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Gao Y, Zhang X, Wu D, Wu C, Ren C, Meng T, Ji X. Evaluation of peripapillary retinal nerve fiber layer thickness in intracranial atherosclerotic stenosis. BMC Ophthalmol 2023; 23:455. [PMID: 37957614 PMCID: PMC10641930 DOI: 10.1186/s12886-023-03196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE To evaluate the peripapillary retinal nerve fiber layer thickness (pRNFL) in patients with intracranial atherosclerotic stenosis (ICAS). METHODS A cross-sectional study was performed in a general hospital. The intracranial atherosclerotic stenosis was evaluated by digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA). High-definition optical coherence tomography (HD-OCT) was used to evaluate the peripapillary retinal nerve fiber layer thickness. RESULTS A total of 102 patients, including 59(57.8%) patients with ICAS and 43(42.2%) patients without ICAS, were finally analysed in the study. The peripapillary retinal nerve fiber layer thickness (pRNFL) was reduced significantly in the average, the superior and the inferior quadrants of the ipsilateral eyes and in the superior quadrant of the contralateral eyes in patients with ICAS compared with patients without ICAS. After multivariate analysis, only the superior pRNFL thickness in the ipsilateral eyes was significantly associated with ICAS (OR,0.968; 95% CI,0.946-0.991; p = 0.006). The area under receiver operator curve was 0.679 (95% CI,0.576-0.782) for it to identify the presence of ICAS. The cut-off value of the superior pRNFL was 109.5 μm, and the sensitivity and specificity were 50.8% and 83.7%, respectively. CONCLUSION The superior pRNFL in the ipsilateral eye was significantly associated with ICAS in this study. Larger studies are needed to explore the relation between pRNFL and ICAS further.
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Affiliation(s)
- Yuan Gao
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Xuxiang Zhang
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Di Wu
- China-America Institute of Neuroscience, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Tingting Meng
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Xunming Ji
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
- Department of Neurology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China.
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Lin CJ, Chung CP, Liao NC, Chen PL, Chi NF, Lai YJ, Tang CW, Wu CH, Chang FC, Luo CB, Fay LY, Lin CF, Chou CH, Lee TH, Lee JT, Jeng JS, Lee IH. The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease. J Chin Med Assoc 2023; 86:697-714. [PMID: 37341526 DOI: 10.1097/jcma.0000000000000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/22/2023] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, especially in Asian populations, which has a high risk of recurrent stroke and cardiovascular comorbidities. The present guidelines aim to provide updated evidence-based recommendations for diagnosis and management of patients with ICAD. Taiwan Stroke Society guideline consensus group developed recommendations for management of patients with ICAD via consensus meetings based on updated evidences. Each proposed class of recommendation and level of evidence was approved by all members of the group. The guidelines cover six topics, including (1) epidemiology and diagnostic evaluation of ICAD, (2) nonpharmacological management of ICAD, (3) medical therapy for symptomatic ICAD, (4) endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD, (5) endovascular interventional therapy for postacute symptomatic intracranial arterial stenosis, and (6) surgical treatment of chronic symptomatic intracranial arterial stenosis. Intensive medical treatment including antiplatelet therapy, risk factor control, and life style modification are essential for patients with ICAD.
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Affiliation(s)
- Chun-Jen Lin
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nien-Chen Liao
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Nai-Fang Chi
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Jun Lai
- Radiology Department, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chih-Wei Tang
- Neurology Department and Stroke Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Yu Fay
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Fu Lin
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Hsing Chou
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jiunn-Tay Lee
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lin X, Ke F, Chen M. Association of albumin levels with the risk of intracranial atherosclerosis. BMC Neurol 2023; 23:198. [PMID: 37210474 PMCID: PMC10199550 DOI: 10.1186/s12883-023-03234-2] [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: 11/20/2022] [Accepted: 04/29/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE Intracranial artery stenosis from atherosclerosis is one of the etiologies of ischemic stroke. There is a correlation between serum albumin level and atherosclerosis. We aimed to investigate whether serum albumin level is related to intracranial atherosclerosis and its significance. METHODS A retrospective analysis of 150 individuals who underwent cervical cerebral angiography after admission, including clinical data, imaging data, and laboratory data. Since atherosclerosis cannot be used as a good quantitative indicator, we choose the degree of arterial stenosis to reflect atherosclerosis. SPSS 24 software was used for data analysis, and P < .05 was considered statistically significant. RESULTS Univariate analysis showed that age, diabetes, and serum albumin level were risk factors for intracranial atherosclerosis (P < .05). Multivariate analysis showed that diabetes and serum albumin levels were independent risk factors for intracranial atherosclerosis (P< 0.05). The average serum albumin level in the non-severe group was 39.80 g/L, and the average serum albumin level in the severe group was 37.60 g/L. The area under the ROC curve of serum albumin was 0.667 (95%CI 0.576-0.758, P = .001), the cutoff value was 0.332176, the sensitivity was 75.9%, and the specificity was 57.3%. CONCLUSION Serum albumin level is an independent risk factor for intracranial atherosclerosis, and provides a new direction for clinical prevention and treatment.
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Affiliation(s)
- Xiaoyu Lin
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
| | - Fangfang Ke
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
| | - Maohua Chen
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
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Tian X, Zheng L, Leung TW, Leng X. Associations of hematological and biochemical markers with intracranial atherosclerotic stenosis in stroke-free populations: A systematic review and meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:287-298. [PMID: 36642607 DOI: 10.1016/j.numecd.2022.12.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack. We aimed to synthesize relevant evidence on the associations of hematological and biochemical markers with ICAS in stroke-free populations. METHODS AND RESULTS We searched MEDLINE and EMBASE for articles reporting associations of hematological and biochemical markers with ICAS presence in stroke-free populations. Weighted mean difference (WMD) and 95% confidence interval (CI) for each biomarker were pooled using fixed- or random-effects models. Among 32 studies included in the systematic review, 23 studies (48,326 subjects) with 22 biomarkers were meta-analyzed. Compared with subjects without ICAS, those with ICAS had significantly higher white blood cell (4118 subjects, WMD 0.28 per 109/L, 95% CI 0.01-0.56), neutrophil (4326 subjects, WMD 0.24 per 109/L, 0.10-0.38), neutrophil/lymphocyte ratio (4326 subjects, WMD 0.16, 0.07-0.26), low-density lipoprotein (28,606 subjects, WMD 0.12 mmol/L, 0.05-0.19), non-high-density lipoprotein (3671 subjects, WMD 0.17 mmol/L, 0.08-0.25), C-reactive protein (CRP; 5355 subjects, WMD 0.06 mg/dL, 0.04-0.07), high-sensitivity CRP (9383 subjects, WMD 0.07 mg/dL, 0.01-0.13), uric acid (5966 subjects, WMD 17.91 μmol/L, 11.16-24.66), creatinine (5731 subjects, WMD 4.03 μmol/L, 0.77-7.29), and homocysteine (7053 subjects, WMD 2.25 μmol/L, 1.02-3.48), but lower lymphocyte (4326 subjects, WMD -0.12 per 109/L, -0.19--0.04). Sensitivity analyses showed similar results. CONCLUSIONS Several hematological and biochemical markers easily accessible were associated with ICAS presence in stroke-free populations. This can facilitate early identification of subjects at a high risk of ICAS, who may benefit from ICAS screening and prevention. PROSPERO REGISTRATION NUMBER CRD42021247990.
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Affiliation(s)
- Xuan Tian
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Lina Zheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR 999077, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR 999077, China.
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Ruzhentsova TA, Khavkina DA, Chukhliaev PV, Garbuzov AA, Ploskireva AA. [Effect of anticoagulant therapy on the course of COVID-19 in comorbid patients]. Vopr Virusol 2021; 66:40-46. [PMID: 33683064 DOI: 10.36233/0507-4088-14] [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: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. MATERIAL AND METHODS Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)» (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). RESULTS AND DISCUSSION The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. CONCLUSION Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.
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Affiliation(s)
- T A Ruzhentsova
- FSBI Gabrichevsky research institute for epidemiology and microbiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - D A Khavkina
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - P V Chukhliaev
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - A A Garbuzov
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
| | - A A Ploskireva
- FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor)
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Yang D, Masurkar AV. Clinical Profiles of Arteriolosclerosis and Alzheimer Disease at Mild Cognitive Impairment and Mild Dementia in a National Neuropathology Cohort. Alzheimer Dis Assoc Disord 2021; 35:14-22. [PMID: 32925200 PMCID: PMC7904566 DOI: 10.1097/wad.0000000000000411] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate early clinical differences between cerebral arteriolosclerosis (pARTE), Alzheimer disease (pAD), and AD with arteriolosclerosis (ADARTE). METHODS Using National Alzheimer's Coordinating Center neuropathology diagnoses, we defined pARTE (n=21), pAD (n=203), and ADARTE (n=158) groups. We compared demographics, medical history, psychometrics, neuropsychiatric symptoms, and apolipoprotein E (APOE) allele variants across neuropathology groups. Retrospective timepoints were first evaluation with Global Clinical Dementia Rating (CDR) score of 0.5 and 1.0, via the CDR Dementia Staging Instrument, corresponding to mild cognitive impairment (MCI) and mild dementia, respectively. RESULTS In MCI, clinical differences were minimal but pARTE subjects were older, had later onset cognitive decline, and progressed less severely than pAD. In mild dementia, pAD subjects were younger and had earlier onset of decline. Neuropsychiatric (depression) and psychometric (Logical Memory Delayed Recall, Trails B) differences also emerged between the groups. In MCI, APOE4 associated with worse Logical Memory Delayed Recall in pAD and ADARTE. In mild dementia, APOE4 associated with better animal fluency in pAD, but with better Trails A performance and more neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire) in ADARTE. CONCLUSIONS Differences between pARTE, pAD, and ADARTE emerge at mild dementia rather than MCI. APOE4 has varied cognitive and psychiatric impact dependent on neuropathology group and stage.
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Affiliation(s)
| | - Arjun V Masurkar
- Department of Neurology, New York University School of Medicine, Center for Cognitive Neurology, New York, NY
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Stapleton CJ, Chen YF, Shallwani H, Vakharia K, Turan TN, Woo HH, Derdeyn CP, Charbel FT, Siddiqui AH, Amin-Hanjani S. Submaximal Angioplasty for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis of Peri-Procedural and Long-Term Risk. Neurosurgery 2020; 86:755-762. [PMID: 31435656 PMCID: PMC7534488 DOI: 10.1093/neuros/nyz337] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Symptomatic intracranial atherosclerotic disease (ICAD) is an important cause of stroke. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option. OBJECTIVE To examine the periprocedural and long-term risks associated with submaximal angioplasty for ICAD based on the available literature. METHODS All English language studies of intracranial angioplasty for ICAD were screened. Inclusion criteria were as follows: ≥ 5 patients, intervention with submaximal angioplasty alone, and identifiable periprocedural (30-d) outcomes. Analysis was co-nducted to identify the following: 1) periprocedural risk of any stroke (ischemic or hemorrh-agic) or death, and 2) stroke in the territory of the target vessel and fatal stroke beyond 30 d. Mixed effects logistic regression was used to summarize event rates. Funnel plot and rank correlation tests were employed to detect publication bias. The relative risk of periprocedural events from anterior vs posterior circulation disease intervention was also examined. RESULTS A total of 9 studies with 408 interventions in 395 patients met inclusion criteria. Six of these studies included 113 posterior circulation interventions. The estimated pooled rate for 30-d stroke or death following submaximal angioplasty was 4.9% (95% CI: 3.2%-7.5%), whereas the estimated pooled rate beyond 30 d was 3.7% (95% CI: 2.2%-6.0%). There was no statistical difference in estimated pooled rate for 30-d stroke or death between patients with anterior (4.8%, 95% CI: 2.8%-7.9%) vs posterior (5.3%, 95% CI: 2.4%-11.3%) circulation disease (P > .99). CONCLUSION Submaximal angioplasty represents a potentially promising intervention for symptomatic ICAD.
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Affiliation(s)
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois
| | - Hussain Shallwani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
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Abstract
Objective The purpose of this study was to identify the predictors of subsequent ischemic stroke events in patients with transient ischemic attack (TIA) attributable to intracranial arterial occlusive lesions. Methods The study population included 82 patients (55 men; mean age, 69.3±12.1 years) with TIA caused by intracranial arterial occlusive lesions who were admitted to our stroke care unit within 48 h of the onset of a TIA between April 2008 and November 2015. TIA was diagnosed if focal neurological symptoms ascribable to a vascular etiology lasted less than 24 h, irrespective of the presence of ischemic insults on imaging. The primary endpoint was an ischemic stroke event within 90 days of the onset of a TIA. Results The 90-day risk of ischemic stroke after the onset of a TIA was 14.6% [95% confidence interval (CI): 8.6-23.9%]. Cox proportional hazards multivariate analyses revealed that diffusion-weighted imaging (DWI) positivity [hazard ratio (HR), 8.73; 95%CI, 2.20-41.59; p=0.002], prior ischemic stroke (HR, 4.03; 95%CI, 1.07-15.99; p=0.040), and a high serum level of alkaline phosphatase (ALP) on admission (HR, 1.15; 95%CI, 1.05-1.26; p=0.002, for every +10 U/L) were significant independent predictors of ischemic stroke within 90 days after the onset of a TIA. Conclusion Our results suggested that patients with a TIA attributable to intracranial artery disease who showed DWI lesions, prior ischemic stroke, or high serum levels of ALP on admission were at high risk of subsequent ischemic stroke events.
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Affiliation(s)
- Toshiyuki Uehara
- Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Tomoyuki Ohara
- Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kazuo Minematsu
- Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kazuyuki Nagatsuka
- Departments of Neurology, National Cerebral and Cardiovascular Center, Japan
| | - Kazunori Toyoda
- Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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Gonzalez NR, Liou R, Kurth F, Jiang H, Saver J. Antiangiogenesis and medical therapy failure in intracranial atherosclerosis. Angiogenesis 2018; 21:23-35. [PMID: 28993906 PMCID: PMC5831393 DOI: 10.1007/s10456-017-9578-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 04/14/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of stroke worldwide and the one with the worst prognosis. In this study, we assessed the hypothesis that the balance of circulating pro- and antiangiogenic factors plays a role in the evolution of the disease and can be used as a potential marker for the disease course and a target for treatment. Seventy-four patients with severe ICAD were enrolled in this prospective observational study, medically optimized, and followed for 6 months. Thirteen pro- and eight antiangiogenic factors were measured in the participants' serum using a sandwich multiplex ELISA. Angiogenic profiles were calculated using principal component analysis. We tested the association between angiogenic profiles and recurring cerebrovascular events despite intensive medical therapy, disability at 6 months after enrollment, and angiographic neovascularization in patients who failed medical treatment and underwent indirect revascularization surgery. There is a strong association between a functionally antiangiogenic profile and recurrent stroke or TIA in patients with ICAD (OR = 7.2, CI 2.4-34.4). Multivariable regression analysis showed that this antiangiogenic profile was also associated with poor functional status after 6 months (p = 0.002), independent from other clinical features such as history of previous stroke, diabetes, and age. In patients who failed medical management and underwent indirect revascularization surgery, high endostatin and angiostatin levels were also associated with low angiographic neovascularization (p = 0.02). The results of this study point to the striking importance of antiangiogenesis as a determinant of ICAD patient prognosis and suggest a possible new target for therapy.
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Affiliation(s)
- Nestor R Gonzalez
- Department of Neurosurgery, Cedars Sinai Medical Center, 127 S San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA.
| | - Raymond Liou
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Florian Kurth
- Department of Neurosurgery, Cedars Sinai Medical Center, 127 S San Vicente Blvd., Suite A6600, Los Angeles, CA, 90048, USA
| | - Hao Jiang
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Jeffrey Saver
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
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Tuleta I, Farrag T, Busse L, Pizarro C, Schaefer C, Pingel S, Nickenig G, Skowasch D, Schahab N. High prevalence of COPD in atherosclerosis patients. Int J Chron Obstruct Pulmon Dis 2017; 12:3047-3053. [PMID: 29089753 PMCID: PMC5655122 DOI: 10.2147/copd.s141988] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 01/18/2023] Open
Abstract
Atherosclerosis and COPD are both systemic inflammatory diseases that may influence each other. The aim of the present study was to determine the prevalence of COPD in patients with cerebral and/or peripheral artery disease and to assess factors associated with the presence of COPD. Following the diagnosis of cerebral and/or peripheral artery disease by means of duplex sonography, 166 consecutive patients underwent body plethysmography with capillary blood gas analysis. Thereafter, blood tests with determination of different parameters such as lipid profile, inflammatory and coagulation markers were conducted in remaining 136 patients who fulfilled inclusion criteria of the study. Thirty-six out of 136 patients suffered from COPD, mostly in early stages of the disease. Residual volume indicating emphysema was increased (162.9%±55.9% vs 124.5%±37.0%, p<0.05) and diffusion capacity was decreased (55.1%±19.5% vs 75.3%±18.6%, p<0.05) in COPD patients vs non-COPD group. In capillary blood gas analysis, COPD patients had lower partial pressure of oxygen (70.9±11.5 vs 75.2±11.0 mmHg, p<0.05) and higher partial pressure of carbon dioxide (36.8±7.5 vs 34.4±4.4 mmHg, p<0.05) compared with non-COPD individuals. Presence of COPD was associated with predominance of diabetes mellitus, interleukin-8-related systemic neutrophilic inflammation and anemia. In conclusion, COPD is highly prevalent in patients with atherosclerotic artery disease.
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Affiliation(s)
- Izabela Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Tarik Farrag
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Laura Busse
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Simon Pingel
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
| | - Nadjib Schahab
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn, Bonn, Germany
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Hu W, Jiang W, Ye L, Tian Y, Shen B, Wang K. Prospective evaluation of the diagnostic value of plasma apelin 12 levels for differentiating patients with moyamoya and intracranial atherosclerotic diseases. Sci Rep 2017; 7:5452. [PMID: 28710384 PMCID: PMC5511181 DOI: 10.1038/s41598-017-05664-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/01/2017] [Indexed: 01/15/2023] Open
Abstract
Patients with moyamoya disease (MMD) or intracranial atherosclerotic disease (ICAD) experience similar cerebral ischaemic events. However, MMD patients show greater angiogenesis and arteriogenesis, which play crucial roles in collateral circulation development to enhance clinical prognosis and outcome. Apelins have been associated with angiogenesis and arteriogenesis. Therefore, the aim of the present study was to determine whether apelin levels were higher in patients with MMD than in patients with ICAD or in healthy controls. We compared plasma apelin levels in 29 patients with MMD, 82 patients with ICAD, and 25 healthy participants. Twelve-hour fasting blood samples were collected and analysed using commercially available kits. Univariate analyses indicated that compared with the ICAD and healthy control groups, the MMD group had higher apelin-12, apelin-13, apelin-36, and nitric oxide levels. Binary logistic regression analyses further showed that the plasma apelin-12 level was substantially higher in MMD patients than in ICAD patients. Patients with MMD were also differentiated from patients with ICAD by their mean ages, with the former being younger. Therefore, the plasma apelin-12 level is a potential diagnostic marker for differentiating MMD and ICAD and may provide a treatment strategy for enhancing collateral circulation development and clinical prognosis and outcome.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Wan Jiang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Li Ye
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Bing Shen
- School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, 230032, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China.
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12
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Wang MY, Liu YS, Li K, Liu YJ, Wang F. Protective effect of the microcatheter placed at the normal vertebral artery in intracranial stent-assisted angioplasty for vertebral artery stenosis: A case report. Medicine (Baltimore) 2017; 96:e7569. [PMID: 28723788 PMCID: PMC5521928 DOI: 10.1097/md.0000000000007569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE A carefully designed intracranial stent-assisted angioplasty (SAA) is presented here that may prevent subsequent branch artery occlusion. PATIENT CONCERNS A 72-year-old man with a 3-month history of progressive and intermittent vertigo without any obvious trigger, accompanied by nausea. DIAGNOSES Intracranial atherosclerotic disease. INTERVENTIONS the patient underwent intracranial SAA in accordance with the procedure described here. OUTCOMES The patient's paroxysmal vertigo completely subsided, with no complications during the short-term follow-up. LESSONS This novel intracranial SAA procedure is safe and may reduce the risk of subsequent artery occlusion.
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Abstract
PURPOSE OF REVIEW Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient's symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon the individual patient's history, examination, and anatomic imaging findings: asymptomatic and symptomatic extracranial carotid stenosis, intracranial atherosclerosis, and extracranial vertebral artery atherosclerotic disease. This review provides a framework for clinicians evaluating and treating such patients. RECENT FINDINGS Intensive medical therapy achieves low rates of stroke and death in asymptomatic carotid stenosis. Evidence indicates that patients with severe symptomatic carotid stenosis should undergo carotid revascularization sooner rather than later and that the risk of stroke or death is lower using carotid endarterectomy than with carotid stenting. Specific to stenting, the risk of stroke or death is greatest among older patients and women. Continuous vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy is the mainstay for stroke prevention in the setting of intracranial and vertebral artery origin atherosclerosis. SUMMARY Lifelong vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy are the key elements to reduce future stroke risk in the setting of large artery atherosclerosis. When considering a revascularization procedure for carotid stenosis, patient demographics, comorbidities, and the periprocedural risks of stroke and death should be carefully considered.
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Tanashian MM, Skrylev SI, Antonova KV, Medvedev RB. [Carotid revascularization in type 2 diabetes mellitus. Significance of chronic hyperglycaemia]. Angiol Sosud Khir 2017; 23:99-106. [PMID: 29240062] [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: 06/07/2023]
Abstract
Patients with type 2 diabetes mellitus (type 2 DM) are typically prone to the development of cerebral atherosclerosis. Presented herein are the results of examination of patients suffering from ischaemic cerebrovascular diseases on the background of type 2 DM subjected to open surgical or endovascular interventions. In patients with cerebrovascular pathology and type 2 DM, atherosclerosis progresses on the background of chronic hyperglycaemia combined with dyslipidaemia, leading to increased incidence of the development of cerebral circulatory impairments and detection of the indications for carrying out angioreconstructive operations on the internal carotid arteries. The presence of type 2 DM is associated with increased risk for the development of ischaemic lesions of the brain matter while performing carotid endarterectomy and endovascular interventions which are associated with higher values of glycaemia (8.0 mmol/l) and glycated haemoglobin (7.8-8 %) prior to the operation.
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Affiliation(s)
| | - S I Skrylev
- Research Centre of Neurology, Moscow, Russia
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15
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Abstract
Increasing our knowledge about intracranial atherosclerosis (ICAS) natural history and prognostic factors is essential to improve its preventive therapy and thus reduce the dramatic clinical consequences caused by this entity. ICAS is characterized by a chronic and progressive course until it becomes symptomatic, mostly through complication of an unstable intracranial atherosclerotic plaque. Population-based studies in healthy subjects have shown that the prevalence of asymptomatic ICAS is higher in Asian than in Caucasian populations. In both settings, asymptomatic ICAS is associated with classical vascular risk factors and with the metabolic syndrome, and it is burdened with an increasing risk of having incident stroke and cognitive impairment. When it reaches its symptomatic stage, ICAS is a dynamic and aggressive condition, and affected patients are at high risk of having recurrent stroke and other major vascular events. The Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial has recently shown a robust impact of intensive medical therapy reducing the risk of clinical recurrence of symptomatic ICAS. However, even under best medical therapy and degree of risk factor control, symptomatic ICAS-related recurrence risk continues to be the highest among all stroke etiologic subtypes. The second part of the chapter reviews the current understanding of prognostic factors that may help discriminate the high-risk ICAS patients, divided into local factors (vulnerable ICAS plaque) and systemic factors (vulnerable ICAS patient). Regarding research on local factors, high-resolution magnetic resonance imaging (HRMRI) is an emerging technique that allows in vivo evaluation of intracranial arterial wall, which is displacing our research focus from intracranial stenosis degree towards intracranial atherosclerotic plaque composition and activity. Characterization of the vulnerable ICAS patient may be improved with biomarker research. The latest contributions in this field help support the hypothesis that inflammation determines the risk of progression and complication of this disease, as it occurs in atherosclerosis affecting extracranial arterial beds.
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16
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Honig A, Eliahou R, Auriel E. Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness. J Neurol Sci 2016; 373:18-20. [PMID: 28131184 DOI: 10.1016/j.jns.2016.11.061] [Citation(s) in RCA: 4] [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: 08/28/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
Abstract
We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness. None had pyramidal signs or increased limb tone. Speech, language, and cognitive performance were intact during admission examination. In all three patients, initial diffusion-weighted imaging (DWI) MRI showed small confined regions of restriction involving the posterolateral border of ACA territory; CT angiography was normal in one patient with a newly diagnosed atrial fibrillation but showed atherosclerotic vasculature with severe narrowing of the A3 segment of the ACA in two. Awareness of ACAI presenting as unilateral axial weakness is warranted. We suggest that optimal diagnostic management should include examination of axial tone. Ischemic involvement of distal ACA branches may herald a more extensive ACAI. Prompt diagnosis may enable thrombolysis or endovascular treatment, and blood pressure maintenance may allow adequate perfusion to damaged tissue.
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Affiliation(s)
- Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Eitan Auriel
- Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Barreto-Neto N, Barros AD, Jesus PAP, Reis CC, Jesus ML, Ferreira ILO, Fernandes RD, Resende LL, Andrade AL, Gonçalves BM, Ventura LMB, Jesus AA, Fonseca LF, Mueller MC, Oliveira-Filho J. Low Ankle-Brachial Index is a Simple Physical Exam Sign Predicting Intracranial Atherosclerotic Stenosis in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2016; 25:1417-20. [PMID: 27021041 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nestor Barreto-Neto
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Alexandre D Barros
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Pedro A P Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carolina C Reis
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Morgana L Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Isadora L O Ferreira
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rodrigo D Fernandes
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lucas L Resende
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Alisson L Andrade
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Beatriz M Gonçalves
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lais M B Ventura
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Adriano A Jesus
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luana F Fonseca
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mila C Mueller
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Stroke Clinic and the Post Graduate Program in Health Sciences (PPgCS), Federal University of Bahia, Salvador, Bahia, Brazil
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18
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Kang K. Low bone mineral density is associated with intracranial posterior circulation atherosclerosis in women. Bone 2015; 81:669-674. [PMID: 26431918 DOI: 10.1016/j.bone.2015.09.016] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/14/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
Low bone mineral density (BMD) is associated with carotid atherosclerosis and the incidence of stroke. However, there are no data on the association of BMD with intracranial atherosclerosis. The study population consisted of 357 participants who underwent dual energy x-ray absorptiometric scanning of the lumbar spine and brain 3D time of flight magnetic resonance angiography as part of their voluntary health checks. The basilar, middle cerebral, intracranial internal carotid and intracranial vertebral arteries were evaluated. Low BMD was defined as a T-score of less than -1. All analyses were stratified by sex and intracranial atherosclerosis location. One hundred seventy-six women (53 years; 66.9% postmenopausal; 33.5% low BMD; 60.2% intracranial atherosclerosis in the anterior circulation (AC); 60.2% intracranial atherosclerosis in the posterior circulation (PC)) and 181 men (51 years; 28.7% low BMD; 61.9% intracranial atherosclerosis in the AC; 55.8% intracranial atherosclerosis in the PC) were included. In women, low BMD was significantly associated with intracranial atherosclerosis in the PC with the odds ratio of 2.57 (95% confidence interval 1.11-5.99). However, intracranial atherosclerosis in the AC was not associated with BMD in women. In men, there were no significant associations between BMD and intracranial atherosclerosis. In conclusion, this study shows that low BMD is associated with subclinical intracranial PC atherosclerosis in women but not in men.
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Affiliation(s)
- K Kang
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea.
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19
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Turan TN, LeMatty T, Martin R, Chimowitz MI, Rumboldt Z, Spampinato MV, Stalcup S, Adams RJ, Brown T. Characterization of intracranial atherosclerotic stenosis using high-resolution MRI study--rationale and design. Brain Behav 2015; 5:e00397. [PMID: 26807333 PMCID: PMC4714642 DOI: 10.1002/brb3.397] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/16/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Intracranial atherosclerosis is a leading cause of stroke, but little is known about the composition of the intracranial atherosclerotic lesion and how intracranial plaque morphology is related to the risk of stroke. High-resolution magnetic resonance imaging (HR MRI) has been used in patients with extracranial carotid atherosclerosis as an in vivo tool to identify, with high-interrater agreement, histologically defined plaque components (i.e., intraplaque hemorrhage, fibrous cap, and lipid core), which have been shown to be predictors of recurrent stroke. With careful imaging the components of atherosclerotic plaque can be visualized in the intracranial arteries using HR MRI, but there are no reports of reproducibility or interrater reliability. METHODS/STUDY DESIGN The Characterization of intracranial atherosclerotic stenosis using high-resolution MRI (CHIASM) study is a single-center NIH-funded prospective observational study, to (1) demonstrate high -interrater agreement for identifying intracranial plaque components on HR MRI, (2) determine the frequency of these components in symptomatic versus asymptomatic plaques, and (3) estimate the 1-year rate of stroke in the territory of high-risk plaque components. CHIASM will recruit 90 patients with 50-99% intracranial atherosclerosis to undergo HRMRI of the intracranial artery plaque at enrollment and 1-year follow-up. Both symptomatic and asymptomatic subjects will be recruited. CONCLUSION Determination of good interrater reliability is an important first step in the development of HR MRI as a tool to predict risk in patients with intracranial atherosclerosis. This study will inform the design of future multicenter studies to determine the prevalence and prognosis of intracranial atherosclerotic plaque components. Such studies could lead to new understanding of the pathophysiological mechanisms of cerebral ischemia in patients with atherosclerotic intracranial stenosis, improvements in risk stratification, and potentially to new treatments of this common and serious disease.
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Affiliation(s)
- Tanya N. Turan
- Department of NeurologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Todd LeMatty
- Department of NeurologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Renee Martin
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSouth Carolina
| | - Marc I. Chimowitz
- Department of NeurologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Zoran Rumboldt
- Department of Radiology and Radiological SciencesMedical University of South CarolinaCharlestonSouth Carolina
| | - M. Vittoria Spampinato
- Department of Radiology and Radiological SciencesMedical University of South CarolinaCharlestonSouth Carolina
| | - Seth Stalcup
- Department of Radiology and Radiological SciencesMedical University of South CarolinaCharlestonSouth Carolina
| | - Robert J. Adams
- Department of NeurologyMedical University of South CarolinaCharlestonSouth Carolina
| | - Truman Brown
- Department of Radiology and Radiological SciencesMedical University of South CarolinaCharlestonSouth Carolina
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20
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Abstract
The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis.Fifty-seven patients with asymptomatic mild, moderate, and severe unilateral MCA stenosis and 8 patients with symptomatic severe unilateral MCA stenosis diagnosed by transcranial Doppler were enrolled. Twenty-four healthy volunteers served as controls. The noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each subject in the supine position. Transfer function analysis was applied to determine the autoregulatory parameters (phase difference [PD] and gain).The PD values in the severe stenosis groups were significantly lower than those of the control group (60.71 ± 18.63°), the asymptomatic severe stenosis group was impaired ipsilaterally (28.94 ± 27.43°, P < 0.001), and the symptomatic severe stenosis group was impaired bilaterally (13.74 ± 19.21°, P < 0.001; 19.68 ± 14.50°, P = 0.006, respectively). The PD values in the mild and moderate stenosis groups were not significantly different than the controls (44.49 ± 27.93°; 48.65 ± 25.49°, respectively). The gain values in the mild and moderate groups were higher than in the controls (1.00 ± 0.58 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, and 1.20 ± 0.59 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, respectively). The gain values in the severe stenosis groups were significantly lower than that in the control group: the asymptomatic severe stenosis group was lower bilaterally (0.56 ± 0.32 cm/s/mm Hg, P = 0.003; 0.60 ± 0.32 cm/s/mm Hg, P < 0.05, respectively), whereas the symptomatic severe group was lower unilaterally (on the contralateral side) (0.53 ± 0.43 cm/s/mm Hg, P < 0.05).In asymptomatic patients with unilateral MCA stenosis, only the dCA of the severe stenosis was ipsilaterally impaired. Acute stroke may aggravate the impaired dCA and even spread contralaterally.
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Affiliation(s)
- Shuang Wang
- From the Stroke Center, Department of Neurology (SW, HM, HJ, YY); Neuroscience Center, Department of Neurology (Z-NG); Center for Neurovascular ultrasound (Y X), the First Hospital of Jilin Universit, Changchun, China and Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Xueyuan Avenue, Shenzhen University Town, Shenzhen, China (JL)
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Inzitari D, Bracco L, Capparelli R, Marini P, Giordano GP, Poggesi L, Miceli M. Cerebrospinal fluid dynamics, white matter degeneration, and mental deterioration in subcortical arteriosclerotic encephalopathy of Binswanger type. Monogr Neural Sci 2015; 11:150-6. [PMID: 6738547 DOI: 10.1159/000409204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Agnoli A, Ruggieri S, Denaro A, Martucci N, Tanfani G, Stocchi F. White matter disease (Binswanger's encephalopathy) in chronic cerebrovascular disorders. Monogr Neural Sci 2015; 11:144-9. [PMID: 6738546 DOI: 10.1159/000409203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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23
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Ding D. Management of intracranial atherosclerotic disease: current roles of medical therapy versus stent-assisted revascularization. Neurol Sci 2015; 36:1531-2. [PMID: 25868599 DOI: 10.1007/s10072-015-2214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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Liu CY, Chen CQ. Intra- and extracranial atherosclerotic stenosis in China: epidemiology, diagnosis, treatment and risk factors. Eur Rev Med Pharmacol Sci 2014; 18:3368-3379. [PMID: 25491610] [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: 06/04/2023]
Abstract
OBJECTIVE Data regarding the cerebral atherosclerotic stenosis (CAS) and incidence of stroke are conflicting. The number of stroke patients is more than three times that from coronary heart disease in China. The main aim of this report is to review the current status of intracranial and extracranial atherosclerotic stenosis including epidemiology, diagnosis, treatment and risk factors in China. METHODS Data was identified by searches of MEDLINE (January 1966 to December 2008), China Biological Medicine Database (CBM-disc 1979 to 2008), China National Knowledge Infrastructure (CNKI 1994 to December 2008). RESULTS The occurrence of intracranial artery stenosis was more frequent than that of extracranial artery in the Chinese population. TCD, Doppler ultrasound, CTA, MRA and DSA techniques are established to examine intracranial and extracranial atherosclerotic stenosis in China. Evidence-based treatments and CAS are more commonly applied in patients with cerebrovascular stenosis in China. However, the development of carotid endoarterectomy (CEA) is limited in Chinese communities. The risks of cerebral atherosclerotic stenosis include age, hypertension, diabetes mellitus, dyslipidemia, smoking and metabolic syndrome. CONCLUSIONS Further studies are needed to focus on the intracranial atherosclerotic stenosis.
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Affiliation(s)
- C-Y Liu
- Department of Neurology PLA 254 Hospital, Hebei District, Tianjin, China.
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25
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Li Z, Liu J. Coexistence of low ankle-brachial index and intra-cranial atherosclerosis? INT ANGIOL 2014; 33:461-465. [PMID: 25294288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Low ankle-brachial index (ABI<0.9) is considered a risk factor for stroke. However, there are disputes regarding the relationship between low ABI and intra-cranial atherosclerosis. The relationship between low ABI and intra/extracranial atherosclerosis was analyzed in the present study. METHODS Patients with large artery atherosclerosis (LAA) and small artery disease (SAD) were enrolled in this study according to the classic Trial of ORG 10172 in Acute Stroke Treatment (TOAST) subtypes. Subjects were divided into three groups: intracranial atherosclerosis (IAS), extracranial atherosclerosis (EAS) and the small artery disease group. All of the enrolled patients underwent ABI measurement and were assessed for risk factors. The association between low ABI (<0.9) and extra/intra cranial atherosclerosis were examined using logistic regression. RESULTS Altogether, 31.51% of LAA patients were diagnosed with peripheral artery disease, which was much higher than that of the SAD patients (19.75%, P=0.045). There was a remarkable difference in the prevalence of abnormal ABI in the EAS stenosis and IAS stenosis patients (47.17% vs. 22.31%, P=0.001). Multivariable logistic regression identified peripheral artery disease (OR=2.759, 95% CI: 1.485-5.124) and smoking (OR=2.032, 95%CI:1.093-3.779) as independent risk factors for EAS stenosis. However hypertension (OR=1.957, 95%CI: 1.119-3.421) as well as male sex (OR=2.024, 95%CI: 1.251-3.274) were found to be independent risk factors for IAS stenosis. Peripheral artery disease was not associated with IAS stenosis (OR=1.075, 95%CI: 0.516-2.238). CONCLUSION Intracranial atherosclerosis was not associated with a low ABI (<0.9) in the stroke patients. Low ABI is significantly associated with age (>65 years), extra-cranial atherosclerotic and diabetes mellitus. Among ischemic stroke patients, a low ABI can be useful in predicting EAS.
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Affiliation(s)
- Z Li
- The Third Hospital of Hebei Medical University, Shijiazhuang, China -
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26
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Abstract
Atherosclerotic disease often involves the intracranial arteries including those encased by cranial bones and dura, and those located in the subarachnoid space. Age, hypertension, and diabetes mellitus are independent risk factors for intracranial atherosclerosis. Intracranial atherosclerosis can result in thromboembolism with or without hypoperfusion leading to transient or permanent cerebral ischaemic events. High rates of recurrent ischaemic stroke and other cardiovascular events mandate early diagnosis and treatment. Present treatment is based on a combination of antiplatelet drugs, optimisation of blood pressure and LDL cholesterol values, and intracranial angioplasty or stent placement, or both, in selected patients.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and CentraCare Health, St Cloud, MN, USA.
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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27
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Kim BJ, Hong KS, Cho YJ, Lee JH, Koo JS, Park JM, Kang DW, Kim JS, Lee SH, Kwon SU. Predictors of symptomatic and asymptomatic intracranial atherosclerosis: what is different and why? J Atheroscler Thromb 2014; 21:605-617. [PMID: 24573015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
AIM The prognoses of symptomatic and asymptomatic intracranial atherosclerotic stenosis(ICAS) differ. Understanding the underlying pathomechanisms and predictors of progression or regression may help to clarify the differences. We herein attempted to compare the course and predictors of symptomatic ICAS to those of coexisting asymptomatic ICAS. METHODS This was a post-hoc analysis of the 'Trials of Cilostazol in Symptomatic intracranial arterial stenosis-2(TOSS-2)' study, which recruited patients with acute symptomatic ICAS receiving intensive medical treatment. Changes in the status of ICAS were classified as being indicative of regression, progression or no changes. Univariate and multivariate ordinal regression analyses were performed to identify predictors of symptomatic and asymptomatic ICAS based on clinical, laboratory and radiologic data. RESULTS Of the 409 patients, symptomatic ICAS demonstrated regression in 110(27%) cases and progression in 52(13%) cases. Among these patients, 250(61.1%) had asymptomatic ICAS, which regressed in 38(15%) cases and progressed in 16(6%) cases. Severe baseline stenosis, a high high-density lipoprotein(HDL) cholesterol level and the use of cilostazol were found to be independently associated with a favorable course of symptomatic ICAS(p<0.001, p=0.005 and p=0.038, respectively). Regarding asymptomatic ICAS, severe stenosis, the use of angiotensin receptor antagonists and a low fasting glucose level were associated with a favorable course(p<0.001, p=0.011 and p=0.007, respectively). CONCLUSIONS Changes in atherosclerosis are more dynamic in patients with symptomatic ICAS, and the predictors of symptomatic and asymptomatic ICAS differ. In this study, changes in the status of symptomatic ICAS were associated with the level of HDL cholesterol, which is known to affect the regression of atherosclerosis and vascular remodeling.
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Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan
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Ozben S, Guvenc TS, Huseyinoglu N, Sanivar HS, Hanikoglu F, Cort A, Ozben T. Low serum copeptin levels in patients with obstructive sleep apnea. Sleep Breath 2013; 17:1187-92. [PMID: 23407918 DOI: 10.1007/s11325-013-0822-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 11/06/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group. METHODS A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method. RESULTS Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409). CONCLUSIONS Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.
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Affiliation(s)
- Serkan Ozben
- Department of Neurology, Medical Faculty, Kafkas University, 36100, Kars, Turkey,
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Maksimova MI, Korobkova DZ, Krotenkova MV. [Diagnostic methods for cerebral artery atherosclerosis in clinical practice]. Vestn Rentgenol Radiol 2012:35-41. [PMID: 23520940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
OBJECTIVE To summarize the value and limitations of magnetic resonance (MR) plaque imaging for intracranial arteries. METHOD The data of MR plaque imaging of intracranial arteries in 422 patients performed in Peking Union Medical College Hospital from December 2006 to September 2010 were analyzed retrospectively. RESULTS The success rate for MR plaque imaging of intracranial arteries was 97%. MR plaque imaging clearly displayed the wall structure of the arteries trunk (M1 segment of middle cerebral arteries, M2-3 segment of anterior cerebral arteries, and basilar arteries). Good inter-observer (k=0.91, 95% CI=0.80-1.03) and intra-observer reproducibility (k=0.96,95% CI=0.88-1.03) was observed in the evaluation of middle cerebral arteries' atherosclerosis. The wall features had significant difference between symptomatic and asymptomatic intracranial arteries'stenosis; compared with asymptomatic middle cerebral artery stenosis(35 cases), symptomatic middle cerebral artery stenosis(26 cases) had a significantly larger wall area (P=0.000), greater remodeling ratio (P=0.000), higher prevalence of expansive remodeling (outward expansion of the vessel wall) (P=0.003), and lower prevalence of constrictive remodeling (P=0.008). Arteritis of middle cerebral artery (3 cases) showed circular wall-thickening with apparent gadolinium-diethylene triamine pentaacetic acid-biotin enhancement. CONCLUSION The MR plaque imaging is helpful in the evaluation of intracranial arteries stenosis, although it still has the limitations such as short scan range and low resolution.
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Affiliation(s)
- Ming-li Li
- Department of Radiology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
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Aslam F, Brown HH, Pandey T, Russell EB. Giant cell arteritis presenting with a lateral medullary stroke in a patient with multiple atherosclerotic risk factors. Scand J Rheumatol 2012; 42:82-3. [PMID: 22992025 DOI: 10.3109/03009742.2012.709273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Choi HN, Kim SH, Kim HH, Kim SK, Choe JY, Park SH. Intracranial vasculopathy in a patient with systemic sclerosis: atherosclerotic or moyamoya-like disease? Korean J Intern Med 2012; 27:239-42. [PMID: 22707901 PMCID: PMC3372813 DOI: 10.3904/kjim.2012.27.2.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/26/2011] [Accepted: 12/02/2011] [Indexed: 11/27/2022] Open
Affiliation(s)
- Han Na Choi
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Si Hye Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun Hee Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
- Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
- Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Chen JK, Teng HL, Chen L, Wang J, Ye Q, Wang XB. [Clinical screening of patients with cerebral arteriosclerosis combined with vertebral artery abnormalies]. Zhongguo Gu Shang 2012; 25:212-215. [PMID: 22712371] [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: 06/01/2023]
Abstract
OBJECTIVE To explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA). METHODS From January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated. RESULTS The abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%. CONCLUSION The reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.
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Affiliation(s)
- Ju-Kun Chen
- The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China
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Abstract
PURPOSE OF REVIEW Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. RECENT FINDINGS We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. SUMMARY Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
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Affiliation(s)
- Shyam Prabhakaran
- Department of Neurological Sciences, Head, Cerebrovascular Disease & Neurocritical Care, Rush University Medical Center, 1725 W. Harrison St. Suite 1121, Chicago, IL 60612, Tel: 312-563-2518 Fax: 312-563-2206
| | - Jose G. Romano
- Cerebrovascular Division, University of Miami, Miller School of Medicine, 1120 NW 14 St. Suite 1357, Miami FL 33136, Tel: 305-243-2336, Fax: 305-243-7081
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Fellman D. Dissection or hemorrhage into arteriosclerotic plaque. ACTA ACUST UNITED AC 2011; 68:830; author reply 830. [PMID: 21670412 DOI: 10.1001/archneurol.2011.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Doi K, Yaku H. Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke. Eur J Cardiothorac Surg 2011; 38:568-72. [PMID: 20399676 DOI: 10.1016/j.ejcts.2010.03.021] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/27/2010] [Accepted: 03/08/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cerebrovascular atherosclerotic disease is a widely known risk factor for stroke after conventional coronary artery bypass grafting (CABG). The aim of this study is to evaluate the incidence of stroke in patients with significant cerebrovascular disease after off-pump CABG. METHODS In this retrospective study, 611 patients, who underwent off-pump CABG, were divided into high-risk (n=196) and low-risk groups (n=415) for perioperative stroke using preoperative brain magnetic resonance angiography/imaging and cervical Doppler sonography, and the incidence of stroke in the two groups was compared. RESULTS No 'intra-operative' stroke was observed. However, seven patients (3.6%) in the high-risk group and one patient (0.2%) in the low-risk group developed 'delayed stroke' between the day of surgery and postoperative day 18 (mean postoperative day 8.8). The predominant aetiology of delayed stroke was thrombo-embolism. Assignment to the high-risk group had a significant association with the occurrence of delayed stroke (p=0.011). The person-time incidence rate of stroke in the high-risk group was much higher within 1 month (3.57) after CABG than beyond 1 month (0.14). CONCLUSIONS Patients with significant cerebrovascular disease did not develop intra-operative stroke after off-pump CABG. However, these patients were likely to suffer from delayed stroke within 30 days of surgery.
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Affiliation(s)
- Kiyoshi Doi
- Department of Cardiovascular Surgery, Koto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan.
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Yu SCH, Leung TWH, Lee KT, Hui JWY, Wong LKS. Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol 2011; 32:753-8. [PMID: 21436335 DOI: 10.3174/ajnr.a2363] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MCA is a common location of intracranial stenosis. It is relatively more peripherally located and of a smaller caliber, and could therefore be a site technically more challenging and risky for angioplasty and stenting. The study aimed to evaluate the clinical outcome, restenosis rate, and procedural safety of Wingspan stent placement for atherosclerosis in the MCA compared with stenosis in other arteries. MATERIALS AND METHODS Patients who underwent Wingspan stent placement for symptomatic intracranial stenosis of ≥70% (or stenosis of ≥50% for recurrent ischemia despite medical therapy) were recruited prospectively and allocated into a study group (MCA stenosis, n=35) and a control group (other stenosis, n=25). Primary end points were the following: 1) all stroke or death rate at 1 year, and 2) significant in-stent restenosis rate at 1 year. Secondary end points were the following: 1) periprocedural complications within 24 hours, rate of TIA during the procedure, all stroke or death rate within 30 days; and 2) the inability to complete the procedure due to technical problems. RESULTS Results of study group versus the control group were the following: degree of stenosis, 78.4 ± 10.9% versus 72.5 ± 11.2% (P value=.0456); diameter of stenosis, 0.6 ± 0.3 versus 1.0 ± 0.5 mm (P=.0017); all stroke or death rate at 1 year, 14.3% versus 12% (OR=1.22); in-stent restenosis rate at 1 year, 10% versus 10.5% (OR=1.05); periprocedural complication rate at 24 hours, 2.9% versus 4% (OR=0.70); TIA rate during the procedure, 8.6% versus 4% (OR=2.25); all stroke or death rate at 30 days, 5.7% versus 12% (OR=0.44); and technical failure rate, 2.9% versus 0%. CONCLUSIONS In this study, there were no significant differences in procedural safety, patient outcome, and restenosis rates of stent placement between the group with MCA stenosis and the group with stenoses located at other sites.
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Affiliation(s)
- S C H Yu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, Hong Kong, China.
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Khan M, Kamal AK. What are the therapeutic options for strokes secondary to intracranial large artery stenosis? J PAK MED ASSOC 2011; 61:194-195. [PMID: 21375179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Maria Khan
- Stroke Service and Vascular Fellowship Program, Aga Khan University Hospital, Karachi, Pakistan
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Karimov SI, Sunnatov RD, Ganiev AM, Keldierov BK, Irnazarov AA, Asrarov UA, Iulbarisov AA, Alidzhanov KK. [Diagnostics and strategy of surgical treatment of multifocal atherosclerosis]. Vestn Ross Akad Med Nauk 2011:14-18. [PMID: 21395090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The study included 148 patients with different combinations of multifocal atherosclerosis. The inclusion criteria were clinical manifestations of chronic cerebrovascular insufficiency concomitant with diseases of other arterial basins. The treatment strategies were chosen based on the results of examination by non-invasive methods for vascular visualization. Contrast agents were used only for curative purposes. The patients were divided into 2 groups depending on surgical strategy. Patients of group 1 underwent one-step reconstruction of several affected basins, those in group 2 step-by-step revascularization of different arterial basins with the use of X-ray endovascular interventions. The former approach was applied at the initial stage of the work. It creating a high risk of complications, the latter approach was preferred in the subsequent period. The incidence of complications in group 2 was 4.05% and the lethality rate 1.49%. These values were significantly higher in patients of group 1.
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Terayama Y. [Topics on the forefront of diagnosis of stroke: branch atheromatous disease (BAD)]. Rinsho Shinkeigaku 2010; 50:918. [PMID: 21921509 DOI: 10.5692/clinicalneurol.50.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Yasuo Terayama
- Department of Neurology and Gerontology, Iwate Medical University
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Wasserman BA, Astor BC, Sharrett AR, Swingen C, Catellier D. MRI measurements of carotid plaque in the atherosclerosis risk in communities (ARIC) study: methods, reliability and descriptive statistics. J Magn Reson Imaging 2010; 31:406-15. [PMID: 20099354 DOI: 10.1002/jmri.22043] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To measure carotid plaque components using MRI and estimate reliability in the population-based Atherosclerosis Risk in Communities (ARIC) study. MATERIALS AND METHODS Contrast-enhanced high-resolution (0.51 x 0.58 x 2 mm(3)) MRI images were acquired through internal (ICA) and common carotid arteries (CCA) of 2066 ARIC participants at four sites. Sixty-one exams were repeated and 164 pairs had repeated interpretations. Plaque component thicknesses, areas and volumes over eight slices (1.6-cm segment) were measured. Intraplaque hemorrhage was recorded. Reliability was evaluated by intraclass correlations and kappa statistics. RESULTS There were 1769 successful MRI exams (mean age 71 years; 57% females; 81% white; 19% African-Americans). Repeat scan reliability was highest for CCA lumen area (0.94) and maximum wall thickness (0.89), ICA lumen area (0.89) and maximum wall thickness (0.77) and total wall volume (0.79), and lowest for small structures-core volume (0.30) and mean cap thickness (0.38). Overall reliability was primarily related to reader variability rather than scan acquisition. K's for presence of core, calcification and hemorrhage were fair to good. White men had the thickest plaques (average maximum ICA wall thickness = 2.3 mm) and the most cores (34%). CONCLUSION The most important limiting factor for MRI measurements of plaque components is reader variability. Measurement error depends largely on the analyzed structure's size.
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Affiliation(s)
- Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Azovtsev RA, Morozov VP, Pudiakov PS. [Strategy of treatment of patients with a combination of esophagus cancer and atherosclerotic lesions of coronary and cerebral arteries]. Vestn Khir Im I I Grek 2010; 169:124-126. [PMID: 20387622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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McTaggart RA, Jayaraman MV, Haas RA, Feldmann E. Intracranial atherosclerotic disease: epidemiology, imaging and treatment. Med Health R I 2009; 92:412-414. [PMID: 20066829] [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: 05/28/2023]
Abstract
Intracranial atherosclerosis accounts for 5 to 10% of all strokes. The natural history is poor, especially among patients with a greater than 70% stenosis. Studies of medical therapy have shown no benefit to warfarin over aspirin in these patients. In fact, patients with a greater than 70% stenosis who present with a stroke in the territory at risk have a 25% risk of stroke in the subsequent 24 months, despite medical therapy. First line therapy for these patients is aggressive risk factor management, including smoking cessation, blood pressure control, management of diabetes and correction ofdyslipidemia. Intracranial angioplasty has a low complication rate between 4-6%, and low post-treatment annual stroke rate between 2-4%. What was once considered a very high risk procedure has now shown to be as safe as carotid endarterectomy for symptomatic patients. Stent placement can be performed in select cases as an adjunct to primary angioplasty. While we await the results of the SAMMPRIS trial, we can still offer aggressive medical and endovascular options for patients with this lethal disease. From a management standpoint, we believe that intracranial imaging (TCD, MRA or CTA) should be performed in patients with stroke or TIA. Consultation with a neurologist would be helpful, as would consultation with a neurointerventional radiologist to help identify patients who may benefit from more aggressive endovascular therapy in conjunction with medical therapy.
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Affiliation(s)
- Ryan A McTaggart
- Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, RI 02903, USA
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Ovbiagele B, Liebeskind DS, Kim D, Ali LK, Pineda S, Saver JL. Optimizing screening and management of asymptomatic coronary artery disease in patients with stroke and patients with transient ischemic attack. Stroke 2009; 40:3407-9. [PMID: 19679844 DOI: 10.1161/strokeaha.109.560151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The feasibility of implementing an expert consensus guideline recommending use of a stroke patient's profile to manage undiagnosed coronary artery disease remains unclear. METHODS Following a guideline-based algorithm, we screened consecutive patients with ischemic stroke and patients with transient ischemic attack for asymptomatic coronary artery disease using the Framingham Heart Study Coronary Risk Score (FCRS) cutoff of high risk (> or = 20%) for experiencing a hard coronary artery disease event over a 10-year period. Patients with high FCRS received dobutamine stress echocardiogram outpatient screening, additional treatment (beta-blocker), or further management (cardiologist referral). RESULTS From July 2004 to September 2007, among 693 patients, 501 (72%) met study criteria, of which 80 (16%) had FCRS > or = 20%. Elevated serum glucose, nonhigh-density lipoprotein, triglycerides, homocysteine, glycosylated hemoglobin as well as large vessel atherosclerotic stroke mechanism were more frequent in high versus low FCRS patients (P<0.05). Among high FCRS patients, 35 (44%) had dobutamine stress echocardiogram performed. Leading reasons for dobutamine stress echocardiogram nonperformance were patient noncompliance (42%) and primary care physician refusal (33%). CONCLUSIONS Screening for coronary artery disease risk using FCRS is feasible in hospitalized patients with stroke, but outpatient adherence to stress testing is challenging largely due to patient and primary care physician-related factors.
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Vibo R, Kõrv J, Roose M, Kampus P, Muda P, Zilmer K, Zilmer M. Acute phase proteins and oxidised low-density lipoprotein in association with ischemic stroke subtype, severity and outcome. Free Radic Res 2009; 41:282-7. [PMID: 17364956 DOI: 10.1080/10715760601083235] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The goal of our study was to investigate the associations of oxidized LDL (apoB100 aldehyde-modified form) and acute phase proteins (fibrinogen, CRP) with acute ischemic stroke severity and outcome. MATERIALS AND METHODS The study included 61 ischemic stroke patients and 64 controls. Strokes were subtyped according to TOAST criteria, the severity and outcome of stroke (at 1 year) were measured. RESULTS The mean triglyceride, fibrinogen, CRP and glucose values were significantly higher among cases. The median oxLDL value for patients with large artery atherosclerosis (LAA) type of stroke was significantly higher than for other subtypes. The oxLDL values did not correlate with age, stroke severity and outcome. CONCLUSIONS Inflammatory markers (fibrinogen and CRP) predicted the stroke severity and outcome whereas elevation of oxLDL levels did not. Our data refer to possibility that there may exist some links between the LAA subtype of stroke and elevated oxLDL (apoB100 aldehyde-modified form).
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Affiliation(s)
- Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Estonia.
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Chen Y, Xue HD, Jin ZY, Liu W, Sun H, Wang X, Zhao WM, Wang Y, Mu WB. [Dual-energy CT angiography for evaluation of internal carotid artery stenosis and occlusion]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2009; 31:215-220. [PMID: 19507603] [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: 05/27/2023]
Abstract
OBJECTIVE To compare the feasibility of bone and calcified plaque subtracted dual-energy CT angiography (CTA) with time of flight magnetic resonance angiography (TOF MRA) in evaluation of internal carotid artery atherosclerosis. METHODS Totally 32 patients received a dual-energy CTA scan, along with a cerebral TOF MRA scan before or after CTA examination from one day to one month. Dual-energy software was used for bone and calcified plaque subtraction. Five anatomical segments were described for each internal carotid artery according to Fischer (1938). Ratings were based on a 1-4 scale for the dual-energy CTA maximum intensity projection (MIP) image: 1 not diagnostic, 2 partially diagnostic, 3 diagnostic, and 4 excellent. Lesions were categorized as mild (0-29%), moderate (30%-69%), severe (70%-99%), or occluded (no flow detected). Stenosis of internal carotid artery was evaluated based on post-subtracted CTA images and TOF MRA images. RESULTS In 320 arterial segments, 99% of arterial segments were > or = 3 score. Grading of stenosis on dual-energy CTA agreed with grading of stenoses on MRA images in 98% of arteries. In the mild and occlusion group, the agreement was 100% respectively. In the moderate and severe group, dual-energy CTA showed more severe stenosis than MRA in 7 vessels and there was significant difference between the results from the two different modalities (Z = -3.071, P = 0.002). CONCLUSION Dual-energy CTA can be used to assess the stenosis of internal arteries around skull base, but may exaggerate the severe stenosis of cerebral arteries compared with TOF MRA.
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Affiliation(s)
- Yu Chen
- Department of Radiology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
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Swartz RH, Bhuta SS, Farb RI, Agid R, Willinsky RA, Terbrugge KG, Butany J, Wasserman BA, Johnstone DM, Silver FL, Mikulis DJ. Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology 2009; 72:627-34. [PMID: 19221296 DOI: 10.1212/01.wnl.0000342470.69739.b3] [Citation(s) in RCA: 299] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R H Swartz
- Division of Neuroradiology, Department of Medical Imaging, New East Wing, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, Ontario M5T2S8, Canada
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Worm-Petersen J, Pakkenberg H. Atherosclerosis of cerebral arteies, pathological and clinical correlations. Acta Neurol Scand 2009; 43:112. [PMID: 5583225 DOI: 10.1111/j.1600-0404.1967.tb02071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Razsolov NA, Krapivnitskaia TA, Rudovskiĭ AA, Khashba BG. [Individual psychological attributes of civil pilots with atherosclerotic cerebral vessels]. Aviakosm Ekolog Med 2009; 43:32-36. [PMID: 19462778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Object of investigation was types of personality of civil pilots. The investigation involved healthy pilots (n = 58, controls) and pilots afflicted with cerebral atherosclerosis (n = 67) including pilots with atherosclerotic plaques (n = 23). The personality questionnaire developed by L.N. Sobchik was used. The investigation showed that signs of personality accentuation in pilots with cerebral atherosclerosis were largely manifested by distortion of individual psychological attributes. This finding may be helpful to members of the medical flight certification board in making prognosis of pilot's health and professional longevity.
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Blois SL, Poma R, Stalker MJ, Allen DG. A case of primary hypothyroidism causing central nervous system atherosclerosis in a dog. Can Vet J 2008; 49:789-792. [PMID: 18978973 PMCID: PMC2465784] [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: 05/27/2023]
Abstract
A 2-year-old, castrated male, Australian shepherd was presented with a history of chronic mild ataxia, obesity, and lethargy. The dog was treated with levothyroxine, but the ataxia worsened. Cranial nerve abnormalities developed and the dog was euthanized. Postmortem examination revealed marked thyroid gland atrophy and widespread, severe central nervous system atherosclerosis.
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Affiliation(s)
- Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario N1G 2W1.
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