51
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Xu X, Li M, Liu R, Yin Q, Shi X, Wang F, Gao J, Xu G, Ye R, Liu X. Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review. J Neurointerv Surg 2020; 12:809-813. [PMID: 32066569 DOI: 10.1136/neurintsurg-2019-015660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intracranial vertebrobasilar artery stenosis is an important cause of ischemic stroke. With its high resolution, intravascular optical coherence tomography (OCT) provides detailed assessment of vessel wall features. It is widely applied to identify high-risk plaque in the cardiovascular system, but its use in the intracranial artery has been limited. OBJECTIVE To explore, in this pilot study, the usefulness of OCT in imaging of the intracranial artery wall. METHODS Between November 2017 and July 2018, four patients with severe intracranial vertebrobasilar artery stenosis were enrolled for preintervention OCT evaluation of the lesion artery. Stenosis was present in the basilar artery in one case and in the intracranial vertebral artery in three cases. RESULTS OCT images of the lesions showed various features of plaque vulnerability, such as intraluminal thrombus, lipid-rich plaque with plaque rupture, thin fibrous cap, macrophage accumulations, and a mixed lesion with dissecting aneurysm. In view of the OCT findings, all patients received balloon angioplasty and stent implantation. CONCLUSIONS These cases describe the successful implementation of OCT in intracranial vertebrobasilar artery stenosis. No side effects were seen during the OCT imaging. This technology may help in the diagnosis and treatment of cerebrovascular disease.
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Affiliation(s)
- Xiaohui Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Min Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qin Yin
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China .,Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Elbeltagy MAF, Elkholy WB, Salman AS. Effect of atherosclerosis and the protective effect of the antioxidant vitamin E on the rabbit cerebellum. Microscopy (Oxf) 2020; 68:369-378. [PMID: 31305899 DOI: 10.1093/jmicro/dfz023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atherosclerosis is a major cardiovascular disease and one of the commonest causes of mortality in the world. Speech, balance, fine motor control and cognition are affected by atherosclerosis of cerebellar arteries. This study investigated the protective role of vitamin E against induced atherosclerosis in the rabbit cerebellum. MATERIALS AND METHODS Forty Rex New Zealand adult male rabbits were randomly divided into four groups (10 rabbits each). Group I was designated as the control and received an ordinary diet. Group II received an ordinary diet, but with vitamin E (12 mg/kg/day) added. Group III were given an ordinary diet along with 1% cholesterol powder for 6 weeks. Finally, group IV received an ordinary diet with both 1% cholesterol powder and vitamin E (12 mg/kg/day). Cerebellum samples were stained with haematoxylin and eosin and examined using light microscopy, along with quantitative immunohistochemical assessments of the expression of caspase-3, glial fibrillary acidic protein (GFAP) and inducible nitric oxide synthase (iNOS). RESULTS Cerebellum sections from cholesterol-treated rabbits showed ischaemic changes as fibre density decreased, with vacuolation of the molecular layer, and deformed and shrunken Purkinje cells. A significant increase in caspase-3, GFAP and iNOS immunoreactivity was found. However, vitamin E administration reduced these ischaemic manifestations. CONCLUSIONS The results demonstrate the neurological protective role of vitamin E therapy in atherosclerosis.
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Affiliation(s)
- Maha Abdel Fatah Elbeltagy
- Department of Anatomy, Faculty of Medicine, Menoufia University, Egypt.,Department of Anatomy and Histology, Faculty of Medicine, University of Jordan, Jordan
| | - Wael Badr Elkholy
- Department of Anatomy, Faculty of Medicine, Menoufia University, Egypt
| | - Ahmed Said Salman
- Department of Anatomy, Faculty of Medicine, Menoufia University, Egypt.,Department of Anatomy and Histology, Faculty of Medicine, University of Jordan, Jordan
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53
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Intracranial Atherosclerosis and Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline. Am J Hypertens 2020; 33:92-98. [PMID: 31433051 DOI: 10.1093/ajh/hpz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new, stricter definition of stage 1 hypertension which was previously considered prehypertension. However, impacts of the novel stage 1 hypertension on deleterious target-organ outcomes are still controversial. In this study, we evaluated the relationship between this newly defined stage 1 hypertension and the presence of intracranial atherosclerosis (ICAS) lesions in neurologically healthy participants. METHODS We assessed consecutive participants in routine health checkups between January 2006 and December 2013. Blood pressure (BP) was classified according to the 2017 ACC/AHA hypertension guideline, and ICAS was defined as occlusion or ≥50% stenosis of intracranial vessels on flight magnetic resonance angiography. RESULTS Among 3,111 healthy participants (mean age: 56 years, sex: 54% men), 85 (3%) had ICAS lesions. In multivariate analysis, stage 1 hypertension (adjusted odds ratio: 2.46, 95% confidence interval: 1.10-5.51, P = 0.029) remained an independent predictor of ICAS after adjustment for confounders. Stage 2 hypertension showed a higher odds ratio and a lower P value, indicating a dose-response effect. Age and HbA1c level were also significantly associated with ICAS, independent of the BP categories. The ICAS lesion burden showed a dose-response effect across the BP categories (P for trend <0.001), whereas ICAS lesion location did not (P for trend = 0.699). CONCLUSIONS We demonstrated that stage 1 hypertension, defined according to the 2017 ACC/AHA guideline, was associated with a higher prevalence and burden of ICAS lesions in a neurologically healthy population.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
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54
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Rutland JW, Delman BN, Gill CM, Zhu C, Shrivastava RK, Balchandani P. Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions. AJNR Am J Neuroradiol 2020; 41:2-9. [PMID: 31879330 DOI: 10.3174/ajnr.a6344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 12/23/2022]
Abstract
Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.
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Affiliation(s)
- J W Rutland
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - B N Delman
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Diagnostic, Molecular, and Interventional Radiology (B.N.D.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C M Gill
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z.), University of California San Francisco, San Francisco, California
| | | | - P Balchandani
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
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55
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Ciftciler R, Haznedaroglu IC. Pathobiological Interactions of Local Bone Marrow Renin-Angiotensin System and Central Nervous System in Systemic Arterial Hypertension. Front Endocrinol (Lausanne) 2020; 11:425. [PMID: 32903745 PMCID: PMC7438890 DOI: 10.3389/fendo.2020.00425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/28/2020] [Indexed: 01/16/2023] Open
Abstract
Circulating renin-angiotensin system (RAS) and local paracrin-autocrin-intracrin tissue-based RAS participate in numerous pathobiological events. Pro-inflammatory, pro-fibrotic, and pro-thrombotic consequences associated with local RAS activation have been detected at cellular and molecular level. Regenerative progenitor cell therapy in response to RAS modulating pharmacotherapy has emerged as an adjunct in the context of endothelial cell injury and regeneration to improve regeneration of the vascular endothelium. Local hematopoietic bone marrow (BM) RAS symbolizes the place of cross-interaction between vascular biology and cellular events from embryogenesis to definitive hematopoiesis underlying vascular atherosclerosis. The BM microenvironment also contains Mas receptors, which control the proliferative role of Ang 1-7 on hematopoietic stem cells. Ang 1-7 is produced from Ang-II or Ang-I with the help of ACE2. Various tissues and organs also have an effect on the RAS system. The leukocytes contain and synthesize immunoreactive angiotensinogen species capable of producing angiotensin in the basal state or after incubation with renin. The significance of RAS employment in atherosclerosis and hypertension was indicated by novel bidirectional Central Nervous System (CNS) RAS-BM RAS communications. Myeloid cells generated within the context of hematopoietic BM RAS are considered as the initiators and decision shapers in atherosclerosis. Macrophages in the atherosclerotic lesions contain angiotensin peptides by which RAS blockers inhibit monocyte activation and adherence. Furthermore, vascular biology in relation to inflammation and neoplasia is also affected by local tissue RAS. The purpose of this article is to outline interactions of circulating and local angiotensin systems, especially local bone marrow RAS, in the vascular pathobiological microenvironment of CNS.
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Abstract
This article reviews the current state of imaging for acute ischemic stroke. Protocolized imaging acquisition using computed tomography in conjunction with coordinated stroke care allows for rapid diagnosis and prompt revascularization. Following the initial evidence to support endovascular therapy for large-vessel occlusion, published between 2014 and 2015, there are now guidelines supporting treatment up to 24 hours after time of onset of symptoms. Neuroimaging remains a central component in diagnosing acute stroke and potentially excluding patients from stroke treatment, as outlined in this article.
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Affiliation(s)
- Steven Hetts
- Division of Neurointerventional Radiology, University of California, San Francisco, 505 Parnassus Avenue # M-380, San Francisco, CA 94143, USA
| | - Rajkamal Khangura
- Department of Radiology and Biomedical Imaging, Division of Neurointerventional Radiology, University of California, San Francisco, 505 Parnassus Avenue # M-380, San Francisco, CA 94143, USA.
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Chen HX, Wang LJ, Yang Y, Yue FX, Chen LM, Xing YQ. The prevalence of intracranial stenosis in patients at low and moderate risk of stroke. Ther Adv Neurol Disord 2019; 12:1756286419869532. [PMID: 31447935 PMCID: PMC6693021 DOI: 10.1177/1756286419869532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Previous studies assessing the risk of stroke in the general population
performed screening with Doppler ultrasonography only for high-risk patients
and neglected low- and moderate-risk patients. The aims of this study were
to explore the current prevalence of intracranial arterial stenosis (ICAS)
and analyze its association with different levels of stroke risk and risk
factors based on the risk assessment scale for stroke used in China. Methods: A total of 3654 participants who underwent transcranial Doppler ultrasound
(TCD) were eligible for inclusion. Information regarding demographic
characteristics and risk factors such as alcohol consumption and
hypertension was collected through interviews and questionnaires and used to
analyze the association of ICAS with different levels of stroke risk and
risk factors. Results: The mean age of 501 subjects diagnosed with at least one ICAS was higher than
that of participants without ICAS (57.13 ± 9.56 years and
55.52 ± 9.35 years, respectively). After adjusting for confounding factors,
gender, education, residence, hypertension and personal history of stroke
were associated with ICAS. The odds ratios for ICAS in patients with
hypertension and a personal history of stroke were 1.655 [95% confidence
interval (CI): 1.341–2.043] and 1.854 (95% CI: 1.371–2.508), respectively.
In addition, participants in the low- and moderate-risk stroke groups
accounted for an unexpectedly high proportion of individuals with ICAS (up
to 38.3%). Results from multivariate analyses indicated that the adjusted
odds ratios for ICAS in patients with moderate and high stroke risks
versus those with a low stroke risk were 1.603 (95% CI:
1.171–2.195) and 1.612 (95% CI: 1.272–2.042), respectively. Conclusion: The prevalence of ICAS is high in northeast China and increases with the
level of stroke risk. However, the proportion of patients with ICAS among
those with low and moderate stroke risks should also be noted.
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Affiliation(s)
- Hong-Xiu Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Fei-Xue Yue
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Min Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
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Chang KC, Chuang IC, Huang YC, Wu CY, Lin WC, Kuo YL, Lee TH, Ryu SJ. Risk factors outperform intracranial large artery stenosis predicting unfavorable outcomes in patients with stroke. BMC Neurol 2019; 19:180. [PMID: 31370812 PMCID: PMC6670158 DOI: 10.1186/s12883-019-1408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background This study examined how intracranial large artery stenosis (ILAS), symptomatic and asymptomatic ILAS, and risk factors affect unfavorable outcome events after medical treatment in routine clinical practice. Methods This was a 24-month prospective observational study of consecutively recruited stroke patients. All participants underwent magnetic resonance angiography, and their clinical characteristics were assessed. Outcome events were vascular outcome, recurrent stroke, and death. Cox regression analyses were performed to identify potential factors associated with an unfavorable outcome, which included demographic and clinical characteristics, the risk factors, and stenosis status. Results The analysis included 686 patients; among them, 371 were assessed as ILAS negative, 231 as symptomatic ILAS, and 84 as asymptomatic ILAS. Body mass index (p < .05), hypertension (p = .01), and old infarction (p = .047) were factors relating to vascular outcomes. Hypertension was the only factor for recurrent stroke (p = .035). Poor glomerular filtration rate (< 30 mL/min/1.73 m2) (p = .011) and baseline National Institutes of Health Stroke Scale scores (p < .001) were significant predictors of death. Conclusions This study extended previous results from clinical trials to a community-based cohort study by concurrently looking at the presence/absence of stenosis and a symptomatic/asymptomatic stenotic artery. Substantiated risk factors rather than the stenosis status were predominant determinants of adverse outcome. Although the degree of stenosis is often an indicator for treatment, we suggest risk factors, such as hypertension and renal dysfunction, should be monitored and intensively treated.
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Affiliation(s)
- K C Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Discharge Planning Service Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I C Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y C Huang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Measurement and Statistics, Education, National University of Tainan, Tainan, Taiwan
| | - C Y Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Physical Medicine and Rehabilitation, Healthy Aging Research Center at Chang Gung University, Chang Gung Memorial Hospital at Linkou, 259 Wen-hwa 1st Road, Taoyuan, Taiwan.
| | - W C Lin
- Department of Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Y L Kuo
- Department of Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - T H Lee
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - S J Ryu
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Shiraishi M, Hasegawa Y, Narita N, Miyake H. Relationship Between Asymptomatic Intracranial Stenosis and Extracranial Arteriosclerotic Findings in Workplace Health Checkups: A Pilot Study. J Stroke Cerebrovasc Dis 2019; 28:2429-2433. [PMID: 31296474 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/07/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Intracranial arteriosclerotic disease (ICAD) is common in Asians and has been presumed to be largely associated with metabolic syndrome (MetS), but the risks for asymptomatic ICAD detectable in examinations of the brain, among other tests, are not well known. The present study is aimed at identifying the risks for asymptomatic ICAD using data on risk factors obtained in health checkups, including data from magnetic resonance imaging (MRI), chest computed tomography (CT), and neck echography. METHODS Subjects comprised 103 examinees more than equal to 40 years old (56.9 ± 4.7 years, 93 men) who underwent head MRI, chest CT, and carotid echography in the same period in a workplace health checkup between April and September 2014. Subjects were evaluated for ICAD based on stenosis of bilateral middle cerebral arteries and the basilar artery on previously reported scores from magnetic resonance angiography. Evaluations for extracranial arteriosclerotic disease (ECAD) were based on findings from carotid echography, and total calcium scores were calculated based on the number, areas, and peak Hounsfield computed tomographic numbers of the aortic arch calcified lesion detected. RESULTS ICAD, including mild cases with stenosis less than 50%, was seen in 21 subjects (20.3%); and MetS was evident in 12 subjects (11.7%). Logistic regression analysis with multivariate adjustment for major vascular risk factor demonstrated that echogenic of plaque was significantly associated with the ICAD (OR 3.69, 95%CI 1.02-13.3), however age was significant predictor of the risk profile in patients with ECAD. CONCLUSIONS Carotid atherosclerosis could predict intracranial atherosclerosis in middle-aged people. However, further study with large sample size is warranted.
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Affiliation(s)
- Makoto Shiraishi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Yasuhiro Hasegawa
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Nobuyoshi Narita
- Fujitsu Limited Health Promotion Unit, Kawasaki, Kanagawa, Japan
| | - Hitoshi Miyake
- Fujitsu Limited Health Promotion Unit, Kawasaki, Kanagawa, Japan
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Lange MC, Ribas G, Scavasine V, Ducci RDP, Mendes DC, Zétola VDHF, Cabral N, Rundek T. Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:649-653. [PMID: 30427503 DOI: 10.1590/0004-282x20180095] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. METHODS All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. RESULTS The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. CONCLUSION Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.
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Affiliation(s)
- Marcos C Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Gustavo Ribas
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Valeria Scavasine
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Danielle C Mendes
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | | | - Norberto Cabral
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brasil
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Department of Neurology, Miami, FL, USA
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61
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Liu S, Luo Y, Wang C, Tang R, Sheng Z, Xie W, Chai S, Guo Y, Chai C, Yang Q, Fan Z, Chang B, Xia S. Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis. J Magn Reson Imaging 2019; 51:195-204. [PMID: 31069889 DOI: 10.1002/jmri.26778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Song Liu
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Luo
- Radiology DepartmentTranslational Research Institute of Brain and Brain‐Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine Shanghai China
| | - Chen Wang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Ruowei Tang
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Zhiguo Sheng
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Weiwei Xie
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Shengting Chai
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Guo
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Chao Chai
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Qi Yang
- Radiology DepartmentXuanwu Hospital, Capital Medical University Beijing China
| | - Zhaoyang Fan
- Biomedical Imaging Research InstituteCedars‐Sinai Medical Center California Los Angeles USA
| | - Binge Chang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Shuang Xia
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
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Arenillas JF, Dieleman N, Bos D. Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives. Int J Stroke 2019; 14:564-573. [DOI: 10.1177/1747493019840942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To review the current state of the art and future development of intracranial vessel wall imaging. Methods Recent literature review and expert opinion about intracranial arterial wall imaging. Results Intracranial large artery diseases represent an important cause of stroke and vascular cognitive impairment worldwide. Our traditional understanding of intracranial large artery diseases is based on the observation of luminal narrowing or occlusion with angiographic or ultrasound techniques. Recently, novel imaging techniques have made the intracranial artery wall accessible for noninvasive visualization. The main advantage of vessel-wall imaging as compared to conventional imaging techniques for visualization of intracranial arteries is the ability to detect vessel wall changes even before they get to cause any significant luminal stenosis. This diagnostic capacity is provoking a revolutionary change in the way we see the intracranial circulation. In this article, we will review the current state of magnetic resonance imaging and computed tomography-based intracranial arterial wall imaging, focusing on technical considerations and their clinical applicability. Moreover, we will provide the readers with our vision on the future development of vessel-wall imaging techniques. Conclusion Intracranial arterial wall imaging methods are gaining increasing potential to impact the diagnosis and treatment of patients with cerebrovascular diseases.
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Affiliation(s)
- Juan F Arenillas
- Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain
- Neurovascular Research Laboratory i3, Instituto de Biología y Genética Molecular, Universidad de Valladolid – Consejo Superior de Investigaciones Científicas, Valladolid, Spain
| | - Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC – University Medical Center Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Vali A, Aristova M, Vakil P, Abdalla R, Prabhakaran S, Markl M, Ansari SA, Schnell S. Semi-automated analysis of 4D flow MRI to assess the hemodynamic impact of intracranial atherosclerotic disease. Magn Reson Med 2019; 82:749-762. [PMID: 30924197 DOI: 10.1002/mrm.27747] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/03/2019] [Accepted: 03/02/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE This study evaluated the feasibility of using 4D flow MRI and a semi-automated analysis tool to assess the hemodynamic impact of intracranial atherosclerotic disease (ICAD). The ICAD impact was investigated by evaluating pressure drop (PD) at the atherosclerotic stenosis and changes in cerebral blood flow distribution in patients compared to healthy controls. METHODS Dual-venc 4D flow MRI was acquired in 25 healthy volunteers and 16 ICAD patients (ICA, N = 3; MCA, N = 13) with mild (<50%), moderate (50-69%), or severe (>70%) intracranial stenosis. A semi-automated analysis tool was developed to quantify velocity and flow from 4D flow MRI and to evaluate cerebral blood flow redistribution. PD at stenosis was estimated using the Bernoulli equation. The PD calculation was examined by an in vitro phantom study against flow simulations. RESULTS Flow analysis in controls indicated symmetry in blood flow rate (FR) and peak velocity (PV) between the brain hemispheres. For patients, PV in the affected hemisphere was significantly (65%) higher than the normal side (P = 0.002). However, FR to both hemispheres of the brain was the same. The PD depicted significant correlation with PV asymmetry in patients (ρ = 0.67 and P = 0.02), and it was significantly higher for severe compared to moderate stenosis (3.73 vs. 2.30 mm Hg, P = 0.02). CONCLUSION 4D flow MRI quantification enables assessment of the hemodynamic impact of ICAD. The significant difference of the PD between patients with severe and moderate stenosis and its correlation with PV asymmetry suggest that PD may be a pertinent hemodynamic biomarker to evaluate ICAD.
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Affiliation(s)
- Alireza Vali
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Maria Aristova
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Parmede Vakil
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Ramez Abdalla
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, Illinois
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Song Y, Lee D, Suh DC, Kim JG, Kim JK, Han M, Liu H, Zhao L, Kim EH, Jung SC, Lee DG, Koo HJ, Kim MJ, Baek S, Hwang SM, Kim BJ, Kim YJ, Cho HJ, Kim SJ, Jeon SB, Kim JS. Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis. Neurointervention 2019; 14:43-52. [PMID: 30827064 PMCID: PMC6433193 DOI: 10.5469/neuroint.2018.01123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. Materials and Methods All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. Results Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. Conclusion In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joong-Goo Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hairi Liu
- Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, China
| | - Lingbo Zhao
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Eun Hye Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung Chul Jung
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dong-Geun Lee
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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65
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Kwee RM, Qiao Y, Liu L, Zeiler SR, Wasserman BA. Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI. Neuroradiology 2019; 61:651-657. [PMID: 30834465 DOI: 10.1007/s00234-019-02190-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about the natural history of intracranial atherosclerotic plaque enhancement and its clinical implications. Our objective was to investigate the value of follow-up high-resolution contrast-enhanced vessel wall MRI (VWMRI) for classifying culprit plaques in patients with intracranial atherosclerotic disease (ICAD). METHODS Fourteen patients with symptomatic ICAD (50% females; median age 48 years) underwent serial 3T VWMRI. Fifty-five plaques were identified and graded based on the likelihood of having caused the ischemic event (non-culprit, indeterminate, culprit) and degree of enhancement (0, 1, 2) at baseline and follow-up (median follow-up, 140 days). For accuracy analysis, plaque enhancement at baseline and stable or increasing plaque enhancement at follow-up was tested to identify a culprit plaque, and areas under the receiver operating characteristic curves (AUCs) were compared. RESULTS In 37/55 (67.3%) plaques, enhancement grade remained unchanged. Lack of enhancement was only seen in non-culprit plaques at baseline, and none developed enhancement over time. Enhancement never changed more than one grade. Thirty-seven percent (10/27) of non-culprit plaques that enhanced decreased in enhancement grade at follow-up, but no culprit plaques decreased in enhancement. AUC of baseline and follow-up plaque enhancement combined was significantly larger than AUC of baseline plaque enhancement alone to identify culprit plaques (0.733 vs. 0.567, p = 0.0001). CONCLUSION Contrast enhancement of ICAD can persist months after the ischemic event. Lack of enhancement at baseline or a decrease in enhancement at follow-up suggests that the plaque is not culprit. Persistent enhancement from baseline to follow-up improves accuracy in identifying culprit plaques.
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Affiliation(s)
- Robert M Kwee
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.,Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Steven R Zeiler
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA.
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Wang T, Yang K, Wang X, Luo J, Gao P, Ma Y, Jadhav V, Zhao N, Jiao L. Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tao Wang
- Xuanwu Hospital, Capital Medical University; Department of Neurosurgery; No. 45 Changchun Street Beijing China 100053
| | - Kun Yang
- Xuanwu Hospital, Capital Medical University; Department of Evidence-based Medicine; No. 45 Changchun Street Beijing China 100053
| | - Xue Wang
- Xuanwu Hospital, Capital Medical University; Medical Library of Xuanwu Hospital; No. 45 Changchun Street Beijing China 100053
| | - Jichang Luo
- Xuanwu Hospital, Capital Medical University; Department of Neurosurgery; No. 45 Changchun Street Beijing China 100053
| | - Peng Gao
- Xuanwu Hospital, Capital Medical University; Department of Neurosurgery; No. 45 Changchun Street Beijing China 100053
| | - Yan Ma
- Xuanwu Hospital, Capital Medical University; Department of Neurosurgery; No. 45 Changchun Street Beijing China 100053
| | - Vikram Jadhav
- CentraCare Health System; Neurosciences - Stroke and Cerebrovascular; 1406 Sixth Ave North St Cloud Minnesota USA
| | - Na Zhao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Department of Anesthesiology; Beijing China
| | - Liqun Jiao
- Xuanwu Hospital, Capital Medical University; Department of Neurosurgery; No. 45 Changchun Street Beijing China 100053
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Vidale S, Agostoni E, Grampa G, Consoli A, Consoli D. Medical and endovascular treatments of symptomatic intracranial stenosis. A Bayesian network meta-analysis. J Clin Neurosci 2019; 63:84-90. [PMID: 30745129 DOI: 10.1016/j.jocn.2019.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/04/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Abstract
Intracranial stenosis is a well-established stroke risk factor with an increase of stroke recurrence or TIA up to 12.6% at 1 year. Treatments are different: medical and endovascular. We performed a multiple treatment comparison analysis to detect the best treatment in reducing the risk of stroke recurrence. We searched in Medline, Embase, Cochrane Central Register of Controlled Trials databases between 1979 and October 2017. Inclusion criteria were prospective randomized trials that evaluated patients with TIA or stroke due to intracranial stenosis and treated with different medical therapies and/or endovascular procedures. Primary endpoint was the recurrence of TIA or stroke in the territory of intracranial stenosis, while secondary endpoint was represented by any stroke or vascular death. Multiple treatment comparison meta-analysis based on a Bayesian fixed and random effects Poisson model was performed. Seven trials were included with a total of 1337 patients. At multiple treatment comparison, no significant differences between treatments were observed for both primary (median fixed effect standard OR: 0.40; 95%CI: 0.02-1.07) and secondary endpoints (median random effect standard OR: 1.17; 95%CI: 0.32-1.92). Treatment with aspirin alone ranked with high values both for primary and secondary endpoints (surface under the cumulative ranking curve of 70% and 82%, respectively). In patients with symptomatic intracranial stenosis, no differences between treatments were observed. However, aspirin alone was more effective than stenting in the reduction of TIA or stroke recurrences, with a better safety profile than oral anticoagulants.
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Affiliation(s)
- S Vidale
- Department of Neurology & Stroke Unit, Sant'Anna Hospital, Como, Italy.
| | - E Agostoni
- Department of Neurology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Grampa
- Department of Neurology & Stroke Unit, Sant'Anna Hospital, Como, Italy
| | - A Consoli
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hopital Foch, Paris, France; Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - D Consoli
- Department of Neurology, "G. Jazzolino" Hospital, Vibo Valentia, Italy
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68
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Shi F, Yang Q, Guo X, Qureshi TA, Tian Z, Miao H, Dey D, Li D, Fan Z. Intracranial Vessel Wall Segmentation Using Convolutional Neural Networks. IEEE Trans Biomed Eng 2019; 66:2840-2847. [PMID: 30716027 DOI: 10.1109/tbme.2019.2896972] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop an automated vessel wall segmentation method using convolutional neural networks to facilitate the quantification on magnetic resonance (MR) vessel wall images of patients with intracranial atherosclerotic disease (ICAD). METHODS Vessel wall images of 56 subjects were acquired with our recently developed whole-brain three-dimensional (3-D) MR vessel wall imaging (VWI) technique. An intracranial vessel analysis (IVA) framework was presented to extract, straighten, and resample the interested vessel segment into 2-D slices. A U-net-like fully convolutional networks (FCN) method was proposed for automated vessel wall segmentation by hierarchical extraction of low- and high-order convolutional features. RESULTS The network was trained and validated on 1160 slices and tested on 545 slices. The proposed segmentation method demonstrated satisfactory agreement with manual segmentations with Dice coefficient of 0.89 for the lumen and 0.77 for the vessel wall. The method was further applied to a clinical study of additional 12 symptomatic and 12 asymptomatic patients with >50% ICAD stenosis at the middle cerebral artery (MCA). Normalized wall index at the focal MCA ICAD lesions was found significantly larger in symptomatic patients compared to asymptomatic patients. CONCLUSION We have presented an automated vessel wall segmentation method based on FCN as well as the IVA framework for 3-D intracranial MR VWI. SIGNIFICANCE This approach would make large-scale quantitative plaque analysis more realistic and promote the adoption of MR VWI in ICAD management.
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69
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Wabnitz AM, Derdeyn CP, Fiorella DJ, Lynn MJ, Cotsonis GA, Liebeskind DS, Waters MF, Lutsep H, López-Cancio E, Turan TN, Montgomery J, Janis LS, Lane B, Chimowitz MI. Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients With Intracranial Stenosis. Stroke 2019; 50:143-147. [PMID: 30580705 PMCID: PMC6559874 DOI: 10.1161/strokeaha.118.020840] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Although aggressive medical therapy was superior to stenting in the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), the stroke rate in the medical arm was still high. The aim of this study was to determine the association between hemodynamic markers (borderzone infarct pattern and impaired collateral flow on baseline imaging) and rates of recurrent stroke in patients treated medically in SAMMPRIS. Methods- This was a post hoc analysis of patients whose qualifying event for SAMMPRIS was an infarct in the territory of a stenotic middle cerebral artery or intracranial carotid artery. Infarcts were adjudicated as involving primarily internal or cortical borderzone territories, the core middle cerebral artery territory, or perforator territories, and collateral flow was assessed according to a standard scale (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology). Log-rank tests and χ2 tests were performed to assess associations of infarct patterns and collateral flow with rates of recurrent stroke. Results- Of 101 patients who qualified, 14 of 53 (26.4%) with borderzone infarcts, 2 of 24 (8.3%) with core middle cerebral artery infarcts, and 3 of 24 (12.5%) with perforator infarcts had a recurrent stroke in the territory (P=0.14 for comparing the 3 groups, P=0.052 for borderzone versus nonborderzone). Of 82 patients with collateral flow assessment, 30 of 43 (70%) with borderzone infarcts, 7 of 19 (37%) with core middle cerebral artery infarcts, and 11 of 20 (55%) with perforator infarcts had impaired collateral flow distal to the stenosis (P=0.049). Patients with borderzone infarcts and impaired collateral flow had the highest risk of recurrent stroke (37%). Conclusions- Borderzone infarcts and impaired collateral flow identify a subgroup of patients with intracranial stenosis who are at particularly high risk of recurrent stroke on medical treatment. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00576693.
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Affiliation(s)
- Ashley M Wabnitz
- From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.)
- Department of Neurology, Ralph H Johnson VA Medical Center, Charleston, SC (A.M.W.)
| | - Colin P Derdeyn
- Departments of Radiology, Neurology and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.)
| | - David J Fiorella
- Department of Neurosurgery, State University of New York, Stony Brook (D.J.F.)
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA (M.J.L., G.A.C.)
| | - George A Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA (M.J.L., G.A.C.)
| | | | - Michael F Waters
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (M.F.W.)
| | - Helmi Lutsep
- Department of Neurology, Oregon Health and Science University, Portland (H.L.)
| | - Elena López-Cancio
- Neurology Department, Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain (E.L.-C.)
| | - Tanya N Turan
- From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.)
| | - Jean Montgomery
- Department of Public Health, Emory University, Atlanta, GA (J.M.)
| | - L Scott Janis
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (L.S.J.)
| | - Bethany Lane
- Piedmont Research Institute, Piedmont Healthcare, Atlanta, GA (B.L.)
| | - Marc I Chimowitz
- From the Department of Neurology, Medical University of South Carolina, Charleston (A.M.W., T.N.T., M.I.C.)
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Gruber P, Braun C, Kahles T, Hlavica M, Anon J, Diepers M, Nedeltchev K, Berberat J, Remonda L. Percutaneous transluminal angioplasty using the novel drug-coated balloon catheter SeQuent Please NEO for the treatment of symptomatic intracranial severe stenosis: feasibility and safety study. J Neurointerv Surg 2018; 11:719-722. [DOI: 10.1136/neurintsurg-2018-014378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesIntracranial arteriosclerotic disease is a relevant cause of ischemic stroke worldwide with a high recurrence rate despite best medical treatment. Following the SAMMPRIS trial, endovascular treatment has remained a second-line therapy. Meanwhile, there has been significant advances in device technology. SeQuent Please NEO is a novel polymer-free, drug-coated (paclitaxel/iopromide) balloon (DCB) primarily designed for cardiology. Because of its high flexibility and pushability, it may also be suitable for intracranial use. The aim of this study was to assess the feasibility and safety of SeQuent Please NEO DCB in symptomatic intracranial severe stenosis.MethodsA single-center retrospective cohort study of patients with symptomatic intracranial severe stenosis treated with SeQuent Please NEO DCB was performed at a tertiary stroke center.ResultsTen patients (all men, median age 73 years (IQR 69–77)) were included. Median pre-treatment stenosis grade was 78% (IQR 75–80%) with four internal carotid artery, two mid-basilar artery, and four vertebral artery lesions. Median post-treatment stenosis grade was 50% (IQR 45–53%). Successful angioplasty was achieved in all cases without technical failure. There were no cases of peri-procedural reocclusion and no deaths at median follow-up of 3 months (IQR 2–3).ConclusionIn this pilot study, SeQuent Please NEO DCB was feasible and safe in the treatment of symptomatic intracranial severe stenosis. It might represent a promising alternative to medical treatment in selected cases.
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Liu L, Ye SH, Gu X, Russell T, Xu Z, Sankar J, Wagner WR, Lee YC, Yun Y. Comparison of endothelial cell attachment on surfaces of biodegradable polymer-coated magnesium alloys in a microfluidic environment. PLoS One 2018; 13:e0205611. [PMID: 30304058 PMCID: PMC6179289 DOI: 10.1371/journal.pone.0205611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/27/2018] [Indexed: 12/28/2022] Open
Abstract
Polymeric coatings can provide temporary stability to bioresorbable metallic stents at the initial stage of deployment by alleviating rapid degradation and providing better interaction with surrounding vasculature. To understand this interfacing biocompatibility, this study explored the endothelial-cytocompatibility of polymer-coated magnesium (Mg) alloys under static and dynamic conditions compared to that of non-coated Mg alloy surfaces. Poly (carbonate urethane) urea (PCUU) and poly (lactic-co-glycolic acid) (PLGA) were coated on Mg alloys (WE43, AZ31, ZWEKL, ZWEKC) and 316L stainless steel (316L SS, control sample), which were embedded into a microfluidic device to simulate a vascular environment with dynamic flow. The results from attachment and viability tests showed that more cells were attached on the polymer-coated Mg alloys than on non-coated Mg alloys in both static and dynamic conditions. In particular, the attachment and viability on PCUU-coated surfaces were significantly higher than that of PLGA-coated surfaces of WE43 and ZWEKC in both static and dynamic conditions, and of AZ31 in dynamic conditions (P<0.05). The elementary distribution map showed that there were relatively higher Carbon weight percentages and lower Mg weight percentages on PCUU-coated alloys than PLGA-coated alloys. Various levels of pittings were observed underneath the polymer coatings, and the pittings were more severe on the surface of Mg alloys that corroded rapidly. Polymer coatings are recommended to be applied on Mg alloys with relatively low corrosion rates, or after pre-stabilizing the substrate. PCUU-coating has more selective potential to enhance the biocompatibility and mitigate the endothelium damage of Mg alloy stenting.
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Affiliation(s)
- Lumei Liu
- National Science Foundation-Engineering Research Center for Revolutionizing Metallic Biomaterials, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
- FIT BEST Laboratory, Department of Chemical, Biological, and Bioengineering, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Xinzhu Gu
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Teal Russell
- FIT BEST Laboratory, Department of Chemical, Biological, and Bioengineering, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - Zhigang Xu
- National Science Foundation-Engineering Research Center for Revolutionizing Metallic Biomaterials, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - Jagannathan Sankar
- National Science Foundation-Engineering Research Center for Revolutionizing Metallic Biomaterials, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Young-Choon Lee
- Jeonbuk Technopark, Regional Industry Promotion Office, Chonbuk Province, Jeonju, South Korea
| | - Yeoheung Yun
- National Science Foundation-Engineering Research Center for Revolutionizing Metallic Biomaterials, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
- FIT BEST Laboratory, Department of Chemical, Biological, and Bioengineering, North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
- * E-mail:
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Lu SS, Qi M, Zhang X, Mu XH, Schmidt M, Sun Y, Forman C, Speier P, Hong XN. Clinical Evaluation of Highly Accelerated Compressed Sensing Time-of-Flight MR Angiography for Intracranial Arterial Stenosis. AJNR Am J Neuroradiol 2018; 39:1833-1838. [PMID: 30213812 DOI: 10.3174/ajnr.a5786] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Time-of-flight MR angiography is the preferred imaging technique to assess intracranial arterial stenosis but is limited by a relatively long acquisition time. Compressed sensing provides an innovative approach in undersampling k-space to minimize the data-acquisition time. We aimed to evaluate the diagnostic accuracy of compressed sensing TOF for detecting intracranial arterial stenosis by comparison with conventional parallel imaging TOF-MRA. MATERIALS AND METHODS Compressed sensing TOF and parallel imaging TOF were performed in 22 patients with intracranial arterial stenosis. The MRA scan times were 2 minutes and 31 seconds and 4 minutes and 48 seconds for compressed sensing TOF and parallel imaging TOF, respectively. The reconstructed resolutions were 0.4 × 0.4 × 0.4 and 0.4 × 0.4 × 0.6 mm3 for compressed sensing TOF and parallel imaging TOF, respectively. The diagnostic quality of the images and visibility of the stenoses were independently ranked by 2 neuroradiologists blinded to the type of method and were compared using the Wilcoxon signed rank test. Concordance was calculated with the Cohen κ. Edge sharpness of the arteries and the luminal stenosis ratio were analyzed and compared using a paired-sample t test. RESULTS The interrater agreement was good to excellent. Compressed sensing TOF resulted in image quality comparable with that of parallel imaging TOF but boosted confidence in diagnosing arterial stenoses (P = .025). The edge sharpness of the intracranial arteries for compressed sensing TOF was significantly higher than that for parallel imaging TOF (P < .001). The luminal stenosis ratio on compressed sensing TOF showed no significant difference compared with that on parallel imaging TOF. CONCLUSIONS Compressed sensing TOF both remarkably reduced the scan time and provided adequate image quality for the diagnosis of intracranial arterial stenosis.
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Affiliation(s)
- S S Lu
- From the Department of Radiology (S.s.L., M.Q., X.Z., X.h.M., X.n.H.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - M Qi
- From the Department of Radiology (S.s.L., M.Q., X.Z., X.h.M., X.n.H.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - X Zhang
- From the Department of Radiology (S.s.L., M.Q., X.Z., X.h.M., X.n.H.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - X H Mu
- From the Department of Radiology (S.s.L., M.Q., X.Z., X.h.M., X.n.H.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - M Schmidt
- Siemens Healthcare GmbH (M.S., C.F., P.S.), Erlangen, Germany
| | - Y Sun
- MR Collaboration NE Asia (Y.S.), Siemens Healthcare, Shanghai, China
| | - C Forman
- Siemens Healthcare GmbH (M.S., C.F., P.S.), Erlangen, Germany
| | - P Speier
- Siemens Healthcare GmbH (M.S., C.F., P.S.), Erlangen, Germany
| | - X N Hong
- From the Department of Radiology (S.s.L., M.Q., X.Z., X.h.M., X.n.H.), The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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73
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Chen CY, Chen SP, Fuh JL, Lirng JF, Chang FC, Wang YF, Wang SJ. Vascular wall imaging in reversible cerebral vasoconstriction syndrome - a 3-T contrast-enhanced MRI study. J Headache Pain 2018; 19:74. [PMID: 30167985 PMCID: PMC6117223 DOI: 10.1186/s10194-018-0906-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Limited histopathology studies have suggested that reversible cerebral vasoconstriction syndromes (RCVS) does not present with vascular wall inflammation. Previous vascular imaging studies have had inconsistent vascular wall enhancement findings in RCVS patients. The aim of this study was to determine whether absence of arterial wall pathology on imaging is a universal finding in patients with RCVS. Methods We recruited patients with RCVS from Taipei Veterans General Hospital prospectively from 2010 to 2012, with follow-up until 2017 (n = 48). We analyzed the characteristics of vascular wall enhancement in these patients without comparisons to a control group. All participants received vascular wall imaging by contrasted T1 fluid-attenuated inversion recovery with a 3-T magnetic resonance machine. The vascular wall enhancement was rated as marked, mild or absent. Results Of 48 patients with RCVS, 22 (45.8%) had vascular wall enhancement (5 marked and 17 mild). Demographics, clinical profiles, and cerebral artery flow velocities were similar across patients with versus without vascular wall enhancement, except that patients with vascular wall enhancement had fewer headache attacks than those without (p = 0.04). Follow-up imaging completed in 14 patients (median interval, 7 months) showed reduced enhancement in 9 patients, but persistent enhancement in 5. Conclusion Almost half of our RCVS patients exhibited imaging enhancement of diseased vessels, and it was persistent for approximately a third of those patients with follow-up imaging. Both acute and persistent vascular wall enhancement may be unhelpful for differentiating RCVS from central nervous system vasculitis or subclinical atherosclerosis.
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Affiliation(s)
- Chun-Yu Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan. .,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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74
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Wu F, Ma Q, Song H, Guo X, Diniz MA, Song SS, Gonzalez NR, Bi X, Ji X, Li D, Yang Q, Fan Z. Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole-Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke. J Am Heart Assoc 2018; 7:JAHA.118.009705. [PMID: 30033434 PMCID: PMC6201468 DOI: 10.1161/jaha.118.009705] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke. Methods and Results Sixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions. Conclusions High signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Marcio A Diniz
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China .,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA .,Departments of Medicine and Bioengineering, University of California, Los Angeles, CA
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75
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Vojinovic D, van der Lee SJ, van Duijn CM, Vernooij MW, Kavousi M, Amin N, Demirkan A, Ikram MA, van der Lugt A, Bos D. Metabolic profiling of intra- and extracranial carotid artery atherosclerosis. Atherosclerosis 2018; 272:60-65. [PMID: 29550646 DOI: 10.1016/j.atherosclerosis.2018.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Increasing evidence shows that intracranial carotid artery atherosclerosis may develop under the influence of a differential metabolic risk factor profile than atherosclerosis in the extracranial part of the carotid artery. To further elucidate these differences, we investigated associations of a wide range of circulating metabolites with intracranial and extracranial carotid artery atherosclerosis. METHODS From the population-based Rotterdam Study, blood samples from 1111 participants were used to determine a wide range of metabolites by proton nuclear magnetic resonance (NMR). Moreover, these participants underwent non-contrast computed tomography of the neck and head to quantify the amount of extra- and intracranial carotid artery calcification (ECAC and ICAC), as a proxy of atherosclerosis. We assessed associations of the metabolites with ICAC and ECAC and compared the metabolic association patterns of the two. RESULTS We found that one standard deviation (SD) increase in concentration of 3-hydroxybutyrate, a ketone body, was significantly associated with a 0.11 SD increase in ICAC volume (p = 1.8 × 10-4). When we compared the metabolic association pattern of ICAC with that of ECAC, we observed differences in glycolysis-related metabolite measures, lipoprotein subfractions, and amino acids. Interestingly, glycoprotein acetyls were associated with calcification in both studied vessel beds. These associations were most prominent in men. CONCLUSIONS We found that a higher circulating level of 3-hydroxybutyrate was associated with an increase in ICAC. Furthermore, we found differences in metabolic association patterns of ICAC and ECAC, providing further evidence for location-specific differences in the etiology of atherosclerosis.
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Affiliation(s)
- Dina Vojinovic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sven J van der Lee
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ayşe Demirkan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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76
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Olatunji RB, Adekanmi AJ, Ogunseyinde AO. Intracranial Arterial Calcification in Black Africans with Acute Ischaemic Stroke. Cerebrovasc Dis Extra 2018; 8:26-38. [PMID: 29402851 PMCID: PMC5836175 DOI: 10.1159/000485195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023] Open
Abstract
Background Intracranial arterial calcification (IAC), a recognized marker of atherosclerosis on cranial computed tomography (CT), is an independent risk factor for ischaemic stroke. This study aimed to determine the prevalence, distribution, severity, and associations of IAC in adults with acute ischaemic stroke (AIS) at the University College Hospital, Ibadan, Nigeria. Methods Cranial CT images of 130 consecutive adults who presented with AIS were acquired on a 64-slice multi-detector Toshiba Aquilion scanner and evaluated for IAC in bone window on Vitrea® software using a semi-quantitative scoring method for extent, thickness, and length of calcifications in the large intracranial arteries. Associations of IAC with clinical and laboratory data were determined by statistical analysis at p < 0.05. Results There were 71 males (54.6%), and the mean age of all patients was 63.0 ± 13.2 years. Hypertension was the most common risk factor (83.1%). IAC was found in 121 patients (93.1%), predominantly in the carotid siphon (86.1%) followed by the intracranial vertebral arteries (9.3%), middle cerebral arteries (2.4%), basilar artery (1.2%), and the anterior cerebral arteries (1%). The burden of IAC ranged from mild (17.4%) to moderate (52.1%) to severe (30.6%). Age (p < 0.001), diastolic blood pressure (p = 0.037), and alcohol use (0.046) were significantly different among the patients with mild, moderate, and severe degrees of IAC. IAC was associated with age (p < 0.001), hypertension (p = 0.03), diabetes mellitus (p = 0.02), hyperlipidaemia (p = 0.04), and alcohol use (p < 0.001) but not with sex (p = 0.35). Conclusions The burden of IAC is very high among native African patients with AIS and preferentially involves proximal inflow arteries. Therefore, the role of large vessel atherosclerosis in ischaemic stroke in native Africans should be explored in future multinational, multimodality studies.
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Affiliation(s)
- Richard B. Olatunji
- *Richard B. Olatunji, Department of Radiology, College of Medicine, University of Ibadan, University College Hospital, PMB 5116, Ibadan 200212 (Nigeria), E-Mail
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77
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Jansen JFA. Assessment of extracranial and intracranial atherosclerosis: Don't dismiss old school autopsy. Atherosclerosis 2018; 270:189-190. [PMID: 29370885 DOI: 10.1016/j.atherosclerosis.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jacobus F A Jansen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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78
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Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J. The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It. Radiology 2018; 286:12-28. [DOI: 10.1148/radiol.2017162096] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arjen Lindenholz
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jaco J. M. Zwanenburg
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
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79
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Clinical significances and features of prompt brain CT scan after intracranial artery stenting: analysis of 501 cases. Oncotarget 2017; 8:114259-114267. [PMID: 29371984 PMCID: PMC5768401 DOI: 10.18632/oncotarget.23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/28/2017] [Indexed: 11/25/2022] Open
Abstract
Cerebral hemorrhage is a serious complication of intracranial artery stenting that could be fatal without timely identification and treatment. Prompt brain CT scan would help to evaluate whether cerebral hemorrhage occurs, however, the diverse features of the CT scan immediately after stenting could influence the judgement sometimes. Therefore, we analyzed and summarized these features to help to determine the clinical significance of these CT features. The prompt CT features after stenting were classified into three types. Type I indicates that no high-density shadows. Type II indicates that high-density shadows scattered in the infarct areas and/or subarachnoid spaces without mass effect. Type III indicates high-density shadows scattered in and/or out of the infarct areas and/or subarachnoid space with obvious mass effects. Based on this classification, the patients in both Type I and II would continue the double anti-platelet treatment (DAPT) and anti-coagulation treatment, while the later need closer monitoring. However, patients in Type III must immediately withdraw the DAPT and anti-coagulation treatment with close monitoring and surgical intervention was needed when necessary. Nineteen (3.79%) patients were classified into Type III, and 5 (1.00%) of the 19 were accepted surgical intervention. Two of these patients died (0.40%). The prompt CT scan timely distinguishing the cerebral hemorrhage was necessary after intracranial artery stent angioplasty. Additionally, based on the different prompt CT features to take different therapeutic strategies after stenting would achieve better outcomes for ischemic stroke or transient ischemic stroke (TIA) patients underwent intracranial artery endovascular therapy.
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80
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Suemoto CK, Grinberg LT, Leite REP, Ferretti-Rebustini REL, Jacob-Filho W, Yaffe K, Nitrini R, Pasqualucci CA. Morphometric measurements of extracranial and intracranial atherosclerotic disease: A population-based autopsy study. Atherosclerosis 2017; 270:218-223. [PMID: 29254693 DOI: 10.1016/j.atherosclerosis.2017.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/04/2017] [Accepted: 12/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Intracranial (IAD) and extracranial atherosclerotic diseases (EAD) have been mostly investigated using imaging methods. Autopsy studies allow for a direct and complete evaluation of the atherosclerotic disease. We aimed to investigate the frequency of IAD and EAD, their association, and related risk profiles in a large cross-sectional autopsy study. METHODS We measured the intima-media thickness and stenosis of the common (CCA) and internal carotid arteries (ICA), using morphometric measurements. The main outcome was stenosis (≥50%) in the artery with the largest obstruction among the 12 cerebral arteries. We used multivariable logistic regression models to investigate the association between EAD and IAD. RESULTS In 661 participants (mean age = 71.3 ± 11.7 y, 51% male), stenosis was more common in IAD than in EAD (59% vs. 51%). EAD was associated with Caucasian race, hypertension, and smoking, while IAD was associated with older age, less years of education, hypertension, diabetes, and a previous history of stroke. Stenosis in CCA and ICA was associated with more than two times the odds of having stenosis in the intracranial arteries (CCA: OR = 2.32, 95% CI = 1.64; 3.28; ICA: OR = 2.51, 95% CI = 1.76; 3.57). CONCLUSIONS In this population-based autopsy study, IAD was common, even more common than EAD, but correlated with EAD.
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Affiliation(s)
- Claudia K Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, Brazil.
| | - Lea T Grinberg
- Memory and Aging Center, University of California San Francisco, USA
| | - Renata E P Leite
- Division of Geriatrics, University of Sao Paulo Medical School, Brazil
| | | | | | - Kristine Yaffe
- Department of Neurology, Department of Psychiatry, and Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco Veterans Affairs Medical Center, USA
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, Brazil
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81
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McKiernan S, Selmes C. Transcranial colour-coded duplex of the intracranial large arteries. SONOGRAPHY 2017. [DOI: 10.1002/sono.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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82
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Lu SS, Ge S, Su CQ, Xie J, Mao J, Shi HB, Hong XN. MRI of plaque characteristics and relationship with downstream perfusion and cerebral infarction in patients with symptomatic middle cerebral artery stenosis. J Magn Reson Imaging 2017; 48:66-73. [PMID: 29083523 DOI: 10.1002/jmri.25879] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Intracranial plaque characteristics are associated with stroke events. Differences in plaque features may explain the disconnect between stenosis severity and the presence of ischemic stroke. PURPOSE To investigate the relationship between plaque characteristics and downstream perfusion changes, and their contribution to the occurrence of cerebral infarction beyond luminal stenosis. STUDY TYPE Case control. SUBJECTS Forty-six patients with symptomatic middle cerebral artery (MCA) stenosis (with acute cerebral infarction, n = 30; without acute cerebral infarction, n = 16). FIELD STRENGTH/SEQUENCE 3.0T with 3D turbo spin echo sequence (3D-SPACE). ASSESSMENT Luminal stenosis grade, plaque features including lesion T2 and T1 hyperintense components, plaque enhancement grade, and plaque distribution were assessed. Brain perfusion was evaluated on mean transient time maps based on the Alberta Stroke Program Early CT score (MTT-ASPECTS). STATISTICAL TESTS Plaque features, grade of luminal stenosis, and MTT-ASPECTS were compared between two groups. The association between plaque features and MTT-ASPECTS were assessed using Spearman's correlation analysis. Multivariate logistic regression and receiver operating characteristic (ROC) curves were constructed to assess the effect of significant variables alone and their combination in determining the occurrence of cerebral infarction. RESULTS Stronger enhanced plaques were associated with downstream lower MTT-ASPECTS (P = 0.010). Plaque enhancement grade (P = 0.039, odds ratio [OR] 5.9, 95% confidence interval [CI] 1.1-32) and MTT-ASPECTS (P = 0.003, OR 2.6, 95% CI 1.4-4.7) were associated with a recent cerebral infarction, whereas luminal stenosis grade was not (P = 0.128). The combination of MTT-ASPECTS and plaque enhancement grade provided incremental information beyond luminal stenosis grade alone. The area under the receiver operating characteristic curve (AUC) improved from 0.535 to 0.921 (P < 0.05). DATA CONCUSION Strongly enhanced plaques are associated with a higher likelihood of downstream perfusion impairment. Plaque enhancement and perfusion evaluation may play a complementary role to luminal stenosis in determining the occurrence of acute cerebral infarction. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
- Shan-Shan Lu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Song Ge
- Department of Neurology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Chun-Qiu Su
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Jun Xie
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Jian Mao
- Siemens Healthineers, Shanghai, P.R. China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
| | - Xun-Ning Hong
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China
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83
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Concomitant Asymptomatic Intracranial Atherosclerotic Stenosis Increase the 30-Day Risk of Stroke in Patients Undergoing Symptomatic Intracranial Atherosclerotic Stenosis Stenting. J Stroke Cerebrovasc Dis 2017; 27:479-485. [PMID: 29056405 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, 19.1% of ischemic strokes occurred out of the territory of previously symptomatic stenosis during the mean follow-up period of 23.4 months. However, it is unknown how many ischemic strokes were due to a previously asymptomatic intracranial atherosclerotic stenosis (ICAS). The objective of this study was to investigate whether the concomitant asymptomatic ICAS influences the outcome of patients undergoing symptomatic ICAS stenting. METHODS We retrospectively reviewed 576 consecutive patients with nondisabling ischemic stroke (modified Rankin scale score of ≤3) who were treated with symptomatic ICAS (≥70% stenosis) stenting with or without concomitant asymptomatic ICAS. The baseline characteristics and the 30-day primary end points (stroke or death after stenting) were compared by bivariate and multivariable logistic analyses. RESULTS The 30-day rate of primary end points was 5.2%, which was higher in patients with concomitant asymptomatic ICAS (≥50% stenosis) than in those without asymptomatic ICAS (no stenosis or <50% stenosis) (8.9% versus 3.8%, P = .014). In patients with concomitant asymptomatic ICAS, 25% of ischemic strokes occurred out of the territory of the stented artery, whereas in patients without asymptomatic ICAS, no ischemic stroke occurred out of the territory of the stented artery. Multivariable analysis showed that concomitant asymptomatic ICAS was an independent risk factor for 30-day stroke (odds ratio = 2.37, 95% confidence interval, 1.14-5.63; P = .023). CONCLUSIONS Concomitant asymptomatic ICAS (≥50% stenosis) might increase the 30-day risk of stroke in patients undergoing symptomatic ICAS stenting.
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84
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O'Connell GC, Tennant CS, Lucke-Wold N, Kabbani Y, Tarabishy AR, Chantler PD, Barr TL. Monocyte-lymphocyte cross-communication via soluble CD163 directly links innate immune system activation and adaptive immune system suppression following ischemic stroke. Sci Rep 2017; 7:12940. [PMID: 29021532 PMCID: PMC5636885 DOI: 10.1038/s41598-017-13291-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022] Open
Abstract
CD163 is a scavenger receptor expressed on innate immune cell populations which can be shed from the plasma membrane via the metalloprotease ADAM17 to generate a soluble peptide with lympho-inhibitory properties. The purpose of this study was to investigate CD163 as a possible effector of stroke-induced adaptive immune system suppression. Liquid biopsies were collected from ischemic stroke patients (n = 39), neurologically asymptomatic controls (n = 20), and stroke mimics (n = 20) within 24 hours of symptom onset. Peripheral blood ADAM17 activity and soluble CD163 levels were elevated in stroke patients relative to non-stroke control groups, and negatively associated with post-stroke lymphocyte counts. Subsequent in vitro experiments suggested that this stroke-induced elevation in circulating soluble CD163 likely originates from activated monocytic cells, as serum from stroke patients stimulated ADAM17-dependant CD163 shedding from healthy donor-derived monocytes. Additional in vitro experiments demonstrated that stroke-induced elevations in circulating soluble CD163 can elicit direct suppressive effects on the adaptive immune system, as serum from stroke patients inhibited the proliferation of healthy donor-derived lymphocytes, an effect which was attenuated following serum CD163 depletion. Collectively, these observations provide novel evidence that the innate immune system employs protective mechanisms aimed at mitigating the risk of post-stroke autoimmune complications driven by adaptive immune system overactivation, and that CD163 is key mediator of this phenomenon.
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Affiliation(s)
- Grant C O'Connell
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA. .,Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
| | - Connie S Tennant
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Noelle Lucke-Wold
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Yasser Kabbani
- Department of Neuroradiology, Ruby Memorial Hospital, Morgantown, WV, USA
| | - Abdul R Tarabishy
- Department of Neuroradiology, Ruby Memorial Hospital, Morgantown, WV, USA
| | - Paul D Chantler
- Center for Cardiovascular and Respiratory Sciences, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA.,Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Taura L Barr
- Center for Basic and Translational Stroke Research, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA.,School of Nursing, West Virginia University, Morgantown, West Virginia, USA.,Valtari Bio Incorporated, Morgantown, WV, USA
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85
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Yum KS, Chang JY, Jeong WJ, Lee S, Jeong JH, Yeo MJ, Hong JH, Park HK, Chung I, Kim BJ, Bang JS, Bae HJ, Han MK. Effect of statin on progression of symptomatic basilar artery stenosis and subsequent ischemic stroke. PLoS One 2017; 12:e0183798. [PMID: 29020008 PMCID: PMC5636063 DOI: 10.1371/journal.pone.0183798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background and objective Symptomatic basilar artery stenosis (BAS) is associated with high risk of ischemic stroke recurrence. We aimed to investigate whether statin therapy might prevent the progression of symptomatic BAS and stroke recurrence. Methods We retrospectively analyzed the data of patients with acute ischemia with symptomatic BAS, which was assessed using magnetic resonance angiogram (MRA) imaging on admission day, and 1 year later (or the day of the clinical event). The clinical endpoints were recurrent ischemic stroke and its composites, transient ischemic attack, coronary disease, and vascular death. Results Of the 153 patients with symptomatic BAS, 114 (74.5%) were treated with a statin after experiencing a stroke. Statin therapy significantly prevented the progression of symptomatic BAS (7.0% vs 28.2%) and induced regression (22.8% vs 15.4%) compared to non-statin users (p = 0.002). There were 31 ischemic stroke incidences and 38 composite vascular events. Statin users showed significantly lower stroke recurrence (14.9% vs 35.9%, p = 0.05) and composite vascular events (17.5% vs 46.2%; odds ratio [OR], 0.29; 95% confidence interval [CI], 0.13–0.64) than those not using statins did. Recurrent stroke in the basilar territory and composite vascular events were more common in patients with progression of BAS than they were in other patients (OR, 5.16; 95% CI, 1.63–16.25 vs OR, 4.2; 95% CI, 1.56–11.34). Conclusion Our study suggests that statin therapy may prevent the progression of symptomatic BAS and decrease the risk of subsequent ischemic stroke. Large randomized trials are needed to confirm this result.
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Affiliation(s)
- Kyu Sun Yum
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Young Chang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Won Joo Jeong
- Department of Critical Care, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangkil Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Heon Jeong
- Department of Intensive Care Medicine and Neurology, Dong-A University Hospital, Busan, Korea
| | - Min-Ju Yeo
- Department of Neurology, Chungbuk National University Hospital, Chungju, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hong-Kyun Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Inyoung Chung
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- * E-mail:
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86
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Nam KW, Kwon HM, Lim JS, Han MK, Nam H, Lee YS. The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease. PLoS One 2017; 12:e0184944. [PMID: 28991905 PMCID: PMC5633141 DOI: 10.1371/journal.pone.0184944] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/02/2017] [Indexed: 12/28/2022] Open
Abstract
Background Cerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA). Aim We evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA. Methods We consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms. Results Among a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components. Conclusions Cerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- * E-mail:
| | - Jae-Sung Lim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong-Seok Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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87
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Kim BS, Chung PW, Park KY, Won HH, Bang OY, Chung CS, Lee KH, Kim GM. Burden of Intracranial Atherosclerosis Is Associated With Long-Term Vascular Outcome in Patients With Ischemic Stroke. Stroke 2017; 48:2819-2826. [DOI: 10.1161/strokeaha.117.017806] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Byung-Su Kim
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Pil-Wook Chung
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Kwang-Yeol Park
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Hong-Hee Won
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Oh Young Bang
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Chin-Sang Chung
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Kwang Ho Lee
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
| | - Gyeong-Moon Kim
- From the Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea (B.-S.K.); Department of Neurology, Samsung Medical Center (B.-S.K., O.Y.B., C.-S.C., K.H.L., G.-M.K) and Department of Neurology, Kangbuk Samsung Hospital (P.-W.C.), Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (K.-Y.P.); and Samsung Advanced Institute for Health Sciences and Technology,
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88
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Zhang W, Yin Y, Zhang Y, Yang F, Shi W, Chen D, Song C, Shi H, Zhao X, Shi J. Influence of cerebrovascular reactivity on outcome of the patients with ≥50% symptomatic unilateral middle cerebral artery stenosis. Int J Neurosci 2017; 128:42-47. [PMID: 28724339 DOI: 10.1080/00207454.2017.1357552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Weiqing Zhang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Yanwei Yin
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Yingqian Zhang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Fen Yang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Wenqian Shi
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Dawei Chen
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Chen Song
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Huiping Shi
- Department of CT and MRI, Chinese PLA Air Force General Hospital, Beijing, China
| | - Xuanzhu Zhao
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Jin Shi
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
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89
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Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3258681. [PMID: 28698870 PMCID: PMC5494066 DOI: 10.1155/2017/3258681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/10/2017] [Accepted: 05/07/2017] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD) by conducting a meta-analysis. Two independent observers searched PubMed, EMBASE, and Cochrane Library for relevant studies up to 31 December 2016. A meta-analysis was conducted using Review Manager 5.3. Three studies involving 581 cases were included. The meta-analysis indicated that any stroke (RR = 3.13; 95% CI: 1.80-5.42), ischemic stroke (RR = 2.15; 95% CI: 1.19-3.89), and intracranial hemorrhage (RR = 14.71; 95% CI: 1.96-110.48) within 30 days in medical therapy alone were lower compared with PTAS plus medical therapy, but there were no significant differences in any stroke and ischemic stroke beyond 30 days between the two groups. There were also no significant differences in any death and myocardial infarction between the two groups. This meta-analysis demonstrated that, compared with medical therapy alone, PTAS for ICAD had a high risk of complication, but most complications in PTAS group occurred within 30 days after the operation, and beyond 30 days the PTAS was not inferior compared with medical therapy alone. Further studies are needed to reduce the periprocedural complications and reappraise the PTAS.
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90
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Harteveld AA, van der Kolk AG, van der Worp HB, Dieleman N, Zwanenburg JJM, Luijten PR, Hendrikse J. Detecting Intracranial Vessel Wall Lesions With 7T-Magnetic Resonance Imaging: Patients With Posterior Circulation Ischemia Versus Healthy Controls. Stroke 2017; 48:2601-2604. [PMID: 28701579 DOI: 10.1161/strokeaha.117.017868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vessel wall magnetic resonance imaging sequences have been developed to directly visualize the intracranial vessel wall, enabling detection of vessel wall changes, including those that have not yet caused luminal narrowing. In this study, vessel wall lesion burden was assessed in patients with recent posterior circulation ischemia using 7T-magnetic resonance imaging and compared with matched healthy controls. METHODS Fifty subjects (25 patients and 25 matched healthy controls) underwent 7T-magnetic resonance imaging with an intracranial vessel wall sequence before and after contrast administration. Two raters scored the presence and contrast enhancement of arterial wall lesions in individual segments of the circle of Willis and its primary branches. Total burden and distribution of vessel wall lesions and lesion characteristics (configuration, thickening pattern, and contrast enhancement) were compared both between and within both groups. RESULTS Overall, vessel wall lesion burden and distribution were comparable between patients and controls. Regarding individual arterial segments, only vessel wall lesions in the posterior cerebral artery were more frequently observed in patients (18.0%) than in controls (5.4%; P=0.003). Many of these lesions showed enhancement, both in patients (48.9%) and in controls (43.5%; P=0.41). In patients, the proportion of enhancing lesions was higher in the posterior circulation (53.3%) than in the anterior circulation (20.6%; P=0.008). CONCLUSIONS Although overall intracranial vessel wall lesion burden and contrast enhancement were comparable between patients with recent posterior circulation ischemia and healthy controls, this study also revealed significant differences between the 2 groups, suggesting an association between posterior circulation lesion burden/enhancement and ischemic events. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR5688.
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Affiliation(s)
- Anita A Harteveld
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
| | - Anja G van der Kolk
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - H Bart van der Worp
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Nikki Dieleman
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jaco J M Zwanenburg
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Peter R Luijten
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
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91
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Sousa JA, Mendes-Pinto M, Sargento-Freitas J, Silva F, Cecília C, Macário C, Gouveia A, Machado C, Rodrigues B, Santo GC, Lima A, Veiga R, Cunha L, Freire-Gonçalves A. Cerebrovascular Dissemination in Time and Space as a Predictor of Cardioembolism. J Stroke Cerebrovasc Dis 2017; 26:1407-1413. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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Hongo H, Miyawaki S, Imai H, Shinya Y, Ono H, Mori H, Nakatomi H, Kunimatsu A, Saito N. Smaller outer diameter of atherosclerotic middle cerebral artery associated with RNF213 c.14576G>A Variant (rs112735431). Surg Neurol Int 2017; 8:104. [PMID: 28695051 PMCID: PMC5473080 DOI: 10.4103/sni.sni_59_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Intracranial atherosclerosis (ICAS) involves diverse histologies and several remodeling patterns. Ring finger protein 213 (RNF213) c.14576G>A variant (rs112735431), recently reported to be associated with ICAS, may be linked with negative remodeling (outer diameter – reducing morphological alteration) of intracranial arteries. This study investigated the outer diameter of atherosclerotic middle cerebral artery (MCA). Methods: Patients with unilateral atherosclerotic MCA stenosis/occlusion were enrolled in this single-hospital-based case-control study at The University of Tokyo Hospital. The patients were divided into two groups by the presence of RNF213 c.14576G>A (variant group and wild-type group) and the outer diameter of the MCA was measured with high-resolution magnetic resonance imaging. Results: Twenty-eight patients with the wild type and 19 patients with the variant type were included. The outer diameter of the stenotic side MCA was smaller in the variant group than in the wild-type group (P = 8.3 × 10-6). The outer diameter of the normal side MCA was also smaller in the variant group than in the wild-type group (P = 5.2 × 10-3). The ratio of stenotic side to normal side was also smaller in the variant group than in the wild-type group (P = 1.5 × 10-5). Conclusions: This study indicates that RNF213 c.14576G>A is associated with negative remodeling of ICAS.
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Affiliation(s)
- Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Harushi Mori
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Kunimatsu
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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93
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Zhang DF, Chen YC, Chen H, Zhang WD, Sun J, Mao CN, Su W, Wang P, Yin X. A High-Resolution MRI Study of Relationship between Remodeling Patterns and Ischemic Stroke in Patients with Atherosclerotic Middle Cerebral Artery Stenosis. Front Aging Neurosci 2017; 9:140. [PMID: 28536522 PMCID: PMC5422497 DOI: 10.3389/fnagi.2017.00140] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/26/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: Recently, high-resolution magnetic resonance imaging (HR-MRI) has been used to depict the wall characteristics of the intracranial arteries. The aim of this study was to explain the relationship between the remodeling patterns and acute ischemic stroke in patients with atherosclerotic middle cerebral artery (MCA) stenosis using HR-MRI. Materials and Methods: From August 2015 to May 2016, we prospectively screened 33 consecutive patients with unilateral MCA stenosis using time-to-flight MR angiography, including 15 patients with symptomatic MCA stenosis and 18 patients with asymptomatic MCA stenosis. Among them, 14 patients were diagnosed as positive remodeling (PR) and 19 as negative remodeling or non-remodeling. The cross-sectional images of the stenotic MCA wall on HR-MRI including T1WI, T2WI, and PDWI were compared between the symptomatic group and the asymptomatic group as well as the PR group and the non-PR group, based on the vessel area, lumen area, wall area, plaque area, degree of stenosis, remodeling index, and NIHSS score. Results: The symptomatic group had larger wall area (P = 0.040), plaque area (P<0.001), degree of stenosis (P = 0.038), remodeling index (P < 0.001), and NIHSS score (P = 0.003) as well as smaller lumen area (P = 0.001) than the asymptomatic group. In addition, more PR patients were observed in symptomatic group. The PR group had larger plaque area (P = 0.014) and NIHSS score (P = 0.037) than the non-PR group. Demographic and clinical characteristics between the symptomatic group and the asymptomatic group, the PR group and the non-PR group showed no statistical difference. Conclusion: The current study suggests that the HR-MRI has emerged as a promising tool to detect the characteristics of intracranial arteries wall and reveal the relationship between remodeling patterns and ischemic stroke. The PR is an unsafe remodeling way and is prone to cause acute ischemic stroke.
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Affiliation(s)
- Dan-Feng Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China.,School of Medicine, Nanjing UniversityNanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Wei-Dong Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Jun Sun
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Cun-Nan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Wen Su
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical UniversityNanjing, China
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Dargazanli C, Mantilla D, Wiesspeiner U, Ayrignac X, Costalat V. Intracranial stenting after the Wingspan withdrawal in France: Clinical experience using a low profile coronary stent. J Neuroradiol 2017; 44:165-167. [PMID: 28168991 DOI: 10.1016/j.neurad.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/11/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Cyril Dargazanli
- Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - Daniel Mantilla
- Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Department of neuroradiology, Clinica Foscal, Fundacion Oftalmologica de Santander, Clinica Ardila Lulle, Bucaramanga, Colombia
| | - Ulrike Wiesspeiner
- Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Department of radiology, division of neuroradiology, Medical university of Graz, Graz, Austria
| | - Xavier Ayrignac
- Department of neurology, Montpellier university hospital center, Gui-de-Chauliac hospital, 34295 Montpellier, France
| | - Vincent Costalat
- Department of neuroradiology, Montpellier university hospital center, Gui-de-Chauliac hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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95
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Wu C, Schnell S, Vakil P, Honarmand AR, Ansari SA, Carr J, Markl M, Prabhakaran S. In Vivo Assessment of the Impact of Regional Intracranial Atherosclerotic Lesions on Brain Arterial 3D Hemodynamics. AJNR Am J Neuroradiol 2017; 38:515-522. [PMID: 28057635 DOI: 10.3174/ajnr.a5051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/26/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis induces hemodynamic disturbance, which is not well-characterized, particularly in cerebral flow redistribution. We aimed to characterize the impact of regional stenotic lesions on intracranial hemodynamics by using 4D flow MR imaging. MATERIALS AND METHODS 4D flow MR imaging was performed in 22 symptomatic patients (mean age, 68.4 ± 14.2 years) with intracranial stenosis (ICA, n = 7; MCA, n = 9; basilar artery, n = 6) and 10 age-appropriate healthy volunteers (mean age, 60.7 ± 8.1 years). 3D blood flow patterns were visualized by using time-integrated pathlines. Blood flow and peak velocity asymmetry indices were compared between patients and healthy volunteers in 4 prespecified arteries: ICAs, MCAs, and anterior/posterior cerebral arteries. RESULTS 3D blood flow pathlines demonstrated flow redistribution across cerebral arteries in patients with unilateral intracranial stenosis. For patients with ICA stenosis compared with healthy volunteers, significantly lower flow and peak velocities were identified in the ipsilateral ICA (P = .001 and P = .001) and MCA (P < .001 and P = .001), but higher flow, in the ipsilateral PCA (P < .001). For patients with MCA stenosis, significantly lower flow and peak velocities were observed in the ipsilateral ICA (P = .009 and P = .045) and MCA (P < .001 and P = .005), but significantly higher flow was found in the ipsilateral posterior cerebral artery (P = .014) and anterior cerebral artery (P = .006). The asymmetry indices were not significantly different between patients with basilar artery stenosis and the healthy volunteers. CONCLUSIONS Regional intracranial atherosclerotic lesions not only alter distal arterial flow but also significantly affect ipsilateral collateral arterial hemodynamics.
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Affiliation(s)
- C Wu
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois .,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Philips Healthcare (C.W.), Gainesville, Florida
| | - S Schnell
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - P Vakil
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - A R Honarmand
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S A Ansari
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Neurological Surgery (S.A.A.)
| | - J Carr
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - M Markl
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois.,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S Prabhakaran
- Neurology (S.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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96
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Timsit S, Bailly P, Nowak E, Merrien FM, Hervé D, Viakhireva-Dovganyuk I, Jourdain A, Thomas E, Goas P, Rouhart F. Cryptogenic mechanism in ischaemic stroke patients is a predictor of 5-year survival: A population-based study. Eur Stroke J 2016; 1:279-287. [PMID: 31008289 DOI: 10.1177/2396987316669216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism. Patients and methods A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At "home without help" was used as a surrogate marker for low Rankin (0-1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan-Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis. Results About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66-2.02]), coronary artery disease (HR = 1.28; [1.05-1.56]), cardiac arrhythmia (HR = 1.36; [1.11-1.67]), peripheral artery disease (HR = 1.66 [1.29-2.13]) and incomplete assessment (HR = 1.39; [1.12-1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68-0.94]), high Glasgow Coma Scale score (GCS > 12) (HR = 0.58; [0.45-0.76]), lacunar syndrome (HR = 0.82; [0.68-0.99], being 'at home without help' (HR = 0.50; [0.41-0.59]) and negative assessment (HR = 0.75; [0.58-0.97], compared to cardioembolism) were associated with better survival probability. Discussion Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality. Conclusion Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers.
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Affiliation(s)
- S Timsit
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Bailly
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Nowak
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | - F M Merrien
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - D Hervé
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | | | - A Jourdain
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Thomas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Goas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - F Rouhart
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
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97
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van den Wijngaard IR, Holswilder G, van Walderveen MAA, Algra A, Wermer MJH, Zaidat OO, Boiten J. Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 2016; 6:e00536. [PMID: 27843693 PMCID: PMC5102638 DOI: 10.1002/brb3.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is a common cause of stroke worldwide. It results in ischemic stroke due to different mechanisms including artery-to-artery embolism, in situ thrombo-occlusion, occlusion of perforating arteries, and hemodynamic failure. In this review, we present an overview of current treatment and imaging modalities in intracranial atherosclerotic stenosis. METHODS PubMed was searched for relevant articles in English that evaluated the treatment and imaging of intracranial atherosclerotic stenosis (ICAS). RESULTS Aggressive medical management, consisting of dual antiplatelet therapy and intensive risk factor management, is important in patients with ICAS because of a substantial risk of recurrent stroke, approximately 20% in the first year, in patients on aspirin or warfarin alone. Recent trials have suggested that, aggressive medical therapy results in better outcome as compared with intracranial stenting. However, the question remains what the optimal treatment strategy would be in patients with recurrent strokes in the setting of failed aggressive medical therapy. Moreover, controversy exists whether a subgroup of patients with symptomatic ICAS could benefit from intracranial stenting if selection is based on radiological evidence of hemodynamic failure. With regard to imaging, transcranial Doppler ultrasound and magnetic resonance angiography are useful screening tests for exclusion of ICAS, but need confirmation by other imaging modalities when stenosis is suggested. Computed tomography angiography has a high positive and negative predictive value for detection of intracranial luminal stenosis of 50% or higher, but performs worse than digital subtraction angiography with regard to establishing the exact degree of luminal stenosis. Novel imaging techniques including high-resolution CT and MRI better identify plaque characteristics than conventional imaging methods. CONCLUSIONS Currently, aggressive medical management remains the standard of care for patients with ICAS. Further research is needed to identify high-risk subgroups and to develop more effective treatments for ICAS patients.
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Affiliation(s)
- Ido R. van den Wijngaard
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
| | | | | | - Ale Algra
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Osama O. Zaidat
- Department of NeurologyMedical College of Wisconsin/Froedtert HospitalMilwaukeeWIUSA
| | - Jelis Boiten
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
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98
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Kass-Hout T, Winningham M, Kass-Hout O, Henriquez L, Tong F, Dion J, Cawley M, Belagaje S, Frankel M, Anderson A, Nahab F. Clopidogrel plus Aspirin for Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study. INTERVENTIONAL NEUROLOGY 2016; 5:157-164. [PMID: 27781044 DOI: 10.1159/000447025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE There are limited data on the optimal duration of dual antiplatelet therapy for secondary stroke prevention in patients with symptomatic intracranial atherosclerotic disease. METHODS Consecutive patients presenting with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011, to December 31, 2013, and evaluated within 30 days of the index event were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) protocol; all patients were given gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n = 227). RESULTS Our cohort included 25 patients that met the inclusion criteria. Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and the SAMMPRIS cohort. At 1 year, the rates of stroke, myocardial infarction or vascular death were 0% in our cohort and 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding rates were similar between our cohort and the SAMMPRIS cohort (4 vs. 2.2%, p = 1.0). CONCLUSION A prolonged course of dual antiplatelet therapy for symptomatic intracranial atherosclerotic disease may be associated with less vascular events with no increase in hemorrhagic complications.
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Affiliation(s)
- Tareq Kass-Hout
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA; Department of Neurosciences, Rochester Regional Health, Rochester, N.Y, USA
| | - Melanie Winningham
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Omar Kass-Hout
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA; Department of Neurosciences, Catholic Health System, Buffalo, N.Y., USA
| | - Laura Henriquez
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Frank Tong
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Jacques Dion
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Michael Cawley
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Samir Belagaje
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Michael Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Aaron Anderson
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA
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99
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Selvaraj UM, Poinsatte K, Torres V, Ortega SB, Stowe AM. Heterogeneity of B Cell Functions in Stroke-Related Risk, Prevention, Injury, and Repair. Neurotherapeutics 2016; 13:729-747. [PMID: 27492770 PMCID: PMC5081124 DOI: 10.1007/s13311-016-0460-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
It is well established that post-stroke inflammation contributes to neurovascular injury, blood-brain barrier disruption, and poor functional recovery in both animal and clinical studies. However, recent studies also suggest that several leukocyte subsets, activated during the post-stroke immune response, can exhibit both pro-injury and pro-recovery phenotypes. In accordance with these findings, B lymphocytes, or B cells, play a heterogeneous role in the adaptive immune response to stroke. This review highlights what is currently understood about the various roles of B cells, with an emphasis on stroke risk factors, as well as post-stroke injury and repair. This includes an overview of B cell functions, such as antibody production, cytokine secretion, and contribution to the immune response as antigen presenting cells. Next, evidence for B cell-mediated mechanisms in stroke-related risk factors, including hypertension, diabetes, and atherosclerosis, is outlined, followed by studies that focus on B cells during endogenous protection from stroke. Subsequently, animal studies that investigate the role of B cells in post-stroke injury and repair are summarized, and the final section describes current B cell-related clinical trials for stroke, as well as other central nervous system diseases. This review reveals the complex role of B cells in stroke, with a focus on areas for potential clinical intervention for a disease that affects millions of people globally each year.
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Affiliation(s)
- Uma Maheswari Selvaraj
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 6000 Harry Hines Blvd, MC8813, Dallas, TX, 75390, USA
| | - Katherine Poinsatte
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 6000 Harry Hines Blvd, MC8813, Dallas, TX, 75390, USA
| | - Vanessa Torres
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 6000 Harry Hines Blvd, MC8813, Dallas, TX, 75390, USA
| | - Sterling B Ortega
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 6000 Harry Hines Blvd, MC8813, Dallas, TX, 75390, USA
| | - Ann M Stowe
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 6000 Harry Hines Blvd, MC8813, Dallas, TX, 75390, USA.
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100
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Tsai MT, Erickson SR, Cohen LJ, Wu CH. The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes: An 11-year population-based retrospective cohort study. J Affect Disord 2016; 202:178-86. [PMID: 27262640 DOI: 10.1016/j.jad.2016.03.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. METHODS This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001-2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. RESULTS Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02-1.72). LIMITATIONS The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. CONCLUSION A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.
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Affiliation(s)
- Meng-Ting Tsai
- Department of Pharmacy, Taipei Medical University Hospital, Taiwan; School of Pharmacy, College of Pharmacy, Taipei Medical University, Taiwan
| | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, United States
| | - Lawrence J Cohen
- Department of Pharmacotherapy, System College of Pharmacy, University of North Texas Health Science Center, United States
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taiwan; Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taiwan.
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