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Ryu JC, Lee SH, Kwon B, Song Y, Lee DH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis. J Clin Neurosci 2024; 125:1-6. [PMID: 38728814 DOI: 10.1016/j.jocn.2024.05.001] [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: 02/14/2024] [Revised: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Carotid artery stenting (CAS) has been the standard treatment for carotid stenosis because it is less invasive; however, the risk of periprocedural thromboembolism is high. We investigated the predictors for silent brain infarcts (SBIs), focusing on embolic protection in CAS. METHODS This study was single-center retrospective study, and we obtained baseline demographics and clinical, laboratory, and periprocedural variables of patients who underwent CAS. Also, methods used for embolic protection (no EPD, distal EPD, or proximal balloon guiding catheter) during CAS were obtained. Distal normal vessel diameter was defined as the diameter of cervical internal carotid artery where the artery wall becomes parallel. Diffusion-weighted imaging was performed before and after procedure to detect SBIs. The primary outcome was stented territory SBIs, and the secondary outcomes were any territories SBIs and stented territory SBIs in cases with EPD. RESULTS A total of 196 CAS procedures with mean age 69.1 ± 9.9 years were included. After CAS, stented territory SBIs occurred in 53 (27.0 %) cases and any territories SBIs in 60 (30.6 %) cases. Univariable analyses revealed that distal normal vessel diameter (odds ratio = 1.71, 95 % confidence interval = 1.20-2.43, P = 0.003) was associated with the occurrence of stented territory SBIs after CAS. After adjusting for potential variables, larger distal normal vessel diameter (1.61 [1.10-2.36], P = 0.014) increased the occurrence of SBIs after CAS. Consistent results were obtained when the outcome was any territories SBIs or stented territory SBIs in cases with EPD. CONCLUSIONS Distal normal vessel diameter was a predictor for the occurrence of SBI after CAS. The passable pore size of EPDs may vary depending on vessel diameter, and may impact the occurrence of SBIs.
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Affiliation(s)
- Jae-Chan Ryu
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Boseong Kwon
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yunsun Song
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Deok Hee Lee
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wha Kang
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun U Kwon
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Jun Young Chang
- Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Zhang L, Wang S, Qiu L, Jiang J, Jiang J, Zhou Y, Ding D, Fang Q. Effects of silent brain infarction on the hemorrhagic transformation and prognosis in patients with acute ischemic stroke after intravenous thrombolysis. Front Neurol 2023; 14:1147290. [PMID: 37251227 PMCID: PMC10212719 DOI: 10.3389/fneur.2023.1147290] [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: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Silent brain infarction (SBI) is a special type of stroke with no definitive time of onset, which can be found on pre-thrombolysis imaging examination in some patients with acute ischemic stroke (AIS). However, the significance of SBI on intracranial hemorrhage transformation (HT) and clinical outcomes after intravenous thrombolysis therapy (IVT) is uncertain. We aimed to explore the effects of SBI on intracranial HT and the 3-month clinical outcome in patients with AIS after IVT. Methods We consecutive collected patients who were diagnosed with ischemic stroke and received IVT from August 2016 to August 2022, and conducted a retrospective analysis in this study. The clinical and laboratory data were obtained from hospitalization data. Patients were divided into SBI and Non-SBI groups based on clinical and neuroimaging data. We use Cohen's Kappa to assess the interrater reliability between the two evaluators, and multivariate logistic regression analysis was used to further assess the association between SBI, HT and clinical outcomes at 3 months after IVT. Results Of the 541 patients, 231 (46.1%) had SBI, 49 (9.1%) had HT, 438 (81%) had favorable outcome, 361 (66.7%) had excellent outcome. There was no significant difference in the incidence of HT (8.2 vs. 9.7%, p = 0.560) and favorable outcome (78.4% vs. 82.9%, p = 0.183) between patients with SBI and Non-SBI. However, patients with SBI had a lower incidence of excellent outcome than the patients with Non-SBI (60.2% vs. 71.6%%, p = 0.005). After adjustment for major covariates, multivariate logistic regression analysis disclosed that SBI was independently associated with the increased risk of worse outcome (OR = 1.922, 95%CI: 1.229-3.006, p = 0.004). Conclusion We found that SBI was no effect for HT after thrombolysis in ischemic stroke patients, and no effect on favorable functional outcome at 3 months. Nevertheless, SBI remained an independent risk factor for non-excellent functional outcomes at 3 months.
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Affiliation(s)
- Lulu Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shan Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lanfeng Qiu
- Department of Emergency, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juean Jiang
- Department of General Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhua Jiang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Zhou
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongxue Ding
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Huang KL, Chang TY, Wu YM, Chang YJ, Wu HC, Liu CH, Lee TH, Ho MY. Mediating roles of leukoaraiosis and infarcts in the effects of unilateral carotid artery stenosis on cognition. Front Aging Neurosci 2022; 14:972480. [PMID: 36248002 PMCID: PMC9559387 DOI: 10.3389/fnagi.2022.972480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectivesLeukoaraiosis and infarcts are common in patients with carotid artery stenosis (CAS), and CAS severity, leukoaraiosis and infarcts all have been implicated in cognitive impairments. CAS severity was not only hypothesized to directly impede specific cognitive domains, but also transmit its effects indirectly to cognitive function through ipsilateral infarcts as well as periventricular leukoaraiosis (PVL) and deep white matter leukoaraiosis (DWML). We aimed to delineate the contributions of leukoaraiosis, infarcts and CAS to different specific cognitive domains.Materials and methodsOne hundred and sixty one participants with unilateral CAS (>50%) on the left (n = 85) or right (n = 76) side and 65 volunteers without significant CAS (<50%) were recruited. The PVL, DWML, and infarct severity were visually rated on MRI. A comprehensive cognitive battery was administered and standardized based on age norms. Correlation and mediation analyses were adopted to examine the direct and indirect influence of CAS, leukoaraiosis, and infarct on specific cognitive domains with adjustment for education, hypertension, diabetes mellitus, and hyperlipidemia.ResultsCarotid artery stenosis severity was associated with ipsilateral leukoaraiosis and infarct. Left CAS had direct effects on most cognitive domains, except for visual memory and constructional ability, and transmitted its indirect effects on all cognitive domains through ipsilateral PVL, and on constructional ability and psychomotor through infarcts. Right CAS only had negative direct effects on visual memory, psychomotor, design fluency and color processing speed, and transmitted its indirect effects on visual memory, word and color processing speed through ipsilateral infarcts. The trends of direct and indirect cognitive effects remained similar after covariate adjustment.ConclusionLeft and right CAS would predominantly lead to verbal and non-verbal cognitive impairment respectively, and such effects could be mediated through CAS-related leukoaraiosis and infarct. Given that cognition is subject to heterogeneous pathologies, the exact relationships between markers of large and small vessel diseases and their composite prognostic effects on cognition requires further investigation.
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Affiliation(s)
- Kuo-Lun Huang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Yu Chang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Ming Wu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Radiology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yeu-Jhy Chang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hsiu-Chuan Wu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Tsong-Hai Lee,
| | - Meng-Yang Ho
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan City, Taiwan
- *Correspondence: Meng-Yang Ho,
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The risk factors of old silent brain infarctions in carotid artery stenosis. Neurol Sci 2021; 43:2397-2404. [PMID: 34586540 DOI: 10.1007/s10072-021-05638-9] [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: 03/07/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to investigate the risk factors of old ipsilateral silent brain infarctions (iSBIs) in patients with internal carotid artery (ICA) stenosis. METHODS Consecutive patients with unilateral ICA stenosis ≥ 50% or occlusion were retrospectively enrolled. Old iSBIs were assessed on magnetic resonance imaging. Baseline characteristics and imaging features were compared between patients with and without iSBIs. Multivariable regression analysis was conducted to identify independent risk factors of iSBIs. RESULTS We enrolled 274 patients with unilateral ICA stenosis ≥ 50% or occlusion. One hundred thirty-three patients had iSBIs to stenosed ICA (48.54%). One hundred thirty-seven patients had recent brain infarction on either side (50.0%). The patients with iSBIs had a lower level of high-density lipoprotein [OR 0.60, 95% CI (0.36-0.96), P = 0.045], higher prevalence of irregular/ulcer plaque [OR 10.71, 95% CI (4.60-24.95), P < 0.0001], and incompleteness of circle of Willis [OR 0.27, 95% CI (0.16-0.45), P < 0.0001] in all enrolled patients. In the patients without recent infarction on either side, lower level of high-density lipoprotein [OR 0.42, 95% CI (0.27-0.88), P = 0.031], higher prevalence of irregular/ulcer plaque [OR 12.73, 95% CI (4.13-39.22), P < 0.0001] and incompleteness of circle of Willis [OR 0.24, 95% CI (0.11-0.50), P = 0.004] were independently associated with iSBIs. The results were similar in ICA stenosis patients with recent brain infarction on either side. CONCLUSION In patients with carotid stenosis, incompleteness of circle of Willis, irregular/ulcer plaque, and lower level of high-density lipoprotein were independently associated with old iSBIs.
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