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Cheng SF, Richards T, Gregson J, Brown MM, de Borst GJ, Bonati LH. Long Term Restenosis Rate After Carotid Endarterectomy: Comparison of Three Surgical Techniques and Intra-Operative Shunt Use. Eur J Vasc Endovasc Surg 2021; 62:513-521. [PMID: 34452836 DOI: 10.1016/j.ejvs.2021.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/01/2020] [Revised: 06/07/2021] [Accepted: 06/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Closure of the artery during carotid endarterectomy (CEA) can be done with or without a patch, or performed with the eversion technique, while the use of intra-operative shunts is optional. The influence of these techniques on subsequent restenosis is uncertain. Long term carotid restenosis rates and risk of future ipsilateral stroke with these techniques were compared. METHODS Patients who underwent CEA in the International Carotid Stenting Study were divided into patch angioplasty, primary closure, or eversion endarterectomy. Intra-operative shunt use was reported. Carotid duplex ultrasound was performed at each follow up. Primary outcomes were restenosis of ≥ 50% and ≥ 70%, and ipsilateral stroke after the procedure to the end of follow up. RESULTS In total, 790 CEA patients had restenosis data at one and five years. Altogether, 511 (64.7%) had patch angioplasty, 232 (29.4%) primary closure, and 47 (5.9%) eversion endarterectomy. The cumulative incidence of ≥ 50% restenosis at one year was 18.9%, 26.1%, and 17.7%, respectively, and at five years it was 25.9%, 37.2%, and 30.0%, respectively. There was no difference in risk between the eversion and patch angioplasty group (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.45 - 1.81; p = .77). Primary closure had a higher risk of restenosis than patch angioplasty (HR 1.45, 95% CI 1.06 - 1.98; p = .019). The cumulative incidence of ≥ 70% restenosis did not differ between primary closure and patch angioplasty (12.1% vs. 7.1%, HR 1.59, 95% CI 0.88 - 2.89; p = .12) or between patch angioplasty and eversion endarterectomy (4.7%, HR 0.45, 95% CI 0.06 - 3.35; p = .44). There was no effect of shunt use on the cumulative incidence of restenosis. Post-procedural ipsilateral stroke was not more common in either of the surgical techniques or shunt use. CONCLUSION Restenosis was more common after primary closure than conventionally with a patch closure. Shunt use had no effect on restenosis. Patch closure is the treatment of choice to avoid restenosis.
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Affiliation(s)
- Suk F Cheng
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Toby Richards
- Faculty of Health and Medical Sciences, Surgery, University of Western Australia, Perth, Australia
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, UK.
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leo H Bonati
- Department of Neurology and Stroke Centre, University Hospital Basel, University of Basel, Basel, Switzerland
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Sonaglioni A, Caminati A, Lipsi R, Lombardo M, Harari S. Association between C-reactive protein and carotid plaque in mild-to-moderate idiopathic pulmonary fibrosis. Intern Emerg Med 2021; 16:1529-1539. [PMID: 33411265 DOI: 10.1007/s11739-020-02607-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023]
Abstract
An association between C-reactive protein (CRP) levels and carotid plaque has never been investigated in idiopathic pulmonary fibrosis (IPF). The aim of this study was to evaluate the extent of carotid atherosclerosis in mild-to-moderate IPF and to assess its relationship to serum CRP. This observational retrospective case-control study included 60 consecutive IPF patients (73.8 ± 6.6 years, 45 males) and 60 matched controls, examined between Sep 2017 and Jan 2019. All patients underwent CRP assessment and a carotid Doppler ultrasonography. CRP levels were significantly higher in IPF patients than controls (0.2 ± 0.09 mg/dl vs 0.09 ± 0.04 mg/dl, p < 0.0001). A total of 46 plaques were detected, with higher prevalence in IPF patients than controls (38 vs 8, p < 0.0001). On univariate logistic regression the main variables independently associated with carotid plaque were: age (HR 1.09, 95% CI 1.03-1.16, p = 0.006), hypertension duration (HR 1.05, 95% CI 1.01-1.09, p = 0.01), diabetes duration (HR 1.09, 95% CI 1.01-1.18, p = 0.03), LDL-cholesterol (HR 1.07, 95% CI 1.04-1.10, p < 0.0001) and finally CRP levels (HR 1.73, 95% CI 0.59-5.00, p < 0.0001). Multivariate logistic regression analysis revealed that LDL-cholesterol (HR 1.05, 95% CI 1.01-1.08, p = 0.009) and CRP levels (HR 1.43, 95% CI 0.39-5.19, p < 0.0001) retained statistical significance. Common carotid artery-intima media thickness was significantly correlated with CRP levels in IPF patients (r = 0.86). SerumCRP might represent both an early marker and a potential therapeutic target for carotid atherosclerosis in mild-to-moderate IPF.
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Affiliation(s)
- Andrea Sonaglioni
- UO Di Cardiologia, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Antonella Caminati
- UO Di Pneumologia E Terapia Semi-Intensiva Respiratoria-Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Lipsi
- UO Di Pneumologia E Terapia Semi-Intensiva Respiratoria-Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Michele Lombardo
- UO Di Cardiologia, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Sergio Harari
- UO Di Pneumologia E Terapia Semi-Intensiva Respiratoria-Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Dipartimento Di Scienze Mediche, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Di Milano, Milan, Italy
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Lin YC, Wang HY, Kuo YC, Chen MJ, Wu MS, Liu CJ, Yang HW, Shih SC, Yu LY, Ko HJ, Yeh HI, Hu KC. Gut-flora metabolites is not associated with synchronous carotid artery plaque and non-alcoholic fatty liver disease in asymptomatic adults: A STROBE-compliant article. Medicine (Baltimore) 2021; 100:e27048. [PMID: 34449492 PMCID: PMC8389962 DOI: 10.1097/md.0000000000027048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
Synchronous non-alcoholic fatty liver disease (NAFLD) and carotid artery plaque formation increase the risk of mortality in patients with cardiovascular disease (CVD). Metabolic status and host gut flora are associated with NAFLD and CVD, but the risk factors require further evaluation.To evaluate the risk factors associated with NAFLD and CVD, including gut-flora-related examinations.This cross-sectional study included 235 subjects aged over 40 years who underwent abdominal ultrasound examination and carotid artery ultrasound examination on the same day or within 12 months of abdominal ultrasound between January 2018 and December 2019. All subjects underwent blood tests, including endotoxin and trimethylamine-N-oxide.The synchronous NAFLD and carotid artery plaque subjects had a higher proportion of men and increased age compared with those without NAFLD and no carotid artery plaque. The synchronous NAFLD and carotid artery plaque group had increased body mass index (BMI), blood pressure, hemoglobin A1C (5.71% vs 5.42%), triglyceride (TG) (164.61 mg/dL vs 102.61 mg/dL), and low-density lipoprotein (135.27 mg/dL vs 121.42 mg/dL). In multiple logistic regression analysis, increased BMI, mean systolic blood pressure, and TG > 110 mg/dL were independent risk factors for synchronous NAFLD and carotid artery plaque formation. Endotoxin and trimethylamine-N-oxide levels were not significantly different between the 2 groups.Host metabolic status, such as elevated BMI, TG, and systolic blood pressure, are associated with synchronous NAFLD and carotid artery plaque in asymptomatic adults. Aggressive TG control, blood pressure control, and weight reduction are indicated in patients with NAFLD.
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Affiliation(s)
- Ying-Chun Lin
- Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Yang-Che Kuo
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Horng Woei Yang
- Departments of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, Taipei, Taiwan
| | - Lo-Yip Yu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-Ju Ko
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, Taipei, Taiwan
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Choi J, Lee JY, Whang K, Cho S, Kim J. Factors associated with hemodynamic instability following carotid artery stenting. Clin Neurol Neurosurg 2021; 203:106589. [PMID: 33706060 DOI: 10.1016/j.clineuro.2021.106589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Carotid artery stenting (CAS) is a major treatment option for carotid artery stenosis, and a recognized alternative to carotid endarterectomy (CEA). However, CAS-related hemodynamic instability occurs frequently and is a known major risk factor of associated complications. This study was undertaken to identify the risk factors of hemodynamic instability associated with CAS. METHODS We analyzed the medical records of 128 patients with carotid artery stenosis treated by CAS at our institution from 2014 to 2019 to identify the risk factors of hemodynamic instability after CAS. In addition, the incidences of hemodynamic instability, including bradycardia and hypotension, during and after the procedure were investigated. RESULTS Overall, periprocedural bradycardia requiring atropine occurred in 18 (14.1 %) of the 128 study subjects, and postprocedural persistent hypotension requiring vasopressors occurred in 15 (11.7 %). Risk-adjusted analysis showed carotid bulb involvement of a stenotic lesion was an independent risk factor of periprocedural bradycardia (OR 4.25, 95 % CI 1.34-13.40) and postprocedural persistent hypotension (OR 7.36, 95 % CI 1.86-29.12). However, though a preoperative regimen of ≥ 2 antihypertensives was found to be an independent protective factor against postprocedural persistent hypotension (OR 0.17, 95 % CI 0.04-0.81), it was not associated with periprocedural bradycardia (OR 0.37 95 % CI 0.08-1.60). CONCLUSIONS The risk of hemodynamic instability development is greater when a carotid stenotic lesion involves the carotid bulb, which cautions that careful evaluation is necessary. In addition, the receipt of antihypertensive regimens before CAS had a protective effect on persistent hypotension after CAS, but did not affect bradycardia.
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Affiliation(s)
- Jongwook Choi
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
| | - Ji Yong Lee
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
| | - Kum Whang
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
| | - Sungmin Cho
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
| | - Jongyeon Kim
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
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Baradaran H, Delic A, Wong KH, Sheibani N, Alexander M, McNally JS, Majersik JJ, De Havenon A. Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of the Multi-Ethnic Study of Atherosclerosis. Cerebrovasc Dis Extra 2021; 11:37-43. [PMID: 33601394 PMCID: PMC7989729 DOI: 10.1159/000514373] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk. METHODS In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model. RESULTS We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics. CONCLUSIONS In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.
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Affiliation(s)
- Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA,
| | - Alen Delic
- Department of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Nazanin Sheibani
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - J Scott McNally
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | | | - Adam De Havenon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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Konishi T, Norikane T, Yamamoto Y, Fujimoto K, Takami Y, Mitamura K, Okauchi M, Nishiyama Y. The potential relationship between 18F-FDG uptake and wall shear stress in a patient with carotid artery disease. J Nucl Cardiol 2021; 28:367-370. [PMID: 31970680 DOI: 10.1007/s12350-019-01957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Toru Konishi
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Kengo Fujimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Masanobu Okauchi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Tatebayashi K, Yoshimura S, Sakai N, Uchida K, Kageyama H, Yamagami H, Morimoto T. Relationship Between Acute Neurological Function and Long-Term Prognosis in Patients with Large Arterial Occlusions. J Stroke Cerebrovasc Dis 2021; 30:105625. [PMID: 33497935 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105625] [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: 10/28/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To clarify the relationship between early neurological symptoms and long-term functional outcomes of acute ischemic stroke, which would be beneficial for patient management and determining clinical study criteria of novel therapeutic interventions. MATERIALS AND METHODS We retrieved data from the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) and investigated the association between 24- and 72-hour National Institutes of Health Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores, stratified by the site of occlusion (carotid or vertebrobasilar circulatory large arterial occlusion [ACO or PCO, respectively]) and endovascular recanalization therapy (EVT) performance. We examined the correlation using Spearman's rank correlation coefficient (rho). Predictive accuracies of 24- and 72-hour NIHSS scores for good outcomes at 90 days (defined as mRS score of 0-2) were evaluated by receiver operating characteristic (ROC) analyses and the corresponding areas under the curves (AUCs). RESULTS Among the 2420 patients, 1745 had ACO (971 with EVT, 774 without EVT) and 263 had PCO (127 with EVT, 136 without EVT). The 24- and 72-hour NIHSS scores were significantly associated with 90-day mRS scores and accurately predicted good outcomes (all rhos ≥0.76, all AUCs ≥0.86). In the ACO group, there were differences in rho and AUC depending on EVT performance and the time from onset to NIHSS acquisition, but no differences were observed in the PCO group. CONCLUSIONS EVT performance and time frame should be considered when determining the criteria of novel therapeutic interventions, especially for patients with ACO.
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Affiliation(s)
- Kotaro Tatebayashi
- Hyogo College of Medicine, Department of Neurosurgery, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Shinichi Yoshimura
- Hyogo College of Medicine, Department of Neurosurgery, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Nobuyuki Sakai
- Kobe City Medical Center General Hospital, Department of Neurosurgery, Kobe City, Japan.
| | - Kazutaka Uchida
- Hyogo College of Medicine, Department of Neurosurgery, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Hiroto Kageyama
- Hyogo College of Medicine, Department of Neurosurgery, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Hiroshi Yamagami
- National Hospital Organization Osaka National Hospital, Division of Stroke Medicine, Osaka, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
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Murphy PA, Jailkhani N, Nicholas SA, Del Rosario AM, Balsbaugh JL, Begum S, Kimble A, Hynes RO. Alternative Splicing of FN (Fibronectin) Regulates the Composition of the Arterial Wall Under Low Flow. Arterioscler Thromb Vasc Biol 2021; 41:e18-e32. [PMID: 33207933 PMCID: PMC8428803 DOI: 10.1161/atvbaha.120.314013] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Exposure of the arterial endothelium to low and disturbed flow is a risk factor for the erosion and rupture of atherosclerotic plaques and aneurysms. Circulating and locally produced proteins are known to contribute to an altered composition of the extracellular matrix at the site of lesions, and to contribute to inflammatory processes within the lesions. We have previously shown that alternative splicing of FN (fibronectin) protects against flow-induced hemorrhage. However, the impact of alternative splicing of FN on extracellular matrix composition remains unknown. Approach and Results: Here, we perform quantitative proteomic analysis of the matrisome of murine carotid arteries in mice deficient in the production of FN splice isoforms containing alternative exons EIIIA and EIIIB (FN-EIIIAB null) after exposure to low and disturbed flow in vivo. We also examine serum-derived and endothelial-cell contributions to the matrisome in a simplified in vitro system. We found flow-induced differences in the carotid artery matrisome that were impaired in FN-EIIIAB null mice. One of the most interesting differences was reduced recruitment of FBLN1 (fibulin-1), abundant in blood and not locally produced in the intima. This defect was validated in our in vitro assay, where FBLN1 recruitment from serum was impaired by the absence of these alternatively spliced segments. CONCLUSIONS Our results reveal the extent of the dynamic alterations in the matrisome in the acute response to low and disturbed flow and show how changes in the splicing of FN, a common response in vascular inflammation and remodeling, can affect matrix composition.
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Affiliation(s)
- Patrick A. Murphy
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139
- UCONN Health, Farmington, CT 06030
| | - Noor Jailkhani
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139
| | | | | | | | - Shahinoor Begum
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139
- Howard Hughes Medical Institute, Chevy Chase, MD 20815
| | | | - Richard O. Hynes
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA 02139
- Howard Hughes Medical Institute, Chevy Chase, MD 20815
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Chen C, Ling C, Luo L, He H, Li M, Bhattarai R, Guo Y, Wang H, Guo Y. Comparison of the Effectiveness of Ring-Stripping Retrograde Endarterectomy and Carotid Artery Crossover Bypass in the Treatment of Patients with Symptomatic Riles Type 1A Common Carotid Artery Occlusion. J Stroke Cerebrovasc Dis 2020; 29:105143. [PMID: 32912498 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105143] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/22/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The surgical procedure most appropriate for treating symptomatic Riles type 1A common carotid artery occlusion (CCAO) is unclear. This study compares the effects of ring-stripping retrograde endarterectomy (RSRE) and carotid artery crossover bypass (CACB) on cerebral perfusion improvement in patients with symptomatic Riles type 1A CCAO. METHODS We conducted a retrospective analysis of symptomatic Riles type 1A CCAO patients treated at our centre. Postoperative improvements in the ipsilateral internal carotid artery (ICA) flow rate, ipsilateral cerebral blood perfusion (CBP) and the stroke recurrence rate were compared between patients who underwent RSRE and those who underwent CACB. RESULTS A total of 20 CCAO patients were surgically treated at our centre from 2011 to 2018. Nine of these patients underwent RSRE, and eleven underwent CACB. No significant differences were identified between the groups in the ipsilateral blood flow rate of the ICA immediately after surgery and the ipsilateral-to-contralateral mean transit time ratios 1 day after surgery. However, the flow rate in the ICA was significantly higher in the RSRE group than in the CACB group 1 year after surgery (135.44 ± 19.22 ml/min vs. 116.36 ± 17.70 ml/min, p = 0.033). For CBP, the ipsilateral-to-contralateral mean transit time ratios were significantly lower in RSRE patients than in CACB patients 1 year after surgery (1.005 ± 0.052 vs. 1.064 ± 0.066, p = 0.044). In addition, the postoperative modified Rankin scale (mRS) score at the latest follow-up point (p = 0.884) and the stroke recurrence rate during the follow-up (88.9% vs. 90.9%, p > 0.999) were not significantly different between the two groups. CONCLUSIONS Although the postoperative mRS score and the stroke recurrence rate were not significantly different between RSRE and CACB patients, compared to CACB, RSRE was better for improving the ipsilateral ICA flow rate and cerebral perfusion in symptomatic Riles type 1A CCAO patients.
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Affiliation(s)
- Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Cong Ling
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Robin Bhattarai
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Maitighar, 24663, Kathmandu, Nepal
| | - Yuefei Guo
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
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10
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He JW, Rabiller G, Nishijima Y, Akamatsu Y, Khateeb K, Yazdan-Shahmorad A, Liu J. Experimental cortical stroke induces aberrant increase of sharp-wave-associated ripples in the hippocampus and disrupts cortico-hippocampal communication. J Cereb Blood Flow Metab 2020; 40:1778-1796. [PMID: 31558106 PMCID: PMC7446570 DOI: 10.1177/0271678x19877889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022]
Abstract
The functional consequences of ischemic stroke in the remote brain regions are not well characterized. The current study sought to determine changes in hippocampal oscillatory activity that may underlie the cognitive impairment observed following distal middle cerebral artery occlusion (dMCAO) without causing hippocampal structural damage. Local field potentials were recorded from the dorsal hippocampus and cortex in urethane-anesthetized rats with multichannel silicon probes during dMCAO and reperfusion, or mild ischemia induced by bilateral common carotid artery occlusion (CCAO). Bilateral change of brain state was evidenced by reduced theta/delta amplitude ratio and shortened high theta duration following acute dMCAO but not CCAO. An aberrant increase in the occurrence of sharp-wave-associated ripples (150-250 Hz), crucial for memory consolidation, was only detected after dMCAO reperfusion, coinciding with an increased occurrence of high-frequency discharges (250-450 Hz). dMCAO also significantly affected the modulation of gamma amplitude in the cortex coupled to hippocampal theta phase, although both hippocampal theta and gamma power were temporarily decreased during dMCAO. Our results suggest that MCAO may disrupt the balance between excitatory and inhibitory circuits in the hippocampus and alter the function of cortico-hippocampal network, providing a novel insight in how cortical stroke affects function in remote brain regions.
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Affiliation(s)
- Ji-Wei He
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
| | - Gratianne Rabiller
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
| | - Yasuo Nishijima
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Akamatsu
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Karam Khateeb
- Departments of Bioengineering and Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Azadeh Yazdan-Shahmorad
- Departments of Bioengineering and Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
- Center for Integrative Neuroscience and Department of Physiology, University of California, San Francisco, CA, USA
| | - Jialing Liu
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- Department of Neurological Surgery, SFVAMC, San Francisco, CA, USA
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11
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Sucher R, Sucher E, Köhler H, Schönherr T, Gockel I, Branzan D. Hyperspectral Imaging of the Carotid Artery Subject to Endarterectomy. Eur J Vasc Endovasc Surg 2020; 60:634-635. [PMID: 32811768 DOI: 10.1016/j.ejvs.2020.07.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany.
| | - Elisabeth Sucher
- Department of Gastroenterology, University Clinic Leipzig, Leipzig, Germany
| | - Hannes Köhler
- Innovation Centre Computer Assisted Surgery (ICCAS), Leipzig University, Germany
| | - Till Schönherr
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany
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12
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González García A, Moniche F, Escudero-Martínez I, Mancha F, Tomasello A, Ribó M, Delgado-Acosta F, Ochoa JJ, de Las Heras JA, López-Mesonero L, González-Delgado M, Murias E, Gil J, Gil R, Zamarro J, Parrilla G, Mosteiro S, Fernández-Couto MD, Fernández de Alarcón L, Ramírez-Moreno JM, Luna A, Gil A, González-Mandly A, Caniego JL, Zapata-Wainberg G, García E, Alcázar PP, Ortega J, Arenillas JF, Algaba P, Zapata-Arriaza E, Alcalde-López J, de Albóniga-Chindurza A, Cayuela A, Montaner J. Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study. JACC Cardiovasc Interv 2020; 12:873-882. [PMID: 31072509 DOI: 10.1016/j.jcin.2019.01.247] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.
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Affiliation(s)
- Alejandro González García
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Irene Escudero-Martínez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marc Ribó
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Fernando Delgado-Acosta
- Interventional Neuroradiology, Department of Radiology, Hospital Reina Sofía, Córdoba, Spain
| | - Juán José Ochoa
- Department of Neurology, Hospital Reina Sofía, Córdoba, Spain
| | - José A de Las Heras
- Interventional Neuroradiology, Department of Radiology, Hospital de Salamanca, Salamanca, Spain
| | | | | | - Eduardo Murias
- Department of Radiology, Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain
| | - Joaquín Gil
- Interventional Neuroradiology, Department of Radiology, Hospital Clínico de Valencia, Valencia, Spain
| | - Rosario Gil
- Department of Neurology, Hospital Clínico de Valencia, Valencia, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Guillermo Parrilla
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Sonia Mosteiro
- Interventional Neuroradiology, Department of Radiology, Hospital Juán Canalejo, A Coruña, Spain
| | | | | | | | - Alain Luna
- Department of Neurology, Hospital de Cruces, Bilbao, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Department of Radiology, Hospital de Cruces, Bilbao, Spain
| | - Andrés González-Mandly
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José L Caniego
- Interventional Neuroradiology, Department of Radiology, Hospital de la Princesa, Madrid, Spain
| | | | - Ernesto García
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de las Nieves, Granada, Spain
| | - Pedro P Alcázar
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de las Nieves, Granada, Spain
| | - Joaquín Ortega
- Interventional Neuroradiology, Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Jesús Alcalde-López
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Aurelio Cayuela
- Unit of Clinical Management of Public Health, Prevention and Promotion of Health, Area of Sanitary Management South of Sevilla, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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13
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Tan J, Wang Q, Shi W, Liang K, Yu B, Mao Q. A Machine Learning Approach for Predicting Early Phase Postoperative Hypertension in Patients Undergoing Carotid Endarterectomy. Ann Vasc Surg 2020; 71:121-131. [PMID: 32653616 DOI: 10.1016/j.avsg.2020.07.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to establish and validate a machine learning-based model for the prediction of early phase postoperative hypertension (EPOH) requiring the administration of intravenous vasodilators after carotid endarterectomy (CEA). METHODS Perioperative data from consecutive CEA procedures performed from January 2013 to August 2019 were retrospectively collected. EPOH was defined in post-CEA patients as hypertension involving a systolic blood pressure above 160 mm Hg and requiring the administration of any intravenous vasodilator medications in the first 24 hr after a return to the vascular ward. Gradient boosted regression trees were used to construct the predictive model, and the featured importance scores were generated by using each feature's contribution to each tree in the model. To evaluate the model performance, the area under the receiver operating characteristic curve was used as the main metric. Four-fold stratified cross-validation was performed on the data set, and the average performance of the 4 folds was reported as the final model performance. RESULTS A total of 406 CEA operations were performed under general anesthesia. Fifty-three patients (13.1%) met the definition of EPOH. There was no significant difference in the percentage of postoperative stroke/death between patients with and without EPOH during the hospital stay. Patients with EPOH exhibited a higher incidence of postoperative cerebral hyperperfusion syndrome (7.5% vs. 0, P < 0.001), as well as a higher incidence of cerebral hemorrhage (3.8% vs. 0, P < 0.001). The gradient boosted regression trees prediction model achieved an average AUC of 0.77 (95% CI 0.62 to 0.92). When the sensitivity was fixed near 0.90, the model achieved an average specificity of 0.52 (95% CI 0.28 to 0.75). CONCLUSIONS We have built the first-ever machine learning-based prediction model for EPOH after CEA. The validation result from our single-center database was very promising. This novel prediction model has the potential to help vascular surgeons identify high-risk patients and reduce related complications more efficiently.
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Affiliation(s)
- Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Wang
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Liang
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Yu
- Department of Vascular Surgery, Pudong Hospital, Fudan University, Shanghai, China.
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14
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Macharzina RR, Kocher S, Hoffmann F, Becher H, Kammerer T, Vogt M, Vach W, Fan N, Rastan A, Neumann FJ, Zeller T. Accuracy of Carotid Artery Stenosis Quantification with 4-D-Supported 3-D Power-Doppler versus Color-Doppler and 2-D Blood Velocity-Based Duplex Ultrasonography. Ultrasound Med Biol 2020; 46:1082-1091. [PMID: 32081584 DOI: 10.1016/j.ultrasmedbio.2019.12.022] [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] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Assessment of the severity of internal carotid artery stenosis is relevant to therapeutic decisions. Direct measurement of stenosis in static three-dimensionally rendered ultrasonographic color-Doppler images after an orientation with 4-D gray-scale views (4D/3D-C-US) was recently observed to be metrically non-inferior to angiography. In the study described here, power-Doppler (Christian Doppler was a physicist) ultrasonography (4D/3D-P-US) was prospectively compared with angiography, 4D/3D-C-US and 2-D duplex ultrasonography (DUS) in a similar fashion using blinded observers. Percentage stenosis was measured in 36 patients. Continuous percentage stenosis measures (standard deviation of difference and concordance correlation coefficient) between angiography and 4D/3D-P-US did not differ from the results between angiography observers (p > 0.05). Dichotomous diagnosis with 4D/3D-P-US resulted in κ values similar to the inter-rater agreement of angiography and the inter-method agreement of 4D/3D-C-US and DUS compared with angiography. Binary accuracy did not differ between 4D/3D-P-US, 4D/3D-C-US and DUS (p > 0.5). In conclusion, stenosis grading using 4D/3D-P-US exhibited non-inferior inter-method agreement with angiography at good accuracies, similar to 4D/3D-C-US and DUS.
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Affiliation(s)
- Roland Richard Macharzina
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany.
| | - Sascha Kocher
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Fabian Hoffmann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Harald Becher
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Kammerer
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Matthias Vogt
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Werner Vach
- Functional Biomechanics Laboratory, University Hospital Basel, Basel, Switzerland
| | - Nian Fan
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Aljoscha Rastan
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Thomas Zeller
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
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15
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Hoving AM, de Vries EE, Mikhal J, de Borst GJ, Slump CH. A Systematic Review for the Design of In Vitro Flow Studies of the Carotid Artery Bifurcation. Cardiovasc Eng Technol 2020; 11:111-127. [PMID: 31823191 PMCID: PMC7082306 DOI: 10.1007/s13239-019-00448-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE In vitro blood flow studies in carotid artery bifurcation models may contribute to understanding the influence of hemodynamics on carotid artery disease. However, the design of in vitro blood flow studies involves many steps and selection of imaging techniques, model materials, model design, and flow visualization parameters. Therefore, an overview of the possibilities and guidance for the design process is beneficial for researchers with less experience in flow studies. METHODS A systematic search to in vitro flow studies in carotid artery bifurcation models aiming at quantification and detailed flow visualization of blood flow dynamics results in inclusion of 42 articles. RESULTS Four categories of imaging techniques are distinguished: MRI, optical particle image velocimetry (PIV), ultrasound and miscellaneous techniques. Parameters for flow visualization are categorized into velocity, flow, shear-related, turbulent/disordered flow and other parameters. Model materials and design characteristics vary between study type. CONCLUSIONS A simplified three-step design process is proposed for better fitting and adequate match with the pertinent research question at hand and as guidance for less experienced flow study researchers. The three consecutive selection steps are: flow parameters, image modality, and model materials and designs. Model materials depend on the chosen imaging technique, whereas choice of flow parameters is independent from imaging technique and is therefore only determined by the goal of the study.
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Affiliation(s)
- A M Hoving
- University of Twente, 7500 AE, Enschede, The Netherlands.
| | - E E de Vries
- University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - J Mikhal
- University of Twente, 7500 AE, Enschede, The Netherlands
| | - G J de Borst
- University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - C H Slump
- University of Twente, 7500 AE, Enschede, The Netherlands
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16
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Kirsanov RI, Kulikov VP. Helical Blood Flow in Hemodynamically Significant Carotid Stenosis. J Ultrasound Med 2020; 39:543-550. [PMID: 31502308 DOI: 10.1002/jum.15131] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To define helical blood flow (HBF) characteristics in hemodynamically significant atherosclerotic stenosis of the internal carotid artery (ICA) by means of duplex scanning. METHODS Twenty-five hemodynamically significant (65.0% [range, 63.0%-69.0%]) carotid stenoses were examined in 23 patients. The severity of the stenosis was calculated by the European Carotid Surgery Trial grading method by transverse section scanning in the B-mode. Rotational components were estimated in color flow mapping by transverse-section scanning of a vessel at the most narrowed site, as well as in the prestenotic and poststenotic segments. A quantitative evaluation of HBF was performed on the basis of pulsed wave Doppler imaging of longitudinal and transverse sections of the arterial lumen. RESULTS Helical blood flow was most often (68%) registered in the poststenotic segment of the ICA as a single vortex (52%) or double vortices (16%). At the most narrowed site, HBF was registered in 48% of the cases (44% single vortex and 4% double vortices), whereas in the prestenotic segment of the blood vessel, it was registered in only 16% of the cases (8% single vortex and 8% double vortices). The time-averaged maximum blood flow velocities at the most narrowed site were 88.5 cm/s (25th-75th percentiles, 73.8-127.8 cm/s) for the axial component and 33.1 cm/s (22.7-40.9 cm/s) for the rotational component. The calculated summary velocity of motion of the blood particles in helical paths was 92.2 cm/s (75.7-144.2 cm/s). CONCLUSIONS It has been shown that HBF can be registered by Doppler ultrasound in atherosclerotic stenosis, and its registration rate increases while passing through the narrowed segment of the ICA.
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Affiliation(s)
- Roman Ivanovich Kirsanov
- Department of Pathological Physiology, Altai State Medical University, Barnaul, Russia
- Department of Functional Diagnostics, Regional Clinical Hospital, Barnaul, Russia
| | - Vladimir Pavlovich Kulikov
- Department of Clinical Pathophysiology and Functional Diagnostics, Altai Medical Institute of Postgraduate Education, Barnaul, Russia
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17
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Göttler J, Kaczmarz S, Nuttall R, Griese V, Napiórkowski N, Kallmayer M, Wustrow I, Eckstein HH, Zimmer C, Preibisch C, Finke K, Sorg C. The stronger one-sided relative hypoperfusion, the more pronounced ipsilateral spatial attentional bias in patients with asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2020; 40:314-327. [PMID: 30480463 PMCID: PMC7370612 DOI: 10.1177/0271678x18815790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 07/29/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
Patients with asymptomatic, high-grade internal carotid artery stenosis often suffer from subtle cognitive impairments with unclear underlying neuro-cognitive mechanisms. Thus, we hypothesized that stenosis-related unilateral cerebral hypoperfusion leads to an ipsilateral attentional bias; 22 patients with asymptomatic, one-sided high-grade carotid stenosis and 24 age-matched healthy controls underwent pseudo-continuous arterial spin labeling to assess brain perfusion in the territory of the carotid arteries. Furthermore, a parametric assessment of attention functions was carried out on the basis of the computational Theory of Visual Attention. Both patients' perfusion and spatial attention were significantly more lateralized than those of healthy controls. Critically, both asymmetry indices were significantly correlated in patients, i.e. the stronger one-sided relative hypoperfusion, the stronger ipsilateral bias of attention. This association was specifically pronounced in parietal cortices and independent of white matter hyperintensities as a surrogate for cerebrovascular brain damage. Results provide evidence for a link between lateralized hypoperfusion and lateralized attentional weighting in asymptomatic, high-grade carotid stenosis. Data suggest that lateralized hypoperfusion with simultaneous spatial attentional bias might serve as a potential therapeutic target in one-sided carotid stenosis.
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Affiliation(s)
- Jens Göttler
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Diagnostic and
Interventional Radiology, Klinikum rechts der Isar, Technische Universität München,
Munich, Germany
- Magnetic Resonance Research Center, Yale
University, New Haven, CT, USA
| | - Stephan Kaczmarz
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Magnetic Resonance Research Center, Yale
University, New Haven, CT, USA
| | - Rachel Nuttall
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vanessa Griese
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Natan Napiórkowski
- Department of Psychology,
Ludwig-Maximilians-Universität München, Munich, Germany
- Graduate School of Systemic
Neurosciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular
Surgery, Klinikum rechts der Isar, Technische Universität München, Munich,
Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik,
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular
Surgery, Klinikum rechts der Isar, Technische Universität München, Munich,
Germany
| | - Claus Zimmer
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Clinic for Neurology, Klinikum rechts
der Isar, Technische Universität München, Munich, Germany
| | - Kathrin Finke
- Department of Psychology,
Ludwig-Maximilians-Universität München, Munich, Germany
- Hans-Berger-Department of Neurology,
Jena University Hospital, Jena, Germany
| | - Christian Sorg
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Psychiatry, Klinikum
rechts der Isar, Technische Universität München, Munich, Germany
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18
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Kronick MD, Chopra A, Swamy S, Brar V, Jung E, Abraham CZ, Liem TK, Landry GJ, Moneta GL. Peak systolic velocity and color aliasing are important in the development of duplex ultrasound criteria for external carotid artery stenosis. J Vasc Surg 2020; 72:951-957. [PMID: 31964570 DOI: 10.1016/j.jvs.2019.10.099] [Citation(s) in RCA: 2] [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: 08/01/2019] [Accepted: 10/25/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The external carotid artery (ECA) serves as a major collateral pathway for ophthalmic and cerebral artery blood supply. It is routinely examined as part of carotid duplex ultrasound, but criteria for determining ECA stenosis are poorly characterized and typically extrapolated from internal carotid artery data. This is despite the fact that the ECA is smaller in diameter, with a higher resistance and lower volume flow pattern. We hypothesized that using the cutoff of a peak systolic velocity (PSV) ≥125 cm/s, extrapolated from internal carotid artery data, will overestimate the prevalence of ≥50% ECA stenosis and aimed to determine a more appropriate criterion. METHODS From December 2016 to July 2017, consecutive carotid duplex ultrasound studies performed in our university hospital Intersocietal Accreditation Commission-accredited vascular laboratory were prospectively identified and categorized with respect to prevalence and distribution of ECA PSVs and color aliasing, an indication of turbulent flow or flow acceleration. Presence of color aliasing was determined by two individual reviewers and agreement assessed by Cohen κ coefficient. ECA stenosis was calculated by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method in patients with computed tomography angiography (CTA) performed within 3 months of carotid duplex ultrasound without an intervening intervention. Receiver operating characteristic analysis was performed to identify best criteria for determining ≥50% ECA stenosis. RESULTS There were 1324 ECAs from 662 patients analyzed; 174 patients had a total of 252 ECAs with PSV ≥125 cm/s (19% of the total sample). Of those ECAs with PSVs ≥125 cm/s, 30.5% were between 125 and 149 cm/s, 22.2% were between 150 and 174 cm/s, 13.1% were between 175 and 199 cm/s, and 34.1% were ≥200 cm/s. There were 341 ECAs that were analyzed for the presence of color aliasing. In 86 ECAs with PSV ≥200 cm/s, 58.1% had color aliasing, whereas in 255 ECAs with PSV <200 cm/s, only 19.2% had color aliasing (P = .0001). There were 325 CTA studies reviewed and assessed for the presence of a ≥50% ECA stenosis as determined by CTA. Overall, the combination of an ECA PSV ≥200 cm/s with the presence of color aliasing provided the highest combination of sensitivity (90%), specificity (96%), positive predictive value (83%), and negative predictive value (98%) and the greatest area under the curve of 0.971 for determining the presence of a ≥50% ECA stenosis based on CTA. CONCLUSIONS A PSV ≥125 cm/s alone probably overestimates the prevalence of ≥50% ECA stenosis. A PSV ≥200 cm/s combined with color aliasing is highly predictive of >50% ECA stenosis based on correlation with CTA.
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Affiliation(s)
- Matthew D Kronick
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
| | - Atish Chopra
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Shivam Swamy
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Varneet Brar
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Enjae Jung
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Cherrie Z Abraham
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Timothy K Liem
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory J Landry
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory L Moneta
- Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
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19
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Polak JF, Alessi-Chinetti JM, Kremkau FW. Doppler Velocity Estimates of Internal Carotid Artery Stenosis: Angle Correction Parallel to the Color Doppler Lumen Versus Parallel to the Artery Wall. J Ultrasound Med 2019; 38:3211-3218. [PMID: 31124163 DOI: 10.1002/jum.15029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We compared internal carotid artery Doppler peak systolic velocities (PSVs) measured with angle correction parallel to the artery wall (// wall) on grayscale images and parallel to the direction of blood flow (// flow) on color Doppler images. METHODS We studied 25 internal carotid lesions with PSVs higher than 125 cm/s. The PSVs were measured in the same imaging plane, at the stenosis orifice (0 cm) and at 0.5 and 1 cm downstream by both methods. Linear regression and correlation analyses were used to study the effects of the angle correction method on changes in PSVs as a function of the differences in angle adjustment and distance from the stenosis. RESULTS The 23 patients studied included 9 women and 14 men. There was a mean difference in absolute PSVs ± SD of -17.2 ± 29.5 cm/s (P < .008) between methods at the stenosis. The difference in the PSVs was associated with the angle difference between the flow jet and the artery wall (P < .01). At 1 cm from the stenosis, // flow PSVs were more strongly correlated with PSVs at the stenosis (r = 0.61; 95% confidence interval, 0.28, 0.82; P = .001) than // wall PSVs (r = 0.39; 95% confidence interval, -0.003, 0.68; P = .052). CONCLUSIONS Blood flow velocity measurements made with angle correction parallel to the direction of the color Doppler blood flow lumen remain more consistent with the distance from the stenosis than blood flow velocity measurements made with angle correction parallel to the outer artery walls.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jean M Alessi-Chinetti
- Department of Vascular Diagnostic Laboratory, Tufts Medical Center, Boston, Massachusetts, USA
| | - Frederick W Kremkau
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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20
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Gao L, Wang T, Qian T, Xiao F, Bai L, Zhang J, Xu H. Severe asymptomatic carotid stenosis is associated with robust reductions in homotopic functional connectivity. Neuroimage Clin 2019; 24:102101. [PMID: 31835289 PMCID: PMC6911862 DOI: 10.1016/j.nicl.2019.102101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/05/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Abstract
Severe (>70% narrowing) asymptomatic carotid stenosis (SACS) is associated with cognitive impairment and future strokes, and connectivity basis for the remote brain consequences is poorly understood. Here we explored homotopic connectivity and parenchymal lesions measured by multimodal magnetic resonance imaging (MRI) parameters in patients with SACS. Twenty-four patients with SACS (19 males/5 females; 64.25 ± 7.18 years), 24 comorbidities-matched controls (19 males/5 females; 67.16 ± 6.10 years), and an independent sample of elderly healthy controls (39 females/45 males; 57.92 ± 4.94 years) were included. Homotopic functional connectivity (FC) of resting-state functional MRI and structural connectivity (SC) of deterministic tractography were assessed. Arterial spin labeling based cerebral perfusion, susceptibility weighted imaging based microhemorrhagic lesions, and T2-weighted white matter hyperintensities were also quantified. Significant and robust homotopic reductions (validated by the independent dataset and support vector machine-based machine learning) were identified in the Perisylvian fissure in patients with SACS (false discovery rate corrected, voxel p < 0.05). These involved regions span across several large-scale brain systems, which include the somatomotor, salience, dorsal attention, and orbitofrontal-limbic networks. This significantly reduced homotopic FC can be partially explained by the corrected white matter hyperintensity size. Further association analyses suggest that the decreased homotopic FC in these brain regions is most closely associated with delayed memory recall, sensorimotor processing, and other simple cognitive functions. Together, these results suggest that SACS predominately affects the lower-order brain systems, while higher-order systems, especially the topographies of default mode network, are least impacted initially, but may serve as a hallmark precursor to vascular dementia. Thus, assessment of homotopic FC may provide a means of noninvasively tracking the progression of downstream brain damage following asymptomatic carotid stenosis.
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Affiliation(s)
- Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Tao Wang
- Department of Neurology, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Tianyi Qian
- MR Collaboration, Siemens Healthcare China, Beijing, China
| | - Feng Xiao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan City, Hubei Province 430071, China.
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21
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Baradaran H, Myneni PK, Patel P, Askin G, Gialdini G, Al‐Dasuqi K, Kamel H, Gupta A. Association Between Carotid Artery Perivascular Fat Density and Cerebrovascular Ischemic Events. J Am Heart Assoc 2019; 7:e010383. [PMID: 30561272 PMCID: PMC6405622 DOI: 10.1161/jaha.118.010383] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Indexed: 12/12/2022]
Abstract
Background Studies have shown that pericoronary artery inflammation can be accurately detected via increased attenuation on computed tomography. Our purpose was to evaluate the association between pericarotid inflammation, measured by density of carotid perivascular fat on computed tomography angiography, with stroke and transient ischemic attack. Methods and Results We screened computed tomography angiography examinations for patients with unilateral internal carotid artery ( ICA ) stenosis ≥50% to 99%. A blinded neuroradiologist placed regions-of-interest in the pericarotid fat on the slice showing maximal stenosis. Two-sample t tests were performed to assess between-subject differences in mean Hounsfield Units in carotid perivascular fat between symptomatic and asymptomatic patients. Paired t tests were used to assess within-subject differences in mean Hounsfield Units between stenotic versus nonstenotic ICA s in a given patient. We included 94 patients, including 42 symptomatic and 52 asymptomatic patients. In the between-subject analysis of stenotic ICA s, we found symptomatic patients had higher mean pericarotid fat density compared with asymptomatic patients (-66.2±19.2 versus -77.1±20.4, P=0.009). When comparing nonstenotic ICA s, there was no significant difference between pericarotid fat density in symptomatic compared with asymptomatic patients (-81.0±13.3 versus -85.3±18.0: P=0.198). Within-subject comparison showed statistically significant increased density in stenotic ICA versus nonstenotic ICA with mean Hounsfield Units difference of 11.1 ( P<0.0001). Conclusions We found increased density, a surrogate marker for perivascular inflammation, in the fat surrounding ICA s ipsilateral to stroke or transient ischemic attack compared with asymptomatic ICA s. Our findings suggest that inflammation associated with culprit carotid plaques extends beyond the vessel lumen and can be identified using simple methods on computed tomography angiography imaging.
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Affiliation(s)
- Hediyeh Baradaran
- Department of RadiologyBoston University School of MedicineBostonMA
- Department of RadiologyWeill Cornell MedicineNew YorkNY
| | | | - Praneil Patel
- Department of RadiologyWeill Cornell MedicineNew YorkNY
| | - Gulce Askin
- Department of Healthcare Policy and ResearchWeill Cornell MedicineNew YorkNY
| | - Gino Gialdini
- Department of NeurologyWeill Cornell MedicineNew YorkNY
| | | | - Hooman Kamel
- Department of NeurologyWeill Cornell MedicineNew YorkNY
- Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research InstituteWeill Cornell MedicineNew YorkNY
| | - Ajay Gupta
- Department of RadiologyWeill Cornell MedicineNew YorkNY
- Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research InstituteWeill Cornell MedicineNew YorkNY
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22
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Varghese T, Meshram NH, Mitchell CC, Wilbrand SM, Hermann BP, Dempsey RJ. Lagrangian carotid strain imaging indices normalized to blood pressure for vulnerable plaque. J Clin Ultrasound 2019; 47:477-485. [PMID: 31168787 PMCID: PMC6760247 DOI: 10.1002/jcu.22739] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Ultrasound Lagrangian carotid strain imaging (LCSI) utilizes physiological deformation caused by arterial pressure variations to generate strain tensor maps of the vessel walls and plaques. LCSI has been criticized for the lack of normalization of magnitude-based strain indices to physiological stimuli, namely blood pressure. We evaluated the impact of normalization of magnitude-based strain indices to blood pressure measured immediately after the acquisition of radiofrequency (RF) data loops for LCSI. MATERIALS AND METHODS A complete clinical ultrasound examination along with RF data loops for LCSI was performed on 50 patients (30 males and 20 females) who presented with >60% carotid stenosis and were scheduled for carotid endarterectomy. Cognition was assessed using the 60-minute neuropsychological test protocol. RESULTS For axial strains correlation of maximum accumulated strain indices (MASI), cognition scores were -0.46 for non-normalized and -0.45, -0.49, -0.37, and -0.48 for systolic, diastolic, pulse pressure, and mean arterial pressure normalized data, respectively. The corresponding area under the curve (AUC) values for classifiers designed using maximum likelihood estimation of a binormal distribution with a median-split of the executive function cognition scores were 0.73, 0.70, 0.71, 0.70, and 0.71, respectively. CONCLUSIONS No significant differences in the AUC estimates were obtained between normalized and non-normalized magnitude-based strain indices.
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Affiliation(s)
- Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nirvedh H Meshram
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carol C Mitchell
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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23
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Liu D, Chen L, Dong S, Peng Z, Yang H, Chen Y, Li L, Zhou H, Zhou R. Bone mass density and bone metabolism marker are associated with progression of carotid and cardiac calcified plaque in Chinese elderly population. Osteoporos Int 2019; 30:1807-1815. [PMID: 31190121 DOI: 10.1007/s00198-019-05031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 10/30/2018] [Accepted: 05/22/2019] [Indexed: 01/02/2023]
Abstract
UNLABELLED Osteoporosis and cardiovascular diseases often coexist in the same elderly individuals. Does this suggest some potential correlation between the two diseases? Low bone mass and change of bone biomarker are associated with a higher risk of carotid and cardiac calcification plaques. INTRODUCTION Bone mineral density (BMD) and bone metabolism marker may contribute to the progression of carotid and cardiac arterial calcifications. The aim of this study was to investigate whether low bone mass and the change of bone biomarker are associated with the prevalence of calcified atherosclerotic plaque in elderly Chinese. METHODS We conducted a five-year prospective study. BMD was measured by dual-energy X-ray absorptiometry scanning. Carotid and cardiac computed tomography angiography (CTA) was conducted using a 64-multidetector row scanner to assess carotid and cardiac arterial plaque at baseline and during follow-up. RESULTS Of 1571 community residents over 60 years of age, 184 (11.7%) subjects developed carotid calcified plaque, 510 (32.5%) subjects developed cardiac calcified plaque and 97 (6.2%) subjects developed co-existence calcified plaques in carotid and cardiac arteries. After adjustment for age and all relevant confounders, Q1, Q2 quartile of BMD, and osteoprotegerin (OPG), osteocalcin (OC), and C-terminal cross-linked telopeptide of type I collagen (CTX) were associated with increased risk of calcified plaques. CONCLUSION This study suggested that lower BMD and change of bone metabolism biomarker were associated with a higher risk of carotid and cardiac calcified plaque development.
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Affiliation(s)
- D Liu
- Trauma Center, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Chen
- Postgraduate School, Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - S Dong
- Postgraduate School, Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - Z Peng
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H Yang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Y Chen
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - R Zhou
- Department of Orthopedics, the Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
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24
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Wang LY, Tao Z, Zhao HP, Wang RL, Li LZ, Luo YM, Chen ZG. Huoluo Yinao decoction mitigates cognitive impairments after chronic cerebral hypoperfusion in rats. J Ethnopharmacol 2019; 238:111846. [PMID: 30954615 DOI: 10.1016/j.jep.2019.111846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/01/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Huoluo Yinao decoction (HLYND) has been used to ameliorate cognitive impairment induced by chronic cerebral hypoperfusion in clinical for years. However, the exact mechanisms remain unknown. AIM OF THE STUDY To investigate the effects and mechanisms underlying HLYND-mediated improvement in cognitive deficits associated with chronic cerebral hypoperfusion. MATERIALS AND METHODS Thirty-six Sprague-Dawley rats were randomly allocated to three groups: sham, model, and HLYND. Daily administration of HLYND or volume-matched vehicle by gavage was initiated 1 day after bilateral carotid artery stenosis (BCAS) and continued for 42 days. The Morris water maze (MWM) test was used to assess cognitive functions from days 36-42. Via western blot and immunofluorescent staining, restoration of neuronal plasticity and remyelination of white matter were evaluated by analyzing the expression profiles of MAP-2, synaptophysin and MBP. In addition, macrophage/microglial activation was assessed by quantifying changes in Iba1, and macrophage/microglial polarization was assessed by changes in iNOS and CD16 (M1 markers), as well as Arg1 and CD206 (M2 markers). RESULTS In the MWM test, BCAS rats showed significantly extended escape latency and reduced platform crossing times, while those in the HLYND group had shortened escape latency and increased frequency of platform crossing. In addition, rats in the model group showed decreased levels and abnormal morphological changes of MAP-2, synaptophysin and MBP, whereas HLYND administration reversed these effects. As expected, Iba1 levels were elevated in both the model and HLYND groups but rats in the model group showed increased levels of the M1 markers, iNOS and CD16, and a correspondent decrease in the M2 marker, Arg1. In contrast, in the HLYND group, iNOS and CD16 levels were suppressed, while Arg1 levels were elevated. CONCLUSIONS Our findings demonstrate that HLYND mitigates cognitive impairment after chronic cerebral hypoperfusion in rats through mechanisms involving increased neuronal plasticity and white matter remyelination, with a subtile modulation of macrophage/microglial polarization toward the M2 phenotype.
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Affiliation(s)
- Li-Ye Wang
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhen Tao
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Hai-Ping Zhao
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Rong-Liang Wang
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Ling-Zhi Li
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yu-Min Luo
- Institute of Cerebrovascular Diseases Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China.
| | - Zhi-Gang Chen
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Schermerhorn ML, Liang P, Dakour-Aridi H, Kashyap VS, Wang GJ, Nolan BW, Cronenwett JL, Eldrup-Jorgensen J, Malas MB. In-hospital outcomes of transcarotid artery revascularization and carotid endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2019; 71:87-95. [PMID: 31227410 DOI: 10.1016/j.jvs.2018.11.029] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [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: 09/13/2018] [Accepted: 11/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Transcarotid artery revascularization (TCAR) with flow reversal offers a less invasive option for carotid revascularization in high-risk patients and has the lowest reported overall stroke rate for any prospective trial of carotid artery stenting. However, outcome comparisons between TCAR and carotid endarterectomy (CEA) are needed to confirm the safety of TCAR outside of highly selected patients and providers. METHODS We compared in-hospital outcomes of patients undergoing TCAR and CEA from January 2016 to March 2018 using the Society for Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project registry and the Society for Vascular Surgery Vascular Quality Initiative CEA database, respectively. The primary outcome was a composite of in-hospital stroke and death. RESULTS A total of 1182 patients underwent TCAR compared with 10,797 patients who underwent CEA. Patients undergoing TCAR were older (median age, 74 vs 71 years; P < .001) and more likely to be symptomatic (32% vs 27%; P < .001); they also had more medical comorbidities, including coronary artery disease (55% vs 28%; P < .001), chronic heart failure (20% vs 11%; P < .001), chronic obstructive pulmonary disease (29% vs 23%; P < .001), and chronic kidney disease (39% vs 34%; P = .001). On unadjusted analysis, TCAR had similar rates of in-hospital stroke/death (1.6% vs 1.4%; P = .33) and stroke/death/myocardial infarction (MI; 2.5% vs 1.9%; P = .16) compared with CEA. There was no difference in rates of stroke (1.4% vs 1.2%; P = .68), in-hospital death (0.3% vs 0.3%; P = .88), 30-day death (0.9% vs 0.4%; P = .06), or MI (1.1% vs 0.6%; P = .11). However, on average, TCAR procedures were 33 minutes shorter than CEA (78 ± 33 minutes vs 111 ± 43 minutes; P < .001). Patients undergoing TCAR were also less likely to incur cranial nerve injuries (0.6% vs 1.8%; P < .001) and less likely to have a postoperative length of stay >1 day (27% vs 30%; P = .046). On adjusted analysis, there was no difference in terms of stroke/death (odds ratio, 1.3; 95% confidence interval, 0.8-2.2; P = .28), stroke/death/MI (odds ratio, 1.4; 95% confidence interval, 0.9-2.1, P = .18), or the individual outcomes. CONCLUSIONS Despite a substantially higher medical risk in patients undergoing TCAR, in-hospital stroke/death rates were similar between TCAR and CEA. Further comparative studies with larger samples sizes and longer follow-up will be needed to establish the role of TCAR in extracranial carotid disease management.
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Affiliation(s)
- Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Hanaa Dakour-Aridi
- Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, Md
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Brian W Nolan
- Division of Vascular and Endovascular Therapy, Department of Surgery, Maine Medical Center, Portland, Me
| | - Jack L Cronenwett
- Section of Vascular Surgery and The Dartmouth Institute, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jens Eldrup-Jorgensen
- Division of Vascular and Endovascular Therapy, Department of Surgery, Maine Medical Center, Portland, Me
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego Health System, San Diego, Calif
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Maus V, Brehm A, Psychogios MN. Stent Retriever Embolectomy in Acute Occlusion of the Anterior and Middle Cerebral Artery using a Transanterior Communicating Artery Approach. J Vasc Interv Radiol 2019; 30:1709-1711. [PMID: 31182274 DOI: 10.1016/j.jvir.2019.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Volker Maus
- Department of Neuroradiology Goettingen, University Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Alex Brehm
- Department of Neuroradiology Goettingen, University Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Marios-Nikos Psychogios
- Department of Neuroradiology Goettingen, University Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany; Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel Basel, Switzerland
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Park SY, Kim HY, Lee YS, Heo HJ, Shin HK, Lee WS, Hong KW, Kim CD. Augmented improvement of cognition and memory by aripiprazole add-on for cilostazol treatment in the chronic cerebral hypoperfusion mouse model. Behav Brain Res 2019; 365:133-140. [PMID: 30851315 DOI: 10.1016/j.bbr.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/17/2019] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/27/2022]
Abstract
Cerebrovascular dysfunction is associated with cognitive impairment in vascular dementia patients. This study aimed to explore augmented improvement of cognition and memory by aripiprazole add-on for cilostazol treatment in vascular dementia model. Male C57BL/6 mice were subjected to BCAS, and spatial probe and memory retention were examined using the Morris water maze (MWM) test. In the present study, the escape latency on the first day after 3rd week was 21.4 ± 4.0 s in sham-operated mice, and 76.3 ± 4.2 s in the vehicle-treated BCAS mice. In the spatial probe tests in the 3rd week, aripiprazole (1 mg/kg/day) showed time-dependently amelioration in spatial learning and memory impairments in contrast to 0.5 mg/kg/day. After treatment with 20 mg/kg/day of cilostazol for 3 weeks, the escape latency significantly decreased to 26.6 ± 5.8 s on the first day and further shortened to 21.6 ± 6.8 s on the fourth day. When the BCAS mice were concurrently treated with 0.5 mg/kg/day aripiprazole plus 20 mg/kg/day of cilostazol for 3 weeks, the escape latency was more shortened from 20.4 ± 1.2 s (1st day) to 14.9 ± 1.7 s on the 4th day of the 3-week trials. Furthermore, decreased spatial memory retention in BCAS mice was significantly alleviated by aripiprazole plus cilostazol cotreatment, indicating the benefit of aripiprazole add-on therapy. In line with these, significantly increased mBDNF and P-CREB levels and reduced apoptosis were identified in the BCAS mouse brain dentate gyrus by cotreatment as contrasted to each monotherapy. These results may provide the synergistic therapeutic avenues for augmented improvement of cognition and memory by cotreatment with aripiprazole plus cilostazol in cases of vascular dementia.
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Affiliation(s)
- So Youn Park
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea; Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Hae Young Kim
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea; Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Yi Sle Lee
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea; Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Hye Jin Heo
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea; Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Hwa Kyoung Shin
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Won Suk Lee
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Ki Whan Hong
- Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Chi Dae Kim
- Department of Pharmacology, School of Medicine, Pusan National University, Gyeongsangnam-do, Republic of Korea; Gene & Cell Therapy Research Center for Vessel-Associated Diseases, Pusan National University, Gyeongsangnam-do, Republic of Korea.
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Massara M, Notarstefano S, De Caridi G, Serra R, Prunella R, Impedovo G. Endovascular Treatment of a Carotid Pseudoaneurysm Using the New Double-Layer Micromesh Stent (Roadsaver ®). Ann Vasc Surg 2019; 59:308.e15-308.e18. [PMID: 31075470 DOI: 10.1016/j.avsg.2019.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysm (PA) formation after carotid endarterectomy (CEA) is a very uncommon but dangerous complication, potentially responsible for cerebral embolism or rupture. Therefore, the PA treatment is imperative. Until few years ago, the treatment of choice was represented by open surgical repair, with a higher mortality and morbidity rate than primary operation. Actually, the advancements in endovascular procedures allow the surgeon the possibility to recur to a less invasive approach in the presence of an adequate anatomy, reducing the risk of cranial nerve injuries. We present a case of post-CEA PA successfully treated using the double-layer micromesh stent (Roadsaver®; Terumo, Tokyo, Japan), with almost immediate thrombosis of the aneurysmal sac.
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Affiliation(s)
- Mafalda Massara
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Stefano Notarstefano
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Giovanni De Caridi
- Vascular Surgery Unit, Department of Biomedical Sciences, University of Messina, Messina, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy; Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy.
| | - Roberto Prunella
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
| | - Giovanni Impedovo
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Taranto, Italy
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Chu WF, Lee HJ, Lin CJ, Chang FC, Guo WY, Chen LW, Lin YY, Luo CB. Fluoroscopic angiography quantifies delay in cerebral circulation time and requires less radiation in carotid stenosis patients: A pilot study. J Chin Med Assoc 2019; 82:396-400. [PMID: 30893249 DOI: 10.1097/jcma.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA. METHODS Twenty-two patients with >70% carotid stenosis according to NASCET criteria were prospectively included in the study. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite. The regions of interest (ROIs) included the extracranial internal carotid artery (eICA), first segment of the middle cerebral artery (MCA1), and sigmoid sinus in the anterior-posterior view; cavernous portion of the ICA (cICA), parietal vein, and jugular vein in the lateral views. The time-to-peak (TTP) for all ROIs and cerebral circulation time (CCT) were measured from FA and DSA scans. TTP, CCT, and radiation doses from DSA were compared with those from FA. RESULTS The mean age of the patients were 69 ± 9.5 years old. The average stenosis was 89.7% ± 7.8% before stenting and 31% ± 3.6% after stenting. No patient suffered from periprocedural stroke. The intermethod correlation for TTP for all ROIs except the eICA and cICA ranged from 0.46 to 0.65 before stenting and 0.57 to 0.73 after stenting, and that for CCT was 0.65 before stenting and 0.57 after stenting. The radiation doses were significantly lower for FA than for DSA regardless of views or periprocedural timing (p < 0.001). CONCLUSION Stenosis facilitated the creation of a bolus by manual injection and therefore increased the accuracy of cerebral flow quantification in FA. Cerebral hemodynamic assessment by FA is quicker and associated with less radiation.
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Affiliation(s)
- Wei-Fa Chu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Jui Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Liang-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Yang Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chao-Bao Luo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Chakshu NK, Carson J, Sazonov I, Nithiarasu P. A semi-active human digital twin model for detecting severity of carotid stenoses from head vibration-A coupled computational mechanics and computer vision method. Int J Numer Method Biomed Eng 2019; 35:e3180. [PMID: 30648344 PMCID: PMC6593817 DOI: 10.1002/cnm.3180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 06/07/2023]
Abstract
In this work, we propose a methodology to detect the severity of carotid stenosis from a video of a human face with the help of a coupled blood flow and head vibration model. This semi-active digital twin model is an attempt to link noninvasive video of a patient face to the percentage of carotid occlusion. The pulsatile nature of blood flow through the carotid arteries induces a subtle head vibration. This vibration is a potential indicator of carotid stenosis severity, and it is exploited in the present study. A head vibration model has been proposed in the present work that is linked to the forces generated by blood flow with or without occlusion. The model is used to generate a large number of virtual head vibration data for different degrees of occlusion. In order to determine the in vivo head vibration, a computer vision algorithm is adopted to use human face videos. The in vivo vibrations are compared against the virtual vibration data generated from the coupled computational blood flow/vibration model. A comparison of the in vivo vibration is made against the virtual data to find the best fit between in vivo and virtual data. The preliminary results on healthy subjects and a patient clearly indicate that the model is accurate and it possesses the potential for detecting approximate severity of carotid artery stenoses.
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Affiliation(s)
- Neeraj Kavan Chakshu
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaSA2 8PPUK
| | - Jason Carson
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaSA2 8PPUK
| | - Igor Sazonov
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaSA2 8PPUK
| | - Perumal Nithiarasu
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaSA2 8PPUK
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31
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Connolly F, Röhl JE, Guthke C, Wengert O, Valdueza JM, Schreiber SJ. Emergency Room Use of "Fast-Track" Ultrasound in Acute Stroke: An Observational Study. Ultrasound Med Biol 2019; 45:1103-1111. [PMID: 30773376 DOI: 10.1016/j.ultrasmedbio.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/01/2019] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
Early information on vascular status in acute stroke is essential. We analyzed whether duplex ultrasound (DUS) using a fast-track protocol provides this information without relevant delay. One hundred forty-six patients were prospectively enrolled. DUS was performed by sonographers with two levels of experience. The carotid and vertebral arteries, as well as all basal cerebral arteries, were bilaterally analyzed. Criteria for vessel analysis were (i) normal or stenosis <50%, (ii) stenosis ≥50% and (iii) occlusion. The mean duration of the ultrasound investigation was 6:07 ± 2:06 min with a significant difference between more and less experienced investigators (p < 0.0001). Insonation times decreased during the study in both groups. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound findings in comparison with computed tomography angiography were 73%, 99%, 84% and 98%, respectively. Our data suggest that "fast track" DUS is feasible and reliable. The time required for DUS assessment depends on the sonographer´s experience.
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Affiliation(s)
- Florian Connolly
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
| | - Jens-Eric Röhl
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Carolin Guthke
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Oliver Wengert
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - José M Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Stephan J Schreiber
- Department of Neurology, Asklepios Fachklinikum Brandenburg, Brandenburg an der Havel, Germany
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32
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Appleton JP, Woodhouse LJ, Belcher A, Bereczki D, Berge E, Caso V, Chang HM, Christensen HK, Collins R, Gommans J, Laska AC, Ntaios G, Ozturk S, Sare GM, Szatmari S, Wang Y, Wardlaw JM, Sprigg N, Bath PM. It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis. Stroke Vasc Neurol 2019; 4:28-35. [PMID: 31105976 PMCID: PMC6475087 DOI: 10.1136/svn-2019-000232] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial. Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; ≥70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors. Results 2023 (60.5%) ischaemic stroke participants had carotid imaging. As compared with <30%, ≥70% ipsilateral stenosis was associated with an unfavourable shift in mRS (worse outcome) at 90 days (OR 1.88, 95% CI 1.44 to 2.44, p<0.001). Those with ≥70% stenosis who received GTN versus no GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34 to 0.93, p=0.024). In those with 50-<70% stenosis, continuing versus stopping prestroke antihypertensives was associated with worse disability, mood, quality of life and cognition at 90 days. Clinical outcomes did not differ across bilateral stenosis groups. Conclusions Following ischaemic stroke, severe ipsilateral carotid stenosis is associated with worse functional outcome at 90 days. GTN appears safe in ipsilateral or bilateral carotid stenosis, and might improve outcome in severe ipsilateral carotid stenosis.
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Affiliation(s)
- Jason P Appleton
- Stroke, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lisa J Woodhouse
- Stroke, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Andrew Belcher
- Stroke, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Hui Meng Chang
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | | | - Ronan Collins
- Tallaght Hospital, Trinity College Dublin, Dublin, Ireland
| | - John Gommans
- Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Ann C Laska
- Department of Clinical Science, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Serefnur Ozturk
- Neurology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Gillian M Sare
- Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Szabolcs Szatmari
- Department of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Yongjun Wang
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | | | - Nikola Sprigg
- Stroke, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip M Bath
- Stroke, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Wangqin R, Krafft PR, Piper K, Kumar J, Xu K, Mokin M, Ren Z. Management of De Novo Carotid Stenosis and Postintervention Restenosis-Carotid Endarterectomy Versus Carotid Artery Stenting-a Review of Literature. Transl Stroke Res 2019; 10:460-474. [PMID: 30793257 DOI: 10.1007/s12975-019-00693-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/22/2018] [Revised: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 01/23/2023]
Abstract
The current literature indicates carotid endarterectomy (CEA) as the preferred treatment for symptomatic, moderate to severe carotid artery stenosis. However, recommendations for the management of acute tandem stenosis and complete occlusion, as well as postintervention restenosis of the carotid artery, remain controversial. Here, we review the literature evaluating these conditions and provide suggestions for clinical decision-making. Acute tandem stenosis or occlusion of the common and internal carotid arteries may be treated with angioplasty alone, reserving carotid artery stenting (CAS) or CEA for severe and complex cases. Patients who underwent CEA and developed ipsilateral restenosis may be subjected to angioplasty followed by CAS, which carries a lower risk of cranial nerve injury and subsequent restenosis of the artery. For post-CAS restenosis, current evidence recommends angioplasty and CAS for the management of moderate stenosis and CEA for severe stenosis of the carotid artery. Given the lack of level 1 evidence for the management of these conditions, the abovementioned recommendations may assist clinical decision-making; however, each case and its unique risks and benefits need to be assessed individually. Future studies evaluating and defining the risks and benefits of specific treatment strategies, such as CEA and CAS, in patients with acute tandem stenosis, occlusion, and postintervention restenosis of the carotid artery need to be conducted.
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Affiliation(s)
- Runqi Wangqin
- Department of Neurology, Duke University Medical Center, 2400 Pratt Street, Durham, NC, 27705, USA
| | - Paul R Krafft
- Department of Neurological Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Keaton Piper
- Department of Neurological Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Jay Kumar
- Department of Neurological Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Kaya Xu
- Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China
| | - Maxim Mokin
- Department of Neurological Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Zeguang Ren
- Department of Neurological Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA.
- Center for Cerebrovascular Diseases, Shiyan Taihe Hospital, Shiyan, 442000, Hubei, China.
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Ito AO, Shindo A, Ii Y, Ishikawa H, Taniguchi A, Shiba M, Toma N, Suzuki H, Tomimoto H. Small Cortical Infarcts Transformed to Lobar Cerebral Microbleeds: A Case Series. J Stroke Cerebrovasc Dis 2019; 28:e30-e32. [PMID: 30655044 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/07/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022] Open
Abstract
Cerebral microbleeds (MBs) have been often observed due to the development of imaging devices, and are classified to deep and lobar MBs. Lobar MBs are strongly associated with cerebral amyloid angiopathy. Here, we report 3 cases of lobar MBs that developed after small cortical ischemic stroke. One case underwent carotid artery stenting for severe carotid stenosis, one was diagnosed with artery-to-artery embolism, and the other was embolic stroke of undetermined source. New small cortical infarctions were detected with diffusion-weighted magnetic resonance imaging (MRI). Initial MRI revealed no hemorrhage around the ischemic lesion on T2*-weighted gradient-recalled echo or susceptibility-weighted imaging (SWI) at the onset of stroke. Follow-up SWI after 12-20 months revealed lobar MBs in the previously detected ischemic lesions, and high-intensity lesions remained around the MBs on fluid-attenuated inversion recovery imaging. These cases revealed that cerebral MBs developed through the transformation of small cortical infarctions. All cases showed lobar MBs, and these MBs existed in the previously detected ischemic lesions at a chronic stage. Lobar MBs present around ischemic lesions may predict embolic infarcts.
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Affiliation(s)
- Ai Ogawa Ito
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masato Shiba
- Department of Neurosurgery, Mie UniversityGraduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie UniversityGraduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie UniversityGraduate School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Quintana DD, Ren X, Hu H, Engler-Chiurazzi EB, Rellick SL, Lewis SE, Povroznik JM, Simpkins JW, Alvi M. Gradual common carotid artery occlusion as a novel model for cerebrovascular Hypoperfusion. Metab Brain Dis 2018; 33:2039-2044. [PMID: 30267298 PMCID: PMC6342504 DOI: 10.1007/s11011-018-0312-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/12/2018] [Indexed: 12/13/2022]
Abstract
Chronic cerebrovascular hypoperfusion results in vascular dementia and increases predisposition to lacunar infarcts. However, there are no suitable animal models. In this study, we developed a novel model for chronic irreversible cerebral hypoperfusion in mice. Briefly, an ameroid constrictor was placed on the right carotid artery to gradually occlude the vessel, while a microcoil was placed on the left carotid artery to prevent compensation of the blood flow. This procedure resulted in a gradual hypoperfusion developing over a period of 34 days with no cerebral blood flow recovery. Histological analysis of the brain revealed neuronal and axonal degeneration as well as necrotic lesions. The most severely affected regions were located in the hippocampus and the corpus callosum. Overall, our paradigm is a viable model to study brain pathology resulting from gradual cerebrovascular hypoperfusion.
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Affiliation(s)
- Dominic D Quintana
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
| | - Xuefang Ren
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA.
- Department of Microbiology, Immunology & Cell Biology, West Virginia University, Morgantown, WV, 26506, USA.
- Experimental Stroke Core, Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, 26506, USA.
- One Medical Center Drive, West Virginia University, Morgantown, WV, 26506, USA.
| | - Heng Hu
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
- Experimental Stroke Core, Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, 26506, USA
| | - Elizabeth B Engler-Chiurazzi
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
| | - Stephanie L Rellick
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
| | - Sara E Lewis
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
| | - Jessica M Povroznik
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
| | - James W Simpkins
- Department of Physiology and Pharmacology, West Virginia University, Morgantown, WV, 26506, USA
- Experimental Stroke Core, Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, 26506, USA
| | - Mohammad Alvi
- One Medical Center Drive, West Virginia University, Morgantown, WV, 26506, USA.
- Department of Neurology, Center for Basic and Translational Stroke Research, West Virginia University, Morgantown, WV, 26506, USA.
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Kaczynski J, Home R, Shields K, Walters M, Whiteley W, Wardlaw J, Newby DE. Reproducibility of Transcranial Doppler ultrasound in the middle cerebral artery. Cardiovasc Ultrasound 2018; 16:15. [PMID: 30200977 PMCID: PMC6131943 DOI: 10.1186/s12947-018-0133-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcranial Doppler ultrasound remains the only imaging modality that is capable of real-time measurements of blood flow velocity and microembolic signals in the cerebral circulation. We here assessed the repeatability and reproducibility of transcranial Doppler ultrasound in healthy volunteers and patients with symptomatic carotid artery stenosis. METHODS Between March and August 2017, we recruited 20 healthy volunteers and 20 patients with symptomatic carotid artery stenosis. In a quiet temperature-controlled room, two 1-h transcranial Doppler measurements of blood flow velocities and microembolic signals were performed sequentially on the same day (within-day repeatability) and a third 7-14 days later (between-day reproducibility). Levels of agreement were assessed by interclass correlation co-efficient. RESULTS In healthy volunteers (31±9 years, 11 male), within-day repeatability of Doppler measurements were 0.880 (95% CI 0.726-0.950) for peak velocity, 0.867 (95% CI 0.700-0.945) for mean velocity, and 0.887 (95% CI 0.741-0.953) for end-diastolic velocity. Between-day reproducibility was similar but lower: 0.777 (95% CI 0.526-0.905), 0.795 (95% CI 0.558-0.913), and 0.674 (95% CI 0.349-0.856) respectively. In patients (72±11 years, 11 male), within-day repeatability of Doppler measurements were higher: 0.926 (95% CI 0.826-0.970) for peak velocity, 0.922 (95% CI 0.817-0.968) for mean velocity, and 0.868 (95% CI 0.701-0.945) for end-diastolic velocity. Similarly, between-day reproducibility revealed lower values: 0.800 (95% CI 0.567-0.915), 0.786 (95% CI 0.542-0.909), and 0.778 (95% CI 0.527-0.905) respectively. In both cohorts, the intra-observer Bland Altman analysis demonstrated acceptable mean measurement differences and limits of agreement between series of middle cerebral artery velocity measurements with very few outliers. In patients, the carotid stenoses were 30-40% (n = 9), 40-50% (n = 6), 50-70% (n = 3) and > 70% (n = 2). No spontaneous embolisation was detected in either of the groups. CONCLUSIONS Transcranial Doppler generates reproducible data regarding the middle cerebral artery velocities. However, larger studies are needed to validate its clinical applicability. TRIAL REGISTRATION ClinicalTrial.gov (ID NCT 03050567), retrospectively registered on 15/05/2017.
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Affiliation(s)
- Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Rachel Home
- College of Medicine and Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Karen Shields
- Stroke Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Matthew Walters
- College of Medical, Veterinary and Life Sciences, Wolfson Medical School Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - William Whiteley
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - Joanna Wardlaw
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA UK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SA UK
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Hariri N, Russell T, Kasper G, Lurie F. Shear rate is a better marker of symptomatic ischemic cerebrovascular events than velocity or diameter in severe carotid artery stenosis. J Vasc Surg 2018; 69:448-452. [PMID: 29941314 DOI: 10.1016/j.jvs.2018.04.036] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/13/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study was designed to test the hypothesis that the high shear rate of flow in the area of carotid stenosis is associated with the incidence of ischemic symptoms in patients with a high degree of carotid stenosis. METHODS This is a case-control study of patients with >70% stenosis of the internal carotid artery (ICA) identified by duplex ultrasound in an Intersocietal Accreditation Commission-accredited laboratory during 1 year. Symptomatic patients were included in the study group, and asymptomatic patients served as controls. Shear rates were calculated from high-resolution ultrasound images. Descriptive statistics and univariate and multivariate analysis were performed to account for confounding factors. Receiver operating characteristic curves were used to compare diagnostic values of shear rate, velocities, and diameters of the ICA. RESULTS The study included 308 patients (55.5% male; mean age, 73 ± 10 years); 209 of them were asymptomatic and 99 were symptomatic. The mean shear rate was 7930 s-1 for asymptomatic and 9338 s-1 for symptomatic patients. Receiver operating characteristic curve identified a cutoff value of 8000 s-1 to differentiate between symptomatic and asymptomatic patients; 92% of asymptomatic patients and 8.0% of symptomatic patients had a shear rate of <8000 s-1 compared with 48.5% asymptomatic and 51.5% symptomatic who had a shear rate ≥8000 s-1. Patients who had a shear rate higher than this cutoff value were 12 times more likely to be symptomatic than those with a shear rate <8000 s-1 (odds ratio, 12.1; 95% confidence interval, 6.12-24.09). Sensitivity and specificity were 84.8% and 61.2%, respectively. CONCLUSIONS In patients with >70% ICA stenosis, the shear rate is associated with the prevalence of symptomatic cerebrovascular ischemic events. A shear rate of 8000 s-1 and above may be used as a predictor for having symptomatic cerebrovascular ischemic events. Further validation as well as further study of the pathologic mechanism connecting the high shear rate and ischemic cerebrovascular events is needed.
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Affiliation(s)
- Nizar Hariri
- Jobst Vascular Institute of ProMedica, Toledo, Ohio
| | - Todd Russell
- Jobst Vascular Institute of ProMedica, Toledo, Ohio
| | | | - Fedor Lurie
- Jobst Vascular Institute of ProMedica, Toledo, Ohio; Division of Vascular Surgery, University of Michigan, Ann Arbor, Mich.
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Zhao ZN, Li XL, Liu JZ, Jiang ZM, Wang AH. Features of branch occlusive disease-type intracranial atherosclerotic stroke in young patients. BMC Neurol 2018; 18:87. [PMID: 29925330 PMCID: PMC6009042 DOI: 10.1186/s12883-018-1089-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/13/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young ischemic stroke patients are common while classification and analysis based upon imaging characteristics are rarely reported. We intend to compare the clinical and MRI characteristics of cerebral stroke induced by intracranial atherosclerosis between young patients with branch occlusive disease (BOD) and those with non-branch occlusive disease (non-BOD) or small artery disease (SAD). METHODS A total of 151 subjects with acute infarction within the middle cerebral artery (MCA) territory were included and patients with ipsilateral internal carotid artery stenosis or cardioembolism were excluded. Based on the distribution characteristics of infarction and the presence of ipsilateral MCA stenosis, the patients were divided into three groups: BOD-striatocapsular area infarction with ipsilateral MCA stenosis; non-BOD -infarction size exceeds the striatocapsular area and accompanied by ipsilateral MCA stenosis; SAD. The clinical and MCA stenosis characteristics of the three groups were compared. RESULTS The number of BOD patients with hypertension was significantly higher than that of SAD (92.9% vs 53.7%, p = 0.000) and non-BOD (92.9% vs 57.1%, p = 0.001); subjects with smoking history significantly exceeded that of SAD (50% vs 26.9%, p = 0.03) and subjects with family history of cardiovascular disease was significantly less than that of non-BOD (14.3% vs 41.1%). Baseline NIHSS scores and mRS scores at discharge in patients with BOD were significantly lower than those with non-BOD (p = 0.000, p = 0.001). Majority of patients in non-BOD group displayed severe MCA stenosis (39 cases, 69.6%) while that in BOD group displayed mild stenosis (26 cases, 92.9%), and the difference was statistically significant (p = 0.000). Compared with non-BOD group, the stenosis in BOD group located at a relatively distal end in the M1 segment of MCA (S/M1, 58% vs 40%, p = 0.000) and was more localized (stenosis level/ (SL/M1), 1.86 (1.35-2.6) vs 2.9 (2.0-5.0), p = 0.002). CONCLUSION BOD in young patients with ischemic stroke induced by intracranial atherosclerosis is not rare (33.3%) and its clinical manifestations and prognosis are similar to those of SAD. This may be related to the mild localized stenosis at the distal end in the M1 segment of MCA. Control of hypertension might play a positive role in secondary prevention.
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Affiliation(s)
- Zhang-Ning Zhao
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Xiao-Lin Li
- Department of Critical Care Medicine, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Jin-Zhi Liu
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Zhi-Ming Jiang
- Department of Critical Care Medicine, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Ai-Hua Wang
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
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Ni XY, Zhang YH, Zhao HX, Pan CW. Numerical research on the biomechanical behaviour of braided stents with different end shapes and stent-oesophagus interaction. Int J Numer Method Biomed Eng 2018; 34:e2971. [PMID: 29461690 DOI: 10.1002/cnm.2971] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/20/2017] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
Quasi-static and dynamic numerical analyses are carried out by referring to computational models of commercial self-expandable braided stents with 3 commonly used end shapes, to evaluate the influence of different end shapes of stent on the biomechanical interaction between stent and oesophagus. The end shape has no influence on the equivalent stress, but has a great influence on the contact stress in the narrowest zone of the oesophagus-neoplasm system. However, the end shapes have significant effect on the equivalent stress and the contact stress in the healthy area of the oesophagus in contact with the stent ends. The results show that the maximum equivalent stress of the oesophagus occurs in the zone contact with the cup-shaped end and the maximum contact stress occurs in the zone contact with the edge of the trumpet-shaped stent end. Moreover, the stent apposition is almost not affected by the end shapes. Although small zones with an incomplete stent apposition appear in the transition zones of spherical-cup-shaped stent, such occurrence might not contribute to stent malapposition or stent migration. Therefore, these stents with 3 types of end shapes all have good stent apposition. Finally, the numerical simulation results can be used to assess the mechanical performance of stents with different end shapes, the effectiveness of stent expansion therapy, and the possibility of complications after stent implantation.
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Affiliation(s)
- Xiao-Yu Ni
- School of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing, Jiangsu Province, 210037, China
| | - Yan-Hong Zhang
- School of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing, Jiangsu Province, 210037, China
| | - Hai-Xia Zhao
- School of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing, Jiangsu Province, 210037, China
| | - Chang-Wang Pan
- Jiangsu Key Laboratory for Design and Manufacture of Micro/Nano Biomedical Instruments Micro-Tech (Nanjing) Co., Ltd., Nanjing, Jiangsu Province, 210037, China
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Nyitrai G, Spisák T, Spisák Z, Gajári D, Diószegi P, Kincses TZ, Czurkó A. Stepwise occlusion of the carotid arteries of the rat: MRI assessment of the effect of donepezil and hypoperfusion-induced brain atrophy and white matter microstructural changes. PLoS One 2018; 13:e0198265. [PMID: 29851990 PMCID: PMC5979036 DOI: 10.1371/journal.pone.0198265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/16/2018] [Indexed: 12/31/2022] Open
Abstract
Bilateral common carotid artery occlusion (BCCAo) in the rat is a widely used animal model of vascular dementia and a valuable tool for preclinical pharmacological drug testing, although the varying degrees of acute focal ischemic lesions it induces could interfere with its translational value. Recently, a modification to the BCCAo model, the stepwise occlusion of the two carotid arteries, has been introduced. To acquire objective translatable measures, we used longitudinal multimodal magnetic resonance imaging (MRI) to assess the effects of semi-chronic (8 days) donepezil treatment in this model, with half of the Wistar rats receiving the treatment one week after the stepwise BCCAo. With an ultrahigh field MRI, we measured high-resolution anatomy, diffusion tensor imaging, cerebral blood flow measurements and functional MRI in response to whisker stimulation, to evaluate both the structural and functional effects of the donepezil treatment and stepwise BCCAo up to 5 weeks post-occlusion. While no large ischemic lesions were detected, atrophy in the striatum and in the neocortex, along with widespread white matter microstructural changes, were found. Donepezil ameliorated the transient drop in the somatosensory BOLD response in distant cortical areas, as detected 2 weeks after the occlusion but the drug had no effect on the long term structural changes. Our results demonstrate a measurable functional MRI effect of the donepezil treatment and the importance of diffusion MRI and voxel based morphometry (VBM) analysis in the translational evaluation of the rat BCCAo model.
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Affiliation(s)
- Gabriella Nyitrai
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
- * E-mail:
| | - Tamás Spisák
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
| | - Zsófia Spisák
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
| | - Dávid Gajári
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
| | - Pálma Diószegi
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
| | - Tamás Zsigmond Kincses
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Czurkó
- Preclinical Imaging Center, Pharmacology and Drug Safety Research, Gedeon Richter Plc., Budapest, Hungary
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Olesen JB, Villagomez-Hoyos CA, Moller ND, Ewertsen C, Hansen KL, Nielsen MB, Bech B, Lonn L, Traberg MS, Jensen JA. Noninvasive Estimation of Pressure Changes Using 2-D Vector Velocity Ultrasound: An Experimental Study With In Vivo Examples. IEEE Trans Ultrason Ferroelectr Freq Control 2018; 65:709-719. [PMID: 29733275 DOI: 10.1109/tuffc.2018.2808328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A noninvasive method for estimating intravascular pressure changes using 2-D vector velocity is presented. The method was first validated on computational fluid dynamic (CFD) data and with catheter measurements on phantoms. Hereafter, the method was tested in vivo at the carotid bifurcation and at the aortic valve of two healthy volunteers. Ultrasound measurements were performed using the experimental scanner SARUS, in combination with an 8 MHz linear array transducer for experimental scans and a carotid scan, whereas a 3.5-MHz phased array probe was employed for a scan of an aortic valve. Measured 2-D fields of angle-independent vector velocities were obtained using synthetic aperture imaging. Pressure drops from simulated steady flow through six vessel geometries spanning different degrees of diameter narrowing, running from 20%-70%, showed relative biases from 0.35% to 12.06%, depending on the degree of constriction. Phantom measurements were performed on a vessel with the same geometry as the 70% constricted CFD model. The derived pressure drops were compared to pressure drops measured by a clinically used 4F catheter and to a finite-element model. The proposed method showed peak systolic pressure drops of -3 kPa ± 57 Pa, while the catheter and the simulation model showed -5.4 kPa ± 52 Pa and -2.9 kPa, respectively. An in vivo acquisition of 10 s was made at the carotid bifurcation. This produced eight cardiac cycles from where pressure gradients of -227 ± 15 Pa were found. Finally, the aortic valve measurement showed a peak pressure drop of -2.1 kPa over one cardiac cycle. In conclusion, pressure gradients from convective flow changes are detectable using 2-D vector velocity ultrasound.
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Qureshi AI, Saleem MA, Naseem N, Wallery SS. A New Technique for the Assessment of Cerebral Vasodilatory Capacity as Part of Catheter-Based Cerebral Angiography. J Stroke Cerebrovasc Dis 2018; 27:1822-1827. [PMID: 29571761 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/08/2017] [Accepted: 02/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated the value of cerebral vasodilatory capacity assessment for risk stratification in patients with extracranial arterial stenosis or occlusion. We describe a new method that assesses cerebral vasodilatory capacity as part of catheter-based cerebral angiography. METHODS We assessed regional cerebral blood volume (rCBV) in the arterial distribution of interest using a controlled contrast injection through a diagnostic catheter placed in the common carotid or the subclavian artery. rCBV maps were created using predefined algorithm based on contrast distribution in the venous phase (voxel size 0.466 mm3) into high, intermediate, low, and no detectable rCBV regions. rCBV maps were acquired again after the administration of intra-arterial nicardipine (1.5-2.5 mg), and percentage increases of the area of various grades of rCBV were calculated. RESULTS Three patients with internal carotid artery stenosis (32% - 64% in severity) and 1 patient with extracranial vertebral artery stenosis (46% in severity) were assessed. There was a variable but consistent increase in the area of high rCBV in the ipsilateral hemisphere in 3 patients with internal carotid artery flow (5.5%-24.5%) and the cerebellum (9.6%) in 1 patient with vertebral artery flow assessments. The increase in high rCBV was most prominent in the patient who received 2.5 mg (24.5%) and least prominent in a patient who received 1.5 mg (5.5%) of intra-arterial nicardipine. There was a concurrent reduction in areas of intermediate and low rCBV (shift) in 3 patients, and there was an increase in all areas of rCBV grades (addition) in 1 patient. CONCLUSIONS Selective assessment of cerebral vasodilatory response in the affected arterial distribution is feasible during catheter-based cerebral angiography.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota; University of Illinois and Mercyhealth, Rockford, Illinois
| | - Muhammad A Saleem
- Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota; Mercyhealth, Janesville, Wisconsin.
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Szarmach A, Kaszubowski M, Sabisz A, Frydrychowski AF, Halena G, Piskunowicz M, Dzierzanowski J, Studniarek M, Szurowska E, Winklewski PJ. Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis. Acta Biochim Pol 2018. [PMID: 29529102 DOI: 10.18388/abp.2018_2581] [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: 11/10/2022]
Abstract
The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis. Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥ 90% on the ipsilateral side and ≤ 50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection. The differences between mean values were examined by paired two-sample t-test and alternative nonparametric Wilcoxon's test. Normality assumption was examined using W Shapiro-Wilk test. The lowest resting-state cerebral blood flow (CBF) was observed in white matter (ipsilateral side: 18.4±6.2; contralateral side: 19.3±6.6) and brainstem (ipsilateral side: 27.8±8.5; contralateral side: 29.1±10.8). Grey matter (cerebral cortex) resting state CBF was below the normal value for subjects of this age: frontal lobe - ipsilateral side: 30.4±7.0, contralateral side: 33.7±7.1; parietal lobe - ipsilateral side: 36.4±11.3, contralateral side: 42.7±9.9; temporal lobe - ipsilateral side: 32.5±8.6, contralateral side: 39.4±10.8; occipital lobe - ipsilateral side: 24.0±6.0, contralateral side: 26.4±6.6). The highest resting state CBF was observed in the insula (ipsilateral side: 49.2±17.4; contralateral side: 55.3±18.4). A relatively high resting state CBF was also recorded in the thalamus (ipsilateral side: 39.7±16.9; contralateral side: 41.7±14.1) and cerebellum (ipsilateral side: 41.4±12.2; contralateral side: 38.1±11.3). The highest CVR was observed in temporal lobe cortex (ipsilateral side: +27.1%; contralateral side: +26.1%) and cerebellum (ipsilateral side: +27.0%; contralateral side: +34.6%). The lowest CVR was recorded in brain stem (ipsilateral side: +20.2%; contralateral side: +22.2%) and white matter (ipsilateral side: +18.1%; contralateral side: +18.3%). All CBF values were provided in milliliters of blood per minute per 100 g of brain tissue (ml/100g/min). Resting state circulation in subjects with carotid artery stenosis is low in all analysed structures with the exception of insula and cerebellum. Acetazolamide challenge yields relatively uniform response in both hemispheres in the investigated population. Grey matter is more reactive to acetazolamide challenge than white matter or brainstem.
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Affiliation(s)
- Arkadiusz Szarmach
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdańsk, Poland
| | - Agnieszka Sabisz
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Grzegorz Halena
- Department of Cardiovascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Piskunowicz
- 1-st Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Michał Studniarek
- 1-st Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Pawel J Winklewski
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of Human Physiology, Medical University of Gdansk, Gdańsk, Poland
- Faculty of Health Sciences, Pomeranian University of Slupsk, Słupsk, Poland
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Tyagi SC, Dougherty MJ, Fukuhara S, Troutman DA, Pineda DM, Zheng H, Calligaro KD. Low carotid stump pressure as a predictor for ischemic symptoms and as a marker for compromised cerebral reserve in octogenarians undergoing carotid endarterectomy. J Vasc Surg 2018; 68:445-450. [PMID: 29482876 DOI: 10.1016/j.jvs.2017.11.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carotid artery occlusive disease can cause stroke by embolization, thrombosis, and hypoperfusion. The majority of strokes secondary to cervical carotid atherosclerosis are believed to be of embolic etiology. However, cerebral hypoperfusion could be an important factor in perioperative stroke. We retrospectively reviewed the stump pressure (SP) of carotid endarterectomy (CEA) of patients at Pennsylvania Hospital to identify whether physiologic perfusion differences account for differences in perioperative stroke rates, particularly in octogenarians. METHODS We conducted a retrospective review of our prospectively maintained database for CEA performed between 1992 and 2015. SP was measured and recorded for 1190 patients. A low SP was defined as systolic pressure <50 mm Hg. Shunts were used only for patients under general anesthesia with SP <50 mm Hg, for awake patients with neurologic changes with carotid clamping, and in some patients with recent stroke. RESULTS Symptomatic patients were more likely to have SP <50 mm Hg compared with asymptomatic patients (35.6% vs 26.2%; P = .0015). Patients having SP <50 mm Hg had a higher postoperative stroke rate compared with patients with SP >50 mm Hg (2.9% vs 0.9%; P = .0174). Octogenarians were more likely to have a lower SP compared with patients younger than 80 years (35.7% vs 27.7%; P = .0328). Symptomatic patients with low SP were at highest risk for perioperative stroke (6.4% vs 1.2%; P = .001) compared with patients without these factors. CONCLUSIONS SP is a marker for decreased cerebrovascular reserve and along with symptomatic status identifies those at highest risk for periprocedural stroke with CEA. Whereas patients older than 80 years may benefit from carotid intervention, they are likely to be at somewhat elevated stroke risk because of higher prevalence of low SP, and shunting does not eliminate this risk.
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Affiliation(s)
- Sam C Tyagi
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa
| | | | - Shinichi Fukuhara
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa
| | | | - Danielle M Pineda
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa
| | - Hong Zheng
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa
| | - Keith D Calligaro
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa
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Hiramatsu R, Furuse M, Yagi R, Ohmura T, Ohnishi H, Ikeda N, Nonoguchi N, Kawabata S, Miyachi S, Kuroiwa T. Continuous Blood Glucose Monitoring May Detect Carotid Occlusion Intolerance during Carotid Artery Stenting. Ann Vasc Surg 2018; 49:91-98. [PMID: 29421420 DOI: 10.1016/j.avsg.2017.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The frequency of the occurrence of adverse events associated with carotid artery stenting (CAS) is usually low, but serious adverse events such as cerebral hyperperfusion syndrome (CHS) may occur. Real-time monitoring is ideal for the early detection of adverse events during the surgical procedure. This study aimed to evaluate continuous blood glucose (BG) monitoring for the detection of adverse events during CAS. METHODS Forty patients undergoing scheduled CAS were prospectively enrolled. An artificial pancreas was used for continuous BG monitoring (once per minute), using venous blood extracted at a rate of 2 mL/hr during CAS. The primary endpoint was a correlation between BG change and adverse events. RESULTS CAS was discontinued in 1 patient, and BG was not measured in 5 patients (12.5%) because of the inability to extract blood. Among 34 evaluable patients, no patient developed CHS, but 3 patients (9%) experienced carotid occlusion intolerance. During CAS, BG was significantly higher in patients with carotid occlusion intolerance (median: 5 mg/dL) than in patients without carotid occlusion intolerance (median: 0 mg/dL) (P = 0.0221). A cutoff BG value ≥4 mg/dL during CAS showed 50% sensitivity and 100% specificity for the detection of carotid occlusion intolerance. There was no significant correlation between BG change and other adverse events. CONCLUSIONS BG elevation may help detect carotid occlusion intolerance although it is still unknown whether BG monitoring can detect CHS. Further studies should validate that a cutoff BG elevation value of ≥4 mg/dL during CAS indicates carotid occlusion intolerance.
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Affiliation(s)
- Ryo Hiramatsu
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Motomasa Furuse
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Ryokichi Yagi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tomohisa Ohmura
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroyuki Ohnishi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Toshihiko Kuroiwa
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
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46
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Tarasov RS, Kazantsev AN, Kokov AN. [Aortic bicarotid subclavian trifurcation bypass grafting combined with coronary aortic bypass grafting]. Angiol Sosud Khir 2018; 24:146-149. [PMID: 30531782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Presented herein is the result of a successful simultaneous operation: carotid endarterectomy on the left + aortic-carotid prosthetic repair on the left + prosthetic repair of the brachiocephalic trunk + graft-subclavian bypass procedure on the left + graft-coronary bypass prosthetic repair of the anterior descending artery with an autovein and coronary aortic bypass grafting of the right coronary artery with an autovein. The chosen method of surgical correction was characterized by a high level of technical difficulty. Retrospectively, the correctness of the implemented surgical policy was confirmed by the worked out in our institution automated decision-making support system for choosing optimal strategy of revascularization in multifocal atherosclerosis. The carried out treatment made it possible to obtain a satisfactory result persisting over a one-year period of follow-up, having prevented unfavourable ischaemic cardiovascular complications in an extremely-difficult-to-cure patient.
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Affiliation(s)
- R S Tarasov
- Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Kazantsev
- Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - A N Kokov
- Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
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47
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Bukhovets IL, Maksimova AS, Plotnikov MP, Kozlov BN, Vorozhtsova IN, Usov VI. [Ultrasonographic control of cerebral blood flow in patients with stenosis of brachiocephalic arteries before and after carotid endarterectomy]. Angiol Sosud Khir 2018; 24:66-71. [PMID: 29688196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors studied the parameters of arterial and venous blood flow in patients presenting with haemodynamically significant atherosclerosis of the carotid arteries before and after carotid endarterectomy, as well as while carrying out functional tests. Comparing the indices of arterial blood flow in the Study Group consisting of 52 patients and the Control Group comprising 15 apparently healthy volunteers at rest prior to the operation revealed statistically significant differences of volumetric parameters of blood flow in the internal carotid artery. The obtained results showed that the breath-holding test was accompanied and followed by increased velocity of blood flow in the middle cerebral artery (MCA) on the side contralateral to stenosis, with the reactivity index (RI) amounting to 0.98±0.20, which statistically significantly differed from the RI in the Control Group patients (1.28±0.13). The forced respiration test demonstrated a decrease in the volumetric indices of blood flow in the MCA on the side of stenosis, as well as an increase of the maximum end-diastolic velocity of blood flow on the side contralateral to stenosis. The test with sublingual administration of nitroglycerin appeared to result in reduced blood flow in the MCA. The supratrochlear test demonstrated decreased velocity of blood flow in the supratrochlear artery. Studying the venous link of cerebral vessels after the operation showed that statistically significant differences were revealed only on the side contralateral to stenosis as compared with the values prior to revascularization. An increase of blood flow in the internal jugular veins after the operation on the side contralateral to the operation was apparently suggestive of an adequate distribution of blood flow through the main vessels of the brain.
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Affiliation(s)
- I L Bukhovets
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - A S Maksimova
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - M P Plotnikov
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - B N Kozlov
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
| | - I N Vorozhtsova
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia; Siberian State Medical University, Tomsk, Russia
| | - V Iu Usov
- Scientific Research Institute of Cardiology, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia
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48
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Cherniavskiĭ MA, Gusev AA, Chernova DV, Iarkov IV, Gordeev ML. [Staged treatment of a multilevel lesion of brachiocephalic arteries in combination with coronary and valvular pathology of the heart]. Angiol Sosud Khir 2018; 24:165-170. [PMID: 29924787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prevention of neurological complications in cardiosurgical and reconstructive vascular surgery is one of the priority tasks of preserving ability to work and decreasing invalidization of patients in the postoperative period. Presented in the article is a clinical case report regarding multiple-stage treatment of a female patient with a combined aortic defect, coronary pathology, and a multilevel bilateral lesion of the brachiocephalic arteries. The first stage consisted in performing a hybrid operation, i. e., carotid endarterectomy from the right internal carotid artery and stenting of the ostium of the right common carotid artery (CCA). The second stage involved balloon angioplasty with stenting of the left CCA, and the third stage was prosthetic repair of the aortic valve by a mechanical prosthesis with simultaneous coronary artery bypass grafting. The woman was discharged in a satisfactory condition. Described in details is the technique of performing the hybrid vascular operation, followed by substantiating the stagewise nature of surgical interventions. The policy chosen demonstrates effective and safe correction of haemodynamically significant tandem stenoses of brachiocephalic arteries, without neurological complications during treatment of patients with cardiological pathology.
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Affiliation(s)
- M A Cherniavskiĭ
- Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - A A Gusev
- Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - D V Chernova
- Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - I V Iarkov
- Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - M L Gordeev
- Scientific Research Division of Vascular and Interventional Surgery, Scientific Research Division of Cardiothoracic Surgery, National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
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49
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Inoue M, Noda R, Yamaguchi S, Tamai Y, Miyahara M, Yanagisawa S, Okamoto K, Hara T, Takeuchi S, Miki K, Nemoto S. Specific Factors to Predict Large-Vessel Occlusion in Acute Stroke Patients. J Stroke Cerebrovasc Dis 2017; 27:886-891. [PMID: 29196201 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 08/28/2017] [Revised: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The effectiveness of thrombectomy for acute ischemic stroke has been established, and earlier treatment produces better outcomes. If possible to identify large-vessel occlusion (LVO) at the prehospital phase, eligible patients can be shipped directly to a hospital that can perform thrombectomy. The purpose of this study was to determine factors that are specific to LVO and can be known before hospital arrival. METHODS The subjects were stroke patients during the period between July 2014 and June 2016, who had a National Institutes of Health Stroke Scale (NIHSS) score of 8 or higher and came to our hospital within 6 hours of onset. These patients were divided into an LVO group and a non-LVO group, and background factors, mode of onset, individual NIHSS item scores, and blood pressure at the time of the visit were retrospectively investigated. The selected factors were compared with LVO prediction scales reported in the past. RESULTS There were 196 stroke patients who had NIHSS scores of 8 or higher and arrived at the hospital within 6 hours. Of these 196 patients, 56 had LVO. This LVO group included a significantly higher number of patients with the 2 items of atrial fibrillation (odds ratio [OR], 11.5: 95% confidence interval [CI], 4.04-32.9; P < .0001) and systolic blood pressure of 170 mm Hg or lower (OR, 2.99: 95% CI, 1.33-6.71, P = .008). These 2 items predicted LVO equally to existing LVO prediction scales. CONCLUSIONS The 2 items of atrial fibrillation and systolic blood pressure of 170 mm Hg or lower were significantly correlated with LVO.
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Affiliation(s)
- Masato Inoue
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Ryuichi Noda
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shoji Yamaguchi
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Tamai
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Makiko Miyahara
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shunsuke Yanagisawa
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koichiro Okamoto
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sosuke Takeuchi
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazunori Miki
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeru Nemoto
- Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan
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50
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Gökçal E, Niftaliyev E, Deniz Ç, Ergelen M, Güzel V, Göktekin Ö, Asil T. Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences. Acta Neurochir (Wien) 2017; 159:2081-2087. [PMID: 28815338 DOI: 10.1007/s00701-017-3295-9] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/01/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hemodynamic changes frequently occur after carotid artery stenting (CAS), and in some patients these changes, particularly hypotension, may be prolonged. There are discrepant results for predicting patients at high risk for these prolonged hemodynamic changes and identifying the effect on clinical outcome. In this study, we aimed to determine the frequency, predictors and consequences associated with prolonged hypotension (PH) after CAS in our center. METHODS We retrospectively analyzed the demographics, risk factors, nature of carotid disease, degree of stenosis of both internal carotid arteries, stent diameter and site of dilatation during stenting in 137 CAS procedures. After CAS, duration of hospital stay, complications during hospital stay and major vascular events or death in a 3-month period were evaluated. PH was defined as a systolic blood pressure <90 mmHg lasting more than 1 h despite adequate treatment after CAS. RESULTS PH occured in 23 (16.8%) patients. The presence of contralateral stenosis ≥70% and absence of diabetes mellitus were significantly associated with PH. Duration of hospital stay was significantly longer in patients with PH. No patients with PH had a periprocedural complication or major vascular events in the follow-up period. CONCLUSION PH was more prevalent in patients with contralateral high-degree carotid stenosis and patients without diabetes mellitus after CAS. PH did not cause any post-procedural complications or major vascular events at follow-up, but it resulted longer hospital stays. Further studies are needed to better define the pathophysiologic mechanisms underlying these hemodynamic alterations.
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Affiliation(s)
- Elif Gökçal
- Neurology Department, Bezmialem Vakıf University, İstanbul, Turkey.
| | - Elvin Niftaliyev
- Neurology Department, Bezmialem Vakıf University, İstanbul, Turkey
| | - Çiğdem Deniz
- Neurology Department, Bezmialem Vakıf University, İstanbul, Turkey
| | - Mehmet Ergelen
- Cardiology Department, Bezmialem Vakıf University, İstanbul, Turkey
| | - Vildan Güzel
- Neurology Department, Bezmialem Vakıf University, İstanbul, Turkey
| | - Ömer Göktekin
- Cardiology Department, Bezmialem Vakıf University, İstanbul, Turkey
| | - Talip Asil
- Neurology Department, Bezmialem Vakıf University, İstanbul, Turkey
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