1
|
Thiankhaw K, Ozkan H, Ambler G, Werring DJ. Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis. J Neurol 2024; 271:772-781. [PMID: 38019295 PMCID: PMC10827828 DOI: 10.1007/s00415-023-12094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke. METHODS We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%). CONCLUSIONS In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.
Collapse
Affiliation(s)
- Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Hatice Ozkan
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gareth Ambler
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.
| |
Collapse
|
2
|
Zhang W, Fu F, Zhan Z. Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis. Front Aging Neurosci 2024; 15:1240509. [PMID: 38259641 PMCID: PMC10800362 DOI: 10.3389/fnagi.2023.1240509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/28/2023] [Indexed: 01/24/2024] Open
Abstract
Background White matter hyperintensities (WMHs) are key neuroimaging markers of cerebral small vessel diseases. This study aimed to investigate whether intracranial and extracranial atherosclerotic stenosis is associated with WMHs. Methods Following a previously registered protocol (PROSPERO protocol: CRD42023407465), PubMed, Web of Science, and Embase were systematically searched for relevant literature published until March 2023. Cross-sectional studies examining the association between intracranial and extracranial atherosclerotic stenosis and WMHs were included. Random effects models were used to calculate the pooled estimates. Results Twenty-one eligible studies, including 10,841 participants, were identified. Intracranial and extracranial atherosclerotic stenosis was associated with an increased risk of WMHs (OR 1.80, 95% CI 1.25-2.57, I2 = 75%) and increased WMH volumes (SMD 0.40, 95% CI 0.18-0.63, I2 = 63%). Heterogeneity resulted from the WMHs rating method and the location. Extracranial atherosclerotic stenosis (ECAS) was significantly associated with WMHs (OR 2.10, 95% CI 1.22-3.62, I2 = 71%), but intracranial atherosclerotic stenosis (ICAS) was insignificantly associated with WMHs (OR 1.75, 95% CI 0.97-3.15, I2 = 84%). The association was stable in the subgroup analysis based on WMHs location, which included deep WMHs and periventricular WMHs. Conclusion Intracranial and extracranial atherosclerotic stenosis is associated with WMHs. This association is significant in ECAS, but attenuated in ICAS.
Collapse
Affiliation(s)
- Wenyuan Zhang
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenxiang Zhan
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| |
Collapse
|
3
|
Ghanaati H, Rahmatian A, Taheri M, Bahaadin Siroos S. Isolated intracranial arterial dolichoectasia of the anterior cerebral artery, a case report and review the literature. INTERDISCIPLINARY NEUROSURGERY 2023; 34:101849. [DOI: 10.1016/j.inat.2023.101849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
|
4
|
Wu F, Zhang M, Qi Z, Ma Q, Yu Z, Lu J. Imaging features of vertebrobasilar dolichoectasia combined with posterior circulation ischemic stroke: A vessel wall magnetic resonance imaging study. Eur J Radiol 2023; 166:110971. [PMID: 37506476 DOI: 10.1016/j.ejrad.2023.110971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To elucidate the vessel wall changes of vertebrobasilar dolichoectasia (VBD) with ischemic stroke, using vessel wall magnetic resonance imaging (VW-MRI). METHOD Thirty-four patients with VBD (22 with stroke and 12 without stroke) who underwent VW-MRI were recruited. Forty-one patients without VBD who underwent VW-MRI were also recruited if they had a recent stroke due to atherosclerosis in the basilar artery or the intracranial vertebral artery. The vessel wall features of VBD were compared between stroke and non-stroke groups. The plaque characteristics were compared between VBD and non-VBD stroke patients. RESULTS The frequency of plaques was higher (54.5% vs. 8.3%, P = 0.011) in VBD patients with stroke than that in non-stroke patients, while the frequencies of aneurysm, dissection, intraluminal thrombus, and diffuse/concentric wall enhancement did not differ. When the plaque features were compared between plaque-positive stroke patients with and without VBD, the degree of stenosis (31.0% ± 26.8% vs. 71.5% ± 19.0%, P < 0.001), normalized wall index (NWI) (0.7 ± 0.1 vs. 0.9 ± 0.1, P < 0.001), and remodeling index (RI) (1.0 ± 0.4 vs. 1.3 ± 0.4, P = 0.023) were lower in the VBD group, while intraplaque hemorrhage, and enhancement ratio showed no difference. CONCLUSIONS This preliminary study suggests that atherosclerosis may be an important cause of stroke in VBD patients. Symptomatic plaques in VBD patients have a lower degree of stenosis, NWI, and RI than that in non-VBD patients. VW-MRI may help to assess stroke mechanisms and identify VBD patients at high risk.
Collapse
Affiliation(s)
- Fang Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Miao Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Zhigang Qi
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Yu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
| |
Collapse
|
5
|
Rezai Jahromi B, Niemelä M. “Dolichoectatic Vertebrobasilar Artery Aneurysms”. Neurosurg Clin N Am 2022; 33:419-429. [DOI: 10.1016/j.nec.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Wang Y, Yu J. Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia. Front Neurol 2022; 13:895527. [PMID: 35865646 PMCID: PMC9294217 DOI: 10.3389/fneur.2022.895527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022] Open
Abstract
Vertebrobasilar dolichoectasia (VBD) is characterized by significant expansion, elongation, and tortuosity of the basilar artery and vertebral artery. Certain highly selected cases of VBD can require intervention. Recent advances in endovascular treatment (EVT) have renewed hope for patients with VBD. However, which cases of VBD can benefit from EVT still needs to be determined. Currently, little is known regarding this matter. Therefore, we performed a review of the literature from a PubMed search and cataloged our experience regarding the classification and natural history of VBD and the prospects, prognosis and complications of EVT. The findings can be summarized as follows: for asymptomatic VBD, “wait and see” or medical management may be a reasonable strategy. EVT may only be effective in certain patients. For saccular aneurysms in VBD, especially ruptured aneurysms, EVT is reasonable. For fusiform aneurysms in VBD, EVT can carry high complication rates and should be recommended with caution. For stenting reconstruction in VBD, the effect is uncertain. For the future of EVT of VBD, randomized controlled trials and the development of neurointerventional products are worth pursuing, but EVT in VBD still has a long way to go.
Collapse
Affiliation(s)
| | - Jinlu Yu
- *Correspondence: Jinlu Yu ; /0000-0003-2329-7946
| |
Collapse
|
7
|
Liu FX, Niu YG, Zhang DP, Zhang HL, Zhang ZQ, Sun RQ, Zhang YK. Modified Protocol for Establishment of Intracranial Arterial Dolichoectasia Model by Injection of Elastase Into Cerebellomedullary Cistern in Mice. Front Neurol 2022; 13:860541. [PMID: 35518204 PMCID: PMC9062172 DOI: 10.3389/fneur.2022.860541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study aimed to construct an animal model of intracranial arterial dolichoectasia (IADE) applying the modified modeling protocol. Materials and Methods Twenty five milliunits elastase and inactivated elastase were, respectively, injected into the cerebellomedullary cistern of 60 C57/BL6 mice which were divided into experimental group (EG, n = 30) and control group (CG, n = 30) by using a computer-based random order generator. The modified modeling protocol clarified these aspects including brain three-dimensional parameters of mouse head fixation, angle of head inclination, fixed position of taper ear, needle holding technique, needle entry depth, prevention of liquid drug back flow, and storage conditions of elastase. And it was observed for the following parts such as mortality, inflammatory factors, craniocerebral arteries scanning, vascular tortuosity index, artery diameter, pathology of the cerebrovascular. Results Within differently surveyed stage, the total mortality of mice in EG was 20%. ELISA illustrated that the levels of matrix metalloproteinase-9 (MMP-9) and tumor necrosis factor α (TNF-α) in peripheral blood were increased significantly after modeling. Angiography indicated that 100% of IADE in EG were observed and the diameter and tortuosity index of the basilar artery were significantly increased (P < 0.01). EVG histological processing and staining showed the disrupted internal elastic lamina, the atrophied muscle layer, and the hyalinized connective tissue of the basilar artery with the vascular wall tunica media in EG. Micro-computed tomography reported that the craniocerebral arteries of the mice in EG were outstandingly elongated, tortuous, and dilated. Conclusion The modified modeling protocol can reduce the mortality, improve the success rate, and provide a stable animal model for IADE.
Collapse
Affiliation(s)
- Fei Xiang Liu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yu Ge Niu
- College of Traditional Chinese Medicine, Henan University of Traditional Chinese Medicine Academy, Zhengzhou, China
| | - Dao Pei Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhen Qiang Zhang
- College of Traditional Chinese Medicine, Henan University of Traditional Chinese Medicine Academy, Zhengzhou, China
| | - Rui Qin Sun
- Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yun Ke Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| |
Collapse
|
8
|
Watanabe A, Tsutsumi S, Sugiyama H, Nonaka S, Okura H, Ishii H. Delayed traumatic intracerebral hemorrhage associated with dolichoectasia of the middle cerebral artery. Radiol Case Rep 2022; 17:1215-1219. [PMID: 35169431 PMCID: PMC8829533 DOI: 10.1016/j.radcr.2022.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
A 74-year-old man tripped while walking. He had not been administered antiplatelet or anticoagulation therapy. At presentation, the patient was well-oriented, with a blood pressure of 130/91 mmHg, while present with tetraplegia and numbness in the upper extremities. Blood work revealed normal findings, while magnetic resonance imaging of the cervical spine revealed severe cord compression at the C3/4 and C4/5 levels. Cranial computed tomography (CT) showed elongated masses in the Sylvian fissures without intracranial hemorrhage. CT taken 2 days later revealed an intraparenchymal hemorrhage located mainly in the right putaminal region, while the patient showed no signs of neurological deterioration. Three-dimensional CT angiography (3D CTA) demonstrated marked ectasia and elongation in the right internal carotid, bilateral middle cerebral, and left anterior cerebral arteries. The patient was conservatively managed. Repeat 3D CTA performed 3 months later showed no de novo abnormalities in the ectatic cerebral arteries. It is assumed that the delayed traumatic intracerebral hemorrhage was caused by disruption of the perforating vessels arising from the ipsilateral dolichoectatic middle cerebral artery. Periodical surveillance neuroimaging is recommended for patients with head trauma who are simultaneously diagnosed with incidental dolichoectasia, especially when complicated with cervical cord injury.
Collapse
|
9
|
Meng LB, Zhang YM, Luo Y, Gong T, Liu DP. Chronic Stress A Potential Suspect Zero of Atherosclerosis: A Systematic Review. Front Cardiovasc Med 2022; 8:738654. [PMID: 34988123 PMCID: PMC8720856 DOI: 10.3389/fcvm.2021.738654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Atherosclerosis (AS) is a chronic vascular inflammatory disease, in which the lipid accumulation in the intima of the arteries shows yellow atheromatous appearance, which is the pathological basis of many diseases, such as coronary artery disease, peripheral artery disease and cerebrovascular disease. In recent years, it has become the main cause of death in the global aging society, which seriously endangers human health. As a result, research on AS is increasing. Lesions of atherosclerosis contain macrophages, T cells and other cells of the immune response, together with cholesterol that infiltrates from the blood. Recent studies have shown that chronic stress plays an important role in the occurrence and development of AS. From the etiology of disease, social, environmental and genetic factors jointly determine the occurrence of disease. Atherosclerotic cardio-cerebrovascular disease (ASCVD) is often caused by chronic stress (CS). If it cannot be effectively prevented, there will be biological changes in the body environment successively, and then the morphological changes of the corresponding organs. If the patient has a genetic predisposition and a combination of environmental factors triggers the pathogenesis, then chronic stress can eventually lead to AS. Therefore, this paper discusses the influence of chronic stress on AS in the aspects of inflammation, lipid metabolism, endothelial dysfunction, hemodynamics and blood pressure, plaque stability, autophagy, ferroptosis, and cholesterol efflux.
Collapse
Affiliation(s)
- Ling-Bing Meng
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Meng Zhang
- Department of Internal Medicine, The Third Medical Centre of Chinese People's Liberation Army (PLA) General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China
| | - Yue Luo
- Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Tao Gong
- Department of Neurology, National Center of Gerontology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - De-Ping Liu
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
10
|
Del Brutto VJ, Prabhakaran S, Liebeskind DS, Campo-Bustillo I, Cotsonis G, Nizam A, Romano JG. Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease: Results from the MYRIAD study. J Neuroimaging 2021; 31:931-939. [PMID: 33942908 DOI: 10.1111/jon.12872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. METHODS We analyzed 98 participants (mean age 63.8 ± 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. RESULTS IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. CONCLUSIONS IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
Collapse
Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | | | - Iszet Campo-Bustillo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | -
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|