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Simard T, Motazedian P, Dhaliwal S, Di Santo P, Jung RG, Ramirez FD, Labinaz A, Short S, Parlow S, Joseph J, Rasheed A, Rockley M, Marbach J, Domecq MC, Russo JJ, Chong AY, Beanlands RS, Hibbert B. Revisiting the Evidence for Dipyridamole in Reducing Restenosis: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2021; 77:450-457. [PMID: 33760800 DOI: 10.1097/fjc.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Atherosclerosis remains a leading cause of morbidity and mortality, with revascularization remaining a cornerstone of management. Conventional revascularization modalities remain challenged by target vessel reocclusion-an event driven by mechanical, thrombotic, and proliferative processes. Despite considerable advancements, restenosis remains the focus of ongoing research. Adjunctive agents, including dipyridamole, offer a multitude of effects that may improve vascular homeostasis. We sought to quantify the potential therapeutic impact of dipyridamole on vascular occlusion. We performed a literature search (EMBASE and MEDLINE) examining studies that encompassed 3 areas: (1) one of the designated medical therapies applied in (2) the setting of a vascular intervention with (3) an outcome including vascular occlusion rates and/or quantification of neointimal proliferation/restenosis. The primary outcome was vascular occlusion rates. The secondary outcome was the degree of restenosis by neointimal quantification. Both human and animal studies were included in this translational analysis. There were 6,839 articles screened, from which 73 studies were included, encompassing 16,146 vessels followed up for a mean of 327.3 days (range 7-3650 days). Preclinical studies demonstrate that dipyridamole results in reduced vascular occlusion rates {24.9% vs. 48.8%, risk ratio 0.53 [95% confidence interval (CI) 0.40-0.70], I2 = 39%, P < 0.00001}, owing to diminished neointimal proliferation [standardized mean differences -1.13 (95% CI -1.74 to -0.53), I2 = 91%, P = 0.0002]. Clinical studies similarly demonstrated reduced occlusion rates with dipyridamole therapy [23.5% vs. 31.0%, risk ratio 0.77 (95% CI 0.67-0.88), I2 = 84%, P < 0.0001]. Dipyridamole may improve post-intervention vascular patency and mitigate restenosis. Dedicated studies are warranted to delineate its role as an adjunctive agent after revascularization.
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Affiliation(s)
- Trevor Simard
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shan Dhaliwal
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard G Jung
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Francisco Daniel Ramirez
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Alisha Labinaz
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Spencer Short
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Joanne Joseph
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Adil Rasheed
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Rockley
- Division of Vascular Surgery, the Ottawa Hospital, Ottawa, Ontario, Canada ; and
| | - Jeffrey Marbach
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Juan J Russo
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun-Yeong Chong
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob S Beanlands
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Ha SH, Chang JY, Lee SH, Lee KM, Heo SH, Chang DI, Kim BJ. Mechanism of Stroke According to the Severity and Location of Atherosclerotic Middle Cerebral Artery Disease. J Stroke Cerebrovasc Dis 2020; 30:105503. [PMID: 33271485 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Strategy for secondary prevention of ischemic stroke depends on the mechanism of stroke. The aim of this study was to compare the stroke mechanism according to the location and severity of middle cerebral artery (MCA) disease. METHODS We analyzed acute ischemic stroke patients within 7 days of onset with symptomatic MCA disease. The location of MCA disease was classified into proximal MCA M1 (pMCA) and distal MCA M1/proximal M2 (dMCA). The mechanism of stroke was categorized according to the pattern of ischemic lesion: local branch occlusion, artery-to-artery embolism/hemodynamic infarction, in situ-thrombosis, or a combined mechanism. The mechanism and imaging characteristics of stroke were compared according to the location and severity. The factors associated with the stroke mechanism were also investigated. RESULTS A symptomatic MCA disease was observed in 126 patients (74 pMCA and 52 dMCA). The mechanism of stroke differed according to the location (p < 0.001); the combined mechanism was most common in pMCA disease (54.1%), especially in those who presented with MCA occlusion and with a susceptible vessel sign. Artery-to-artery embolism/hemodynamic infarction was most common in dMCA disease (46.2%). A longer length of stenosis was observed in local branch occlusion than in other mechanisms (p = 0.04) and was an independent factor associated with local branch occlusion (OR=1.631, 95% CI=1.161-2.292; p = 0.005). CONCLUSIONS The mechanism of stroke differed according to the location of MCA disease: occlusion caused by plaque rupture with combined mechanism of stroke type was predominant in pMCA. Longer length of stenosis was associated with local branch occlusion.
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Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Kyung Mi Lee
- Department of Neurology and Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea.
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Gui X, Wang L, Wu C, Wang H, Kong J. Prognosis of Subtypes of Acute Large Artery Atherosclerotic Cerebral Infarction by Evaluation of Established Collateral Circulation. J Stroke Cerebrovasc Dis 2020; 29:105232. [PMID: 33066931 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prognosis of acute ischemic stroke is related to collateral circulation, which is different with different pathogenesis. OBJECTIVE To explore the prognosis of acute large atherosclerotic (LAA) cerebral infarction with different pathogenesis by assessing the establishment of collateral circulation. METHODS 108 patients with acute LAA cerebral infarction in our hospital, who failed to thrombolytic or thrombectomy in the acute phase were selected and classified by Chinese ischemic stroke subclassification (CISS). They were evaluated by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). CT angiography (CTA) of head and neck were used to evaluate the collateral circulation for patients with large vessel stenosis or occlusion within one week of admission. The CTA collateral scores (CS) were recorded in a dichotomized fashion (ie, poor vs good). RESULTS Patients with good CS had significantly lower NIHSS score and good prognosis at 2 weeks and 3 months than patients with poor CS (P < 0.001). The arterial-to-arterial embolization mechanism was the highest in the ratio of good CS and good prognosis at 3 months (P < 0.001). Multivariate Logistic regression analysis showed that baseline NIHSS score (OR=1.407, 95%CI:1.153-1.717, P=0.001) was an independent factor affecting poor CS. The NIHSS score at baseline (OR=0.604, 95%CI:0.436-0.837, P=0.002) and good CS (OR=39.552, 95%CI:8.908-175.618, P=0.000) were important predictors of good prognosis at 3 months. CONCLUSION The prognosis and collateral circulation of acute LAA cerebral infarction with different pathogenesis was different. Baseline NIHSS score and collateral circulation had great impact on prognosis at 3 months.
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Affiliation(s)
- Xiaohong Gui
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Liping Wang
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China.
| | - Chenglong Wu
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Hua Wang
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
| | - Jianguo Kong
- It was performed in the department of Neurology, Shaoxing People's hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, China
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Alfieri DF, Lehmann MF, Flauzino T, de Araújo MCM, Pivoto N, Tirolla RM, Simão ANC, Maes M, Reiche EMV. Immune-Inflammatory, Metabolic, Oxidative, and Nitrosative Stress Biomarkers Predict Acute Ischemic Stroke and Short-Term Outcome. Neurotox Res 2020; 38:330-343. [PMID: 32415527 DOI: 10.1007/s12640-020-00221-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
Immune-inflammatory, metabolic, oxidative, and nitrosative stress (IMO&NS) pathways and, consequently, neurotoxicity are involved in acute ischemic stroke (IS). The simultaneous assessment of multiple IMO&NS biomarkers may be useful to predict IS and its prognosis. The aim of this study was to identify the IMO&NS biomarkers, which predict short-term IS outcome. The study included 176 IS patients and 176 healthy controls. Modified Rankin scale (mRS) was applied within 8 h after IS (baseline) and 3 months later (endpoint). Blood samples were obtained within 24 h after hospital admission. IS was associated with increased white blood cell (WBC) counts, high sensitivity C-reactive protein (hsCRP), interleukin (IL-6), lipid hydroperoxides (LOOHs), nitric oxide metabolites (NOx), homocysteine, ferritin, erythrocyte sedimentation rate (ESR), glucose, insulin, and lowered iron, 25-hydroxyvitamin D [25(OH)D], total cholesterol, and high-density lipoprotein (HDL) cholesterol. We found that 89.4% of the IS patients may be correctly classified using the cumulative effects of male sex, systolic blood pressure (SBP), glucose, NOx, LOOH, 25(OH)D, IL-6, and WBC with sensitivity of 86.2% and specificity of 93.0%. Moreover, increased baseline disability (mRS ≥ 3) was associated with increased ferritin, IL-6, hsCRP, WBC, ESR, and glucose. We found that 25.0% of the variance in the 3-month endpoint (mRS) was explained by the regression on glucose, ESR, age (all positively), and HDL-cholesterol, and 25(OH)D (both negatively). These results show that the cumulative effects of IMO&NS biomarkers are associated with IS and predict a poor outcome at 3-month follow-up.
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Affiliation(s)
- Daniela Frizon Alfieri
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Marcio Francisco Lehmann
- Department of Clinical Surgery, Health Sciences Center, Neurosurgery Service of the University Hospital, State University of Londrina, Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Nicolas Pivoto
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Rafaele Maria Tirolla
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Londrina, Paraná, 86.038-440, Brazil
| | - Michael Maes
- Department Psychiatry, Chulalongkorn University, Bangkok, Thailand
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Edna Maria Vissoci Reiche
- Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
- Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, Londrina, Paraná, 86.038-440, Brazil.
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Krasteva MP, Lau KK, Mordasini P, Tsang ACO, Heldner MR. Intracranial Atherosclerotic Stenoses: Pathophysiology, Epidemiology, Risk Factors and Current Therapy Options. Adv Ther 2020; 37:1829-1865. [PMID: 32270364 PMCID: PMC7467483 DOI: 10.1007/s12325-020-01291-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 01/03/2023]
Abstract
Intracranial atherosclerotic stenoses (ICAS) are one of the most common causes of first and recurrent cerebrovascular ischaemic events worldwide, with highest prevalence in Asian, Hispanic and African populations. Clinical trials have improved the understanding of epidemiology, risk factors and imaging characteristics of patients with ICAS. Current therapeutic approaches concerning these patients include management of risk factors, best medical therapy, potentially endovascular and rarely surgical therapy. In our review, we elucidate the current epidemiology and evidence in evaluation of risk factors and therapeutic options for providing favourable outcome for patients with ICAS.
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Affiliation(s)
- Marina Petrova Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Anderson Chun On Tsang
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mirjam Rachel Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
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Lin YH, Chen KW, Tang SC, Lee CW. Endovascular Treatment Outcome and CT Angiography Findings in Acute Basilar Artery Occlusion with and without Underlying Intracranial Atherosclerotic Stenosis. J Vasc Interv Radiol 2020; 31:747-753. [PMID: 32107127 DOI: 10.1016/j.jvir.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare clinical characteristics and treatment outcomes of intra-arterial thrombectomy (IAT) in acute basilar artery occlusion (BAO) with and without underlying intracranial atherosclerotic stenosis (ICAS) and to investigate the usefulness of preprocedural CT angiography findings in the diagnosis of ICAS. MATERIALS AND METHODS Twenty patients who received IAT for acute BAO between September 2014 and March 2019 were included. Additional therapies such as angioplasty, stent placement, and tirofiban infusion were provided while treating ICAS. Clinical and angiographic results of treatment were recorded. Preprocedural CT angiography findings in ICAS and non-ICAS groups were compared to assess (i) basilar tip opacification, (ii) partial occlusion, (iii) presence of convex border, (iv) occlusion segment longer than two thirds of the basilar artery or 20 mm, (v) dense basilar artery, and (vi) wall calcification in the occluded segment. RESULTS Among the 20 patients (mean age, 71.3 y; mean stroke score, 24.8), optimal recanalization was achieved in 19 (95%). Three patients had good clinical outcomes. There were 6 patients with underlying ICAS. No difference was observed between ICAS and non-ICAS groups in terms of optimal angiographic recanalization and good outcome. On CT angiography, basilar tip occlusion (100% vs 29%), partial occlusion (100% vs 83%), and long occlusion length (100% vs 14%) significantly differed between the groups (P ≤ .01). CONCLUSIONS In acute BAO, underlying ICAS does not affect optimal recanalization rate or clinical outcome. Preprocedural CT angiography is a potentially useful tool to detect it.
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Affiliation(s)
- Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C
| | - Kuo-Wei Chen
- Department of Traumatology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C
| | - Sung-Chun Tang
- Department of Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 100, Taiwan, R.O.C..
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Lan L, Leng X, Ip V, Soo Y, Abrigo J, Liu H, Fan F, Ma SH, Ma K, Ip BYM, Chan KL, Mok VCT, Liebeskind DS, Wong KS, Leung TW. Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow. J Cereb Blood Flow Metab 2020; 40:126-134. [PMID: 30351176 PMCID: PMC6928549 DOI: 10.1177/0271678x18805209] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50-69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70-99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.
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Affiliation(s)
- Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Neurology, The First affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Xinyi Leng, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Thomas W Leung, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Karen Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Bonaventure YM Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Vincent CT Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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8
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MATSUSHIGE T, SHIMONAGA K, MIZOUE T, HOSOGAI M, HASHIMOTO Y, TAKAHASHI H, KANEKO M, ONO C, ISHII D, SAKAMOTO S, KURISU K. Lessons from Vessel Wall Imaging of Intracranial Aneurysms: New Era of Aneurysm Evaluation beyond Morphology. Neurol Med Chir (Tokyo) 2019; 59:407-414. [PMID: 31611525 PMCID: PMC6867935 DOI: 10.2176/nmc.ra.2019-0103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022] Open
Abstract
Recent basic studies have clarified that aneurysmal wall inflammation plays an important role in the pathophysiology of intracranial aneurysms. However, it remains an interdisciplinary challenge to visualize aneurysm wall status in vivo. MR-vessel wall imaging (VWI) is a current topic of advanced imaging techniques since it could provide an additional value for unruptured intracranial aneurysms (UIAs) risk stratification. With regard to ruptured intracranial aneurysms, VWI could identify a ruptured aneurysm in patients with multiple intracranial aneurysms. Intraluminal thrombus could be a clue to interpret aneurysm wall enhancement on VWI in ruptured intracranial aneurysms. The interpretation of VWI findings in UIAs would require much caution. Actually aneurysm wall enhancement in VWI was significantly associated with consensus morphologic risk factors. However, aneurysmal wall with contrast enhancement oftentimes associated with atherosclerotic, degenerated and thickened wall structure. It remains ill defined if thin wall without wall enhancement (oftentimes invisible in VWI) could be actually safe or look over wall vulnerability. We reviewed currently available studies, especially focusing on VWI for intracranial aneurysms and discussed the clinical utility of VWI.
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MESH Headings
- Aged
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/pathology
- Aneurysm, Ruptured/physiopathology
- Cerebral Angiography
- Cerebral Arteries/diagnostic imaging
- Cerebral Arteries/pathology
- Cerebral Arteries/physiopathology
- Female
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Inflammation/diagnostic imaging
- Inflammation/pathology
- Inflammation/physiopathology
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/pathology
- Intracranial Aneurysm/physiopathology
- Intracranial Arteriosclerosis/diagnostic imaging
- Intracranial Arteriosclerosis/pathology
- Intracranial Arteriosclerosis/physiopathology
- Intracranial Thrombosis/diagnostic imaging
- Intracranial Thrombosis/pathology
- Intracranial Thrombosis/physiopathology
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Muscle, Smooth, Vascular/diagnostic imaging
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Risk Factors
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Affiliation(s)
- Toshinori MATSUSHIGE
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Koji SHIMONAGA
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Tatsuya MIZOUE
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Masahiro HOSOGAI
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Yukishige HASHIMOTO
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Hiroki TAKAHASHI
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Mayumi KANEKO
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Chiaki ONO
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Daizo ISHII
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
- Department of Neurosurgery, Iowa University, Iowa City, IA, USA
| | - Shigeyuki SAKAMOTO
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kaoru KURISU
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Arteaga DF, Strother MK, Faraco CC, Davis LT, Scott AO, Donahue MJ. Cerebral blood flow territory instability in patients with atherosclerotic intracranial stenosis. J Magn Reson Imaging 2019; 50:1441-1451. [PMID: 30938468 PMCID: PMC6774918 DOI: 10.1002/jmri.26737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Stroke risk stratification in patients with symptomatic intracranial atherosclerotic arterial disease (ICAD) remains an important clinical objective owing to the high 14-19% recurrent stroke rate in these patients on standard-of-care medical management. There thus remains a need for hemodynamic markers that may allow for the selection of personalized therapies for high-risk symptomatic patients. PURPOSE To determine if shifting of cerebral blood flow (CBF) territories in response to changes in cerebral perfusion pressure (CPP) may provide a marker for stroke risk in ICAD patients. STUDY TYPE Prospective. POPULATION Twenty ICAD patients who experienced a stroke within 45 days of study enrollment and 10 healthy controls. SEQUENCE 3.0T MRI including anatomical imaging (T1 -weighted, T2 -weighted/FLAIR), 3D MR angiography, and normocapnic and hypercapnic vessel-encoded CBF-weighted arterial spin labeling. ASSESSMENT Patients were scanned within 45 days of overt stroke and monitored (duration = 13.2 ± 4.4 months) for the endpoint of non-cardioembolic stroke or transient ischemic attack. Flow territory shifting (shifting index) was calculated from the first scan by determining whether a voxel shifted from its primary arterial source from normocapnia to hypercapnia. STATISTICAL TESTS A Mann-Whitney U-test (significance: P < 0.05) was performed to determine whether patients meeting the endpoint had greater shifting indices relative to controls or patients not meeting the endpoint. RESULTS Shifting indices (mean ± standard error) were significantly higher in patients meeting endpoint criteria relative to controls (P = 0.0057; adjusted P = 0.036) and patients not meeting endpoint criteria (P = 0.0047; adjusted P = 0.036). DATA CONCLUSION Flow territory shifting may provide a marker of recurrent stroke risk in symptomatic ICAD patients on standard-of-care medical management therapies. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1441-1451.
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Affiliation(s)
- Daniel F. Arteaga
- Dept. of Neurology, University of Virginia, Charlottesville, VA
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Megan K. Strother
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Carlos C. Faraco
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - L. Taylor Davis
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Allison O. Scott
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J. Donahue
- Dept. of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Dept. of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Dept. of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
- Dept. of Physics and Astronomy, Vanderbilt University, Nashville, TN
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Yamauchi H, Kagawa S, Takahashi M, Oishi N, Ono M, Higashi T. Misery perfusion and amyloid deposition in atherosclerotic major cerebral artery disease. Neuroimage Clin 2019; 22:101762. [PMID: 30884364 PMCID: PMC6424140 DOI: 10.1016/j.nicl.2019.101762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/08/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
Although experimental studies have shown that global cerebral hypoperfusion leads to amyloid deposition in the hemisphere with carotid artery occlusion in rodents, the results of such occurrence are controversial in humans. Hence, we aim to determine whether global cerebral hypoperfusion leading to decreased blood flow relative to metabolic demand [increased oxygen extraction fraction (OEF), misery perfusion] is associated with increases in amyloid deposition in the hemisphere with atherosclerotic major cerebral artery disease in patients. We evaluated the distribution of β-amyloid plaques using positron emission tomography and a [18F]-pyridylbenzofuran derivative (18F-FPYBF-2) in 13 patients with unilateral atherosclerotic disease of the internal carotid artery (ICA) or middle cerebral artery (MCA) disease and no cortical infarction. The distribution volume ratio (DVR) of 18F- FPYBF-2 was calculated using dynamic data and Logan graphical analysis with reference tissue and was correlated with the cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and OEF, obtained from 15O-gas PET. The mean cortical value was calculated as the mean value within the frontal, posterior cingulate, precuneus, parietal, and lateral temporal cortical regions. Significant reductions in CBF and CMRO2 and increases in OEF were found in the hemisphere ipsilateral to the arterial lesion compared with the contralateral hemisphere. There was no significant difference for 18F-FPYBF-2 DVR between hemispheres. The ipsilateral to contralateral ratio of the 18F- FPYBF-2 DVR was increased in 3 patients, while the ipsilateral to contralateral OEF ratio was increased in 4 patients. The incidence of an increased hemispheric DVR ratio was significantly higher in patients with an increased hemispheric OEF ratio (3/4) than in patients without (0/9) (p < 0.02). Although the 18F- FPYBF-2 DVR in the ipsilateral hemisphere was positively correlated with OEF after adjustment for the 18F- FPYBF-2 DVR in the contralateral hemisphere using multiple regression analysis (p < 0.05), the contribution rate of OEF was small (R2 = 5.5%). Only one of the 4 patients with an increased hemispheric OEF ratio showed amyloid positivity based on the DVR value. In atherosclerotic major cerebral artery disease, misery perfusion accompanied only small increases of amyloid deposition at best. Misery perfusion was not associated with amyloid positivity. Misery perfusion accompanied only small increases of amyloid deposition at best. Relative oxygen extraction fraction correlated with relative amyloid deposition. Misery perfusion was not associated with amyloid positivity.
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Affiliation(s)
- Hiroshi Yamauchi
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan.
| | - Shinya Kagawa
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan
| | - Masaaki Takahashi
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan
| | - Naoya Oishi
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Ono
- Department of Patho-Functional Bioanalysis, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Tatsuya Higashi
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan; National Institute of Radiological Sciences, National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan
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Zhao ZN, Li XL, Liu JZ, Jiang ZM, Wang AH. Features of branch occlusive disease-type intracranial atherosclerotic stroke in young patients. BMC Neurol 2018; 18:87. [PMID: 29925330 PMCID: PMC6009042 DOI: 10.1186/s12883-018-1089-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/13/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young ischemic stroke patients are common while classification and analysis based upon imaging characteristics are rarely reported. We intend to compare the clinical and MRI characteristics of cerebral stroke induced by intracranial atherosclerosis between young patients with branch occlusive disease (BOD) and those with non-branch occlusive disease (non-BOD) or small artery disease (SAD). METHODS A total of 151 subjects with acute infarction within the middle cerebral artery (MCA) territory were included and patients with ipsilateral internal carotid artery stenosis or cardioembolism were excluded. Based on the distribution characteristics of infarction and the presence of ipsilateral MCA stenosis, the patients were divided into three groups: BOD-striatocapsular area infarction with ipsilateral MCA stenosis; non-BOD -infarction size exceeds the striatocapsular area and accompanied by ipsilateral MCA stenosis; SAD. The clinical and MCA stenosis characteristics of the three groups were compared. RESULTS The number of BOD patients with hypertension was significantly higher than that of SAD (92.9% vs 53.7%, p = 0.000) and non-BOD (92.9% vs 57.1%, p = 0.001); subjects with smoking history significantly exceeded that of SAD (50% vs 26.9%, p = 0.03) and subjects with family history of cardiovascular disease was significantly less than that of non-BOD (14.3% vs 41.1%). Baseline NIHSS scores and mRS scores at discharge in patients with BOD were significantly lower than those with non-BOD (p = 0.000, p = 0.001). Majority of patients in non-BOD group displayed severe MCA stenosis (39 cases, 69.6%) while that in BOD group displayed mild stenosis (26 cases, 92.9%), and the difference was statistically significant (p = 0.000). Compared with non-BOD group, the stenosis in BOD group located at a relatively distal end in the M1 segment of MCA (S/M1, 58% vs 40%, p = 0.000) and was more localized (stenosis level/ (SL/M1), 1.86 (1.35-2.6) vs 2.9 (2.0-5.0), p = 0.002). CONCLUSION BOD in young patients with ischemic stroke induced by intracranial atherosclerosis is not rare (33.3%) and its clinical manifestations and prognosis are similar to those of SAD. This may be related to the mild localized stenosis at the distal end in the M1 segment of MCA. Control of hypertension might play a positive role in secondary prevention.
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Affiliation(s)
- Zhang-Ning Zhao
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Xiao-Lin Li
- Department of Critical Care Medicine, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Jin-Zhi Liu
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Zhi-Ming Jiang
- Department of Critical Care Medicine, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
| | - Ai-Hua Wang
- Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, 250014 Shandong province People’s Republic of China
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12
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Chang Y, Choi GS, Lim SM, Kim YJ, Song TJ. Interarm Systolic and Diastolic Blood Pressure Difference Is Diversely Associated With Cerebral Atherosclerosis in Noncardioembolic Stroke Patients. Am J Hypertens 2017; 31:35-42. [PMID: 28985258 DOI: 10.1093/ajh/hpx126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/11/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interarm systolic and diastolic blood pressure differences (IASBD, IADBD) are not infrequent in various populations. Cerebral atherosclerosis, including extracranial cerebral atherosclerosis (ECAS) and intracranial cerebral atherosclerosis (ICAS), is an important risk factor for stroke. In this study, we aimed to investigate the relationship of IASBD, IADBD with presence and burden of ICAS and ECAS. METHODS This was a retrospective hospital-based cross-sectional study. In total, 1,063 consecutive noncardioembolic ischemic stroke patients, who were checked for bi-brachial blood pressures from ankle-brachial index and brain magnetic resonance angiographic images of cerebral arteries, were included. The IASBD and IADBD were defined as absolute value of the blood pressure difference in both arms. RESULTS In all included patients, patients with IASBD ≥10 and IADBD ≥10 were noted in 9.4% (100/1,063) and 5.3% (56/1,063). The patients with IASBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.001) and ECAS (P = 0.027) and patients with IADBD ≥10 mm Hg were more frequently burdened with ICAS (P = 0.042) but not ECAS (P = 0.187). Multivariate analysis after adjusting gender, age, and a P value <0.1 in univariate analysis showed IASBD ≥10 mm Hg was associated with the presence of both ECAS and ICAS [odds ratio (OR): 2.96, 95% confidence interval (CI): 1.65-5.31]. The IADBD ≥10 mm Hg was related with presence of ICAS only (OR: 1.87, 95% CI: 1.05-3.37) but not with ECAS only (OR: 1.50, 95% CI: 0.73-3.06). CONCLUSIONS Our study showed IASBD and IADBD were diversely associated with cerebral atherosclerosis. In noncardioembolic stroke patients with IASBD ≥10 or IADBD ≥10, the possibility of accompanying cerebral atherosclerosis should be considered.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Gyeong Seon Choi
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Soo Mee Lim
- Department of Radiology, College of Medicine, Ewha Womans University, Korea
| | - Yong-Jae Kim
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
| | - Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University, Korea
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13
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Lee SJ, Lee DG. Distribution of atherosclerotic stenosis determining early neurologic deterioration in acute ischemic stroke. PLoS One 2017; 12:e0185314. [PMID: 28945817 PMCID: PMC5612689 DOI: 10.1371/journal.pone.0185314] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022] Open
Abstract
Background and purpose Early neurologic deterioration (END) during the acute stage of stroke is clinically important because of its association with poor outcomes. The purpose of this study was (1) to investigate variables associated with END, (2) to determine the distribution of atherosclerotic stenosis associated with END, and (3) to clarify the relationship between END and clinical outcomes. Methods 516 patients with acute ischemic stroke were included. The median follow-up period was 31.7 months. END was defined as a ≥2 point increase in the National Institutes of Health Stroke Scale (NIHSS), ≥1 point increase in level of consciousness or motor item of the NIHSS, or the development of any new neurological deficits during the first 72 hours of hospitalization. A signal loss on 1.5-T magnetic resonance angiography exceeding 50% was considered to be significant for the categorization of stenosis pattern. Results The prevalence of END was 19.0%. END was associated with intracranial atherosclerotic stenosis (IAS) together with large artery atherosclerosis (LAA) subtype. In particular, stenosis of basilar artery or posterior cerebral artery was independently associated with END. Lesion growth or hypoperfusion was more accountable for END in patients with IAS, whereas intracerebral hemorrhage or edema/herniation was more frequently observed in END patients without IAS. Patients with END had a higher rate of mortality, but a similar rate of further vascular events compared to patients without END. Conclusion Pre-stroke IAS and LAA subtype could determine the development of END during the acute stage of ischemic stroke.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
- * E-mail:
| | - Dong-Geun Lee
- Department of Neurology, Sejong General Hospital, Bucheon, South Korea
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14
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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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15
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Abstract
RATIONALE Intracranial vascular atherosclerotic occlusion is one of the most common causes of ischemic stroke world wide. The involvement of large intracranial vessels, in particular, the middle cerebral artery, is usually associated with unfavorable outcomes in patients. Spontaneous recanalization of atherosclerotic occlusion is relatively rare. PATIENT CONCERNS The first patient was a 43-year-old male with slurred speech and left-sided weakness for a duration of 24 hours. The second was a 59-year-old male with left-sided weakness over a period of 13 hours. The last was a 49-year-old female patient presented with a 1-month history of right-sided headache. DIAGNOSES Atherosclerotic middle cerebral artery occlusion. INTERVENTIONS In all cases, oral aspirin (100 mg; once daily), Plavix (75 mg; once daily), and Lipitor (40 mg; once daily) were used . Oral Plavix was stopped 3 months. OUTCOMES Spontaneous recanalization occured in the three cases of atherosclerotic middle cerebral artery occlusion. LESSONS Spontaneous recanalization may occur in both early and late stages of atherosclerotic middle cerebral artery occlusion. Clinicians should be aware of this particular condition, as it may represent a relatively favorable prognosis.
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Yamamoto N, Satomi J, Yamamoto Y, Shono K, Kanematsu Y, Izumi Y, Nagahiro S, Kaji R. Risk Factors of Neurological Deterioration in Patients with Cerebral Infarction due to Large-Artery Atherosclerosis. J Stroke Cerebrovasc Dis 2017; 26:1801-1806. [PMID: 28476508 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/29/2017] [Accepted: 04/09/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In some patients with acute ischemic stroke, neurological deterioration (ND) is observed, and it is difficult to predict at the time of admission. Especially in some patients with large-artery atherosclerosis (LAA), aggressive medical treatments and surgical interventions might be helpful to prevent ND. Therefore, we investigated factors associated with ND in patients with LAA. METHODS We studied patients with LAA who were admitted to our hospital. We divided them into 2 groups with (group 1) and without deterioration (group 2), and evaluated their medical records, risk factors, and radiological findings, such as number of diffusion-positive lesion and degree of stenosis. RESULTS Our study population consisted of 171 patients; 71 (41.5%) did and 100 (58.5%) did not suffer deterioration. By univariate analysis, blood pressure (BP), heart rate, National Institutes of Health Stroke Scale (NIHSS) score, number of diffusion-positive lesion, count of red blood cell, high-density lipoprotein, and degree of stenosis differed significantly between the 2 groups. By multivariate analysis, systolic BP (≥170 mm Hg, odds ratio: 7.20, P <.001) was associated with ND. Furthermore, number of diffusion-weighted image (DWI)-positive lesion (≥8), degree of stenosis (>80.0%), and NIHSS score (≥4) were also independent factors associated with ND. CONCLUSIONS High BP, severity of neurological deficit at the time of admission, and radiological findings, such as degree of stenosis and number of DWI-positive lesion, are independently associated with ND in patients with LAA.
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Affiliation(s)
- Nobuaki Yamamoto
- Department of Clinical Neurosciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Junichiro Satomi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yuki Yamamoto
- Department of Clinical Neurosciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Shono
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Clinical Neurosciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Department of Clinical Neurosciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Xu Y, Yuan C, Zhou Z, He L, Mi D, Li R, Cui Y, Wang Y, Wang Y, Liu G, Zheng Z, Zhao X. Co-existing intracranial and extracranial carotid artery atherosclerotic plaques and recurrent stroke risk: a three-dimensional multicontrast cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:90. [PMID: 27908279 PMCID: PMC5134005 DOI: 10.1186/s12968-016-0309-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a systemic disease, atherosclerosis commonly affects intracranial and extracranial carotid arteries simultaneously which is defined as co-existing plaques. Previous studies demonstrated that co-existing atherosclerotic diseases are significantly associated with ischemic cerebrovascular events. The aim of this study was to investigate the characteristics of co-existing intracranial and extracranial carotid atherosclerotic plaques and their relationships with recurrent stroke by using 3D multi-contrast magnetic resonance (MR) vessel wall imaging. METHODS Patients with recent cerebrovascular symptoms in anterior circulation and at least one carotid plaque were recruited. All patients underwent cardiovascular magnetic resonance (CMR) for brain and intracranial and extracranial arteries. Presence/absence of atherosclerotic plaque at each arterial segment was identified. The maximum wall thickness (Max WT), length, stenosis of each plaque was measured. The presence/absence of calcification, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH) was assessed. Cerebral old and acute infarcts in anterior circulation were evaluated. RESULTS Fifty-eight patients (mean age: 58.0 ± 8.5 years old, 34 males) were recruited. Of the 58 patients, co-existing intracranial and extracranial carotid artery plaques were found in 45 patients (77.6%), of which 7 (15.6%) had first time acute stroke and 26 (57.8%) had recurrent stroke. For these 33 patients with stroke, the number of intracranial plaques (OR = 11.26; 95% CI, 1.27-100; p = 0.030) and co-existing intracranial and extracranial carotid artery plaques (OR = 2.42; 95% CI, 1.04-5.64; p = 0.040) was significantly associated with recurrent stroke. After adjusting for traditional risk factors, the number of co-existing plaques was still significantly correlated with recurrent stroke (OR = 3.31; 95% CI, 1.09-10.08; p = 0.035). No correlations were found between recurrent stroke and Max WT, length, stenosis, and compositions of plaques. CONCLUSIONS Co-existing intracranial and extracranial carotid artery plaques are prevalent in symptomatic patients and the number of co-existing plaques is independently associated with the risk of recurrent stroke.
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Affiliation(s)
- Yilan Xu
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Department of Radiology, University of Washington, Seattle, WA USA
| | - Zechen Zhou
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Yuanyuan Cui
- Department of Radiology, PLA General Hospital, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Haidian District, 100084 Beijing, China
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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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Dieleman N, van der Kolk AG, Zwanenburg JJM, Brundel M, Harteveld AA, Biessels GJ, Visser F, Luijten PR, Hendrikse J. Relations between location and type of intracranial atherosclerosis and parenchymal damage. J Cereb Blood Flow Metab 2016; 36:1271-80. [PMID: 26661234 PMCID: PMC4929701 DOI: 10.1177/0271678x15616401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the relation between location and type of intracranial atherosclerosis (ICAS) and cortical microinfarcts (CMIs) and macroinfarcts in 18 patients presenting with ischemic stroke (n = 12) or transient ischemic attack (TIA) (n = 6) using 7 tesla MR imaging. The protocol included: 3D T2-weighted FLAIR and 3D T1-weighted Magnetization-Preparation Inversion Recovery Turbo Spin Echo sequence. ICAS lesions and infarcts were scored by two raters. The relation between ICAS lesions, calculated ratios of ICAS lesion characteristics, location, and infarcts were examined using linear regression analyses. A total number of 75 ICAS lesions (all patients), 101 CMIs (78% of patients), and 31 macroinfarcts (67% of patients) were found. Seventy-six and sixty-five percent of the CMIs and macroinfarcts, respectively, were found in the same vascular territory as the ICAS lesions (p = 0.977, p = 0.167, respectively). A positive correlation existed between the number of macroinfarcts and CMIs (p < 0.05). In patients with macroinfarcts, we found more concentric (p < 0.01) and diffuse (p < 0.05) type of ICAS lesions. A high prevalence of brain tissue lesions, both macroinfarcts and CMIs, were found in patients with ICAS. Macroinfarcts were found to be related to specific ICAS lesion types. The type of ICAS lesion seems to be promising as a marker for ICAS patients at higher risk of future infarcts.
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Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | | | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, the Netherlands Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Geert J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, the Netherlands Philips Healthcare, Best, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, the Netherlands
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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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21
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Mao X, Xie L, Greenberg DA. Effects of flow on LOX-1 and oxidized low-density lipoprotein interactions in brain endothelial cell cultures. Free Radic Biol Med 2015; 89:638-41. [PMID: 26462413 DOI: 10.1016/j.freeradbiomed.2015.10.403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/17/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 01/19/2023]
Abstract
Fluid shear stress and uptake of oxidized low-density lipoprotein (ox-LDL) into the vessel wall both contribute to atherosclerosis, but the relationship between shear stress and ox-LDL uptake is unclear. We examined the effects of flow, induced by orbital rotation of bEnd.3 brain endothelial cell cultures for 1 wk, on ox-LDL receptor (LOX-1) protein expression, ox-LDL uptake and ox-LDL toxicity. Orbitally rotated cultures showed no changes in LOX-1 protein expression, ox-LDL uptake or ox-LDL toxicity, compared to stationary cultures. Flow alone does not modify ox-LDL/LOX-1 signaling in bEnd.3 brain endothelial cells in vitro, suggesting that susceptibility of atheroprone vascular sites to lipid accumulation is not due solely to effects of altered flow on endothelium.
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Affiliation(s)
- Xiaoou Mao
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - Lin Xie
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA
| | - David A Greenberg
- Buck Institute for Research on Aging, 8001 Redwood Boulevard, Novato, CA 94945, USA.
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22
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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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Methawasin K, Suwanwela NC, Phanthumchinda K. The 2-Year Outcomes Comparison between Ischemic Stroke Patients with Intracranial Arterial Stenosis without Significant Extracranial Carotid Stenosis and Patients with Extracranial Carotid Stenosis. J Med Assoc Thai 2015; 98 Suppl 9:S98-S105. [PMID: 26817217] [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: 06/05/2023]
Abstract
OBJECTIVE The risk of recurrent ischemic stroke and acute coronary syndrome increased in the large artery atherosclerotic subtype. The purpose of this study was to compare 2-year outcomes between the ischemic stroke patients with intracranial arterial stenosis without significant extracranial carotid stenosis and the patients with extracranial carotid stenosis. MATERIAL AND METHOD This study prospectively compared 123 ischemic stroke patients: 71 patients with intracranial arterial stenosis without significant extracranial carotid stenosis and 52 patients with extracranial carotid stenosis. Neurologic and radiologic investigations were performed at the beginning of the study. All of them were treated as regular outpatients of the neurology unit with a mean follow-up of 24 months. Recurrent stroke, myocardial infarction, and death were recorded. RESULTS Fifteen patients of the extracranial carotid stenosis group and eighteen patients ofthe intracranial arterial stenosis without significant extracranial carotid stenosis group developed recurrent stroke during follow-up (p = 0.40). Acute coronary syndrome occurred in eight patients of the extracranial carotid stenosis group and only one of the intracranial arterial stenosis without significant extracranial carotidstenosis group (p = 0.004). Causes of death were end stage cancers, stroke and related conditions, and acute coronary syndrome. The multivariate analysis showed that symptomatic extracranial carotid stenosis is an important risk factor of the acute coronary syndrome (p = 0.03, OR = 10.81, 95% CI 1.23-94.77). CONCLUSION There was no significant difference of recurrent ischemic stroke and recurrent stroke between patients with intracranial arterial stenosis without extracranial carotid stenosis and patients with extracranial carotid stenosis. On the other hand, patients with extracranial carotid stenosis had more incidences of acute coronary syndrome significantly than patients with intracranial arterial stenosis.
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Naritomi H, Sawada T, Kaneko T, Tagawa T, Shimizu H. Difference in critical rCBF level of ischemia between children and adults. Monogr Neural Sci 2015; 11:17-21. [PMID: 6429522 DOI: 10.1159/000409183] [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: 01/20/2023]
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25
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Leng X, Scalzo F, Ip HL, Johnson M, Fong AK, Fan FSY, Chen X, Soo YOY, Miao Z, Liu L, Feldmann E, Leung TWH, Liebeskind DS, Wong KS. Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence. PLoS One 2014; 9:e97531. [PMID: 24818753 PMCID: PMC4018340 DOI: 10.1371/journal.pone.0097531] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/21/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with symptomatic intracranial atherosclerosis (ICAS) of ≥ 70% luminal stenosis are at high risk of stroke recurrence. We aimed to evaluate the relationships between hemodynamics of ICAS revealed by computational fluid dynamics (CFD) models and risk of stroke recurrence in this patient subset. METHODS Patients with a symptomatic ICAS lesion of 70-99% luminal stenosis were screened and enrolled in this study. CFD models were reconstructed based on baseline computed tomographic angiography (CTA) source images, to reveal hemodynamics of the qualifying symptomatic ICAS lesions. Change of pressures across a lesion was represented by the ratio of post- and pre-stenotic pressures. Change of shear strain rates (SSR) across a lesion was represented by the ratio of SSRs at the stenotic throat and proximal normal vessel segment, similar for the change of flow velocities. Patients were followed up for 1 year. RESULTS Overall, 32 patients (median age 65; 59.4% males) were recruited. The median pressure, SSR and velocity ratios for the ICAS lesions were 0.40 (-2.46-0.79), 4.5 (2.2-20.6), and 7.4 (5.2-12.5), respectively. SSR ratio (hazard ratio [HR] 1.027; 95% confidence interval [CI], 1.004-1.051; P = 0.023) and velocity ratio (HR 1.029; 95% CI, 1.002-1.056; P = 0.035) were significantly related to recurrent territorial ischemic stroke within 1 year by univariate Cox regression, respectively with the c-statistics of 0.776 (95% CI, 0.594-0.903; P = 0.014) and 0.776 (95% CI, 0.594-0.903; P = 0.002) in receiver operating characteristic analysis. CONCLUSIONS Hemodynamics of ICAS on CFD models reconstructed from routinely obtained CTA images may predict subsequent stroke recurrence in patients with a symptomatic ICAS lesion of 70-99% luminal stenosis.
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Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Fabien Scalzo
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Mark Johnson
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Albert K. Fong
- UCLA Stroke Center, Los Angeles, California, United States of America
| | - Florence S. Y. Fan
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Xiangyan Chen
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Zhongrong Miao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Edward Feldmann
- Department of Neurology, Tufts University, Boston, Massachusetts, United States of America
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | | | - Ka Sing Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- * E-mail:
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Chang HC, Tai YT, Cherng YG, Lin JW, Liu SH, Chen TL, Chen RM. Resveratrol attenuates high-fat diet-induced disruption of the blood-brain barrier and protects brain neurons from apoptotic insults. J Agric Food Chem 2014; 62:3466-3475. [PMID: 24694235 DOI: 10.1021/jf403286w] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The blood-brain barrier (BBB) maintains brain microenvironment. Our previous study showed that oxidized low-density lipoprotein (oxLDL) can damage the BBB by inducing apoptosis of cerebrovascular endothelial cells. This study was aimed at evaluating the effects of resveratrol on high-fat diet-induced insults to the BBB and brain neurons. Exposure of mice to a high-fat diet for 8 weeks increased levels of serum total cholesterol (146 ± 13) and LDL (68 ± 8), but resveratrol decreased such augmentations (119 ± 6; 45 ± 8). Permeability assays showed that a high-fat diet induced breakage of the BBB (88 ± 21). Meanwhile, resveratrol alleviated this interruption (16 ± 6). Neither resveratrol nor a high-fat diet caused the death of cerebrovascular endothelial cells. Instead, exposure to a high-fat diet disrupted the polymerization of occludin and zonula occludens (ZO)-1, but resveratrol significantly attenuated those injuries. Neither a high-fat diet nor resveratrol changed the levels of occludin or ZO-1 in brain tissues. Resveratrol protected brain neurons against high-fat diet-induced caspase-3 activation and genomic DNA fragmentation. This study shows that resveratrol can attenuate the high-fat diet-induced disruption of the BBB via interfering with occludin and ZO-1 tight junctions, and protects against apoptotic insults to brain neurons.
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Affiliation(s)
- Huai-Chia Chang
- Graduate Institute of Medical Sciences, Taipei Medical University; Comprehensive Cancer Center of Taipei Medical University , Taipei 11031, Taiwan
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Mizuma A, Ishikawa T, Kajihara N, Takano H, Endo K, Kawakata M, Shibukawa S, Nakamura T, Nishio H, Horie T, Yanagimachi N, Takizawa S. Dynamic cross-sectional changes of the middle cerebral artery in atherosclerotic stenosis detected by 3·0-Tesla MRI. Neurol Res 2014; 36:795-9. [PMID: 24649808 DOI: 10.1179/1743132813y.0000000309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Atherosclerotic stenosis of the middle cerebral artery (MCA) is one of the causes of ischemic stroke, but aside from investigations using magnetic resonance angiography (MRA), studies evaluating stenosis are rare. The purpose of this study was to assess dynamic changes of MCA cross section between the systolic and diastolic phases in patients with cerebral infarction using 3·0-Tesla magnetic resonance imaging (3T MRI). METHODS We assessed 12 stroke patients with M1 stenosis in the MCA and 12 healthy volunteers. We measured MCA cross sections (proximal/distal to stenosis and on the stenosis) in the systolic and diastolic phases by synchronizing imaging with heartbeats, as well as the maximum flow velocity by using cine-phase contrast (PC) MRI. Each patient also underwent conventional MRA. RESULTS Differences in cross sections between systolic and diastolic phases were significantly smaller in the stenosed artery compared to the distal (P < 0·05) and proximal areas (P < 0·01) in stroke patients. The difference in maximal blood velocity between systolic and diastolic phases at the M1 stenosis was significantly larger than that in the area proximal to the stenosis (P < 0·05). DISCUSSION We clearly demonstrated dynamic cross-sectional changes in the stenotic areas by 3T MRI, suggesting hemodynamic shear stress, which may further enhance MCA atherosclerosis.
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Fedin AI, Starykh EP, Parfenov AS, Mironova OP, Abdrakhmanova EK, Starykh EV. [Pharmacotherapy of endothelial dysfunction in patients with atherosclerotic brain ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2013; 113:45-48. [PMID: 24300805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We studied the effect of deproteinized hemoderivative of calf blood, thioctic acid and vinpocetine with piracetam on the endothelial function in patients with chronic cerebral ischemia stage III. After pharmacological treatment, there was the improvement in the endothelium properties of both large and small blood vessels. The index of occlusion that characterized the function of small vessels reached normal values while the phase shift did not approach to the reference values. This notion indicates that in cerebral atherosclerosis small arteries initially are subject to alterations to a lesser extent compared to the arteries of large and medium caliber. The most effective medicines of those used for the correction of endothelial dysfunction are deproteinized hemoderivative of calf blood and thioctic acid.
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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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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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31
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Hoshino H, Suzuki N. [Pathophysiology and treatment of branch atheromatous disease]. No Shinkei Geka 2011; 39:543-551. [PMID: 21628732] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Haruhiko Hoshino
- Department of Neurology, Stroke Center, Tokyo Saiseikai Central Hospital, Japan
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32
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Ovchinnikov IV, Simonenko VB, Shirokov EA, Denishchuk IS, Ibragimova FM. [Clinico-instrumental characteristics of arterial hypertension, liable to the ishemic stroke]. Voen Med Zh 2011; 332:43-52. [PMID: 21899079] [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: 05/31/2023]
Abstract
Clinico-instrumental characteristics of arterial hypertension, liable to the ishemic stroke were studied. The pecularities of clinical, neurological picture of disease and results of instrumental methods of examination were determined. These peculiarities let to educe the course of arterial hypertension, liable to the ishemic stroke. This course appeared because of hypertensional macroangiopathy during 3-5 years, two atherosclerotic stenosis of brachiocephalic arteria, occlusions and stenosis of these arterias, left ventricular hypertrophy of hypodynamic type, circulatory dynamics against the bad daily profile of arterial pressure and/or increased variability of arterial pressure accompanied with ischemic attacks, signs of chronicle heart failure and circulatory encephalopathy. The scheme of the examination of patients with AH during the long-term examination with the goal of prophylaxis IS was offered.
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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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34
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Hadjiev DI, Mineva PP. Subclinical cerebrovascular disease in older adults. Stroke 2010; 41:e447; author reply e448-9. [PMID: 20431076 DOI: 10.1161/strokeaha.110.582270] [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: 11/16/2022]
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Abstract
BACKGROUND The aim of the study was to evaluate correlation of breath holding index (BHI) as functional parameter for intracranial subclinical atherosclerotic changes - we have shown in our previous works and arterial stiffness (AS-functional parameter for extracranial subclinical atherosclerotic changes) in normal population. PATIENTS AND METHODS We included 120 healthy volunteers (conventional risk factors for cerebrovascular disease were excluded) who were examined at our Neurology Department. They were divided into 6 age groups-(25-35, 36-45, 46-55, 56-65, 66-75, 76+ years). We performed standard laboratory workup, body weight and height measurements, Color Doppler and Power Doppler of the main head and neck vessels and Transcranial Doppler, (measured by means of e-Tracking software). RESULTS There was decline of BHI, and increase in AS - in correlation with age increase (p<0.01). There was statistically significant negative correlation between BHI and AS (r= -0,931, p<0.01 right and r = -0,938, p<0.01 left). CONCLUSION These results show that decline in BHI as parameter for intracranial microvessel dysfunction is in good correlation with increase of AS as functional parameter of extracranial vascular aging.
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Affiliation(s)
- Iris Zavoreo
- University Department of Neurology, University Hospital Sestre Milosrdnice, Zagreb, Croatia
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Stroganova IM, Kiparisov MA. [Omaron in the restorative treatment of patients with chronic cerebrovascular insufficiency]. Zh Nevrol Psikhiatr Im S S Korsakova 2010; 110:70-72. [PMID: 20443242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ohira T, Peacock JM, Iso H, Chambless LE, Rosamond WD, Folsom AR. Serum and dietary magnesium and risk of ischemic stroke: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 2009; 169:1437-44. [PMID: 19372211 DOI: 10.1093/aje/kwp071] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [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: 02/01/2023] Open
Abstract
The authors sought to examine the relation between serum or dietary magnesium and the incidence of ischemic stroke among blacks and whites. Between 1987 and 1989, 14,221 men and women aged 45-64 years took part in the first examination of the Atherosclerosis Risk in Communities Study cohort. The incidence of stroke was ascertained from hospital records. Higher serum magnesium levels were associated with lower prevalence of hypertension and diabetes mellitus at baseline. During the 15-year follow-up, 577 ischemic strokes occurred. Serum magnesium was inversely associated with ischemic stroke incidence. The age-, sex-, and race-adjusted rate ratios of ischemic stroke for those with serum magnesium levels of <or=1.5, 1.6, 1.7, and >or=1.8 mEq/L were 1.0, 0.78 (95% confidence interval (CI): 0.62, 0.96), 0.70 (95% CI: 0.56, 0.88), and 0.75 (95% CI: 0.59, 0.95) (P(trend) = 0.005). After adjustment for hypertension and diabetes, the rate ratios were attenuated to nonsignificant levels. Dietary magnesium intake was marginally inversely associated with the incidence of ischemic stroke (P(trend) = 0.09). Low serum magnesium levels could be associated with increased risk of ischemic stroke, in part, via effects on hypertension and diabetes.
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Affiliation(s)
- Tetsuya Ohira
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA
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Belcastro V, Striano P. Commentary to: "Evaluation of serum lipids and carotid artery intima media thickness in epileptic children treated with valproic acid". Brain Dev 2009; 31:474. [PMID: 19268510 DOI: 10.1016/j.braindev.2009.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 02/03/2009] [Indexed: 11/17/2022]
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Razsolov NA, Krapivnitskaia TA, Khashba BG. [Results of intelligence investigations in civil pilots with atherosclerotic changes in cerebral vessels]. Aviakosm Ekolog Med 2009; 43:50-52. [PMID: 19621804] [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: 05/28/2023]
Abstract
Intelligence was evaluated in 73 normal civil pilots (control) and 70 with atherosclerotic cerebral vessels including 23 men with atheromas. Intelligence was evaluated with the use of computerized EPI (Gorbov's modification). Pilots with cerebral atherosclerosis tended to slightly decrease mean IQ values in comparison with the normal; IQ values remained high enough to attest professional efficiency. Atheromas did not impact results of the numerical (IQ2) and verbal (IQ3) tests. Hemodynamically negligible stable atheromas did not disturb cognitive functions of the pilots and, therefore, they were certified for continuation of the flight career.
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Garrett MC, Komotar RJ, Starke RM, Merkow MB, Otten ML, Connolly ES. Radiographic and clinical predictors of hemodynamic insufficiency in patients with athero-occlusive disease. J Stroke Cerebrovasc Dis 2009; 17:340-3. [PMID: 18984424 DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/04/2008] [Accepted: 04/21/2008] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recent studies have shown that patients with increased oxygen extraction fraction (OEF) as measured by positron emission tomography (PET) have a substantially increased risk of stroke as a result of hemodynamic insufficiency. These patients appear to be ideal candidates for extracranial (EC)-intracranial (IC) bypass. The feasibility of this screening protocol, however, is controversial given PET's limited availability and high expense. A better understanding of the clinical factors that identify patients with potential hemodynamic insufficiency would streamline screening and improve cost-efficiency. METHODS We performed a MEDLINE (1985-2007) database search for studies identifying clinical and radiographic predictors of hemodynamic failure and increased OEF on PET. We used the following key words, singly and in combination: "EC-IC bypass," "hemodynamic failure," and "misery perfusion." Additional studies were identified manually by scrutinizing references from manuscripts, major neurosurgical journals and texts, and personal files. Each study was reviewed for methodology, clinical criteria, and correlation with subsequent PET findings and stroke rates. A consensus was determined regarding the predictive value of each marker. RESULTS Our literature search revealed 5 clinical and radiographic markers that have been used to identify patients with hemodynamic failure: orthostatic limb shaking, blurry vision on exposure to heat, leptomeningeal and ophthalmic collateral circulation on angiography, watershed infarction, and impaired vasodilatory response to acetazolamide. Orthostatic limb shaking is a rare finding but is predictive of hemodynamic failure and is associated with increased stroke risk. Blurry vision on exposure to heat is not predictive of increased stroke risk. Leptomeningeal and ophthalmic collateral circulation is a sensitive but not specific marker. Watershed infarction is highly sensitive and impaired vasodilatory response to acetazolamide is associated with increased OEF but may not be interchangeable. CONCLUSIONS Orthostatic limb shaking, watershed infarction, collateral circulation, and impaired vasoreactivity to acetazolamide in patients with athero-occlusive disease may predict hemodynamic failure, increased OEF on PET, and high stroke rates. Recognition of these predictive markers may improve patient selection for surgical intervention, as such individuals appear to benefit from EC-IC bypass.
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Affiliation(s)
- Matthew C Garrett
- Department of Neurosurgery, Columbia University, New York, New York 10032, USA
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Gottstein U. Pharmacological studies of total cerebral blood flow in man with comments on the possibility of improving regional cerebral blood flow by drugs. Acta Neurol Scand Suppl 2009; 14:136-41. [PMID: 5214086 DOI: 10.1111/j.1600-0404.1965.tb01971.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cheng J, Liu J, Li X, Peng J, Han S, Zhang R, Xu Y, Nie S. Insulin-like growth factor-1 receptor polymorphism and ischemic stroke: a case-control study in Chinese population. Acta Neurol Scand 2008; 118:333-8. [PMID: 18477064 DOI: 10.1111/j.1600-0404.2008.01040.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 02/02/2023]
Abstract
OBJECTIVES Low levels of insulin-like growth factor 1 (IGF-1) are associated with atherosclerosis, and insulin-like growth factor-1 receptor (IGF-1R) polymorphisms can change plasma levels of IGF-1 and may alter the function of the receptor. Whether there is any association of genetic variation in IGF-1R gene with ischemic stroke (IS) is presently unknown. MATERIALS AND METHOD A 1:1 case-control study was conducted. The G --> A polymorphism of IGF-1R gene (rs2229765) were analyzed by TaqMan SNP genotyping technique in Chinese patients with IS (n = 309) and old subjects without IS (n = 309). RESULTS The frequency of A allele in the patients and controls was 45.79% and 39.64%, respectively. The AA genotype distribution of IGF-1R gene was significantly higher in the patients (27.51%) than controls (18.23%; P = 0.022). Conditional logistic regression revealed that the AA genotype of IGF-1R was associated with IS (OR = 1.641, P = 0.022). After adjustment for smoking, alcohol drinking, history of hypertension, and body mass index, IGF-1R AA genotype was still significantly associated with an increased risk of IS (OR = 1.787, P = 0.029), compared with IGF-1R GG. CONCLUSIONS The G --> A polymorphism in IGF-1R gene may affect the susceptibility to IS in Chinese population.
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Affiliation(s)
- J Cheng
- Department of Molecular Biology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
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Wang DM, Liu JR, Hu HY, Shi GP. [Cathepsin S in pathogenesis of neurological diseases]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2008; 37:422-426. [PMID: 18705018 DOI: 10.3785/j.issn.1008-9292.2008.04.017] [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: 05/26/2023]
Abstract
Cathepsin S, one of the lysosomal proteinases, has many important physiological functions in the nervous system, especially in process of extracellular matrix degradation and endocellular antigen presentation. Those functions are closely associated with the pathogenesis of various neurological diseases. It would be beneficial to elucidate the role of Cathepsin S in the pathogenesis of various neurological diseases.
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Affiliation(s)
- Da-Ming Wang
- Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
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Abstract
OBJECTIVES The paraoxonase (PON) gene can reduce the risk of developing atherosclerosis. We investigated the associations between PON polymorphisms and ischemic stroke. We also investigated the associations between PON polymorphisms and lipid profile in stroke patients. METHODS A total of 350 patients with ischemic stroke and 242 control subjects in Korean population were genotyped for the PON1M55 L, PON1Q192R, PON2A148 G and PON2S311C polymorphisms using melting point analysis with LightCycler real-time polymerase chain reaction (PCR) technology. RESULTS There were no significant differences in genotype and allele distribution of the PON polymorphisms between the ischemic stroke patients and control subjects. The concentration of total homocysteine was significantly different in the PON1M55 L polymorphism (P = 0.047), and the apolipoprotein (Apo)B concentration was significantly different in the PON1Q192R polymorphism (P = 0.02) in stroke patients. The concentrations of low-density lipoprotein (LDL) cholesterol and ApoB were significantly different between the PON2A148 G (P = 0.011, P = 0.000, respectively) and PON2S311C polymorphisms (P = 0.046, P = 0.003, respectively) in stroke patients. CONCLUSIONS This study did not provide association between PON gene polymorphisms and ischemic stroke. However, it confirmed that the PON1L55 L allele is associated with plasma concentration of total homocysteine and that the PON2G148 G and PON2S311S allele is associated with plasma concentrations of LDL cholesterol and ApoB.
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Affiliation(s)
- B-S Shin
- Department of Neurology, Chonbuk National University Hospital and Medical School, Keumamdong, Jeonju, Chonbuk, Republic of Korea
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Tiehuis AM, van der Graaf Y, Visseren FL, Vincken KL, Biessels GJ, Appelman APA, Kappelle LJ, Mali WPTM. Diabetes increases atrophy and vascular lesions on brain MRI in patients with symptomatic arterial disease. Stroke 2008; 39:1600-3. [PMID: 18369167 DOI: 10.1161/strokeaha.107.506089] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Diabetes type 2 (DM2) is associated with accelerated cognitive decline and structural brain abnormalities. Macrovascular disease has been described as a determinant for brain MRI changes in DM2, but little is known about the involvement of other DM2-related factors. METHODS Brain MRI was performed in 1043 participants (151 DM2) with symptomatic arterial disease. Brain volumes were obtained through automated segmentation. RESULTS Patients with arterial disease and DM2 had more global and subcortical brain atrophy (-1.20% brain/intracranial volume [95%CI -1.58 to -0.82], P<0.0005 and 0.20% ventricular/intracranial volume [0.05 to 0.34], P<0.01), larger WMH volumes (0.22 logtransformed volume [0.07 to 0.38], P<0.005), and more lacunar infarcts (OR 1.75 [1.13 to 2.69], P<0.01) than identical patients without DM2. In patients with DM2, high glucose levels (B-0.12% per mmol/L [-0.23 to -0.01], P<0.05) and diabetes duration (B-0.05% per year [-0.10 to -0.001], P<0.05) were associated with global brain atrophy. CONCLUSIONS In patients with symptomatic arterial disease, DM2 has an added detrimental effect on the brain. In patients with DM2, hyperglycemia and diabetes duration contribute to brain atrophy.
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Nahab F, Cotsonis G, Lynn M, Feldmann E, Chaturvedi S, Hemphill JC, Zweifler R, Johnston K, Bonovich D, Kasner S, Chimowitz M. Prevalence and prognosis of coexistent asymptomatic intracranial stenosis. Stroke 2008; 39:1039-41. [PMID: 18239161 DOI: 10.1161/strokeaha.107.499475] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There are limited data on the prevalence and prognosis of asymptomatic intracranial stenosis (AIS). METHODS Baseline cerebral angiograms and MR angiograms were used to determine AIS (50% to 99%) coexistent to symptomatic intracranial stenosis for patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease study. RESULTS Coexisting AIS were detected in 18.9% (n=14/74) of patients undergoing 4-vessel cerebral angiography and 27.3% (n=65/238) of patients undergoing MR angiogram. During a mean follow-up period of 1.8 years, no ischemic strokes were attributable to an AIS on cerebral angiography and 5 ischemic strokes (5.9%, 95% CI: 2.1% to 12.3%) occurred in the AIS territory on MR angiogram (risk at 1 year=3.5%, 95% CI: 0.8% to 9.0%). CONCLUSIONS Whereas the prevalence of coexisting AIS (50% to 99%) in patients with symptomatic stenosis is high, the risk of stroke from these asymptomatic stenoses is low.
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Ovbiagele B, Buck BH, Liebeskind DS, Starkman S, Bang OY, Ali LK, Villablanca JP, Salamon N, Yun SW, Pineda S, Saver JL. Prior antiplatelet use and infarct volume in ischemic stroke. J Neurol Sci 2008; 264:140-4. [PMID: 17854835 DOI: 10.1016/j.jns.2007.08.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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] [Received: 04/03/2007] [Revised: 07/03/2007] [Accepted: 08/08/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Conflicting data exist on the role of antiplatelet agents in reducing incident ischemic stroke magnitude, but most prior studies used clinically-assessed neurologic deficit as the index of stroke extent rather than more precise volumetric measurements of infarct size. We assessed the relation of premorbid antiplatelet use to initial diffusion-weighted MRI (DWI) lesion volumes among acute ischemic stroke patients. METHODS Consecutive patients presenting within 24 h of ischemic stroke over an 18-month period were studied. DWI lesions were outlined using a semi-automated threshold technique. Subjects were categorized into two groups: antiplatelet (AP) or no antithrombotic (NA). The relationship between prestroke antithrombotic status and DWI infarct volumes was examined using multivariate quantile regression. RESULTS One hundred sixty-six individuals met study criteria: 75 AP and 91 NA patients. Median DWI volume was lower in the AP group than in the NA group (1.5 cc vs. 5.4 cc, p=0.031). A multivariable model (adjusting for age, history of transient ischemic attack, admission temperature, admission blood pressure, admission serum glucose, stroke onset to imaging interval, stroke mechanism, premorbid statin and antihypertensive use) demonstrated smaller infarcts in the AP vs. NA group (adjusted volume difference: -1.3 cc, 95% CI=-0.09, -2.5, p=0.037). Prior statin use, no history of TIA, large vessel atherosclerosis and microvascular ischemic disease stroke mechanism were also independently associated with reduced infarct volume. CONCLUSIONS Prior antiplatelet treatment is independently associated with reduced cerebral infarct volume among acute ischemic stroke patients. Premorbid statin use, TIA history and stroke mechanism also predict infarct volume in ischemic stroke.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center, Department of Neurology, University of California, Los Angeles 90095, USA.
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Badaliants IE. [Clinical therapeutic aspects of the origin and the course of atherosclerosis in the veterans of the Great Patriotic War]. Adv Gerontol 2008; 21:633-639. [PMID: 19432216] [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
The article presents the results of the research defining a number of features in development and course of some diseases typical for the veterans of the Great Patriotic war who got during the war craniocerebral traumas and wounds of various localization in compare with the patients of the same age who did not participate in the Great Patriotic war and did not have either brain traumas or wounds. Earlier development of ischemic heart disease, arterial hypertension, and cerebral atherosclerosis in veterans of Great Patriotic war has been found. The main intercurrent diseases in senior age persons have been distinguished. Some groups of psychopathological syndromes observed in persons of elderly and senile age and long-livers have been revealed.
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Mulić S, Selesković H, Basić NK, Krizić M, Zerem E, Cickusić A, Kusljugić Z, Baraković F, Bećirović E, Krizić N, Hajdarović A. Atherosclerotic changes on head and neck blood vessels in patients with systemic lupus erythematosus. Reumatizam 2008; 55:19-21. [PMID: 19024265] [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
The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67+/-9.96 and whose disease lasted 3.8+/-4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention.
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Affiliation(s)
- Suada Mulić
- Department of Rheumatology, Internal Clinic, University Clinical Center Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina
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