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Sun J, Sui Y, Chen Y, Lian J, Wang W. Predicting acute ischemic stroke using the revised Framingham stroke risk profile and multimodal magnetic resonance imaging. Front Neurol 2023; 14:1264791. [PMID: 37840926 PMCID: PMC10568328 DOI: 10.3389/fneur.2023.1264791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background and purpose Patients with transient ischemic attacks (TIA) have a significant risk of developing acute ischemic strokes (AIS), emphasizing the critical need for hierarchical management. This study aims to develop a clinical-imaging model utilizing multimodal magnetic resonance imaging (mMRI) and the revised Framingham Stroke Risk Profile (FSRP) to predict AIS and achieve early secondary prevention. Methods mMRI scans were conducted on patients with symptomatic intracranial atherosclerotic disease (ICAD) to assess vascular wall features and cerebral perfusion parameters. Based on diffusion-weighted imaging (DWI), patients were divided into two groups: TIA and AIS. Clinical data were evaluated to calculate the FSRP score. Differences in clinical and imaging characteristics between the groups were analyzed, and a predictive model for AIS probability in patients with ICAD was established. Results A total of 112 TIA and AIS patients were included in the study. The results showed that the AIS group had higher proportions of FSRP-high risk, hyperhomocysteinemia, and higher value of low-density lipoprotein (LDL), standardized plaque index (SQI), and enhancement rate (ER) compared to the TIA group (p < 0.05). Mean transit time (MTT) and time to peak (TTP) in the lesion area were significantly longer in the AIS group (p < 0.05). Multivariate analysis identified FSRP-high risk (p = 0.027) and high ER (p = 0.046) as independent risk factors for AIS. The combined clinical and mMRI model produced an area under the curve (AUC) of 0.791 in receiver operating characteristic (ROC) analysis. The constructed nomogram model combining clinical and mMRI features demonstrated favorable clinical net benefits. Conclusion FSRP-high risk and high ER were confirmed as independent risk factors for AIS. The combined prediction model utilizing clinical and imaging markers effectively predicts stroke risk in symptomatic ICAD patients.
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Affiliation(s)
- Jiali Sun
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Sui
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Chen
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxiu Lian
- Department of Advisory Clinical Scientist C&TS North, Philips Healthcare, Beijing, China
| | - Wei Wang
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
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Li Y, Guo R, Zhang X, Yang Y, Yan Y, Yuan X, Wang C, Xie S. Effect of dominant vertebral artery angle on basilar artery curvature and plaque. Quant Imaging Med Surg 2023; 13:5748-5758. [PMID: 37711832 PMCID: PMC10498226 DOI: 10.21037/qims-23-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/26/2023] [Indexed: 09/16/2023]
Abstract
Background Quantification of vertebral arteries can provide insights into basilar curvature and plaque. Therefore, this retrospective study aimed at identifying the dominant vertebral artery (VA) causing basilar artery (BA) curvature and to further quantify the effect of dominant VA angle on BA curvature and BA plaque using high-resolution magnetic resonance imaging (HRMRI) and 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA). Methods This retrospective analysis included 521 participants who underwent HRMRI in the China-Japan Friendship Hospital from November 2015 to October 2021 for neurological symptoms or signs. The VA angle more related to BA curvature was defined as the dominant VA angle. Multivariable linear regression analysis was used to evaluate the relationship between the dominant VA angle and mid-BA angle, while multivariable logistics regression was used to evaluate the influence of the dominant VA angle and clinical risk factors on BA plaque. Results In total, 259 participants were included in this study (mean age 53.71±13.12 years; 146 males). The balanced-type participants had a significantly lower probability of BA plaques (P<0.001). The Chi-squared test showed that the BA curvature direction was significantly associated with the side with larger VA diameter (P<0.001) and larger VA angle (P<0.001). As a result, the VA angle on the side with the larger diameter or the larger VA angle when the diameters were similar was considered to be the dominant VA angle. The dominant VA angle was independently correlated with the mid-BA angle (P<0.001). In addition, the dominant VA angle was also an independent risk factor for BA plaque. Additionally, 80° was the cutoff value of the dominant VA angle, and when the dominant VA angle was greater than 80°, the risk of BA plaque increased about 18-fold [odds ratio, 18.951; 95% confidence interval (CI): 4.545-79.026; P<0.001]. Conclusions The dominant VA angle was independently associated with BA plaque, and a dominant VA angle greater than 80° may be a marker for a high risk of posterior circulation atherosclerosis.
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Affiliation(s)
- Yangchen Li
- Department of Radiology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xuebing Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yang Yang
- Department of Radiology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yuchun Yan
- Department of Radiology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Xinyu Yuan
- Department of Radiology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Ce Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Huang R, Yang B, Gao F, Mo D, Yang M, Hou Z, Liu Y, Cui R, Kang K, Gu W, He J, Lou X, Miao Z, Ma N. Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting. Interv Neuroradiol 2023:15910199231164840. [PMID: 36987683 DOI: 10.1177/15910199231164840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND AND PURPOSE We investigated the relationship between basilar artery (BA) atherosclerotic stenosis features and vertebral artery (VA) stenosis and explored whether BA stenosis features are associated with perforator stroke after stenting. METHODS Patients with BA stenosis who underwent HRMRI and DSA were recruited. Patients were divided into proximal BA stenosis and middle-or-distal BA stenosis groups, and then subgroup analyses were performed based on whether they had VA stenosis. BA plaque features were evaluated by HRMRI. Artery stenosis was measured by DSA. The incidence of perforator stroke after BA stenting was recorded, and the potential association between BA stenosis features and perforator stroke was analyzed. RESULTS One hundred and seventy-four patients were consecutively enrolled. Patients with proximal BA stenosis had a higher proportion of severe stenosis than those with middle-or-distal BA stenosis (P = 0.027). In the subgroup analysis, this difference mainly existed in patients complicated with VA stenosis (P = 0.023). Patients with proximal BA stenosis had a higher proportion of strong plaque enhancement than those with middle-or-distal BA stenosis (P < 0.001), especially in those with vertebrobasilar junction (VBJ) stenosis (P < 0.001). Perforator stroke after BA stenting occurred in five patients, of whom four had lateral wall BA plaques, four had plaque enhancement and four had proximal BA stenosis. CONCLUSION Patients with proximal BA stenosis had a higher proportion of severe stenosis and strong plaque enhancement, particularly in patients complicated with VA stenosis and VBJ stenosis. Perforator stroke after BA stenting may be related to distribution, burden and characteristics of BA lesions.
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Affiliation(s)
- Rui Huang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Bo Yang
- Department of Neurology, 626035Beijing Jiangong Hospital, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ming Yang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Zhikai Hou
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Yifan Liu
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Rongrong Cui
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Kaijiang Kang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Disease, Beijing, China
- Department of Radiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianfeng He
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
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Li Y, Chen F, Yang B, Xie S, Wang C, Guo R, Zhang X, Liu Z. Effect of Mid-Basilar Artery Angle and Plaque Characteristics on Pontine Infarction in Patients with Basilar Artery Plaque. J Atheroscler Thromb 2023; 30:182-191. [PMID: 35418542 PMCID: PMC9925201 DOI: 10.5551/jat.63520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS The basilar artery (BA) geometry and plaque characteristics may play an important role in the development of atherosclerosis. This study was performed to explore the relationship between the mid-BA angle and plaque characteristics and its effect on pontine infarction using high-resolution magnetic resonance imaging and three-dimensional time-of-flight magnetic resonance angiography. METHODS In total, 77 patients with BA plaques were included in this study. According to the presence of acute pontine infarction on diffusion-weighted imaging, the patients were divided into a pontine infarction group and pontine non-infarction group. The mid-BA angle, plaque burden, stenosis ratio, positive remodeling, and intraplaque hemorrhage were evaluated to investigate their effects on stroke. RESULTS The pontine infarction group had a greater plaque burden, stenosis ratio, positive remodeling, and mid-BA angle than the pontine non-infarction group. The correlation between the plaque burden and mid-BA angle was the highest (r=0.441, P<0.001). Multivariate logistic regression analysis showed that the plaque burden (odds ratio, 1.164; 95% confidence interval, 1.093-1.241; P<0.001) was an independent risk factor for pontine infarction. CONCLUSION The mid-BA angle may increase the incidence of pontine infarction by increasing the plaque burden.
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Affiliation(s)
- Yangchen Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China,Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Fengxin Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bo Yang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China,Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Ce Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xuebing Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zunjing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
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