw AA, Li Y, Gong H, Bai X, Zhang C, Chen J, Dong J, Wang Y, Gao P, Wang T, Luo J, Xu X, Feng Y, Zhang X, Yang R, Ma Y, Jiao L. Correlations between intravascular pressure gradients and cerebral blood flow in patients with symptomatic, medically refractory, anterior circulation artery stenosis: an exploratory study. J Neurointerv Surg 2024; 16:608-614. [PMID: 37402573 DOI: 10.1136/jnis-2023-020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Fractional flow reserve is widely used in coronary disease management, with a threshold of 0.80. However, similar thresholds are unclear in functional assessment of intracranial atherosclerotic stenosis (ICAS). OBJECTIVE To investigate the potential threshold values in functional assessment of ICAS by studying the relation between pressure-derived indexes and perfusion parameters derived from arterial spin labeling (ASL). METHODS Patients were consecutively screened between June 2019 and December 2020. The translesional gradient indices were measured by pressure guidewire under resting-state conditions and recorded as mean distal/proximal pressure ratios (Pd/Pa) and translesional pressure difference (Pa-Pd). Preoperative and postoperative cerebral blood flow (CBF) bilaterally and the relative cerebral blood flow ratio (rCBF) were measured and recorded by ASL imaging. Patients were defined as having reversible hemodynamic insufficiency only if the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Preoperative and postoperative Pd/Pa or Pa-Pd values of those patients were used to calculate the threshold. RESULTS Twenty-five patients (19 men, 6 women) with a mean age of 56.7±9.4 years were analyzed. Seventeen patients (68%) had lesions at the M1 segment of the middle cerebral artery, eight patients (32%) had lesions in the intracranial internal carotid artery. In 14 of the 25 patients, the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Cut-off values of Pd/Pa=0.81 and Pa-Pd=8 mm Hg were suggested to be associated with hemodynamic insufficiency. CONCLUSIONS In a highly selected subgroup with ICAS, cut-off values of translesional pressure gradients (Pd/Pa=0.81 or Pa-Pd=8 mm Hg) were preliminarily established, which may facilitate clinical decision-making in the management of ICAS.
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Affiliation(s)
- Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yanling Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, Beijing, China
| | - Haozhi Gong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Chao Zhang
- Neuroendovascular Program, Beijing Escope Technology Inc, Beijing, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jia Dong
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Peng Gao
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
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Gao F, Tong X, Jia B, Yang M, Pan Y, Ren Z, Burgin WS, Liu L, Zhao X, Wang Y, Wang Y, Miao Z. Randomised study of bailout intracranial angioplasty following thrombectomy for acute large vessel occlusion (ANGEL-REBOOT): protocol of a multicentre randomised controlled trial. Stroke Vasc Neurol 2024; 9:181-188. [PMID: 37474136 PMCID: PMC11103159 DOI: 10.1136/svn-2023-002433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
RATIONALE Unsuccessful thrombectomy of acute large vessel occlusions (LVOs) has been associated with unfavourable outcomes. Multiple randomised controlled trials (RCTs) have reported a failure rate of 12%-41% for thrombectomy procedures. Various factors contribute to failed thrombectomy, including technical difficulties in accessing the occlusion, unsuccessful thrombus retrieval, thrombotic reocclusion and pre-existing intracranial atherosclerotic stenosis. Although some studies have explored balloon dilation or permanent stenting as rescue intracranial angioplasty for failed thrombectomy in individual cases, there is currently no evidence from RCTs on this specific topic. AIM To evaluate the potential superiority of bailout angioplasty over standard treatment in cases of unsuccessful recanalisation (eTICI 0 to 2a) or residual severe stenosis (>70%) after thrombectomy in acute LVO patients within 24 hours of stroke onset. DESIGN This study is a multicentre, prospective, randomised, controlled clinical trial designed by investigators. It compares bailout angioplasty with standard therapy and follows an open-label treatment approach while maintaining a blinded outcome assessment (PROBE design). Our objective is to allocate 348 patients in a 1:1 ratio to either receive bailout angioplasty as an intervention or standard therapy as a control, following unsuccessful thrombectomy. OUTCOME The main measure of interest is the modified Rankin Scale (mRS) Score, which will be assessed in a blinded manner at 90 (±14) days following randomisation. The primary effect size will be determined using ordered logistic regression to calculate the common OR, representing the shift on the six-category mRS Scale at the 90-day mark. Additionally, the safety outcomes will be evaluated, including symptomatic intracranial haemorrhage within 18-36 hours, severe procedure-related complications and mortality within 90 (±14) days, among others. DISCUSSION The ANGEL-REBOOT study aims to generate substantial evidence regarding the efficacy and safety of bailout intracranial angioplasty as a treatment option for patients with LVO who have experienced unsuccessful thrombectomy. TRIAL REGISTRATION NUMBER NCT05122286.
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Affiliation(s)
- Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Ming Yang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Yuesong Pan
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Zeguang Ren
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - William Scott Burgin
- Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Comprehensive Stroke Center, Tampa General Hospital, Tampa, Florida, USA
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Yilong Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Beijing, China
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Huang LX, Wu XB, Liu YA, Guo X, Liu CC, Cai WQ, Wang SW, Luo B. High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review. Heliyon 2024; 10:e27948. [PMID: 38571643 PMCID: PMC10987942 DOI: 10.1016/j.heliyon.2024.e27948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Ischemic stroke is a significant burden on human health worldwide. Carotid Atherosclerosis stenosis plays an important role in the comprehensive assessment and prevention of ischemic stroke patients. High-resolution vessel wall magnetic resonance imaging has emerged as a successful technique for assessing carotid atherosclerosis stenosis. This advanced imaging modality has shown promise in effectively displaying a wide range of characteristics associated with the condition, leading to a comprehensive evaluation. High-resolution vessel wall magnetic resonance imaging not only enables a comprehensive evaluation of the instability of carotid atherosclerosis stenosis plaques but also provides valuable information for understanding the pathogenesis and predicting the prognosis of ischemic stroke patients. The purpose of this article is to review the application of high-resolution magnetic resonance imaging in ischemic stroke and carotid atherosclerotic stenosis.
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Affiliation(s)
- Li-Xin Huang
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiao-Bing Wu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Ao Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xin Guo
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Chi-Chen Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wang-Qing Cai
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng-Wen Wang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Hirano Y, Miyawaki S, Sakaguchi Y, Koizumi S, Hongo H, Saito N. A bibliometric analysis of the 100 most-cited clinical articles in the research of intracranial artery stenosis and intracranial atherosclerosis. Surg Neurol Int 2024; 15:74. [PMID: 38628533 PMCID: PMC11021113 DOI: 10.25259/sni_1030_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background Intracranial arterial stenosis (ICAS), caused by intracranial atherosclerosis, is one of the major causes of ischemic stroke. This study identified the top 100 most-cited publications on ICAS through a bibliometric analysis. Methods Two independent authors conducted a search in the Web of Science database for clinical articles on ICAS published between 1993 and 2022. The top 100 most-cited articles were then extracted. For each article, the analysis covered the title, author, country of origin/affiliation, journal, total number of citations, number of citations per year, and type of study. Results The top 100 most-cited papers in the ICAS were authored by 565 authors from 12 countries and published in 29 journals. In terms of the 5-year trend, the largest number of papers were published between 2003 and 2007 (n = 31). The median number of citations for the 100 papers was 161 (range 109-1,115). The journal with the highest proportion of the 100 most published articles was Stroke, accounting for 41% of articles and 37% of the citations. According to country of origin, the United States of America accounted for the largest number of articles, followed by China, Japan, and South Korea, with these four countries together accounting for 81% of the total number of articles and 88% of the citations. Trends in the past five years included the use of terms such as acute ischemic stroke and mechanical thrombectomy. Conclusion The findings of this study provide novel insight into this field and will facilitate future research endeavors.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Yusuke Sakaguchi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan
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Sun B, Wang L, Li X, Zhang J, Zhang J, Tian J, Mossa-Basha M, Xu J, Zhou Y, Zhao H, Zhu C. Delayed Enhancement of Intracranial Atherosclerotic Plaque Can Better Differentiate Culprit Lesions: A Multiphase Contrast-Enhanced Vessel Wall MRI Study. AJNR Am J Neuroradiol 2024; 45:262-270. [PMID: 38388686 DOI: 10.3174/ajnr.a8132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial plaque enhancement (IPE) identified by contrast-enhanced vessel wall MR imaging (VW-MR imaging) is an emerging marker of plaque instability related to stroke risk, but there was no standardized timing for postcontrast acquisition. We aim to explore the optimal postcontrast timing by using multiphase contrast-enhanced VW-MR imaging and to test its performance in differentiating culprit and nonculprit lesions. MATERIALS AND METHODS Patients with acute ischemic stroke due to intracranial plaque were prospectively recruited to undergo VW-MR imaging with 1 precontrast phase and 4 consecutive postcontrast phases (9 minutes and 13 seconds for each phase). The signal intensity (SI) values of the CSF and intracranial plaque were measured on 1 precontrast and 4 postcontrast phases to determine the intracranial plaque enhancement index (PEI). The dynamic changes of the PEI were compared between culprit and nonculprit plaques on the postcontrast acquisitions. RESULTS Thirty patients with acute stroke (aged 59 ± 10 years, 18 [60%] men) with 113 intracranial plaques were included. The average PEI of all intracranial plaques significantly increased (up to 14%) over the 4 phases. There was significantly increased PEI over the 4 phases for culprit plaques (an average increase of 23%), but this was not observed for nonculprit plaques. For differentiating culprit and nonculprit plaques, we observed that the performance of IPE in the second postcontrast phase (cutoff = 0.83, AUC = 0.829 [0.746-0.893]) exhibited superior accuracy when compared with PEI in the first postcontrast phase (cutoff = 0.48; AUC = 0.768 [0.680-0.843]) (P = .022). CONCLUSIONS A 9-minute delay of postcontrast acquisition can maximize plaque enhancement and better differentiate between culprit and nonculprit plaques. In addition, culprit and nonculprit plaques have different enhancement temporal patterns, which should be evaluated in future studies.
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Affiliation(s)
- Beibei Sun
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Lingling Wang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjian Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Jianrong Xu
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
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Cantrell CG, Nguyen V, Vakil P, Jeong Y, Menon R, Ansari SA, Kawaji K, Carroll TJ. Transient susceptibility imaging as a measure of hemodynamic compromise: A pilot study. Magn Reson Imaging 2023; 104:105-114. [PMID: 37820979 DOI: 10.1016/j.mri.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/11/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the hypothesis that hemodynamically compromised brains exhibit transient changes in magnetic susceptibility throughout the cardiac cycle, and to model these changes using Linear System Theory to extract an index that reflects cerebrovascular reserve. MATERIALS AND METHODS Eleven patients with angiographically-confirmed intracranial atherosclerotic disease with >50% stenosis were imaged with susceptibility weighted, cardiac-gated single shot images of cerebral Oxygen Extraction Fraction (OEF) at different timepoints of the cardiac cycle. Cardiac gating of the OEF acquisition allowed interrogation of oxygenated blood and the detection of changes throughout the cardiac cycle. Independent component analysis (ICA) of raw k-space data across the cardiac phase allowed MRI signal decomposition into dynamic and static components for image reconstruction. An asymmetry index score of the resultant parametric images were compared to test the hypothesis that variation in hemoglobin-induced susceptibility across the cardiac cycle indeed reflects pathophysiology of cerebrovascular disease. A mathematical model was derived to parameterize physiologic changes induced by the presence of a hemodynamically significant stenosis in the brain as a tissue impulse response parameter (β). RESULTS OEF was elevated in the affected hemisphere (50.34 ± 12.13% vs 46.93 ± 12.34%), but failed to reach statistical significance (p < .0796). Transient changes in the OEF signal showed significant distinction between healthy and compromised tissue (0.56 ± 0.067 vs 0.44 ± 0.067, p < .019)). The derived tissue impulse response function was found to be significant as well (10.72 ± 3.48 10-3 ms-1, 9.69 ± 3.51 10-3 ms-1; p < .037). CONCLUSION In this pilot study, we found transient OEF and β to be significant predictors of hemispheric compromise.
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Affiliation(s)
- Charles G Cantrell
- University of Chicago, Department of Radiology, Billings Hospital, P220 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA
| | - Vivian Nguyen
- University of Chicago, Department of Radiology, Billings Hospital, P220 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA; Illinois Institute of Technology, Department of Biomedical Engineering, Wishnick Hall 3255 South Dearborn Street, Suite 314, Chicago, IL 60616, USA
| | - Parmede Vakil
- University of Illinois, College of Medicine, 1853 W Polk St, Chicago, IL 60612, USA; Northwestern University, Department of Radiology, 676 N. St. Clair St. Suite 800, Chicago, IL 60611, USA
| | - Yong Jeong
- McCormick School of Engineering, Northwestern University, Technological Institute, 2145 Sheridan Road, E310, Evanston, IL 60208, USA
| | - Rajiv Menon
- New York University, Langone Medical Center, 424 E 34th St., New York, NY 10016, USA
| | - Sameer Ahmad Ansari
- Northwestern University, Department of Radiology, 676 N. St. Clair St. Suite 800, Chicago, IL 60611, USA; Northwestern University, Departments of Neurology and Neurological Surgery, 676 North St. Clair Street Suite 2210, Chicago, IL 60611, USA
| | - Keigo Kawaji
- University of Chicago, Department of Radiology, Billings Hospital, P220 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA; Illinois Institute of Technology, Department of Biomedical Engineering, Wishnick Hall 3255 South Dearborn Street, Suite 314, Chicago, IL 60616, USA
| | - Timothy J Carroll
- University of Chicago, Department of Radiology, Billings Hospital, P220 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
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Shen Y, Wang J, Wang A, Zhao X. Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis: Results From the APAC Study. Neurologist 2023; 28:300-303. [PMID: 37083844 PMCID: PMC10521774 DOI: 10.1097/nrl.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS. METHODS The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS. RESULTS During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively). CONCLUSIONS LDL-C is not an independent predictor of AICAS incidence in the Chinese population.
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Affiliation(s)
- Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Jing Wang
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
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Zhao G, He X, Liu Y, Zhang L, Li K. Single-center experience of endovascular treatment for patients with progressive posterior circulation cerebral infarction exceeding 24 h. ASIAN BIOMED 2023; 17:64-71. [PMID: 37719319 PMCID: PMC10505061 DOI: 10.2478/abm-2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Evidence of endovascular treatment (ET) for patients with progressive infarction of the posterior circulation exceeding 24 h is lacking. Objective To evaluate the efficacy and safety of ET for progressive posterior circulation cerebral infarction. Methods This retrospective study evaluated the ET for 18 patients with posterior circulation infarction caused by vertebrobasilar artery occlusion from July 2017 to November 2018. The conditions of patients worsened despite receiving intravenous thrombolysis or combination therapy with clopidogrel and aspirin. The time from the onset of cerebral infarction to puncture was >24 h. The preoperative National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and related risk factors of patients at 3 months were analyzed postoperatively. Results The preoperative NIHSS score was 10.6 (IQR: 6.5), and the time from onset to puncture was 163.5 ± 144.7 h. Postoperative blood flow was modified thrombolysis in cerebral infarction (mTICI) grade 2b or above. During the follow-up period, 1 patient died of basilar artery re-occlusion and pulmonary infection, and 1 died of postoperative hyperperfusion hemorrhage, with a mortality rate of 11.1% (2/18). No recurrent ischemic events were observed in any of the 16 patients during the 3-month follow-up period. The mean mRS score was 1.3 (IQR: 2.3), and 75% patients (12/16) had an mRS score of 0-2. There were no significant differences in age, gender, clinical characteristics, and stroke subtype between patients with mRS scores ≤2 and >2. Conclusion In patients with progressive posterior circulation cerebral infarction caused by vertebral basilar artery occlusion, ET is effective and safe even if the time from onset to puncture exceeds 24 h.
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Affiliation(s)
- Guangfeng Zhao
- Department of Encephalopathy, Hainan Province Hospital of Traditional Chinese Medicine, Haikou, Hainan570203, China
| | - Xiongjun He
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Liang Zhang
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
| | - Kaifeng Li
- Department of Neurology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong518101, China
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9
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Lang S, Hoelter P, Schmidt MA, Mrochen A, Kuramatsu J, Kaethner C, Roser P, Kowarschik M, Doerfler A. Accuracy of Dose-Saving Artificial-Intelligence-Based 3D Angiography (3DA) for Grading of Intracranial Artery Stenoses: Preliminary Findings. Diagnostics (Basel) 2023; 13:diagnostics13040712. [PMID: 36832200 PMCID: PMC9954830 DOI: 10.3390/diagnostics13040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Based on artificial intelligence (AI), 3D angiography (3DA) is a novel postprocessing algorithm for "DSA-like" 3D imaging of cerebral vasculature. Because 3DA requires neither mask runs nor digital subtraction as the current standard 3D-DSA does, it has the potential to cut the patient dose by 50%. The object was to evaluate 3DA's diagnostic value for visualization of intracranial artery stenoses (IAS) compared to 3D-DSA. MATERIALS AND METHODS 3D-DSA datasets of IAS (nIAS = 10) were postprocessed using conventional and prototype software (Siemens Healthineers AG, Erlangen, Germany). Matching reconstructions were assessed by two experienced neuroradiologists in consensus reading, considering image quality (IQ), vessel diameters (VD1/2), vessel-geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of IAS (e.g., location, visual IAS grading [low-/medium-/high-grade] and intra-/poststenotic diameters [dintra-/poststenotic in mm]). Using the NASCET criteria, the percentual degree of luminal restriction was calculated. RESULTS In total, 20 angiographic 3D volumes (n3DA = 10; n3D-DSA = 10) were successfully reconstructed with equivalent IQ. Assessment of the vessel geometry in 3DA datasets did not differ significantly from 3D-DSA (VD1: r = 0.994, p = 0.0001; VD2:r = 0.994, p = 0.0001; VGI: r = 0.899, p = 0.0001). Qualitative analysis of IAS location (3DA/3D-DSA:nICA/C4 = 1, nICA/C7 = 1, nMCA/M1 = 4, nVA/V4 = 2, nBA = 2) and the visual IAS grading (3DA/3D-DSA:nlow-grade = 3, nmedium-grade = 5, nhigh-grade = 2) revealed identical results for 3DA and 3D-DSA, respectively. Quantitative IAS assessment showed a strong correlation regarding intra-/poststenotic diameters (rdintrastenotic = 0.995, pdintrastenotic = 0.0001; rdpoststenotic = 0.995, pdpoststenotic = 0.0001) and the percentual degree of luminal restriction (rNASCET 3DA = 0.981; pNASCET 3DA = 0.0001). CONCLUSIONS The AI-based 3DA is a resilient algorithm for the visualization of IAS and shows comparable results to 3D-DSA. Hence, 3DA is a promising new method that allows a considerable patient-dose reduction, and its clinical implementation would be highly desirable.
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Affiliation(s)
- Stefan Lang
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-85-39388
| | - Philip Hoelter
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Manuel Alexander Schmidt
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Joji Kuramatsu
- Department of Neurology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christian Kaethner
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Philipp Roser
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Markus Kowarschik
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
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10
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Nguyen VN, Motiwala M, Parikh K, Miller LE, Barats M, Nickele CM, Inoa V, Elijovich L, Goyal N, Hoit DA, Arthur AS, Morcos JJ, Khan NR. Extracranial-Intracranial Cerebral Revascularization for Atherosclerotic Vessel Occlusion: An Updated Systematic Review of the Literature. World Neurosurg 2023; 173:199-207.e8. [PMID: 36758795 DOI: 10.1016/j.wneu.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Atherosclerotic steno-occlusive cerebrovascular disease includes extracranial carotid occlusive and intracranial atherosclerotic disease. Despite the negative findings in Carotid Occlusion Surgery Study (COSS), many large centers continue to report favorable results for revascularization surgery in select groups of patients. The aim of our study was to perform an updated systematic review to investigate the role of revascularization surgery for atherosclerotic steno-occlusive patients in the modern era. METHODS Five independent reviewers performed Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature searches in October 2022 to identify articles reporting clinical outcomes in adult patients undergoing bypass for atherosclerotic steno-occlusive disease. Primary endpoints used were perioperative and long-term ischemic strokes, intracerebral hemorrhage, bypass patency, and favorable clinical outcomes. Study quality was evaluated with Newcastle-Ottawa, JADAD, and the Oxford Center for Evidence-Based Medicine scales. RESULTS A total of 6709 articles were identified in the initial search. Of these articles, 50 met the inclusion criteria and were included in the systematic review. A notable increase in the proportion of articles published over the past 10 years was observed. There were 6046 total patients with 4447 bypasses performed over the period from 1978 to 2022. The average length of follow-up was 2.75 ± 2.71 years. The average Newcastle-Ottawa was 6.23 out of 9 stars. There was a significant difference in perioperative stroke (odds ratio [OR], 0.65 [0.48-0.87]; P = 0.004), long-term ischemia (OR, 0.32 [0.23-0.44]; P < 0.0001), overall ischemia (OR, 0.36 [0.28-0.44]; P < 0.0001), and favorable outcomes (OR, 3.63 [2.84-4.64]; P < 0.0001) when comparing pre-COSS to post-COSS time frames in favor of post-COSS. CONCLUSIONS Based on a systematic review of 50 articles, the existing literature indicates that long-term stroke rates and favorable outcomes for surgical revascularization for steno-occlusive disease have improved over time and are lower than previously reported. Improved patient selection, perioperative care, and surgical techniques may contribute to improved outcomes.
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Affiliation(s)
- Vincent N Nguyen
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA
| | - Kara Parikh
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA
| | - L Erin Miller
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA
| | - Michael Barats
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA
| | - Christopher M Nickele
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Violiza Inoa
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; University of Tennessee Health Sciences Center Department of Neurology, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Lucas Elijovich
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; University of Tennessee Health Sciences Center Department of Neurology, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Nitin Goyal
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; University of Tennessee Health Sciences Center Department of Neurology, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Daniel A Hoit
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Adam S Arthur
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Jacques J Morcos
- University of Miami Department of Neurosurgery, Miami, Florida, USA
| | - Nickalus R Khan
- University of Tennessee Health Sciences Center Department of Neurosurgery, Memphis, Tennessee, USA; Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee, USA.
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11
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Liu R, Shao J. Research progress on risk factors related to intracranial artery, carotid artery, and coronary artery stenosis. Front Cardiovasc Med 2022; 9:970476. [PMID: 36386370 PMCID: PMC9640748 DOI: 10.3389/fcvm.2022.970476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 07/25/2023] Open
Abstract
In recent decades, with the rapid development of economy, the acceleration of social aging and urbanization, and the prevalence of unhealthy lifestyles, the number of patients with cardiovascular and cerebrovascular diseases has shown an increasing trend year by year. It has also become one of the important causes of disability and death in all ages and groups. Atherosclerosis is the main pathological change of ischemic cardiovascular and cerebrovascular diseases, which mainly invades the large and medium arteries of the body circulation. In particular, cerebral artery and coronary artery lesions have the most significant impact on life. There is the same pathogenic mechanism between intracranial and extracranial arteries and coronary atherosclerosis, so there is a certain relationship between the degree of atherosclerosis. In this paper, the risk factors related to intracranial and extracranial arteries and coronary artery stenosis were reviewed. It provides a theoretical basis for early detection, early diagnosis and early treatment of intracranial and extracranial artery and coronary artery stenosis to reduce the occurrence and development of cardiovascular and cerebrovascular diseases.
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Affiliation(s)
- Ruijun Liu
- Department of Neurointerventional, The Third Hospital of Jinan, Jinan, China
| | - Jing Shao
- Department of Cardiovascular, The Third Hospital of Jinan, Jinan, China
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12
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Psychogios M, Brehm A, López-Cancio E, Marco De Marchis G, Meseguer E, Katsanos AH, Kremer C, Sporns P, Zedde M, Kobayashi A, Caroff J, Bos D, Lémeret S, Lal A, Arenillas JF. European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease. Eur Stroke J 2022; 7:III-IV. [PMID: 36082254 PMCID: PMC9446330 DOI: 10.1177/23969873221099715] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 07/22/2023] Open
Abstract
The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of patients with intracranial atherosclerotic disease (ICAD). The guidelines were prepared following the Standard Operational Procedure of the European Stroke Organisation guidelines and according to GRADE methodology. ICAD represents a major cause of ischemic stroke worldwide, and patients affected by this condition are exposed to a high risk for future strokes and other major cardiovascular events, despite best medical therapy available. We identified 11 relevant clinical problems affecting ICAD patients and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions. The first two questions refer to the asymptomatic stage of the disease, which is being increasingly detected thanks to the routine use of noninvasive vascular imaging. We were not able to provide evidence-based recommendations regarding the optimal detection strategy and management of asymptomatic ICAD, and further research in the field is encouraged as subclinical ICAD may represent a big opportunity to improve primary stroke prevention. The second block of PICOs (3-5) is dedicated to the management of acute large vessel occlusion (LVO) ischemic stroke caused by ICAD, a clinical presentation of this disease that is becoming increasingly relevant and problematic, since it is associated with more refractory endovascular reperfusion procedures. An operational definition of probable ICAD-related LVO is proposed in the guideline. Despite the challenging context, no dedicated randomized clinical trials (RCTs) were identified, and therefore the guideline can only provide with suggestions derived from observational studies and our expert consensus, such as the escalated use of glycoprotein IIb-IIIa inhibitors and angioplasty/stenting in cases of refractory thrombectomies due to underlying ICAD. The last block of PICOs is devoted to the secondary prevention of patients with symptomatic ICAD. Moderate-level evidence was found to recommend against the use of oral anticoagulation as preferred antithrombotic drug, in favor of antiplatelets. Low-level evidence based our recommendation in favor of double antiplatelet as the antithrombotic treatment of choice in symptomatic ICAD patients, which we suggest to maintain during 90 days as per our expert consensus. Endovascular therapy with intracranial angioplasty and or stenting is not recommended as a treatment of first choice in high-grade symptomatic ICAD (moderate-level evidence). Regarding neurosurgical interventions, the available evidence does not support their use as front line therapies in patients with high-grade ICAD. There is not enough evidence as to provide any specific recommendation regarding the use of remote ischemic conditioning in ICAD patients, and further RCTs are needed to shed light on the utility of this promising therapy. Finally, we dedicate the last PICO to the importance of aggressive vascular risk factor management in ICAD, although the evidence derived from RCTs specifically addressing this question is still scarce.
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Affiliation(s)
- Marios Psychogios
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
| | - Elena López-Cancio
- Department of Neurology, Hospital
Universitario Central de Asturias, Oviedo, Spain
| | - Gian Marco De Marchis
- Department of Neurology and Stroke
Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Elena Meseguer
- Department of Neurology and Stroke
Center, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster
University and Population Health Research Institute, Hamilton, ON, Canada
| | - Christine Kremer
- Department of Neurology, Skåne
University Hospital, Malmö, Department of Clinical Sciences Lund University, Lund,
Sweden
| | - Peter Sporns
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
- Department of Neuroradiology,
University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - Marialuisa Zedde
- Neurology Unit, Department of
Neuromotor Physiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio
Emilia, Italy
- Neurology Unit, Stroke Unit, Azienda
Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Adam Kobayashi
- Department of Pharmacology and
Clinical Pharmacology, Institute of Medical Sciences, Faculty of Medicine –
Collegium Medicum Cardinal Stefan Wyszynski University in Warsaw, Poland
- Department of Neurology and Stroke
Unit, Mazovian Voivodeship Hospital in Siedlce, Poland
| | - Jildaz Caroff
- Department of Interventional
Neuroradiology – NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique
Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Daniel Bos
- Department of Radiology and Nuclear
Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus
MC, Rotterdam, The Netherlands
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Juan F Arenillas
- Stroke Program, Department of
Neurology, Hospital Clínico Universitario de Valladolid, Spain
- Clinical Neurosciences Research
Group, Department of Medicine, University of Valladolid, Spain
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13
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Park SK, Suh SH, Jang KS, Jang DK, Jo DY, Shin YS. Long-term clinical and angiographic outcome from angioplasty and stenting for intracranial stenosis. Acta Neurochir (Wien) 2022; 164:1627-1634. [PMID: 35001232 DOI: 10.1007/s00701-022-05110-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe intracranial atherosclerotic stenosis (ICAS) is a major cause of stroke. Although percutaneous transluminal angioplasty and stenting (PTAS) treatment methods have increased over the last decade as alternative therapies, there is debate regarding the best method of treatment, with medical and surgical therapies often suggested. METHODS We analyzed the long-term follow-up results from 5 years of intracranial stenting for intracranial stenosis from three stroke centers. The primary endpoints were early stroke complications or death within 30 days after stent insertion, and the secondary endpoint was a recurrent stroke between 30 days and 60 months. Correlating factors and Kaplan-Meier survival curves for recurrent stroke and in-stent restenosis (ISR) were also obtained. RESULTS Seventy-three PTAS in 71 patients were examined in this study. The primary and secondary endpoints were all 8.2% (n = 6), and restenosis was 13.7% (n = 10) during the 5-year follow-up. The primary endpoints were significantly frequent in the high National Institutes of Health Stroke Scale (NIHSS) and early stent (≤ 7 days after dual antiplatelet medication) groups. Secondary endpoint and ISR were identically frequent in the younger age group and in the presence of tandem stenosis in other major intracranial arteries. The cumulative probability of recurrent stroke and ISR at 60 months was 16.4% and 14.1%, respectively. CONCLUSIONS This study shows that PTAS is safe and effective for major ICAS. Reducing the early complication rate is still an important factor, despite the fact that long-term stroke recurrence was low.
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Affiliation(s)
- Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyeong Sool Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dong Kyu Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dong Young Jo
- Department of Neurosurgery, Seoul Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Medicine, Seoul, Republic of Korea
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14
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Li S, Chen X, Yang H, Li H, Ren B. Value of IMA, IMAR, the IMA Index, and Other Hematological Features in Predicting AIS Caused by MCA Stenosis/Occlusion. Curr Neurovasc Res 2022; 19:137-149. [PMID: 35578847 DOI: 10.2174/1567202619666220516145120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In this study, we investigated the relationship between serum ischemic modified albumin (IMA) levels and other hematologic features and middle cerebral artery (MCA) severe stenosis/occlusion in acute ischemic stroke (AIS) patients. METHODS The levels of serum IMA and Albumin (ALB) of 169 AIS patients were measured, and the ratio of IMA to albumin (IMAR) and the albumin-adjusted ischemia-modified albumin index (IMA index) were calculated. Different combinations of other hematologic changes and clinical features of the patients were analyzed. RESULTS The results indicated that the levels of blood IMA and IMAR were significantly higher in the group with severe intracranial stenosis/occlusion than in the group with non-severe stenosis/ occlusion in AIS patients, while the CHE levels were significantly lower than those in the other groups. In the MCA severe stenosis/occlusion group, the levels of blood IMA and IMAR were significantly higher than that in the other vascular severe stenosis/occlusion groups, while the IMA index, ALB, and CHE were significantly lower than that in the other groups. Multiple linear regression analysis showed a significant negative correlation between IMA and albumin. A combined diagnostic ROC curve analysis showed that among AIS patients, the best combination for determining severe stenosis/occlusion of the great intracranial arteries was the admission NIHSS score + CHE (AUC = 0.783). The best combination for determining severe stenosis or occlusion of the MCA in AIS patients was IMAR combined with the admission NIHSS score and CHE (AUC = 0.827). CONCLUSION The combined use of IMA, IMAR, and the IMA index has some diagnostic value in AIS caused by severe stenosis or occlusion of the MCA. IMAR, CHE, and the admission NIHSS scores are the best combinations to determine whether an AIS patient has severe stenosis or occlusion of the MCA.
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Affiliation(s)
- Sijin Li
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Xing Chen
- Department of Blood Transfusion, Loudi Central Hospital, Loudi, Hunan 417000, China
| | - Huan Yang
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Huiyang Li
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China
| | - Biqiong Ren
- School of Clinical Medicine, Hunan University of Chinese Medicine, Hunan, China.,Department of Laboratory Medicine, Second People's Hospital of Hunan Province, Changsha, Hunan 410007, China
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15
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Wang J, Zhang S, Lu J, Qi P, Hu S, Yang X, Chen K, Wang D. High-Resolution MR for Follow-Up of Intracranial Steno-Occlusive Disease Treated by Endovascular Treatment. Front Neurol 2022; 12:706645. [PMID: 35002907 PMCID: PMC8740140 DOI: 10.3389/fneur.2021.706645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: An endovascular recanalization is an alternative option for symptomatic intracranial atherosclerotic steno-occlusive disease (ICAD). Accurate non-invasive alternatives to digital subtraction angiography (DSA) for follow-up imaging after endovascular treatment are desirable. We aimed to evaluate the image quality and diagnostic performance of high-resolution magnetic imaging in follow-up using DSA as a reference. Materials and Methods: From January 2017 to June 2021, data from 35 patients with 40 intracranial steno-occlusive lesions who underwent endovascular recanalization and received high-resolution magnetic resonance (HR-MR) follow-up were retrospectively collected in our prospective database. Studies were evaluated for the quality of visualization of the vessel lumen, restenosis rate, and accuracy of high-resolution magnetic resonance (HR-MR) with DSA used as the reference standard. Intraclass correlation coefficient (ICC) analyses were performed to assess the agreement between the two different readers. Results: In total, 40 intracranial steno-occlusive lesions in 35 patients, with 34 lesions undergoing balloon angioplasty [including 16 drug-coated balloons (DCBs)] and 8 lesions undergoing stenting were enrolled. The median age was 63.6 years (IQR 58.5-70.0 years), and the mean imaging follow-up time was 9.5 months (IQR 4.8-12.5 months). The median degrees of preprocedural and residual stenosis were 85.0% (IQR 75.0-99.0%) and 32.8% (IQR 15.0-50.0%), respectively. Intracranial periprocedural complications occurred in 1 (3.6%) patient. In the case of a stainless-steel stent (n = 1), there was a signal drop at the level of the vessel, which did not allow evaluation of the vessel lumen. However, this was visible in the case of nitinol stents (n = 7) and angioplasty (n = 34). The overall restenosis rate was 25.8% (n = 9). The DCB subgroup showed a lower rate of restenosis than the percutaneous transluminal angioplasty (PTA) subgroup [5.3% (2/13) vs. 35.7% (5/14)]. Conclusion: High-resolution magnetic resonance may be a reliable non-invasive method for demonstrating the vessel lumen and diagnostic follow-up after endovascular recanalization for ICAD. Compared with MR angiography (MRA), HR-MR showed a higher inter-reader agreement and could provide more information after endovascular recanalization, such as enhancement of the vessel wall.
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Affiliation(s)
- Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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16
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Tsivgoulis G, Safouris A, Alexandrov AV. Ultrasonography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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17
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Li L, Yang B, Dmytriw AA, Wang T, Luo J, Li Y, Ma Y, Chen J, Wang Y, Gao P, Feng Y, Bai X, Zhang X, Dong J, Yang R, Jiao L, Ling F. Hemodynamic Versus Anatomic Assessment of Symptomatic Atherosclerotic Middle Cerebral Artery Stenosis: the Relationship Between Pressure Wire Translesional Gradient and Angiographic Lesion Geometry. Front Neurol 2021; 12:671778. [PMID: 34456841 PMCID: PMC8385769 DOI: 10.3389/fneur.2021.671778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Intracranial cerebral atherosclerosis (ICAS) is a leading etiology of ischemic stroke. The diagnosis and assessment of intracranial stenosis are shifting from anatomic to hemodynamic for better risk stratification. However, the relationships between lesion geometry and translesional pressure gradient have not been clearly elucidated. Methods: Patients with symptomatic unifocal M1 middle cerebral artery (M1-MCA) stenosis were consecutively recruited. The translesional pressure gradient was measured with a pressure wire and was recorded as both mean distal/proximal pressure ratios (Pd/Pa) and translesional pressure difference (Pa–Pd). Lesion geometry measured on angiography was recorded as diameter stenosis, minimal lumen diameter, and lesion length. The correlations between pressure-derived and angiography-derived indices were then analyzed. Results: Forty-three patients were analyzed. A negative correlation was found between Pd/Pa and diameter stenosis (r = −0.371; p = 0.014) and between Pa – Pd and minimal lumen diameter (r = −0.507; p = 0.001). A positive correlation was found between Pd/Pa and minimal lumen diameter (r = 0.411; p = 0.006) and between Pa – Pd and diameter stenosis (r = 0.466; p = 0.002). Conclusions: In a highly selected ICAS subgroup, geometric indices derived from angiography correlate significantly with translesional pressure gradient indices. However, the correlation strength is weak-to-moderate, which implies that anatomic assessment could only partly reflect hemodynamic status. Translesional pressure gradient measured by pressure wire may serve as a more predictive marker of ICAS severity. More factors need to be identified in further studies.
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Affiliation(s)
- Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanling Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia Dong
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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18
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Serulle Y, Khatri D, Sy H, Yerneni S, Langer D, Ortiz R. Use of quantitative magnetic resonance angiography in patients with symptomatic intracranial arterial stenosis who undergo stenting: Presentation of three cases. J Cerebrovasc Endovasc Neurosurg 2021; 23:136-144. [PMID: 34107594 PMCID: PMC8256016 DOI: 10.7461/jcen.2021.e2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. The etiology of stroke in patients with ICAD could be due to several mechanisms including hypoperfusion, artery-to-artery embolism, and plaque extension over small penetrating artery ostia. Management of symptomatic ICAD includes medical and endovascular management. Quantitative magnetic resonance angiography (MRA) is a technique that allows for non-invasive measurement of large vessel blood flow in the head and neck. Here, we describe procedural and clinical outcomes on three patients who presented with symptomatic ICAD and were treated with angioplasty and stenting. Quantitative MRA was used pre- and post- procedurally to assess the effects of stenting on the intracranial blood flow. Quantitative measures of intracranial blood flow may serve as an additional triage tool in the evaluation of patients with symptomatic ICAD.
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Affiliation(s)
- Yafell Serulle
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Deepak Khatri
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Heustein Sy
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | | | - David Langer
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Rafael Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
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19
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Wang G, Jing J, Wang A, Zhang X, Zhao X, Li Z, Wang C, Li H, Liu L, Wang Y, Wang Y. Non-High-Density Lipoprotein Cholesterol Predicts Adverse Outcomes in Acute Ischemic Stroke. Stroke 2021; 52:2035-2042. [PMID: 34000828 DOI: 10.1161/strokeaha.120.030783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Liping Liu
- China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Center of Stroke, Beijing Institute for Brain Disorders, China (G.W., J.J., A.W., X. Zhang., X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang)
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20
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Wang G, Yang X, Jing J, Zhao X, Liu L, Wang C, Wang D, Wang A, Meng X, Wang Y, Wang Y. Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction. Front Neurol 2021; 12:631220. [PMID: 33854474 PMCID: PMC8039512 DOI: 10.3389/fneur.2021.631220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Methods: SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI - PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD. Results: Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25-2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40-2.68, interaction P = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, P = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI - PAD. Conclusions: There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI - PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.
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Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaomeng Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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21
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Zhang X, Chen L, Li S, Shi Z, Tian X, Peng W, Chen S, Zhan Q, Liu Q, Lu J. Enhancement Characteristics of Middle Cerebral Arterial Atherosclerotic Plaques Over Time and Their Correlation With Stroke Recurrence. J Magn Reson Imaging 2020; 53:953-962. [PMID: 33034113 DOI: 10.1002/jmri.27351] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xuefeng Zhang
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Luguang Chen
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Shuai Li
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Zhang Shi
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Xia Tian
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Wenjia Peng
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Shiyue Chen
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Qian Zhan
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Qi Liu
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Jianping Lu
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
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22
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Lan L, Liu H, Ip V, Soo Y, Abrigo J, Fan F, Ma SH, Ma K, Ip B, Liu J, Fan Y, Zeng J, Mok V, Wong L, Liebeskind D, Leung T, Leng X. Regional High Wall Shear Stress Associated With Stenosis Regression in Symptomatic Intracranial Atherosclerotic Disease. Stroke 2020; 51:3064-3073. [PMID: 32883193 DOI: 10.1161/strokeaha.120.030615] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose:
Understanding the mechanisms underlying progression/regression of symptomatic intracranial atherosclerotic stenosis (sICAS) will inform secondary prevention of the patients. Focal wall shear stress (WSS) may play an important role, which, however, had seldom been investigated.
Methods:
Patients with acute ischemic stroke or transient ischemic attack (TIA) attributed to 50% to 99% intracranial atherosclerotic stenosis were recruited. All patients underwent cerebral computed tomography angiography at baseline, and a computational fluid dynamics model was built based on computed tomography angiography to simulate blood flow and quantify WSS in the vicinity of the sICAS lesion. All patients received optimal medical treatment and a second computed tomography angiography at 1 year. The change in the luminal stenosis from baseline to 1 year in sICAS was defined as progression (increased >10%), quiescence (±10%), or regression (decreased >10%). Associations between baseline WSS metrics and sICAS regression were analyzed.
Results:
Among 39 patients (median age 62 years; 27 males), sICAS luminal stenosis progressed, remained quiescent and regressed in 6 (15.4%), 15 (38.5%), and 18 (46.2%) cases, respectively. A higher maximum WSS and larger high-WSS area, throughout the sICAS lesion or obtained separately in the proximal and distal parts of the lesion, were independently associated with regression of luminal stenosis in sICAS over 1 year.
Conclusions:
A majority of sICAS lesions regress or stay quiescent in the luminal stenosis over 1 year after stroke under optimal medical treatment, when higher focal WSS may facilitate stenosis regression. Further studies of the effects of hemodynamics including WSS in altering plaque vulnerability and stroke risks are needed.
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Affiliation(s)
- Linfang Lan
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University (L.L., Y.F., J.Z.)
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China (L.L., Y.F., J.Z.)
| | - Haipeng Liu
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
- Department of Imaging and Interventional Radiology (H.L., J.A.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, United Kingdom (H.L.)
| | - Vincent Ip
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Yannie Soo
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology (H.L., J.A.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Florence Fan
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Karen Ma
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Bonaventure Ip
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China (J.L.)
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University (L.L., Y.F., J.Z.)
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China (L.L., Y.F., J.Z.)
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University (L.L., Y.F., J.Z.)
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China (L.L., Y.F., J.Z.)
| | - Vincent Mok
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - Lawrence Wong
- Department of Medicine and Therapeutics (L.L., H.L., V.I., Y.S., F.F., S.H.M., K.M., B.I., V.M., L.W., T.L., X.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, China
| | - David Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles (D.L.)
| | | | - Xinyi Leng
- Shenzhen Research Institute, The Chinese University of Hong Kong, China (X.L.)
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Huang J, Jiao S, Song Y, Chen Y, Zhang J, Zhang C, Gong T, Chen M. Association between type 2 diabetes mellitus, especially recently uncontrolled glycemia, and intracranial plaque characteristics: A high-resolution magnetic resonance imaging study. J Diabetes Investig 2020; 11:1278-1284. [PMID: 32100945 PMCID: PMC7477510 DOI: 10.1111/jdi.13239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS/INTRODUCTION Type 2 diabetes mellitus is a specific risk factor for intracranial atherosclerosis. The purpose of this study was to investigate the relationship between type 2 diabetes mellitus, especially uncontrolled glycemia, and intracranial plaque characteristics using high-resolution magnetic resonance imaging. MATERIALS AND METHODS A total of 263 patients (182 men; mean age 62.6 ± 11.5 years) with intracranial atherosclerotic plaques detected on high-resolution magnetic resonance imaging from December 2017 to March 2019 were included in this study. Patients were divided into different groups: (i) patients with and without type 2 diabetes mellitus; (ii) diabetes patients with uncontrolled glycemia (glycated hemoglobin level ≥7.0%) and controlled glycemia; and (iii), diabetes patients with diabetes duration of <5, 5-10 and >10 years. Comparisons of plaque features between groups were made, respectively. RESULTS Type 2 diabetes mellitus was diagnosed in 118 patients (44.9%). Diabetes patients had a significantly greater prevalence of enhanced plaque, greater maximum plaque length, maximum wall thickness and more severe luminal stenosis than non-diabetes patients. Compared with diabetes patients with controlled glycemia, those with uncontrolled glycemia had a significantly greater prevalence of enhanced plaque and greater maximum plaque length (all P < 0.05). There were no significant differences in plaque features among patients with different durations of type 2 diabetes mellitus. Uncontrolled glycemia was an independent factor for plaque enhancement after adjustment for potential confounding factors (odds ratio 5.690; 95% confidence interval 1.748-18.526; P = 0.004). CONCLUSIONS Type 2 diabetes mellitus is closely related to intracranial plaque enhancement and burden. Recently uncontrolled glycemia might play an important role in the development of enhanced plaque.
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Affiliation(s)
- Juan Huang
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Sheng Jiao
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Yan Song
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Yuhui Chen
- Department of NeurologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Jintao Zhang
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Chen Zhang
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Tao Gong
- Department of NeurologyNational Center of GerontologyBeijing HospitalBeijingChina
| | - Min Chen
- Department of RadiologyNational Center of GerontologyBeijing HospitalBeijingChina
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Zhang X, Hou XH, Ma YH, Shen XN, Cao XP, Song JH, Tan L, Yu JT. Association of peripheral neutrophil count with intracranial atherosclerotic stenosis. BMC Neurol 2020; 20:65. [PMID: 32087674 PMCID: PMC7035752 DOI: 10.1186/s12883-020-01641-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inflammation plays an important role in atherosclerosis but the contribution of neutrophils to this process is unclear. We sought to assess whether neutrophil count is associated with intracranial atherosclerotic stenosis (ICAS). METHODS A total of 2847 individuals were included in our study, including 1363 with acute ischemic stroke and 1484 normal controls without stroke. The presence of ICAS was confirmed by magnetic resonance angiography. The association between neutrophil count and ICAS was evaluated by multivariable logistic regression analysis. RESULTS Among 2847 individuals included in this study, individuals with ICAS had higher neutrophil counts than those without ICAS in groups with and without stroke (P < 0.0001 for stroke group, P = 0.0097 for group without stroke). The multivariable logistic regression analysis showed that the third and fourth quartiles were independent predictors of ICAS in all the subjects (Q3: OR 1.81, 95% CI 1.39-2.37, Q4: OR 2.29, 95% CI 1.70-3.10) and patients in the fourth quartile had a higher risk for the occurrence of ICAS in stroke group (Q4: OR 2.82, 95% CI 1.79-4.48). However, there was no significant association between neutrophil count and ICAS in the group without stroke. CONCLUSIONS The levels of circulating neutrophils were associated with the presence of ICAS. Our findings suggest that neutrophils may play a role in the pathogenesis of stroke related to ICAS and emphasize the need to develop proper strategies to control neutrophil response for the treatment of ICAS.
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Affiliation(s)
- Xing Zhang
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jing-Hui Song
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China. .,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
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Li L, Zhu JX, Hou XH, Ma YH, Xu W, Tan CC, Sun FR, Li HQ, Dong Q, Tan L, Yu JT. Serum Uric Acid Levels and Risk of Intracranial Atherosclerotic Stenosis: A Cross-Sectional Study. Neurotox Res 2020; 37:936-943. [PMID: 32034694 DOI: 10.1007/s12640-020-00171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/07/2023]
Abstract
Elevated serum uric acid (SUA) has been reported to be associated with an increased risk of cardiovascular diseases, but the role of SUA in intracranial atherosclerosis remains unclear. To investigate the association between SUA and intracranial atherosclerotic stenosis (ICAS), we evaluated 1522 subjects (305 with ICAS, 1217 without ICAS) with magnetic resonance angiography (MRA). Subjects were classified into ten groups according to the deciles of the SUA level. The rate of ICAS reached a minimum in the seventh decile (6.0-6.3 mg/dL; reference group). After adjusting for confounding factors, multivariate logistic regression analysis demonstrated that both low SUA level (≤ 3.8 mg/dL; OR, 2.34; 95% CI, 1.29-4.39; p = 0.006) and high SUA level (≥ 7.8 mg/dL; OR, 2.10; 95% CI, 1.15-3.92; p = 0.017) conferred greater risk for ICAS. In multivariable analysis with a quadratic model which used SUA as a continuous variable, a U-shaped association between SUA and the rate of ICAS was confirmed (α > 0; p < 0.001). The estimated SUA level associated with the lowest rate of ICAS was 6.2 mg/dL. In conclusion, our findings suggest a U-shaped association between ICAS and SUA.
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Affiliation(s)
- Lin Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jun-Xia Zhu
- Department of Prevention and Health Protection, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Fu-Rong Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
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26
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Lan L, Leng X, Ip V, Soo Y, Abrigo J, Liu H, Fan F, Ma SH, Ma K, Ip BYM, Chan KL, Mok VCT, Liebeskind DS, Wong KS, Leung TW. Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow. J Cereb Blood Flow Metab 2020; 40:126-134. [PMID: 30351176 PMCID: PMC6928549 DOI: 10.1177/0271678x18805209] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50-69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70-99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.
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Affiliation(s)
- Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Neurology, The First affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Xinyi Leng, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Thomas W Leung, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Karen Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Bonaventure YM Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Vincent CT Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Abstract
This review highlights the recent evolution of the imaging, medical management, surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease (ICAD). Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed, not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment. Potential future developments in the treatment of ICAD are discussed, including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries, new iterations of self-expanding intracranial stents with easier delivery systems, and the re-examination of indirect surgical bypass techniques for revascularisation. In addition to these important technological developments, however, is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology.
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Affiliation(s)
- Zachary R Barnard
- Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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28
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Ilyas A, Chen CJ, Ironside N, Buell TJ, Chagoya G, Schmalz PG, Stetler WR, Andaluz N, James RF, Ding D. Medical Management Versus Surgical Bypass for Symptomatic Intracranial Atherosclerotic Disease: A Systematic Review. World Neurosurg 2019; 129:62-71. [DOI: 10.1016/j.wneu.2019.05.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022]
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Chen HX, Wang LJ, Yang Y, Yue FX, Chen LM, Xing YQ. The prevalence of intracranial stenosis in patients at low and moderate risk of stroke. Ther Adv Neurol Disord 2019; 12:1756286419869532. [PMID: 31447935 PMCID: PMC6693021 DOI: 10.1177/1756286419869532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Previous studies assessing the risk of stroke in the general population
performed screening with Doppler ultrasonography only for high-risk patients
and neglected low- and moderate-risk patients. The aims of this study were
to explore the current prevalence of intracranial arterial stenosis (ICAS)
and analyze its association with different levels of stroke risk and risk
factors based on the risk assessment scale for stroke used in China. Methods: A total of 3654 participants who underwent transcranial Doppler ultrasound
(TCD) were eligible for inclusion. Information regarding demographic
characteristics and risk factors such as alcohol consumption and
hypertension was collected through interviews and questionnaires and used to
analyze the association of ICAS with different levels of stroke risk and
risk factors. Results: The mean age of 501 subjects diagnosed with at least one ICAS was higher than
that of participants without ICAS (57.13 ± 9.56 years and
55.52 ± 9.35 years, respectively). After adjusting for confounding factors,
gender, education, residence, hypertension and personal history of stroke
were associated with ICAS. The odds ratios for ICAS in patients with
hypertension and a personal history of stroke were 1.655 [95% confidence
interval (CI): 1.341–2.043] and 1.854 (95% CI: 1.371–2.508), respectively.
In addition, participants in the low- and moderate-risk stroke groups
accounted for an unexpectedly high proportion of individuals with ICAS (up
to 38.3%). Results from multivariate analyses indicated that the adjusted
odds ratios for ICAS in patients with moderate and high stroke risks
versus those with a low stroke risk were 1.603 (95% CI:
1.171–2.195) and 1.612 (95% CI: 1.272–2.042), respectively. Conclusion: The prevalence of ICAS is high in northeast China and increases with the
level of stroke risk. However, the proportion of patients with ICAS among
those with low and moderate stroke risks should also be noted.
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Affiliation(s)
- Hong-Xiu Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Fei-Xue Yue
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Min Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
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Shiraishi M, Hasegawa Y, Narita N, Miyake H. Relationship Between Asymptomatic Intracranial Stenosis and Extracranial Arteriosclerotic Findings in Workplace Health Checkups: A Pilot Study. J Stroke Cerebrovasc Dis 2019; 28:2429-2433. [PMID: 31296474 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/07/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Intracranial arteriosclerotic disease (ICAD) is common in Asians and has been presumed to be largely associated with metabolic syndrome (MetS), but the risks for asymptomatic ICAD detectable in examinations of the brain, among other tests, are not well known. The present study is aimed at identifying the risks for asymptomatic ICAD using data on risk factors obtained in health checkups, including data from magnetic resonance imaging (MRI), chest computed tomography (CT), and neck echography. METHODS Subjects comprised 103 examinees more than equal to 40 years old (56.9 ± 4.7 years, 93 men) who underwent head MRI, chest CT, and carotid echography in the same period in a workplace health checkup between April and September 2014. Subjects were evaluated for ICAD based on stenosis of bilateral middle cerebral arteries and the basilar artery on previously reported scores from magnetic resonance angiography. Evaluations for extracranial arteriosclerotic disease (ECAD) were based on findings from carotid echography, and total calcium scores were calculated based on the number, areas, and peak Hounsfield computed tomographic numbers of the aortic arch calcified lesion detected. RESULTS ICAD, including mild cases with stenosis less than 50%, was seen in 21 subjects (20.3%); and MetS was evident in 12 subjects (11.7%). Logistic regression analysis with multivariate adjustment for major vascular risk factor demonstrated that echogenic of plaque was significantly associated with the ICAD (OR 3.69, 95%CI 1.02-13.3), however age was significant predictor of the risk profile in patients with ECAD. CONCLUSIONS Carotid atherosclerosis could predict intracranial atherosclerosis in middle-aged people. However, further study with large sample size is warranted.
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Affiliation(s)
- Makoto Shiraishi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Yasuhiro Hasegawa
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Nobuyoshi Narita
- Fujitsu Limited Health Promotion Unit, Kawasaki, Kanagawa, Japan
| | - Hitoshi Miyake
- Fujitsu Limited Health Promotion Unit, Kawasaki, Kanagawa, Japan
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Lange MC, Ribas G, Scavasine V, Ducci RDP, Mendes DC, Zétola VDHF, Cabral N, Rundek T. Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease. Arq Neuropsiquiatr 2019; 76:649-653. [PMID: 30427503 DOI: 10.1590/0004-282x20180095] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. METHODS All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. RESULTS The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. CONCLUSION Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.
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Affiliation(s)
- Marcos C Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Gustavo Ribas
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Valeria Scavasine
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Danielle C Mendes
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | | | - Norberto Cabral
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brasil
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Department of Neurology, Miami, FL, USA
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32
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Meng Y, Yu K, Zhang L, Liu Y. Cognitive Decline in Asymptomatic Middle Cerebral Artery Stenosis Patients with Moderate and Poor Collaterals: A 2-Year Follow-Up Study. Med Sci Monit 2019; 25:4051-4058. [PMID: 31148547 PMCID: PMC6558999 DOI: 10.12659/msm.913797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to determine whether poor collaterals contribute to the occurrence of certain types of cognitive disorders in asymptomatic middle cerebral artery stenosis (MCAS). Material/Methods Patients aged ≥45 years with asymptomatic MCAS confirmed by computed tomography angiography were included in a single-center retrospective study. They did not have prior stroke or dementia. Within 7 days of admission, MRI and comprehensive neuropsychological assessment were performed. Cognitive assessment was conducted after 2 years. Two independent neuroradiologists evaluated intracranial collaterals by using the Miteff scale. Demographic date and Fazekas scores were collected. Results A total of 173 patients with asymptomatic MCAS (66% men, mean age 59.4 years) and 42 controls (45% men, mean age 61.4 years) were enrolled. Executive function, attention, and information-processing speed in poor collateral circulation patients were more frequently and more often impaired than those in good collateral circulation patients. Throughout the study period, patients with poor collateral circulation had worse executive function, attention, and information-processing speed than those with moderate collateral circulation. Over time, MCAS patients with good collateral circulation did not show an association with cognitive function. Conclusions MCAS patients with moderate and poor collateral circulation have impairment of ≥1 cognitive domain over time. The affected domains are consistent with the profile of vascular cognitive impairment. Good collateral circulation is more important in patients with MCAS, and is associated with less risk of cognitive disorders.
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Affiliation(s)
- Yuanyuan Meng
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Kun Yu
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Ligong Zhang
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
| | - Yingchun Liu
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong, China (mainland)
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Fujita K, Tanaka K, Yamagami H, Ide T, Ishiyama H, Sonoda K, Satow T, Takahashi JC, Ihara M, Koga M, Yokota T, Toyoda K. Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke. Stroke 2019; 50:1751-1757. [PMID: 31233392 DOI: 10.1161/strokeaha.119.025142] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications ( P for trend <0.001). Conclusions- Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.
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Affiliation(s)
- Kyohei Fujita
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.)
| | - Kanta Tanaka
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihiro Ide
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.,Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan (T.I.)
| | - Hiroyuki Ishiyama
- Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazutaka Sonoda
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsu Satow
- Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun C Takahashi
- Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.)
| | - Kazunori Toyoda
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
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Meng Y, Li M, Yu Y, Xu Y, Gao S, Feng F, Xu WH. Quantitative score of the vessel morphology in middle cerebral artery atherosclerosis. J Neurol Sci 2019; 399:111-7. [PMID: 30798108 DOI: 10.1016/j.jns.2019.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to quantitatively assess the vessel morphology of middle cerebral artery (MCA) atherosclerosis and explore its value in discriminating plaque types. METHODS Patients were selected from a high-resolution magnetic resonance imaging (HRMRI) study from January 2007 to December 2015. One hundred and three patients with acute cerebral infarcts due to MCA stenosis (>50%) and eighty-nine patients with asymptomatic MCA stenosis (>50%) were included. Quantitative measurements of MCA morphology, including lumen area, outer-wall and wall area at stenotic site and reference site, stenotic degree, plaque length, remodeling index and plaque eccentricity, were performed on HRMRI with observers blinded to clinical presentations. Firth's penalized logistic regression analysis was used to construct a symptomatic plaque score (SPS) model. Then, the HRMRI data of 39 patients prospectively enrolled from January 2016 to January 2017 were used to validate the SPS model. RESULTS The HRMRI data of 103 patients with symptomatic MCA stenosis and 89 patients with asymptomatic MCA stenosis in the construction cohort were analyzed. Four main factors were found to be associated with symptomatic plaques: stenotic lumen area ≥ 2.28 mm2, stenotic wall area ≥ 8.88 mm2, plaque length and presence of an eccentric plaque. Summation of each logistic regression coefficient multiplying the corresponding score produced the SPS with an area under curve (AUC) of 0.890 on receiver operating characteristics analysis. Validation of the score of 39 plaques (19 symptomatic and 20 asymptomatic) revealed an AUC of 0.862, confirming the continued diagnostic ability. When the data were pooled in all 235 plaques, the optimal cutoff score of discriminating symptomatic and asymptomatic plaques was 2.79 (SPS ≥ 2.79 indicating a symptomatic plaque) with AUC = 0.886, sensitivity 81.1% and specificity 80.5%. CONCLUSIONS The quantitative analysis of MCA morphology can independently and accurately discriminate plaque types, suggesting its close association with the underlying pathophysiology. Further prospective studies are required to verify whether the SPS model is clinically valuable in monitoring plaque progression and assessing the vulnerability.
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Fu X, Li X, Xiong L, Li X, Huang R, Gao Q. Cerebral Arterial Stiffness as A New Marker of Early Stage Atherosclerosis of The Cerebral Large Artery in Acute Stroke. J Atheroscler Thromb 2019; 26:783-791. [PMID: 30662019 PMCID: PMC6753241 DOI: 10.5551/jat.46573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: Carotid–cer ebral pulse wave velocity (ccPWV) reflects the segment (C-M segment) stiffness between the common carotid artery and ipsilateral middle cerebral artery. C-M segment atherosclerosis (CMSA) is regarded the most frequent cause of anterior circulation ischemic stroke. We aimed to evaluate the association of ccPWV with early stage CMSA in this study. Methods: Eighty-one acute ischemic stroke (AIS) patients with 154 C-M segments who were successfully evaluated with digital subtraction angiography, ccPWV, carotid intima–media thickness (cIMT), and brachial–ankle pulse wave velocity were enrolled into this study. Patient demographics and clinical data were retrieved from our AIS databases. Results: Multivariate analyses showed that CMSA was independently associated with higher systolic BP, ccPWV, and cIMT. ccPWV and cIMT presented good diagnostic values for evaluating early stage CMSA in the receiver operating characteristic curve analyses. The areas under the curve (AUCs) of ccPWV were significantly higher than that of cIMT (Z = 2.204, P = 0.007). The AUC, sensitivity, specificity, Youden index, and cutoff of ccPWV for detecting early stage CMSA were 0.815 (P < 0.001), 86%, 70.7%, 0.567, and 5.4 m/s, respectively. Furthermore, ccPWV was significantly correlated with the stenosis of CMSA at the early stage in Spearman's correlation analyses (r = 0.877, P < 0.001) and fractional polynomial plot with 95% confidence intervals. Conclusions: Cerebral arterial stiffness has the potential to be a new marker of early stage atherosclerosis of the cerebral large artery. This finding may help us prevent the occurrence of stroke and decrease the burden of society from stroke patients.
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Affiliation(s)
- Xian Fu
- Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University
| | - Xianliang Li
- Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University
| | - Li Xiong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Xuelong Li
- Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University
| | - Ruxun Huang
- Department of Neurology, the First Affiliated Hospital, Sun Yat-Sen University
| | - Qingchun Gao
- Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University
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Affiliation(s)
- M. W. Hayman
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Visiting Specialist Anaesthestist
| | - M. S. Paleologos
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Staff Specialist Anaesthetist, Director of Services
| | - P. C. A. Kam
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Nuffield Professor and Head, Departments of Anaesthetics, University of Sydney and Royal Prince Alfred Hospital
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Liang J, Guo J, Liu D, Shi C, Luo L. Application of High-Resolution CUBE Sequence in Exploring Stroke Mechanisms of Atherosclerotic Stenosis of Middle Cerebral Artery. J Stroke Cerebrovasc Dis 2019; 28:156-62. [PMID: 30322755 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/17/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study aimed to analyze the vascular wall and atherosclerotic plaques of the middle cerebral artery (MCA) and compare their differences between patients with cerebral infarction and transient ischemic attack (TIA) using 3-dimensional fast-spin-echo T1-weighted sequence (namely CUBE). METHODS Forty-seven patients with atherosclerotic stenosis of the MCA were included in this study. They received magnetic resonance examinations with routine T1WI, T2WI, 3-dimensional time-of-flight magnetic resonance angiography and diffusion-weighted imaging, as well as high-resolution CUBE T1WI sequence. Two physicians independently observed the location and degree of enhancement of the atheromatous plaques. The vessel area and lumen area at the maximal-lumen-narrowing and reference site were measured to calculate the plaque area, rate of stenosis, and remodeling index of the MCA. The chi-squared test was used to compare the differences of degree of enhancement between the cerebral infarction and TIA groups. The differences of rate of stenosis and remodeling index were compared by independent sample t test. RESULTS Twenty-five lesion vessels in the infarction group and 22 in the TIA group were analyzed. The difference of stenosis rate between the groups was not statistically significant. The lesion vessels of infarction group had a significantly larger remodeling index and plaque area, and the plaques had a significantly higher degree of enhancement, compared to the TIA group. CONCLUSIONS CUBE T1WI can be used to characterize the MCA vessel wall and atherosclerotic plaque. Positive remodeling and enhanced plaques are closely correlated with the occurrence of brain stroke.
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Liang M, Wang P, Ma Y, Zhang X, Gao J, Ma M, Dai Z, Liu D, Liu X. New vessels formation in young strokes with isolated steno-occlusive MCA. Brain Behav 2018; 8:e01088. [PMID: 30260098 PMCID: PMC6192400 DOI: 10.1002/brb3.1088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE New vessels formation (NVF) along the steno-occlusive middle cerebral artery (MCA) is often observed in digital subtraction angiography (DSA) imaging. In the study, we aim to explore the clinical relevance of NVF in young ischemic stroke patients with isolated middle cerebral artery (MCA) stenosis. METHODS We retrospectively reviewed the digital subtraction angiography (DSA) images of 93 young ischemic stroke patients (age ≤ 45 years old) in our center from January 2006 to June 2016. All the patients were diagnosed with isolated steno-occlusive middle cerebral artery (MCA) disease.NVF was defined as new vessels formation along the stenotic MCA on anteroposterior DSA projection. The association between NVF and functional outcome was analyzed. RESULTS The prevalence of NVF was 0 in moderate stenosis, 15.8% in severe stenosis, and 53.7% in MCA occlusions. The presence of NVF had a strong correlation with the severity of MCA stenosis (r = 0.467, p < 0.001). Compared to patients without NVF, patients with NVF were more likely to suffer an unfavorable functional outcome (6.2% vs. 21.4%, p = 0.061) at 3 months. Univariate logistic regression analysis showed that NVF was associated with unfavorable outcome [Odds Ratio (OR) = 4.159, 95% confidence intervals (CI) = (1.072, 16.137), p = 0.039]. CONCLUSIONS This study demonstrated that NVF were associated with poor clinical outcome in young ischemic stroke patients who were diagnosed with isolated steno-occlusive MCA.
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Affiliation(s)
- Meng Liang
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Peng Wang
- Department of Medical Imaging, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Yan Ma
- Department of Medical Imaging, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Xiaohao Zhang
- Department of Neurology, Second Afliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Minmin Ma
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Zhengze Dai
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
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Zheng L, Yang WJ, Niu CB, Zhao HL, Wong KS, Leung TWH, Chen XY. Correlation of Adventitial Vasa Vasorum with Intracranial Atherosclerosis: A Postmortem Study. J Stroke 2018; 20:342-349. [PMID: 30309229 PMCID: PMC6186920 DOI: 10.5853/jos.2018.01263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/07/2018] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose Vasa vasorum (VV) have been believed to be rare or non-existent in small-caliber intracranial arteries. In a series of human cerebral artery specimens, we identified and examined the distribution of VV in association with co-existing intracranial atherosclerosis.
Methods We obtained cerebral artery specimens from 32 consecutive autopsies of subjects aged 45 years or above. We scrutinized middle cerebral artery (MCA), vertebral artery (VA), and basilar artery (BA) for the presence of adventitial VV. We described the distribution of VV, and the characteristics of co-existing atherosclerotic lesions.
Results Among 157 intracranial arteries, adventitial VV were present in 74 of the 157 specimens (47%), involving MCA (n=13, 18%), BA (n=14, 19%), and VA (n=47, 64%). Although qualitatively these 74 adventitial VV distributed similarly in arteries with or without atherosclerotic lesions (disease-free arteries n=4/8; arteries of pre-atherosclerosis n=17/42; and arteries of progressive atherosclerosis n=53/107), the presence of adventitial VV in intracranial VA was associated with a heavier plaque load (1.72±1.66 mm2 vs. 0.40±0.32 mm2, P<0.001), severer luminal stenosis (25%±21% vs. 12%±9%, P=0.002), higher rate of concentric lesions (79% vs. 36%, P=0.002), and denser intraplaque calcification (44% vs. 0%, P=0.003). Histologically, intracranial VA with VV had a larger diameter (3.40±0.79 mm vs. 2.34±0.58 mm, P<0.001), thicker arterial wall (0.31±0.13 mm vs. 0.23±0.06 mm, P=0.002), and a larger intima-media (0.19±0.09 mm vs. 0.13± 0.04 mm, P=0.003) than VA without VV.
Conclusions Our study demonstrated the distribution of adventitial VV within brain vasculature and association between vertebral VV and progressive atherosclerotic lesions with a heavier plaque load and denser intraplaque calcification.
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Affiliation(s)
- Lu Zheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wen Jie Yang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chun Bo Niu
- Department of Pathology, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Hai Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Xiang Yan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
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Fu X, Liu Q, Zeng X, Huang S, Huang R, Gao Q. Association between Cerebral Arterial Stiffness and Large Artery Atherosclerosis in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:2993-3000. [PMID: 30146389 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/15/2018] [Accepted: 06/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Carotid-cerebral pulse wave velocity (ccPWV) reflects the segment (C-M segment) stiffness between common carotid artery and ipsilateral middle cerebral artery. The C-M segment atherosclerosis (CMSA) is regarded as a most frequent cause of anterior circulation ischemic stroke. We therefore, attempted to investigate the relationship between cerebral arterial stiffness and CMSA, and provide reliable data for the early diagnosis of CMSA. METHODS Between June 2012 and August 2016, 81 acute ischemic stroke (AIS) patients with 154 C-M segments successfully evaluated with digital subtraction angiography and ccPWV were enrolled into this study. Patient demographics and clinical data were retrieved from our AIS databases. RESULTS Multivariate analyses showed that ccPWV was independently associated with CMSA (β = 39.6, P = .009) and Systolic blood pressure (β = 7.1, P < .001) in AIS patients. The values of ccPWV had a trend to be higher in the groups with more lesions (F = 45.9, P < .01) and severer stenosis (F = 102.6, P = .000), and was positively correlated with the number of lesions (r = .662, P = .000), and degree of stenosis (r = .858, P = .000) of CMSA. The fractional polynomial plots with 95% CIs also describe the close relationship between ccPWV and the number of lesions and degree of stenosis in CMSA. CONCLUSIONS Cerebral arterial stiffness is independently associated with the presence of CMSA, closely related to the vascular damage of C-M segment and reflects the vascular structure change of C-M segment in AIS patients. It may have the potential for assessment of CMSA in its initial stage.
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Affiliation(s)
- Xian Fu
- Department of Neurology and Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Qi Liu
- New Era Stroke Care and Research Institute, General Hospital of the PLA Rocket Force, Beijing
| | - Xianfan Zeng
- Department of Neurology and Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Shiyan Huang
- Department of Neurology and Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Ruxun Huang
- Department of Neurology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingchun Gao
- Department of Neurology and Institute of Neuroscience, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou.
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Shen M, Gao P, Zhang Q, Jing L, Yan H, Li H. Middle Cerebral Artery Atherosclerosis and Deep Subcortical Infarction: A 3T Magnetic Resonance Vessel Wall Imaging Study. J Stroke Cerebrovasc Dis 2018; 27:3387-92. [PMID: 30145026 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deep subcortical infarction is a major subtype of stroke in middle cerebral artery (MCA) territory. This study aims to evaluate the relationship between characteristics of MCA plaque and features of deep subcortical infarction. METHODS Patients with recent acute ischemic stroke and deep subcortical infarction were prospectively enrolled. Both multicontrast brain sequences and 3D high-resolution vessel wall imaging (VWI) sequences were scanned for all patients. MCA plaque characteristics, including plaque presence, location, maximum vessel wall thickness (Max WT), signal intensity and luminal stenosis, and deep subcortical infarction features, including lowest infarct layer index (LILI), area, volume, maximum area, and infarct quantity were evaluated. Infarct feature differences were compared between MCA plaque+ group and MCA plaque- group. The correlations between MCA plaque characteristics and deep subcortical infarction features were analyzed. RESULTS Of all 50 patients included in this study, 30 (60%) had MCA plaques. All deep subcortical infarction was single lesion for patients without MCA plaque. The average number of deep subcortical infarction for patients with MCA plaque was 3.10 ± 4.44. The LILI (P = .036) and infarct quantity (P = .030) showed significant differences between 2 groups. Max WT (P = .025) and stenosis degree (P = .023) were negatively correlated with LILI. Intraplaque hemorrhage was positively correlated with maximum area (P = .029) and infarct volume (P = .030). CONCLUSIONS MCA plaque characteristics were correlated with deep subcortical infarct features. Magnetic resonance VWI may provide more information for etiological evidence of deep subcortical infarction.
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Wu F, Ma Q, Song H, Guo X, Diniz MA, Song SS, Gonzalez NR, Bi X, Ji X, Li D, Yang Q, Fan Z. Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole-Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke. J Am Heart Assoc 2018; 7:JAHA.118.009705. [PMID: 30033434 PMCID: PMC6201468 DOI: 10.1161/jaha.118.009705] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke. Methods and Results Sixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions. Conclusions High signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Marcio A Diniz
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China .,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA .,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
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Padalia A, Sambursky JA, Skinner C, Moureiden M. Percutaneous Transluminal Angioplasty with Stent Placement versus Best Medical Therapy Alone in Symptomatic Intracranial Arterial Stenosis: A Best Evidence Review. Cureus 2018; 10:e2988. [PMID: 30397562 PMCID: PMC6207274 DOI: 10.7759/cureus.2988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intracranial arterial stenosis (ICAS) is a common cause of stroke, and the risk of ischemic stroke from a stenotic intracranial artery remains high despite best medical therapy (BMT). As a result, clinicians have increasingly turned to percutaneous transluminal angioplasty and stenting (PTAS) over the last decade as an alternative therapy in high-risk patients with symptomatic ICAS. In this review, we will critically analyze multiple clinical trials to assess the safety and efficacy of PTAS with BMT versus BMT alone. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial reported a higher rate of stroke or death within 30 days in the PTAS plus BMT group (14.7%) than the BMT only group (5.8%, p = 0.002). The rate of any stroke during the follow-up period (mean = 32 months) was higher in the PTAS plus BMT group (22.3%) than the BMT only group (14.1%, p = 0.03). The Vitesse Intracranial Stent Study for Ischemic Stroke Therapy (VISSIT) trial reported a higher rate of stroke or death within 30 days in the PTAS plus BMT cohort (24.1%) than the BMT only cohort (9.4%, p = 0.05). There was also a higher rate of hard transient ischemic attack (TIA) or stroke within one year in the PTAS plus BMT group (36.2%) than the BMT only group (15.1%, p = 0.02). The Vertebral Artery Ischaemia Stenting (VIST) trial reported the rate of any stroke during the follow-up period to be two events in 50 person-years in the PTAS plus BMT cohort versus four events in 45 person-years in the BMT only cohort, with a calculated hazard ratio of 0.47 (p = 0.39). Vertebral Artery Stenting Trial (VAST) reported a higher incidence of stroke, MI, or vascular death in the PTAS with BMT cohort (22%) than the BMT only cohort (0%). Tang et al. reported no significant difference in the incidence of vascular events at one year and three years between the PTAS plus BMT and BMT only cohorts. However, the distribution of vascular events was more concentrated in the first postoperative week in the PTAS plus BMT cohort (75% of all vascular events) versus the BMT only cohort (17%). Feng et al. reported a lower periprocedural complication rate (9.1%) with the Enterprise stent in comparison to the Wingspan and balloon-expandable stents used in the SAMMPRIS and VISSIT trials. We conclude that PTAS should not be employed as first-line treatment in patients with symptomatic ICAS. However, PTAS should be considered in symptomatic ICAS patients that are hemodynamically unstable or have repeatedly failed BMT, especially at sites with lower rates of perioperative complications than those reported here.
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Affiliation(s)
- Arjun Padalia
- College of Medicine, University of Central Florida, Orlando, USA
| | | | - Colby Skinner
- College of Medicine, University of Central Florida, Orlando, USA
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Liu L, Ding J, Leng X, Pu Y, Huang LA, Xu A, Wong KSL, Wang X, Wang Y. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol 2018; 3:117-130. [PMID: 30294467 PMCID: PMC6169613 DOI: 10.1136/svn-2017-000135] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 12/24/2022] Open
Abstract
Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute, subacute or chronic phases after an ischaemic stroke or transient ischaemic attack. Good collateral circulation has shown protective effects towards a favourable functional outcome and a lower risk of recurrence in stroke attributed to different aetiologies or undergoing medical or endovascular treatment. Over the past decade, the importance of collateral circulation has attracted more attention and is becoming a hot spot for research. However, the diversity in imaging methods and criteria to evaluate collateral circulation has hindered comparisons of findings from different cohorts and further studies in exploring the clinical relevance of collateral circulation and possible methods to enhance collateral flow. The statement is aimed to update currently available evidence and provide evidence-based recommendations regarding grading methods for collateral circulation, its significance in patients with stroke and methods under investigation to improve collateral flow.
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Affiliation(s)
- Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-An Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ka Sing Lawrence Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Tsivgoulis G, Safouris A, Kim DE, Alexandrov AV. Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke. J Stroke 2018; 20:145-166. [PMID: 29886715 PMCID: PMC6007302 DOI: 10.5853/jos.2018.00773] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/13/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023] Open
Abstract
Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk. Advances in antithrombotic treatments include combinations of antiplatelets and new antiplatelet agents in the acute phase post-stroke, which carries a high risk of recurrence. Intensive medical treatment has also limited the indications for carotid interventions, especially for asymptomatic disease. Intracranial atherosclerotic disease may provoke stroke through various mechanisms; it is increasingly recognized as a cause of ischemic stroke with advanced imaging and is best managed with lifestyle modifications and medical therapy. The diagnostic search for the vulnerable culprit atherosclerotic plaque is an area of intense research, from the level of the intracranial arteries to that of the aortic arch. Ultrasonography and novel magnetic resonance imaging techniques (high-resolution vessel-wall imaging) may assist in the identification of vulnerable atherosclerotic plaques as the underlying cause in cryptogenic or misdiagnosed non-atherosclerotic ischemic stroke. Vertebrobasilar atherosclerotic disease is less common than carotid artery disease; thus, high-quality data on effective prevention strategies are scarcer. However, aggressive medical treatment is also the gold standard to reduce cerebrovascular disease located in posterior circulation.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Apostolos Safouris
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- Stroke Unit, Metropolitan Hospital, Pireus, Greece
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Andrei V. Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
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Liu J, Cui X, Wang D, Wu S, Xiong Y, Zhang S, Wu B, Liu M. Relationship of thyroid function with intracranial arterial stenosis and carotid atheromatous plaques in ischemic stroke patients with euthyroidism. Oncotarget 2017; 8:46532-9. [PMID: 28147329 DOI: 10.18632/oncotarget.14883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 01/16/2017] [Indexed: 02/05/2023] Open
Abstract
This study aimed to help clarify the possible relationships of thyroid function with intracranial arterial stenosis or carotid atheromatous plaques in ischemic stroke patients with euthyroidism. We retrospectively reviewed the medical records of a consecutive series of ischemic stroke patients prospectively entered into the Chengdu Stroke Registry between February 2010 and March2012. We performed univariate and multivariate analysis to assess possible relationships of thyroid function with intracranial artery stenosis or carotid atheromatous plaques. Of the 172 patients analyzed (42 women; 61.7 ± 14.0 years old), 62 (32.0%) had carotid atheromatous plaques, and 81 (47.1%) had intracranial artery stenosis. Free thyroxine levels were lower in patients with carotid atheromatous plaques than in patients without plaques (15.80±2.09 vs. 16.92±2.69, P = 0.005). After adjusting for age, gender, hyperlipidemia, and previous smoking, free thyroxine levels were independently associated with carotid atheromatous plaques (OR 0.73, 95% CI 0.54-0.99, P = 0.04). In contrast, thyroid function indicators showed no associations with intracranial arterial stenosis. In conclusion, low free thyroxine levels were independently associated with carotid atheromatous plaques in ischemic stroke patients with euthyroidism, but thyroid function indicators were not associated with intracranial artery stenosis.
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Wang Y, Zhou B, Zhou P, Yao Y, Cui Q, Liu Y, Yang J, Wu S, Zhao X, Zhou Y. Association of lipoprotein-associated phospholipase A2 mass with asymptomatic cerebral artery stenosis. J Cell Mol Med 2018; 22:2329-2336. [PMID: 29424477 PMCID: PMC5867129 DOI: 10.1111/jcmm.13521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/08/2017] [Indexed: 12/25/2022] Open
Abstract
Cerebral artery stenosis (CAS) is the most important causes of ischaemic stroke. Lipoprotein-associated phospholipase A2 (Lp-PLA2) plays 2 diverse roles in atherosclerosis (pro-inflammatory and anti-inflammatory), and the association between Lp-PLA2 mass and cardiovascular or cerebrovascular events is inconsistent among previous studies. A cross-sectional study including 2012 North Chinese adults aged ≥40 years was performed in 2010-2011 to investigate whether Lp-PLA2 mass is associated with asymptomatic cerebral artery stenosis (ACAS). Serum Lp-PLA2 mass was determined by enzyme-linked immunosorbent assay (ELISA). All participants underwent transcranial Doppler (TCD) and bilateral carotid duplex ultrasound to evaluate intracranial artery stenosis (ICAS) and extracranial arterial stenosis (ECAS). The median serum Lp-PLA2 mass of the participants was 140.74 ng/mL (interquartile range: 131.79-158.07 ng/mL). The adjusted odds ratio (OR) when comparing the 4th quartile to the 1st quartile of Lp-PLA2 was 1.98 (95% confidence interval (CI): 1.42-2.78), 1.79 (95% CI: 1.08-2.94) and 1.87 (95% CI: 1.28-2.73) for the occurrence of ACAS, asymptomatic ECAS and asymptomatic ICAS, respectively, after controlling for vascular risk factors. These independently significant associations remained statistically significant in the male or elderly subgroups, but not in females or middle-aged participants. Lp-PLA2 mass is positively correlated with subclinical atherosclerosis determined by ACAS, ICAS and ECAS in North Chinese, particularly in male and older participants, suggesting that serum Lp-PLA2 mass might be potential biomarker for the detection of ACAS in the adults.
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Affiliation(s)
- Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Bin Zhou
- Department of Neurosurgery, Baotou Eighth Hospital, Baotou, China
| | - Pingan Zhou
- Department of Ultrasound, Yan'an University Affiliated Hospital, Yan'an, China
| | - Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinghua Cui
- Department of Biomedical Informatics, Center for Noncoding RNA Medicine, MOE Key Laboratory of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yingping Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jichun Yang
- Pathophysiology, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Science of the Ministry of Education Center for Non-coding RNA Medicine, Peking University Health Science Center, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Municipal Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Zhou
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Alexander MD, Rebhun JM, Hetts SW, Amans MR, Settecase F, Darflinger RJ, Dowd CF, Halbach VV, Higashida RT, Cooke DL. Technical factors affecting outcomes following endovascular treatment of posterior circulation atherosclerotic lesions. Surg Neurol Int 2017; 8:284. [PMID: 29279801 PMCID: PMC5705933 DOI: 10.4103/sni.sni_255_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/22/2017] [Indexed: 11/04/2022] Open
Abstract
Background Atherosclerotic disease of the vertebrobasilar system causes significant morbidity and mortality. All lesions require aggressive medical management, but the role of endovascular interventions remains unsettled. This study examines such endovascular interventions for vertebrobasilar atherosclerosis. Methods Retrospective review was performed of prospectively maintained procedure logs at three hospitals with comprehensive neurointerventional services. Patients with angiographically-proven stenosis undergoing elective stent placement were selected for analysis of demographic factors, lesion characteristics, and treatment details. Multivariate analysis was performed to evaluate for associations with ischemic stroke, death, and functional status as measured by modified Rankin scale at multiple intervals. Results One hundred and twenty-three lesions were treated in 110 patients. A total of 43 (58.1%) lesions caused stroke, while 66 (89.2%) caused transient ischemic attacks (TIAs). Forty lesions (32.5%) were at the vertebral origin; 97 (60.2%) were intracranial. A total of 112 (91.1%) were treated successfully. 4 (3.3%) of 10 (8.1%) procedural complications were symptomatic. Intracranial lesions were associated with death at 1 and 2 years (OR 24.91, P < 0.001) and mRS >2 at last contact (OR 12.83, P < 0.001). Stenting treatment with conjunctive angioplasty had lower rates of death (OR 0.303, P = 0.046) and mRS >2 at last contact (OR 0.234, P = 0.018) when angioplasty was performed with a device other than that packaged with the stent. Conclusion Endovascular treatment of vertebrobasilar atherosclerosis can be performed safely, particularly for vertebral origin lesions. Higher rates of technical failure and complication may be acceptable for certain intracranial lesions due to their refractory nature and the morbidity caused by such lesions. Treatment should be tailored to features of each individual lesion.
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Affiliation(s)
- Matthew D Alexander
- Department of Radiology and Imaging Sciences, Division of Neurointerventional Radiology, Salt Lake City, Utah, USA
| | - Jeffrey M Rebhun
- Ochsner Clinical School, University of Queensland, Brisbane, Australia
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Fabio Settecase
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Robert J Darflinger
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California San Francisco, San Francisco, California, USA
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Zhang X, Zhang M, Ding W, Yan S, Liebeskind DS, Lou M. Distinct predictive role of collateral status on clinical outcome in variant stroke subtypes of acute large arterial occlusion. Eur J Neurol 2017; 25:293-300. [PMID: 29053905 DOI: 10.1111/ene.13493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Clinical trials have shown that robust collateral flow has a relationship with good clinical outcome; however, different stroke subtypes were lumped together. This study explored the relationship between baseline collaterals and the onset-to-imaging time (OIT) and the correlation between pre-treatment collateral status and clinical outcome amongst different subtypes. METHOD Prospectively collected data from consecutive acute ischaemic stroke patients with acute middle cerebral artery occlusion who received reperfusion therapy were reviewed. The regional leptomeningeal score (20 points) was based on the scoring extent of contrast opacification in the six Alberta Stroke Program Early CT Score (ASPECTS) cortical regions (M1-6), parasagittal anterior cerebral artery territory and the basal ganglia by perfusion-derived dynamic four-dimensional computed tomography angiography (4D CTA). Stroke subtype was determined by the TOAST classification criteria. A 3-months modified Rankin Scale score of 0-2 was defined as a good outcome. RESULTS The analysis included 158 patients: 30 (19.0%) patients had large artery atherosclerotic stroke (LAA), 87 (55.1%) cardioembolic stroke (CE) and 41 (25.9%) stroke of undetermined etiology. Baseline collateral was negatively correlated with OIT (P = 0.0205) in the CE group after adjusting for female sex, smoking, hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) and baseline mismatch ratio, but not in the LAA group. Baseline collateral showed a strong relationship with good clinical outcome after adjusting for recanalization, baseline NIHSS, age and female sex (odds ratio 1.120, confidence interval 1.013-1.238, P = 0.027) in all patients and in the CE group (odds ratio 3.223, confidence interval 1.212-8.570, P = 0.019), but not in the LAA patients. CONCLUSIONS Based on 4D CTA, sustained good leptomeningeal collaterals may predict good outcome in CE but not in LAA patients. Moreover, the extent of collaterals was associated with OIT in the CE patients, which indicates prompt reperfusion therapy in this group of patients.
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Affiliation(s)
- X Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - M Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - W Ding
- Department of Radiology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - S Yan
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - D S Liebeskind
- UCLA Stroke Center, University of California Los Angeles, Los Angeles, CA, USA
| | - M Lou
- Department of Neurology, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Abstract
Intracranial artery stenosis (ICAS), a common cause of ischemic stroke, is a growing cause of concern in China. Recently, many epidemiological, etiological, pathophysiological, therapy, and diagnostic imaging studies have focused on ICAS, and guidelines and consensus on the diagnosis and treatment of ICAS have been published and updated by domestic experts. Such work is pivotal to our enhanced comprehension, diagnosis, and treatment of ICAS. In this review, we summarize the latest progress in the evaluation and treatment of ICAS in China.
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Affiliation(s)
- Bin Cai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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