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Zhang Q, Chen Z, Chen Y, Niu Y. Basilar artery fenestration with slit-like configuration mimicking artery dissection. J Clin Neurosci 2024; 126:77-79. [PMID: 38852426 DOI: 10.1016/j.jocn.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/15/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Qiang Zhang
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Chongqing 400038, China; Department of Neurosurgery, The 961st Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, No. 71 Postal Road, Qiqihar 161000, Heilongjiang, China
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Chongqing 400038, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Chongqing 400038, China
| | - Yin Niu
- Department of Neurosurgery, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Street, Chongqing 400038, China.
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Morris L, Lawless A, McDonnell JM, Wilson KV, Marland H, Darwish S, Butler JS. Retrospective case series of vertebral artery injuries associated with cervical spine trauma. Surgeon 2024:S1479-666X(24)00079-9. [PMID: 39084923 DOI: 10.1016/j.surge.2024.07.007] [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: 11/30/2023] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Vertebral artery injuries (VAI) can occur due to cervical spine trauma. VAI can prove a serious complication and potentially compromise vascular supply to the posterior aspect of the brain. Currently, there is a paucity of evidence with regards to incidence, management, and outcomes for these patients. The purpose of this study is to investigate and elucidate the incidence of VAI associated with cervical trauma at a national tertiary referral centre for spinal pathology, their respective management, and associated outcomes. METHODS A retrospective review was conducted from 2012 to 2021 to identify patients with VAI secondary to cervical spine trauma. Demographic, clinical, and radiological data was collected to identify common traits in injury characteristics and management. RESULTS 1013 spine patients presented to our institution across the 10-year period. 739/1013 (72.9 %) were trauma patients. 42/739 (5.7 %) were imaged for suspected VAI secondary to trauma. There were 14/739 (1.9 %) confirmed VAI. All patients had CT-angiography for diagnosis. Four of the confirmed VAI patients (28.6 %) had additional MR-angiography imaging. Right-side was the most common side of VAI injury (7/14; 50 %), followed by left (5/14; 35.7 %) and bilateral (2/14; 14.3 %) injuries. 8/14 (57.1 %) patients were prescribed anti-thrombotic therapy. Acute mortality within 3-months was noted to be 2/14 (14.3 %) and occurred at 49 days and 57 days respectively. CONCLUSION VAI associated with cervical spine injury is rare in occurrence. However, it can be associated with high morbidity and mortality. As such, a multi-disciplinary approach to care is integral to ensuring good outcomes in these patients.
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Affiliation(s)
- Leah Morris
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anna Lawless
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; Trinity Centre of Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Kielan V Wilson
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | - Harry Marland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University of Galway, Galway, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Jia X, Zhu Y. Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e39084. [PMID: 39058866 PMCID: PMC11272348 DOI: 10.1097/md.0000000000039084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). PATIENT CONCERNS A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. DIAGNOSES The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. INTERVENTIONS Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. OUTCOMES This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. LESSONS Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.
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Affiliation(s)
- Xiaojian Jia
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yuefeng Zhu
- Department of Vascular Surgery, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Salih M, Taussky P, Ogilvy CS. Association between cervicocerebral artery dissection and tortuosity - a review on quantitative and qualitative assessment. Acta Neurochir (Wien) 2024; 166:285. [PMID: 38977512 DOI: 10.1007/s00701-024-06171-2] [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: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
Cervicocerebral artery dissection stands out as a significant contributor to ischemic stroke in young adults. Several studies have shown that arterial tortuosity is associated with dissection. We searched Pubmed and Embase to identify studies on the association between arterial tortuosity and cervicocerebral artery dissection, and to perform a review on the epidemiology of cervicocerebral artery tortuosity and dissection, pathophysiology, measurement of vessels tortuosity, strength of association between tortuosity and dissection, clinical manifestation and management strategies. The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation is used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervicocerebral artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with cervicocerebral artery dissection. Symptomatic patients with extracranial cervical artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Patients with recurrent ischemia, compromised cerebral blood flow or contraindications for antithrombotic agents are usually treated with open surgery or endovascular technique. Those with subarachnoid hemorrhage and intracranial artery dissection are often managed with surgical intervention due to high risk of re-hemorrhage.
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Affiliation(s)
- Mira Salih
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Philipp Taussky
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Christopher S Ogilvy
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States.
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Puggaard R, Laugesen NG, Hansen K, Brandt AH, Stavngaard T, Truelsen TC. Outcome and safety of mechanical thrombectomy in patients with acute ischemic stroke due to internal carotid artery dissection. Interv Neuroradiol 2024:15910199241261753. [PMID: 38870399 DOI: 10.1177/15910199241261753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Mechanical thrombectomy (MT) in patients with symptoms of acute ischemic stroke (AIS) due to internal carotid artery dissection (ICAD) remains controversial. In this study, we present clinical outcome and safety of MT in acute ICAD compared to other acute carotid artery pathology. METHODS Patients with symptoms of AIS due to internal carotid artery pathology, treated with MT from 2017-2021, were categorized as ICAD or non-ICAD. Baseline and procedural characteristics, complications, and functional outcome at 90 days were compared between the two groups. Factors associated with a favorable outcome (modified Rankin Scale 0-2) were analyzed using multivariate logistic regression. Safety analyses included in-stent thrombosis, perforation, intracranial hemorrhage, and mortality. RESULTS Sixty-seven ICAD patients (14.8%) and 387 non-ICAD patients (85.2%) were enrolled. ICAD patients were younger, median age 53 years (interquartile range (IQR) 47-61) vs. non-ICAD 72 years (IQR 64-79), p < 0.001. Favorable outcome was more common in ICAD patients, 49 ICAD patients (76.6%) vs. 158 non-ICAD patients (42.4%), p < 0.001. Post-procedural symptomatic intracranial hemorrhage occurred in 41 patients, 5 (7.5%) ICAD patients vs. 36 (9.3%) non-ICAD patients, p = 0.6. Mortality differed significantly, 6 (9%) ICAD patients vs. 94 (24.3%) non-ICAD patients, p = 0.01. ICAD was not associated with functional outcome in multivariate analysis, OR = 1.25 [95%confidence interval:0.55-2.86]. CONCLUSION ICAD patients achieved a better 90-day functional outcome compared with non-ICAD patients. ICAD patients did not perform worse in safety measures than non-ICAD patients. Our data provide indirect evidence that MT is of clinical benefit in ICAD patients with symptoms of AIS.
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Affiliation(s)
- Rikke Puggaard
- Cerebrovascular Research Unit Rigshospitalet, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Nicolaj Grønbæk Laugesen
- Cerebrovascular Research Unit Rigshospitalet, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Hansen
- Cerebrovascular Research Unit Rigshospitalet, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas H Brandt
- Neurovascular Section, Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Trine Stavngaard
- Neurovascular Section, Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Thomas C Truelsen
- Cerebrovascular Research Unit Rigshospitalet, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Kaufmann JE, Harshfield EL, Gensicke H, Wegener S, Michel P, Kägi G, Nedeltchev K, Kellert L, Rosenbaum S, Nolte CH, Christensen H, Arnold M, Lyrer P, Levi C, Bath PM, Engelter ST, Traenka C, Markus HS. Antithrombotic Treatment for Cervical Artery Dissection: A Systematic Review and Individual Patient Data Meta-Analysis. JAMA Neurol 2024; 81:630-637. [PMID: 38739383 PMCID: PMC11091821 DOI: 10.1001/jamaneurol.2024.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/15/2024] [Indexed: 05/14/2024]
Abstract
Importance Cervical artery dissection is the most common cause of stroke in younger adults. To date, there is no conclusive evidence on which antithrombotic therapy should be used to treat patients. Objective To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection. Data Sources PubMed.gov, Cochrane database, Embase, and ClinicalTrials.gov were searched from inception to August 1, 2023. Study Selection Randomized clinical trials that investigated the effectiveness and safety of antithrombotic treatment (antiplatelets vs anticoagulation) in patients with cervical artery dissection were included in the meta-analysis. The primary end point was required to include a composite of (1) any stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up. Data Extraction/Synthesis Two independent investigators performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inconsistencies were resolved by a principal investigator. Main Outcomes and Measures The primary outcome was a composite of (1) ischemic stroke, (2) death, or (3) major bleeding (extracranial or intracranial) at 90 days of follow-up. The components of the composite outcome were also secondary outcomes. Subgroup analyses based on baseline characteristics with a putative association with the outcome were performed. Logistic regression was performed using the maximum penalized likelihood method including interaction in the subgroup analyses. Results Two randomized clinical trials, Cervical Artery Dissection in Stroke Study and Cervical Artery Dissection in Stroke Study and the Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection, were identified, of which all participants were eligible. A total of 444 patients were included in the intention-to-treat population and 370 patients were included in the per-protocol population. Baseline characteristics were balanced. There were fewer primary end points in those randomized to anticoagulation vs antiplatelet therapy (3 of 218 [1.4%] vs 10 of 226 [4.4%]; odds ratio [OR], 0.33 [95% CI, 0.08-1.05]; P = .06), but the finding was not statistically significant. In comparison with aspirin, anticoagulation was associated with fewer strokes (1 of 218 [0.5%] vs 10 of 226 [4.0%]; OR, 0.14 [95% CI, 0.02-0.61]; P = .01) and more bleeding events (2 vs 0). Conclusions and Relevance This individual patient data meta-analysis of 2 currently available randomized clinical trial data found no significant difference between anticoagulants and antiplatelets in preventing early recurrent events.
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Affiliation(s)
- Josefin E. Kaufmann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Eric L. Harshfield
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Susanne Wegener
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, and University of Zurich, Switzerland
| | - Patrik Michel
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Georg Kägi
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Christian H. Nolte
- Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charite-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Healths at Charite, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
| | - Christopher Levi
- Faculty of Health and Medicine, University of Newcastle, and John Hunter Hospital, Newcastle, Australia
| | - Philip M. Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Stefan T. Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Hugh S. Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Shangguan PX, Zhou KC. Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture: Three case reports. World J Clin Cases 2024; 12:2664-2671. [PMID: 38817232 PMCID: PMC11135449 DOI: 10.12998/wjcc.v12.i15.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Traumatic internal carotid artery (ICA) occlusion is a rare complication of skull base fractures, characterized by high mortality and disability rates, and poor prognosis. Therefore, timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis. This article retrospectively analyzed the imaging and clinical data of three patients, to explore the imaging characteristics and treatment strategies for carotid artery occlusion, combined with severe skull base fractures. CASE SUMMARY This case included three patients, all male, aged 21, 63, and 16 years. They underwent plain film skull computed tomography (CT) examination at the onset of their illnesses, which revealed fractures at the bases of their skulls. Ultimately, these cases were definitively diagnosed through CT angiography (CTA) examinations. The first patient did not receive surgical treatment, only anticoagulation therapy, and recovered smoothly with no residual limb dysfunction (Case 1). The other two patients both developed intracranial hypertension and underwent decompressive craniectomy. One of these patients had high intracranial pressure and significant brain swelling postoperatively, leading the family to choose to take him home (Case 2). The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction (Case 3). We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease. CONCLUSION For patients with cranial trauma combined with skull base fractures, it is essential to complete a CTA examination as soon as possible, to screen for blunt cerebrovascular injury.
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Affiliation(s)
- Pei-Xin Shangguan
- Department of Emergency, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Ke-Chun Zhou
- Department of Emergency, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
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Zhou B, Hua Z, Li C, Jiao Z, Cao H, Xu P, Liu S, Li Z. Classification and management strategy of spontaneous carotid artery dissection. J Vasc Surg 2024:S0741-5214(24)01210-2. [PMID: 38777158 DOI: 10.1016/j.jvs.2024.05.031] [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: 01/22/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Spontaneous carotid artery dissections (sCADs) are the common cause of stroke in middle-aged and young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 patients with sCAD and proposed a new classification for sCAD with prognostic and therapeutic significance. METHODS This is a retrospective review of prospectively collected data from June 2018 to June 2023 of patients with sCAD treated at a large tertiary academic institution in an urban city in China. Based on imaging results, we categorize sCAD into four types: type Ⅰ, intramural hematoma or dissection with <70% luminal narrowing; type Ⅱ, intramural hematoma or dissection with ≥70% luminal narrowing; type Ⅲ, dissecting aneurysm; type ⅣA, extracranial carotid artery occlusion; and type ⅣB, tandem occlusion. We compared the clinical data and prognostic outcomes among various types of sCADs. RESULTS A total of 179 patients and 197 dissected arteries met the inclusion criteria. The mean age of the 179 patients with sCAD was 49.5 years, 78% were male, and 18 patients (10%) had bilateral sCAD. According to our classification, there were 56 type Ⅰ (28.4%), 50 type Ⅱ (25.4%), 60 type Ⅲ (30.5%), and 31 type Ⅳ (15.7%) dissections. During a mean hospitalization length of 11.4 ± 47.0 days, there were nine recurrent strokes (4.6%) after medical treatment, two type Ⅲ dissections (1.0%), seven type Ⅳ dissections (3.6%), all ipsilateral, and one death. Overall, there were seven (3.6%, 1 type Ⅰ dissection, 3 type Ⅱ dissections, 2 type Ⅲ dissections, and 1 type Ⅳ dissection) recurrent strokes and three (1.5%, all type Ⅲ dissections) recurrent transient ischemic attacks in patients treated with just medical therapy during the follow-up period, all ipsilateral, with a mean follow-up of 26 months (range, 3-59 months). These patients did not undergo further intervention due to the high difficulty associated with endovascular treatment (EVT) or the mild nature of recurrent cerebral ischemic symptoms. Twenty-nine type I dissections (51.8%) were completely recanalized after antithrombotic therapy. A total of 19 type II dissections (38%) and 44 type III dissections (73%) received EVT for persistent flow-limited dissections, enlargement of dissecting aneurysms, or aggravation of neurological symptoms despite antithrombotic therapy. Type Ⅳ dissections are more likely to lead to the occurrence of ischemic stroke and presented with more severe symptoms. Eight type IVB dissections (33%) received acute phase intervention due to distal thromboembolism or aggravation of neurological symptoms after medical treatment. In terms of cerebral ischemic events and mortality, there were no statistically significant differences among the four types of sCAD (all P > .05). Favorable outcome was achieved in 168 patients (93.9%). CONCLUSIONS This study proposed a novel and more comprehensive classification method and the modern management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA dissections. Urgent procedure with neurovascular intervention is necessary for some type IVB dissections. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcomes should undergo further research.
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Affiliation(s)
- Baoning Zhou
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaohui Hua
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Zhouyang Jiao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Cao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Xu
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shirui Liu
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Shlapakova PS, Dobrynina LA, Kalashnikova LA, Gubanova MV, Danilova MS, Gnedovskaya EV, Grigorenko AP, Gusev FE, Manakhov AD, Rogaev EI. Peripheral Blood Gene Expression Profiling Reveals Molecular Pathways Associated with Cervical Artery Dissection. Int J Mol Sci 2024; 25:5205. [PMID: 38791244 PMCID: PMC11121660 DOI: 10.3390/ijms25105205] [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: 03/26/2024] [Revised: 05/01/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical artery dissection (CeAD) is the primary cause of ischemic stroke in young adults. Monogenic heritable connective tissue diseases account for fewer than 5% of cases of CeAD. The remaining sporadic cases have known risk factors. The clinical, radiological, and histological characteristics of systemic vasculopathy and undifferentiated connective tissue dysplasia are present in up to 70% of individuals with sporadic CeAD. Genome-wide association studies identified CeAD-associated genetic variants in the non-coding genomic regions that may impact the gene transcription and RNA processing. However, global gene expression profile analysis has not yet been carried out for CeAD patients. We conducted bulk RNA sequencing and differential gene expression analysis to investigate the expression profile of protein-coding genes in the peripheral blood of 19 CeAD patients and 18 healthy volunteers. This was followed by functional annotation, heatmap clustering, reports on gene-disease associations and protein-protein interactions, as well as gene set enrichment analysis. We found potential correlations between CeAD and the dysregulation of genes linked to nucleolar stress, senescence-associated secretory phenotype, mitochondrial malfunction, and epithelial-mesenchymal plasticity.
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Affiliation(s)
- Polina S. Shlapakova
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Larisa A. Dobrynina
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Ludmila A. Kalashnikova
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Mariia V. Gubanova
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Maria S. Danilova
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Elena V. Gnedovskaya
- Third Neurological Department, Research Center of Neurology, Moscow 125367, Russia; (P.S.S.); (L.A.K.); (M.V.G.); (E.V.G.)
| | - Anastasia P. Grigorenko
- Department of Genomics and Human Genetics, Laboratory of Evolutionary Genomics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia (F.E.G.)
| | - Fedor E. Gusev
- Department of Genomics and Human Genetics, Laboratory of Evolutionary Genomics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia (F.E.G.)
- Department of Genetics, Center for Genetics and Life Science, Sirius University of Science and Technology, Sochi 354340, Russia; (A.D.M.)
| | - Andrey D. Manakhov
- Department of Genetics, Center for Genetics and Life Science, Sirius University of Science and Technology, Sochi 354340, Russia; (A.D.M.)
- Center for Genetics and Genetic Technologies, Faculty of Biology, Lomonosov Moscow State University, Moscow 119192, Russia
| | - Evgeny I. Rogaev
- Department of Genetics, Center for Genetics and Life Science, Sirius University of Science and Technology, Sochi 354340, Russia; (A.D.M.)
- Department of Psychiatry, UMass Chan Medical School, 222 Maple Ave, Reed-Rose-Gordon Building, Shrewsbury, MA 01545, USA
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Kaufmann JE, Gensicke H, Schaedelin S, Luft AR, Goeggel-Simonetti B, Fischer U, Michel P, Strambo D, Kägi G, Vehoff J, Nedeltchev K, Kahles T, Kellert L, Rosenbaum S, von Rennenberg R, Riegler C, Seiffge D, Sarikaya H, Zietz A, Wischmann J, Polymeris AA, Hänsel M, Globas C, Bonati LH, Brehm A, De Marchis GM, Peters N, Nolte CH, Christensen H, Wegener S, Psychogios MN, Arnold M, Lyrer P, Traenka C, Engelter ST. Toward Individual Treatment in Cervical Artery Dissection: Subgroup Analysis of the TREAT-CAD Randomized Trial. Ann Neurol 2024; 95:886-897. [PMID: 38362818 DOI: 10.1002/ana.26886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Uncertainty remains regarding antithrombotic treatment in cervical artery dissection. This analysis aimed to explore whether certain patient profiles influence the effects of different types of antithrombotic treatment. METHODS This was a post hoc exploratory analysis based on the per-protocol dataset from TREAT-CAD (NCT02046460), a randomized controlled trial comparing aspirin to anticoagulation in patients with cervical artery dissection. We explored the potential effects of distinct patient profiles on outcomes in participants treated with either aspirin or anticoagulation. Profiles included (1) presenting with ischemia (no/yes), (2) occlusion of the dissected artery (no/yes), (3) early versus delayed treatment start (>median), and (4) intracranial extension of the dissection (no/yes). Outcomes included clinical (stroke, major hemorrhage, death) and magnetic resonance imaging outcomes (new ischemic or hemorrhagic brain lesions) and were assessed for each subgroup in separate logistic models without adjustment for multiple testing. RESULTS All 173 (100%) per-protocol participants were eligible for the analyses. Participants without occlusion had decreased odds of events when treated with anticoagulation (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.07-0.86). This effect was more pronounced in participants presenting with cerebral ischemia (n = 118; OR = 0.16, 95% CI = 0.04-0.55). In the latter, those with early treatment (OR = 0.26, 95% CI = 0.07-0.85) or without intracranial extension of the dissection (OR = 0.34, 95% CI = 0.11-0.97) had decreased odds of events when treated with anticoagulation. INTERPRETATION Anticoagulation might be preferable in patients with cervical artery dissection presenting with ischemia and no occlusion or no intracranial extension of the dissection. These findings need confirmation. ANN NEUROL 2024;95:886-897.
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Affiliation(s)
- Josefin E Kaufmann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
- Center for Neurology and Rehabilitation, Cereneo, Vitznau, Switzerland
| | - Barbara Goeggel-Simonetti
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neuropediatrics, Institute of Pediatrics of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Georg Kägi
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Jochen Vehoff
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology and Stroke Center, Cantonal Hospital Aarau, Aarau, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Regina von Rennenberg
- Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Riegler
- Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David Seiffge
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | | | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martin Hänsel
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Christoph Globas
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Alex Brehm
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Healths at Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Susanne Wegener
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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11
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Bachhuber A. [Imaging in headache]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:425-436. [PMID: 38647549 DOI: 10.1007/s00117-024-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/25/2024]
Abstract
Headache is worldwide one of the leading reasons to consult a general practitioner or a neurologist. In addition to the medical history and results of laboratory parameters, imaging represents one of the most important diagnostic steps. As there is a myriad of possible causes, it is nearly impossible to cover the whole spectrum of this topic. This article summarizes the most important morphological imaging findings and their pitfalls.
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Affiliation(s)
- Armin Bachhuber
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Kirrberger Straße, Gebäude 90, 66421, Homburg/Saar, Deutschland.
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12
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Dejakum B, Kiechl S, Knoflach M, Mayer-Suess L. A narrative review on cervical artery dissection-related cranial nerve palsies. Front Neurol 2024; 15:1364218. [PMID: 38699055 PMCID: PMC11063253 DOI: 10.3389/fneur.2024.1364218] [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: 01/01/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction This study aimed to emphasize the importance of cranial nerve (CN) palsies in spontaneous cervical artery dissection (sCeAD). Methods A search term-based literature review was conducted on "cervical artery dissection" and "cranial nerve palsy." English and German articles published until October 2023 were considered. Results Cranial nerve (CN) palsy in sCeAD is evident in approximately 10% of cases. In the literature, isolated palsies of CN II, III, VII, IX, X, and XII have been reported, while CN XI palsy only occurs in combination with other lower cranial nerve palsies. Dissection type and mural hematoma localization are specific to affected CN as CN palsies of II or III are solely evident in those with steno-occlusive vessel pathologies located at more proximal segments of ICA, while those with CN palsies of IX, X, XI, and XII occur in expansive sCeAD at more distal segments. This dichotomization emphasizes the hypothesis of a different pathomechanism in CN palsy associated with sCeAD, one being hypoperfusion or microembolism (CN II, III, and VII) and the other being a local mass effect on surrounding tissue (CN IX, X, XI, and XII). Clinically, the distinction between peripheral palsies and those caused by brainstem infarction is difficult. This differentiation is key, as, according to the reviewed cases, peripheral cranial nerve palsies in sCeAD patients mostly resolve completely over time, while those due to brainstem stroke do not, making cerebrovascular imaging appraisal essential. Discussion It is important to consider dissections as a potential cause of peripheral CN palsies and to be aware of the appropriate diagnostic pathways. This awareness can help clinicians make an early diagnosis, offering the opportunity for primary stroke prevention.
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Affiliation(s)
- Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Thomas LC, Holliday E, Attia JR, Levi C. Development of a diagnostic support tool for predicting cervical arterial dissection in primary care. J Man Manip Ther 2024; 32:173-181. [PMID: 37651397 PMCID: PMC10956904 DOI: 10.1080/10669817.2023.2250164] [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: 02/27/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Cervical arterial dissection (CAD) is an important cause of stroke in young people which may be missed because early features may mimic migraine or a musculoskeletal presentation. The study aimed to develop a diagnostic support tool for early identification of CAD. DESIGN Retrospective observational study. SETTING Tertiary hospital. PARTICIPANTS Radiologically confirmed CAD cases (n = 37), non-CAD stroke cases (n = 20), and healthy controls (n = 100). MAIN OUTCOME MEASURES The presence of CAD is confirmed with imaging. Predictive variables included risk factors and clinical characteristics of CAD. Variables with a p-value <0.2 included in a multivariable model. Predictive utility of the model is assessed by calculating area underthe ROC curve (AUC). RESULTS The model including four variables: age 40-55 years (vs < 40), trauma, recent onset headache, and > 2 neurological features, demonstrated excellent discrimination: AUC of 0.953 (95% CI: 0.916, 0.987). A predictive scoring system (total score/7) identified an optimal threshold of ≥ 3 points, with a sensitivity of 87% and specificity of 79%. CONCLUSIONS The study identified a diagnostic support tool with four variables to predict increased risk of CAD. Validation in a clinical sample is needed to confirm variables and refine descriptors to enable clinicians to efficiently apply the tool.Optimum cutoff scores of ≥ 3/7 points will help identify those in whom CAD should be considered and further investigation instigated. The potential impact of the tool is to improve early recognition of CAD in those with acute headache or neck pain, thereby facilitating more timely medical intervention, preventing inappropriate treatment, and improving patient outcomes.Wordcount: 3195.
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Affiliation(s)
- Lucy Caroline Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, QLD, Australia
- School of Health Sciences, The University of Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
| | - John R. Attia
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
| | - Christopher Levi
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia
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14
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Bernstein RA, Previch L, Caprio FZ. Data Over Dogma in Treatment of Cervical Artery Dissections. Stroke 2024; 55:919-920. [PMID: 38527153 DOI: 10.1161/strokeaha.124.046745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Richard A Bernstein
- Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, IL
| | - Lauren Previch
- Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, IL
| | - Fan Z Caprio
- Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, IL
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15
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Lin X, Guo W, She D, Kang Y, Xing Z, Cao D. Initial and follow-up high-resolution vessel wall MRI study of spontaneous cervicocranial artery dissection. Eur Radiol 2024; 34:1704-1715. [PMID: 37670185 DOI: 10.1007/s00330-023-10207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES To explore the factors associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection (sCCAD) and evaluate the initial imaging markers related to outcomes. METHODS Initial and follow-up high-resolution vessel wall MRI (VW-MRI) in consecutive patients with sCCAD were retrospectively analyzed. The associations of clinical and imaging factors and variants of the circle of Willis (COW) with ischemic stroke were evaluated using binary logistic regression analyses. The anatomical outcomes were categorized as complete, partial, and no remodeling based on changes of the vessel wall and lumen. Ordinal logistic regression analysis was used to assess associations between initial features and outcomes. RESULTS A total of 115 dissected arteries (79 strokes, 36 non-strokes) were detected in 103 patients. Follow-up VW-MRI was available in 46 patients (44.7%, with 51 vessels), with a median interval of 8.5 months. Pseudoaneurysm (odd ratio [OR], 0.178; 95% confidence interval [CI], 0.039-0.810; p = 0.026) tended to rarely cause ischemic stroke, while intraluminal thrombus (OR, 5.558; 95% CI, 1.739-17.765; p = 0.004), incomplete COW (OR, 9.309; 95% CI, 2.122-40.840; p = 0.003), and partial complete COW (OR, 4.463; 95% CI, 1.211-16.453; p = 0.025) were independently associated with stroke occurrence. Furthermore, the presence of double lumen (OR, 5.749; 95% CI, 1.358-24.361; p = 0.018) and occlusion (OR, 12.975; 95% CI, 3.022-55.645; p = 0.001) were associated with no remodeling of sCCAD. CONCLUSIONS Multiple initial factors were found to be related to stroke occurrence and anatomical outcomes of sCCAD. High-resolution VW-MRI may provide valuable insights into the pathophysiology and evolution of sCCAD. CLINICAL RELEVANCE STATEMENT Initial and follow-up high-resolution vessel wall MRI may help elucidate the pathophysiology of spontaneous cervicocranial artery dissection and provide important insights into the evolution and further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection. KEY POINTS • Clinical and imaging factors, as well as the status of primary collateral circulation, are associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection. • The follow-up high-resolution vessel wall MRI provides valuable insights into the long-term evolution and anatomical outcomes of spontaneous cervicocranial artery dissection. • The high-resolution vessel wall MRI features related to ischemic stroke and anatomical outcomes may further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
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Affiliation(s)
- Xuehua Lin
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Wei Guo
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Dejun She
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Yaqing Kang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Zhen Xing
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, China.
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Lu GD, Yang W, Jia ZY, Liu S. Endovascular reconstruction of high cervical and long-segment carotid artery dissections with Leo plus stent. Neuroradiology 2024; 66:409-416. [PMID: 38191867 DOI: 10.1007/s00234-023-03274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Endovascular reconstruction has emerged as a viable alternative for carotid artery dissections (CADs) that are unresponsive to antithrombotic therapy. However, high cervical and long-segment CADs pose challenges during endovascular treatment due to their distal location and tortuous anatomy. We presented our experiences using endovascular reconstruction with the Leo plus stent for this type of CAD. METHODS We conducted a retrospective review of patients with high cervical and long-segment CADs treated using the Leo plus stent. We analyzed patient demographics, clinical presentations, procedural features, complications, and follow-up outcomes. RESULTS A total of 17 patients (mean age, 48.1 years) with 17 CADs were identified. Seven of these dissections were accompanied by pseudoaneurysm. The mean length of the dissection was 5.7 cm, and the mean degree of stenosis was 92.3%. A single Leo plus stent was deployed in 15 patients, while another Wallstent carotid stent was used in 2 cases. All stents were successfully positioned in their intended sites. The average degree of residual stenosis was 22.2%. There were no perioperative complications. With a median follow-up duration of 29 months, no ischemic stroke events occurred. All but one Leo plus stent remained patent during follow-up, and all 7 pseudoaneurysms had disappeared at the last radiological assessment. CONCLUSION Our experience in treating high cervical and long-segment CADs with the Leo plus stent demonstrates that this approach is practical, safe, and effective, as evidenced by long-term observations. The Leo Plus stent appears to be a suitable option for managing this type of CAD.
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Affiliation(s)
- Guang-Dong Lu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Wei Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China.
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Griffin KJ, Harmsen WS, Mandrekar J, Brown RD, Keser Z. Epidemiology of Spontaneous Cervical Artery Dissection: Population-Based Study. Stroke 2024; 55:670-677. [PMID: 38288608 DOI: 10.1161/strokeaha.123.043647] [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: 04/20/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Cervical artery dissection (CeAD) represents up to 15% to 25% of ischemic strokes in people under the age of 50 years. Noninvasive vessel imaging is increasingly used in clinical practice, but the impact on the frequency of detection of CeAD is unknown. In 2006, the yearly incidence rate of CeAD was estimated at 2.6 per 100 000 person-years, but the current incidence is unknown. METHODS In this population-based retrospective observational cohort study, we utilized the resources of the Rochester Epidemiology Project to ascertain all adult residents of Olmsted County, MN, diagnosed with internal carotid artery dissection and common carotid artery dissection or vertebral artery dissection from 2002 to 2020. Patients with only intracranial involvement or CeAD following major trauma were excluded. Age-adjusted sex-specific and age- and sex-adjusted incidence rates were estimated using the US White 2010 decennial census, with rates expressed per 100 000 person-years. We assessed longitudinal trends by dividing the data into 5-year time intervals, with the last being a 4-year interval. RESULTS We identified 123 patients with a diagnosis of CeAD. There were 63 patients with internal carotid artery dissection, 54 with vertebral artery dissection, 2 with concurrent internal carotid artery dissection and vertebral artery dissection, and 4 with common carotid artery dissection. There were 63 (51.2%) female patients and 60 (48.8%) male patients. The average age at diagnosis was 50.2 years (SD, 15.1 [95% CI, 20.1-90.5] years). The incidence rate of spontaneous CeAD encompassing all locations was 4.69 per 100 000 person-years (2.43 for internal carotid artery dissection and 2.01 for vertebral artery dissection). The incidence rate increased from 2.30 per 100 000 person-years from 2002 to 2006 to 8.93 per 100 000 person-years from 2017 to 2020 (P<0.0001). The incidence rate for female patients rose from 0.81 per 100 000 person-years from 2002 to 2006 to 10.17 per 100 000 person-years from 2017 to 2020. CONCLUSIONS The incidence rate of spontaneous CeAD increased nearly 4-fold over a 19-year period from 2002 to 2020. The incidence rate in women rose over 12-fold. The increase in incidence rates likely reflects the increased use of noninvasive vascular imaging.
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Affiliation(s)
- Kim J Griffin
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
| | - William S Harmsen
- Department of Quantitative Health Sciences (W.S.H., J.M.), Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- Department of Quantitative Health Sciences (W.S.H., J.M.), Mayo Clinic, Rochester, MN
| | - Robert D Brown
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
| | - Zafer Keser
- Department of Neurology (K.J.G., R.D.B., Z.K.), Mayo Clinic, Rochester, MN
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18
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Verburgt E, Hilkens NA, Ekker MS, Schellekens MMI, Boot EM, Immens MHM, van Alebeek ME, Brouwers PJAM, Arntz RM, van Dijk GW, Gons RAR, van Uden IWM, den Heijer T, van Tuijl JH, de Laat KF, van Norden AGW, Vermeer SE, van Zagten MSG, van Oostenbrugge RJ, Wermer MJH, Nederkoorn PJ, Kerkhoff H, Rooyer FA, van Rooij FG, van den Wijngaard IR, ten Cate TJF, Tuladhar AM, de Leeuw FE, Verhoeven JI. Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults. JAMA Netw Open 2024; 7:e240054. [PMID: 38376841 PMCID: PMC10879951 DOI: 10.1001/jamanetworkopen.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2023] [Indexed: 02/21/2024] Open
Abstract
Importance Cause of ischemic stroke in young people is highly variable; however, the risk of recurrence is often presented with all subtypes of stroke grouped together in classification systems such as the Trial of ORG (danaparoid sodium [Orgaran]) 10172 in Acute Stroke Treatment (TOAST) criteria, which limits the ability to individually inform young patients with stroke about their risk of recurrence. Objective To determine the short-term and long-term risk of recurrent vascular events after ischemic stroke at a young age by stroke cause and to identify factors associated with recurrence. Design, Setting, and Participants This cohort study used data from the Observational Dutch Young Symptomatic Stroke Study, a prospective, multicenter, hospital-based cohort study, conducted at 17 hospitals in the Netherlands between 2013 and 2021. Eligible participants included 30-day survivors of an initial, neuroimaging-proven ischemic stroke (aged 18-49 years). Data analysis was conducted from June to July 2023. Exposure Diagnosis of a first-ever, ischemic stroke via neuroimaging. Main Outcome and Measures The primary outcome was short-term (within 6 months) and long-term (within 5 years) recurrence risk of any vascular event, defined as fatal or nonfatal recurrent ischemic stroke, transient ischemic attack, myocardial infarction, and revascularization procedure. Predefined characteristics were chosen to identify factors associated with risk of recurrence (cause of stroke, age, sex, stroke severity, and cardiovascular health factors). Results A total of 1216 patients (median [IQR] age, 44.2 [38.4-47.7] years; 632 male [52.0%]; 584 female [48.0%]) were included, with a median (IQR) follow-up of 4.3 (2.6-6.0) years. The 6-month risk of any recurrent ischemic event was 6.7% (95% CI, 5.3%-8.1%), and the 5-year risk was 12.2% (95% CI, 10.2%-14.2%)The short-term risk was highest for patients with cervical artery dissections (13.2%; 95% CI, 7.6%-18.7%). Other factors associated with a recurrent short-term event were atherothrombotic stroke, rare causes of stroke, and hypertension. The long-term cumulative risk was highest for patients with atherothrombotic stroke (22.7%; 95% CI, 10.6%-34.7%) and lowest for patients with cryptogenic stroke (5.8%; 95% CI, 3.0%-8.5%). Cardioembolic stroke was associated with a recurrent long-term event, as were diabetes and alcohol abuse. Conclusions and Relevance The findings of this cohort study of 1216 patients with an ischemic stroke at a young age suggest that the risk of recurrent vascular events was high and varied by cause of stroke both for short-term and long-term follow-up, including causes that remained concealed when combined into 1 category in the routinely used TOAST criteria. This knowledge will allow for more personalized counseling of young patients with stroke.
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Affiliation(s)
- Esmée Verburgt
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nina A. Hilkens
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Merel S. Ekker
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mijntje M. I. Schellekens
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Esther M. Boot
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maikel H. M. Immens
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | - Renate M. Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Gert W. van Dijk
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Rob A. R. Gons
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Tom den Heijer
- Department of Neurology, Sint Franciscus Gasthuis Hospital, Rotterdam, the Netherlands
| | - Julia H. van Tuijl
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | | | - Sarah E. Vermeer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | | | - Marieke J. H. Wermer
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Henk Kerkhoff
- Department Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Fergus A. Rooyer
- Department of Neurology, Zuyderland Hospital, Sittard-Geleen, the Netherlands
| | - Frank G. van Rooij
- Medical Centre Leeuwarden, Department of Neurology, Leeuwarden, the Netherlands
| | | | - Tim J. F. ten Cate
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anil M. Tuladhar
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jamie I. Verhoeven
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
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19
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Long B, Pelletier J, Koyfman A, Bridwell RE. High risk and low prevalence diseases: Spontaneous cervical artery dissection. Am J Emerg Med 2024; 76:55-62. [PMID: 37995524 DOI: 10.1016/j.ajem.2023.11.011] [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: 10/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Spontaneous cervical artery dissection (sCAD) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of sCAD, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION sCAD is a condition affecting the carotid or vertebral arteries and occurs as a result of injury and compromise to the arterial wall layers. The dissection most commonly affects the extracranial vessels but may extend intracranially, resulting in subarachnoid hemorrhage. Patients typically present with symptoms due to compression of local structures, and the presentation depends on the vessel affected. The most common symptom is headache and/or neck pain. Signs and symptoms of ischemia may occur, including transient ischemic attack and stroke. There are a variety of risk factors for sCAD, including underlying connective tissue or vascular disorders, and there may be an inciting event involving minimal trauma to the head or neck. Diagnosis includes imaging, most commonly computed tomography angiography of the head and neck. Ultrasound can diagnose sCAD but should not be used to exclude the condition. Treatment includes specialist consultation (neurology and vascular specialist), consideration of thrombolysis in appropriate patients, symptomatic management, and administration of antithrombotic medications. CONCLUSIONS An understanding of sCAD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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20
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Poblete RA, Zhong C, Patel A, Kuo G, Sun PY, Xiao J, Fan Z, Sanossian N, Towfighi A, Lyden PD. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment. Neurol Int 2024; 16:95-112. [PMID: 38251054 PMCID: PMC10801491 DOI: 10.3390/neurolint16010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.
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Affiliation(s)
- Roy A. Poblete
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Charlotte Zhong
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Anish Patel
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Grace Kuo
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Philip Y. Sun
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Jiayu Xiao
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Zhaoyang Fan
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Nerses Sanossian
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Amytis Towfighi
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Patrick D. Lyden
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
- Zilkha Neurogenetic Institute, Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA
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21
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Yaghi S, Albin C, Chaturvedi S, Savitz SI. Roundtable of Academia and Industry for Stroke Prevention: Prevention and Treatment of Large-Vessel Disease. Stroke 2024; 55:226-235. [PMID: 38134259 DOI: 10.1161/strokeaha.123.043910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Shadi Yaghi
- Alpert Medical School at Brown University, Providence, RI (S.Y.)
| | | | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston (S.I.S.)
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22
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Chen L, Hu F, Dong S, Wang J, Lin X, Zheng H, He L. Pathological migrating intramural hematoma in stenting for carotid artery dissection: A ten-year consecutive cohort study. Clin Neurol Neurosurg 2024; 236:108118. [PMID: 38237209 DOI: 10.1016/j.clineuro.2024.108118] [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: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. METHODS We consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. RESULTS A total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. CONCLUSION Pathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.
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Affiliation(s)
- Lizhang Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China
| | - Fayun Hu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China
| | - Shuju Dong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China; The Affiliated Hospital of Kunming University of Science and Technology, 650000 Kunming, Yunnan, China; Department of Geriatrics, The First People's Hospital of Yunnan Province, 650000 Kunming, Yunnan, China
| | - Jian Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China
| | - Xue Lin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China
| | - Hongbo Zheng
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China.
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, China.
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23
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Xie S, Ran Y, Zhang Y, Cheng J. Photorealistic depiction of the intimal flap in carotid dissection. Asian J Surg 2023; 46:5529-5530. [PMID: 37537066 DOI: 10.1016/j.asjsur.2023.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Shanshan Xie
- Depatment of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Yuncai Ran
- Depatment of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yong Zhang
- Depatment of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jingliang Cheng
- Depatment of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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24
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Parodi F, Severi I, Flora G, Cioni S, Vallone IM, Betti V, Martini G, Tassi R. Concurrent subarachnoid haemorrhage and internal carotid artery dissection: a transcranial colour-coded sonography diagnosis. J Ultrasound 2023; 26:771-776. [PMID: 35482247 PMCID: PMC10632309 DOI: 10.1007/s40477-022-00686-z] [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: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
We report the case of a young woman affected by an aneurysmal subarachnoid haemorrhage (SAH) and numerous anatomic abnormalities. A Transcranial Colour-Coded Duplex Sonography, performed with the aim of monitoring the vasospasm, showed a non-pulsatile flow with loss of sharp systolic peak and lowering of mean flow velocities in the right extracranial Internal Carotid Artery (ICA) and all its intra-cranial branches. This event suggested a possible concomitant acute right ICA sub-occlusion with a lack of collateral circulation. This type of flow is typically found in systemic and brain arteries of patients undergoing to venous-arterial extracorporeal membrane oxygenation or to left ventricular assist devices. The absence of an adequate cerebral collateral circulation might be the explanation for this type of atypical flow. Aneurysms and arterial dissections contribute to SAH and ischemic stroke events, leading to long-term physical and cognitive disability. In our case, the prompt neurosonological diagnosis leaded to patient's good outcome.
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Affiliation(s)
- Francesca Parodi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Ilaria Severi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Giammarco Flora
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Ignazio Maria Vallone
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Veronica Betti
- Anesthesia and Neuro-ICU, Department of Neurological and Sensorineural, Azienda Opsedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy.
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25
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Sun Z, Kleine-Borgmann J, Suh J, McDermott GC, Vishnevetsky A, Rist PM. Migraine and the risk of cervical artery dissection: A systematic review and meta-analysis. Eur Stroke J 2023; 8:904-914. [PMID: 37555306 PMCID: PMC10683742 DOI: 10.1177/23969873231191860] [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: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Migraine is a common, disabling chronic pain condition possibly related to changes in endothelial and vascular structure and function. Several observational studies have suggested an elevated risk of cervical artery dissection (CeAD) in patients with a history of migraine. We aimed to investigate this potential association using systematic review and meta-analytic methods. PATIENTS AND METHODS We utilized a pre-defined search protocol to identify and screen studies related to migraine and CeAD in PubMed, Embase, and the Web of Science Core Collection. We assessed the risk of bias and performed a meta-analysis of selected studies to assess the association between migraine and CeAD. We also performed subgroup analyses by migraine subtype, biological sex, and the use of stroke versus non-stroke controls. RESULTS We identified 11 studies (N = 9857 patients) for inclusion in the meta-analysis. Meta-analysis showed an association between migraine and CeAD with an odds ratio of 1.74 (95%CI 1.38-2.19). There was high heterogeneity among the included studies (I2 = 61%). Publication bias was present but the Trim-Fill imputation suggested that the impact on results was likely minimal. Subgroup analyses revealed an association between migraine without aura and CeAD (OR 1.86, 95%CI 1.55-2.24) but not migraine with aura and CeAD (OR 1.15, 95%CI 0.71-1.88). There was no difference in the association between migraine and CeAD in men compared to women. DISCUSSION AND CONCLUSION A history of migraine is associated with an increased risk of CeAD. Further studies are needed to elucidate the potential pathophysiologic mechanisms underlying this association.
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Affiliation(s)
- Zihan Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julian Kleine-Borgmann
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Translational Neuro- and Behavioral Sciences, Department of Neurology, University Medicine Essen, Essen, Germany
| | - Joome Suh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Neurology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory C McDermott
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anastasia Vishnevetsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela M Rist
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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26
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Mayer-Suess L, Dejakum B, Ratzinger G, Gizewski ER, Kiechl S, Knoflach M. Clinical characteristics and outcome in expansive compared with steno-occlusive mural hematoma in spontaneous cervical artery dissection. Int J Stroke 2023; 18:1186-1192. [PMID: 37401395 PMCID: PMC10676031 DOI: 10.1177/17474930231185032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Spontaneous cervical artery dissection (sCeAD) is one of the prime causes of ischemic stroke in young adults. Based on vessel wall imaging, steno-occlusive or expansive wall hematomas can be distinguished. It is unclear whether these two distinct morphological phenotypes reflect different pathophysiological processes. AIM We aim to evaluate differences in clinical characteristics and long-term recurrence between patients with expansive and steno-occlusive mural wall hematoma in the acute phase. METHODS Participants of the ReSect-study, one of the largest single-center cohort studies with long-term follow-up of sCeAD patients, with sufficient magnetic resonance imaging (MRI) were included. All available MRI scans were retrospectively evaluated for patients dichotomized to two groups: (1) mural hematoma causing steno-occlusive pathologies without expansion of total vessel diameter (steno-occlusive hematoma), and (2) mural hematoma causing vessel diameter expansion without lumen stenosis (expansive hematoma). Patients with mixed steno-occlusive and expansive vessel pathologies were excluded from the analysis. RESULTS In total, 221 individuals were available for analysis. The pathognomonic vessel wall hematoma was steno-occlusive in 187 (84.6%) and expansive in 34 (15.4%). No difference was seen in patient demographics, clinical status at admission, laboratory parameters, family history, or the frequency of clinical stigmata for connective tissue disorders. Both patients with expansive and steno-occlusive mural hematoma had a high likelihood of suffering cerebral ischemia (64.7 vs 79.7). Still, time from symptom onset to diagnosis was significantly longer in those with expansive dissection (17.8 vs 7.8 days, p = 0.02). Those with expansive dissections were more likely to have upper respiratory infection within 4 weeks prior to dissection (26.5% vs 12.3%, p = 0.03). Upon follow-up, functional outcome was identical and groups did not differ in rate of sCeAD recurrence, but those with expansive mural hematoma at baseline more frequently had residual aneurysmal formation (41.2% vs 11.5%, p < 0.01). CONCLUSIONS As cerebral ischemia was frequent in both, our clinical results do not advise for differential treatment or follow-up based on the acute morphological phenotype. There was no clear evidence of a different aetiopathogenesis between patients with steno-occlusive or expansive mural hematoma in the acute phase. More mechanistic approaches are needed to elucidate potential differences in pathomechanism between both entities. DATA ACCESS Anonymized data not published within this article will be made available by request from any qualified investigator.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Gudrun Ratzinger
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
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27
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Giorelli M, Leone R, Balzano RF. Spontaneous Multiple Cervical Artery Dissections and Recurrent Deep Vein Thrombosis in a Young Adult. J Clin Neurol 2023; 19:615-617. [PMID: 37901898 PMCID: PMC10622725 DOI: 10.3988/jcn.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Maurizio Giorelli
- Department of Neurology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy.
| | - Ruggiero Leone
- Department of Neurology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy
| | - Rosario Francesco Balzano
- Department of Radiology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy
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28
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Venu R, Muceniece L, Mittal N, Mendoza R, Matl C, Bettarelli D. When headache is just too much-A case report and literature review of bilateral vertebral artery dissection. Clin Case Rep 2023; 11:e8168. [PMID: 37965181 PMCID: PMC10641300 DOI: 10.1002/ccr3.8168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Rakshaya Venu
- Department of Internal MedicineSaveetha Medical College and HospitalChennaiIndia
| | - Liene Muceniece
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Neha Mittal
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Roberto Mendoza
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Christina Matl
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Douglas Bettarelli
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
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29
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Muppa J, Gunduz ME, Aleyadeh R, Yaghi S, Shu L, Henninger N. Small vessel disease is associated with later onset of major adverse cardiovascular events after acute cervicocerebral artery dissection. J Neurol Sci 2023; 453:120786. [PMID: 37703707 DOI: 10.1016/j.jns.2023.120786] [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: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is common among the elderly and has been associated with an increased risk of major adverse cardiac events (MACE) and increased risk of long-term disability. Little is known whether CSVD affects outcomes after cervicocerebral artery dissection (CAD), which predominantly affects younger patients. Specifically, there is a paucity as to whether CSVD increases the risk of MACE after CAD and whether this risk is different for early versus late events. METHODS We retrospectively analyzed 140 consecutive patients with acute CAD. We determined CSVD on MRI using the STRIVE criteria and calculated the CSVD sum score based on the individual CSVD components. For statistical analysis the CSVD burden was dichotomized to mild (score 0-1) versus severe (score 2-4). The primary outcome of interest was the 6-month MACE risk. Secondary outcomes of interest were early versus late MACE, stroke at presentation, and good 90-day outcome (modified Rankin Scale score 0-2). RESULTS There was no difference in overall MACE between subjects when stratified by CSVD burden (10.1% versus 9.8%, Log-rank P = 0.953). We found that patients with severe CSVD had significantly more late MACE as compared to mild CSVD (9.8% versus 1.1%, P = 0.024). There was no significant difference in the prevalence of stroke at the time of CAD diagnosis (50.6% versus 47.1%, P = 0.690) and the 90-day disability-free survival in subjects with mild versus severe CSVD (93.7% versus 91.7%, P = 0.729). CONCLUSION Severe CSVD burden was associated with a significantly greater risk of late MACE. CSVD assessment in CAD patients may aid risk stratification and treatment optimization.
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Affiliation(s)
- Jayachandra Muppa
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Muhammed E Gunduz
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rozaleen Aleyadeh
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Liqi Shu
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Feng X, Zheng X, Lin A, Yang S, Zhang S, Wu D, Wu W, Han X. FBN1 knockout promotes cervical artery dissection by inducing N-glycosylation alternation of extracellular matrix proteins in rat VSMCs. Cell Signal 2023; 110:110834. [PMID: 37532137 DOI: 10.1016/j.cellsig.2023.110834] [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: 03/07/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023]
Abstract
FBN1 mutation promotes the degeneration of microfibril structures and extracellular matrix (ECM) integrity in the tunica media of the aorta in Marfan syndrome. However, whether FBN1 modulates cervical artery dissection (CAD) development and the potential molecular mechanisms of abnormal FBN1 in CAD remains elusive. In this study, FBN1 deficiency participated in the development of CAD and influenced the proliferation, apoptosis, and migration of vascular smooth muscle cells. FBN1 knockout induced alternations in mRNA levels of the transcriptome, protein expression of the proteome, and abundance of N-glycosylation of the N-glycoproteome. Comprehensive analysis of multiple omics showed up-regulation in mRNA levels of ECM proteins; yet, both the ECM protein levels and relative abundance of N-glycosylation were decreased. Moreover, we performed in vivo experiments to confirm the altered glycosylation of proteins in vascular smooth muscle cells. In conclusion, FBN1 deletion in vascular smooth muscle cells can result in altered N-glycosylation of ECM protein, which were critical for the stability of ECM and the process of CAD. This may open the way for a novel therapeutic strategy to treat people with CAD.
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Affiliation(s)
- Xiaochao Feng
- Department of Neurology, Shanghai Fifth People(')s Hospital of Fudan University, Shanghai, China
| | - Xixi Zheng
- Human Phenome Institute of Fudan University, Shanghai, China
| | - Aiqi Lin
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Shilin Yang
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Shufan Zhang
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People(')s Hospital of Fudan University, Shanghai, China
| | - Weicheng Wu
- Human Phenome Institute of Fudan University, Shanghai, China; Fudan University-Rugao People's Hospital Joint Research Institute of Longevity and Aging, Jiangsu, China.
| | - Xiang Han
- Department of Neurology, Shanghai Fifth People(')s Hospital of Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China.
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Ifergan H, Reiner P, Simonato D, Polara GF, Mazighi M, Houdart E, Jouvent E, Labeyrie MA. Early ischemic recurrence in acute spontaneous cervical artery dissection. J Neuroradiol 2023; 50:523-529. [PMID: 36907266 DOI: 10.1016/j.neurad.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND PURPOSE Early ischemic recurrence (EIR) following the diagnosis of acute spontaneous cervical artery dissection (CeAD) has been little investigated. We aimed to determine the prevalence and determinants on admission of EIR in a large single-center retrospective cohort study of patients with CeAD. METHODS EIR was defined as any ipsilateral clinical or radiological cerebral ischemia or intracranial artery occlusion, not present on admission and occurring within 2 weeks. CeAD location, degree of stenosis, circle of Willis support, presence of intraluminal thrombus, intracranial extension, and intracranial embolism were analyzed on initial imaging by 2 independent observers. Uni- and multivariate logistic regression was used to determine their association with EIR. RESULTS Two hundred thirty-three consecutive patients with 286 CeAD were included. EIR was observed in 21 patients (9%,95%CI=5-13%) with a median time from diagnosis of 1.5 days (range:0.1-14.0 days). No EIR was observed in CeAD without ischemic presentation or with less than 70% stenosis. In the remaining cases, poor circle of Willis (OR=8.5, CI95%=2.0-35.4, p = 0.003), CeAD extending to other intracranial arteries than just V4 (OR=6.8, CI95%=1.4-32.6, p = 0.017), cervical artery occlusion (OR=9.5, CI95%=1.2- 39.0, p = 0.031), and cervical intraluminal thrombus (OR=17.5, CI95%=3.0-101.7, p = 0.001) were independently associated with EIR. CONCLUSIONS Our results suggests that EIR is more frequent than previously reported, and that its risk might be stratified on admission with a standard workup. In particular, the presence of a poor circle of Willis, intracranial extension (other than just V4), cervical occlusion, or cervical intraluminal thrombus are associated with high risk of EIR, for which specific management should be further evaluated.
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Affiliation(s)
- Héloïse Ifergan
- Neurointerventional Unit, Tours Hospital, Tours, Paris, France
| | - Peggy Reiner
- Vascular Neurology Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; FHU NeuroVasc, Paris, France
| | - Davide Simonato
- Neurointerventional Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; Université de Paris, Paris, France
| | - Giulia Frasca Polara
- Vascular Neurology Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; FHU NeuroVasc, Paris, France
| | - Mikael Mazighi
- Vascular Neurology Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; FHU NeuroVasc, Paris, France; Université de Paris, Paris, France
| | - Emmanuel Houdart
- Neurointerventional Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; Université de Paris, Paris, France
| | - Eric Jouvent
- Vascular Neurology Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; FHU NeuroVasc, Paris, France; Université de Paris, Paris, France; INSERM U1141, Paris, France
| | - Marc-Antoine Labeyrie
- Neurointerventional Unit, Lariboisière Hospital, APHP, F-75475, Paris, France; Université de Paris, Paris, France; INSERM U942, Paris, France.
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Li H, Xu S, Xu B, Zhang Y, Yin J, Yang Y. Unraveling the Links between Chronic Inflammation, Autoimmunity, and Spontaneous Cervicocranial Arterial Dissection. J Clin Med 2023; 12:5132. [PMID: 37568534 PMCID: PMC10419694 DOI: 10.3390/jcm12155132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Advances in imaging techniques have led to a rise in the diagnosis of spontaneous cervicocranial arterial dissection (SCCAD), which is now considered a common cause of stroke in young adults. However, our understanding of the pathophysiological mechanisms underlying SCCAD remains limited. Prior studies have proposed various factors contributing to arterial wall weakness or stress as potential causes for SCCAD. A combination of biopsies, case reports, and case-control studies suggests that inflammatory changes and autoimmunity may play roles in the cascade of events leading to SCCAD. In this review, we examine the close relationship between SCCAD, chronic inflammation, and autoimmune diseases, aiming to explore potential underlying pathophysiological mechanisms connecting these conditions. While some relevant hypotheses and studies exist, direct evidence on this topic is still relatively scarce. Further investigation of the underlying mechanisms in larger clinical cohorts is needed, and the exploration of animal models may provide novel insights.
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Affiliation(s)
- Hao Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Shiyao Xu
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Beibei Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Yutong Zhang
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Jun Yin
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
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Fujiwara G, Oka H, Fujii A. In-hospital recurrence and functional outcome between ischemic stroke caused by intracranial arterial dissection and intracranial atherosclerosis: Retrospective cohort study of the nationwide multicenter registry. J Stroke Cerebrovasc Dis 2023; 32:107212. [PMID: 37331251 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107212] [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: 10/31/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients' backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome. RESULTS Among 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06-9.97) and 0.97 (0.54-1.74), respectively, relative to ICAS. CONCLUSION ICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
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Bukhari S, Yaghi S, Bashir Z. Stroke in Young Adults. J Clin Med 2023; 12:4999. [PMID: 37568401 PMCID: PMC10420127 DOI: 10.3390/jcm12154999] [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: 05/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.
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Affiliation(s)
- Syed Bukhari
- Temple University Hospital, Philadelphia, PA 19140, USA
| | - Shadi Yaghi
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
| | - Zubair Bashir
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
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Li Y, Bai X, Tu H, Zou Z, Huang Y, Cai J. Multiple intracranial enlarging dissecting aneurysms: a case report. BMC Neurol 2023; 23:265. [PMID: 37438693 DOI: 10.1186/s12883-023-03303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cases of multiple cerebral aneurysms are rare. In this case report, we describe a male patient with multiple, enlarging, and ruptured aneurysms. The two aneurysms were believed to be dissecting aneurysms. CASE DESCRIPTION A 47-year-old man presented with left limb paralysis. Magnetic resonance imaging revealed a cerebral infarction. Digital subtraction angiography (DSA) identified an aneurysm and occlusion in the right middle cerebral artery (MCA). The MCA aneurysm was remarkably enlarged on the eighth day after cerebral ischemia and was treated using endovascular techniques. Two weeks after the endovascular treatment, the patient experienced a severe headache and became comatose, and a subarachnoid re-hemorrhage was confirmed. The fourth DSA revealed an enlarging dissecting aneurysm in the posterior cerebral artery. The patient died without further treatment. CONCLUSION Some dissecting aneurysms rapidly enlarge and rupture.
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Affiliation(s)
- Yingbin Li
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Xiaoxin Bai
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China.
- Department of Neurosurgery, Hospital of Guangzhou Higher Education Mega Center, Guangdong Provincial Hospital of Chinese Medicine, 55 Neihuan Xi Road, Guangzhou, 510006, Guangdong, China.
| | - Huai Tu
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Zhimin Zou
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Yan Huang
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Jun Cai
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China.
- Department of Neurosurgery, Hospital of Guangzhou Higher Education Mega Center, Guangdong Provincial Hospital of Chinese Medicine, 55 Neihuan Xi Road, Guangzhou, 510006, Guangdong, China.
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Janquli M, Selvarajah L, Moloney MA, Kavanagh E, O'Neill DC, Medani M. Long-term outcome of cervical artery dissection. J Vasc Surg 2023; 78:158-165. [PMID: 36918105 DOI: 10.1016/j.jvs.2023.03.020] [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: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the natural history of extracranial cervical artery dissection (CAD) including comorbidities, symptoms at presentation, recurrence of symptoms, and long-term outcome following different treatment approaches. METHODS A retrospective review of patients treated for acute CAD was performed over a 5-year period from January 2017 to April 2022. RESULTS Thirty-nine patients were included in the study, 25 (64.1%) with acute internal carotid artery dissection and 14 (35.9%) with acute vertebral artery dissection. Thirty-four patients (87.1%) had spontaneous CAD, and five patients (12.8%) had traumatic CAD. The mean age of the cohort was 54.2 years. The mean time from symptom onset to presentation was 4.34 days. The most common symptoms in internal carotid artery dissection were unilateral weakness (44%), headache (44%), slurred speech (36%), facial droop (28%), unilateral paraesthesia (24%), neck pain (12%), visual disturbance (8%), and Horner's syndrome (8%). The most common symptoms in vertebral artery dissection were headache (35.7%), neck pain (35.7%), vertigo (28.57%), ataxia (14.28%), and slurred speech (14.28%). The imaging modalities used for diagnosis included computed tomography angiography (48.7%), magnetic resonance angiography (41%), and duplex ultrasound (10.2%). In patients with carotid artery dissection, 57% had severe stenosis, 24% had moderate stenosis, and 20% had mild stenosis. All patients treated were managed conservatively with either anticoagulation or antiplatelets. Long-term clinical follow-up was available for 33 patients (84.6%). Thirty patients (90.9%) reported complete resolution of symptoms, and three patients (9%) reported persistent symptoms. Anatomic follow-up with imaging was available for 17 patients (43.58%). Thirteen patients (76.47%) had complete resolution of dissection, two patients (11.76%) had partial resolution of dissection, and two patients (11.76%) had persistent dissection. There was one death unrelated to CAD in a multi-trauma patient. There were four early recurrent symptoms in the first 3 to 8 weeks post discharge. The mean follow-up time was 308.27 days. CONCLUSIONS The majority of CADs can be managed conservatively with good clinical and anatomical outcome and low rates of recurrence.
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Affiliation(s)
- Mohammed Janquli
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland.
| | - Logeswaran Selvarajah
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland
| | - Michael Anthony Moloney
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland
| | - Damien Christopher O'Neill
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland
| | - Mekki Medani
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland
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Agarwal A, Srivastava MVP. Cervical Artery Dissection: An Important Cause of Stroke in Young. Ann Indian Acad Neurol 2023; 26:363. [PMID: 37970312 PMCID: PMC10645216 DOI: 10.4103/aian.aian_311_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 11/17/2023] Open
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Makita N, Ishii R, Yamaguchi Y, Nakamura Y, Miwa K, Yoshimura S, Hosoki S, Ihara M, Toyoda K, Mizuno T, Koga M. Recurrence of intracranial artery dissection more than a half year after the initial event. J Neurol Sci 2023; 451:120716. [PMID: 37379727 DOI: 10.1016/j.jns.2023.120716] [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: 01/30/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The management of intracranial artery dissection (IAD) has not been established, partly because the long-term course of the disease is not well-known. We retrospectively investigated the long-term course of IAD without subarachnoid hemorrhage (SAH) as an initial clinical presentation. METHODS Of 147 consecutive spontaneous first-ever IAD patients hospitalized between March 2011 and July 2018, 44 with SAH were excluded, and the remaining 103 were investigated. We divided the patients into two groups: Recurrence group as those with recurrent intracranial dissection >1 month after the initial dissection, and Non-recurrence group as those without them. Clinical characteristics were compared between those two groups. RESULTS The mean follow-up period was 33 months from the initial event. Recurrent dissection occurred in 4 patients (3.9%) >7 months after the initial dissection, none of whom were on antithrombotic treatments at recurrence. Three had ischemic stroke and the other had local symptoms [range: 8 to 44 months]. Nine (8.7%) had an ischemic stroke within 1 month of the initial event. There was no recurrent dissection between 1 and 7 months after the initial event. There was no significant difference in baseline characteristics between Recurrence and Non-recurrence groups. CONCLUSIONS Four out of the 103 (3.9%) IAD patients had recurrent IAD >7 months after the initial event. IAD patients should be followed up for more than a half year after the initial event, with consideration given to the recurrence of IAD. Further research is needed on recurrence prevention measures to IAD patients.
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Affiliation(s)
- Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Ryotaro Ishii
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Nakamura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Hosoki
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Bao J, Gan X, Feng W, Li Y, Qiu Y, Zhou M, Guo J, He L. Abnormal flow pattern of low wall shear stress and high oscillatory shear index in spontaneous vertebral artery dissection with vertebral artery hypoplasia. Front Neurosci 2023; 17:1179963. [PMID: 37389359 PMCID: PMC10303804 DOI: 10.3389/fnins.2023.1179963] [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: 03/05/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Spontaneous vertebral artery dissection (sVAD) might tend to develop in vertebral artery hypoplasia (VAH) with hemodynamic dysfunction and it is crucial to assess hemodynamics in sVAD with VAH to investigate this hypothesis. This retrospective study aimed to quantify hemodynamic parameters in patients with sVAD with VAH. Methods Patients who had suffered ischemic stroke due to an sVAD of VAH were enrolled in this retrospective study. The geometries of 14 patients (28 vessels) were reconstructed using Mimics and Geomagic Studio software from CT angiography (CTA). ANSYS ICEM and ANSYS FLUENT were utilized for mesh generation, set boundary conditions, solve governing equations, and perform numerical simulations. Slices were obtained at the upstream area, dissection or midstream area and downstream area of each VA. The blood flow patterns were visualized through instantaneous streamline and pressure at peak systole and late diastole. The hemodynamic parameters included pressure, velocity, time-averaged blood flow, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), endothelial cell action potential (ECAP), relative residence time (RRT) and time-averaged nitric oxide production rate (TARNO). Results Significant focal increased velocity was present in the dissection area of steno-occlusive sVAD with VAH compared to other nondissected areas (0.910 m/s vs. 0.449 vs. 0.566, p < 0.001), while focal slow flow velocity was observed in the dissection area of aneurysmal dilatative sVAD with VAH according to velocity streamlines. Steno-occlusive sVAD with VAH arteries had a lower time-averaged blood flow (0.499 cm3/s vs. 2.268, p < 0.001), lower TAWSS (1.115 Pa vs. 2.437, p = 0.001), higher OSI (0.248 vs. 0.173, p = 0.006), higher ECAP (0.328 Pa-1 vs. 0.094, p = 0.002), higher RRT (3.519 Pa-1 vs. 1.044, p = 0.001) and deceased TARNO (104.014 nM/s vs. 158.195, p < 0.001) than the contralateral VAs. Conclusion Steno-occlusive sVAD with VAH patients had abnormal blood flow patterns of focal increased velocity, low time-averaged blood flow, low TAWSS, high OSI, high ECAP, high RRT and decreased TARNO. These results provide a good basis for further investigation of sVAD hemodynamics and support the applicability of the CFD method in testing the hemodynamic hypothesis of sVAD. More detailed hemodynamic conditions with different stages of sVAD are warranted in the future.
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Affiliation(s)
- Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinling Gan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wentao Feng
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University) Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Osteraas ND, Dafer RM. Advances in Management of the Stroke Etiology One-Percenters. Curr Neurol Neurosci Rep 2023; 23:301-325. [PMID: 37247169 PMCID: PMC10225785 DOI: 10.1007/s11910-023-01269-z] [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] [Accepted: 04/13/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE OF REVIEW Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from "standard" care. RECENT FINDINGS Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in "high-risk" patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of L-arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance. Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.
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Affiliation(s)
| | - Rima M Dafer
- Rush University Medical Center, Chicago, IL, USA.
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St., Suite 1118, Chicago, IL, 60612, USA.
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Xia S, Wang Y, Lv X, Chen C, Hui J, Wu X, Wang Z, Chen H, Ji J. The use of SNAP and T1-weighted VISTA in cervical artery dissection. Interv Neuroradiol 2023; 29:235-242. [PMID: 35234066 PMCID: PMC10369114 DOI: 10.1177/15910199221082847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Some cervical artery dissection (CAD) can't be easily confirmed by commonly used angiography techniques in clinical practice. We aimed to compare the abilities of the vessel wall magnetic resonance imaging (MRI) techniques including simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) sequence and T1-weighted volumetric isotropic turbo spin echo acquisition (T1-w VISTA) sequence alone for evaluating CAD. MATERIALS AND METHODS From July 2017 to October 2020, 59 patients underwent MRI examinations including SNAP and T1-w VISTA sequences for cervical artery pathologies. SNAP and T1-w VISTA images were retrospectively and independently reviewed to evaluate their diagnostic performances of CAD by using the final diagnosis as the reference standard which was established by clinical history, physical examination, and all available images. The agreement between T1-w VISTA and SNAP in the identification of the imaging features of CAD, including intramural hematoma (IMH), intimal flap, and double lumen, were compared. The IMH-wall contrasts by T1-w VISTA and SNAP were also compared. RESULTS CAD was confirmed in 43 of the 59 patients. T1-w VISTA and SNAP showed the same diagnostic performance, and their consistencies with the final diagnosis were good (κ = 0.776, p < 0.001). The sensitivity and specificity in CAD diagnosis were 0.978 and 0.750 for T1-w VISTA and SNAP. The IMH, intimal flap, and double lumen observed on SNAP were also determined by T1-w VISTA (κ = 1.000, p < 0.001 for all). The SNAP sequence showed higher IMH-wall contrast than T1-w VISTA (7.34 ± 4.56 vs. 3.12 ± 1.17, p < 0.001). CONCLUSIONS SNAP and T1-w VISTA sequences had the same performance in CAD diagnosis, thus they were both recommended. In addition, SNAP showed better IMH-wall contrast than T1-w VISTA.
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Affiliation(s)
- Shuiwei Xia
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chunmiao Chen
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Junguo Hui
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Xulu Wu
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Zufei Wang
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jiansong Ji
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, Zhejiang, China
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Han J, Chen J, Tong X, Han M, Peng F, Niu H, Liu L, Liu F, Liu A. Association between smoking and intracranial artery dissection in patients aged less than 50 years: A propensity score-matched analysis. Tob Induc Dis 2023; 21:62. [PMID: 37215191 PMCID: PMC10193922 DOI: 10.18332/tid/162380] [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: 05/25/2022] [Revised: 09/07/2022] [Accepted: 03/19/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Smoking is a common risk factor for stroke in the young population. Intracranial artery dissection (ICAD) is a major cause of stroke in this population. However, the association between smoking and ICAD in young patients is not well characterized. We aimed to evaluate the association between smoking and ICAD in young individuals using propensity score-matched analysis. METHODS We conducted a retrospective study of consecutive patients aged <50 years with ICAD who were admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Patients with other non-atherosclerotic/non-aneurysmal cerebrovascular diseases were selected as controls. Propensity score matching was based on age and sex. Smoking and other vascular risk factors were compared between the two groups. RESULTS The ICAD and control group included 120 and 197 patients, respectively. Propensity score matching resulted in 70 matched pairs. Smoking was the only significant factor association with ICAD in the matched cohort (p=0.031). CONCLUSIONS In this propensity score-matched analysis, smoking showed a positive association with ICAD in young patients with common cerebrovascular diseases that were neither atherosclerotic nor aneurysmal. Further studies are required to investigate the predictive role of smoking for ICAD in the young population.
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Affiliation(s)
- Jiangli Han
- Department of Neurosurgery, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yatsen University, Zhuhai, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
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Arcadi FA, Morabito R, Marino S, Formica C, Calabrò RS. Cervical Artery Dissection and Patent Foramen Ovale in Juvenile Stroke: Causality or Casuality? A Familiar Case Report. Med Sci (Basel) 2023; 11:medsci11020034. [PMID: 37218986 DOI: 10.3390/medsci11020034] [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: 04/10/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Cervical artery dissection (CAD) and Patent Foramen Ovale (PFO) are important causes of stroke in young patients. Although PFO is considered an independent risk factor for cerebral infarction in young adults with cryptogenic stroke, other concomitant causes may be necessary to cause brain injury. PFO could be a predisposing factor of stroke through several mechanisms including paradoxical embolism from a venous source, thrombus formation in atrial septum, or atrial arrhythmias causing cerebral thromboembolism. The pathophysiology of CAD is poorly understood and includes both constitutional and environmental factors. A causal association is often difficult to establish, as other predisposing factors may also play a role in CAD etiopathogenesis. We present a family with ischemic stroke (a father and his three daughters), in which the two different stroke causes are present. We hypothesized that a paradoxical embolism caused by PFO, associated with arterial wall disease, in the presence of a procoagulant state, could produce arterial dissection and then stroke.
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Affiliation(s)
| | - Rosa Morabito
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
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Xie S, Ran Y, Wang X, Zhang Y, Fu Q, Ren Y, Liu J, Teng Z, Cheng J. Diagnostic potential of routine brain MRI and high-resolution, multi-contrast vessel wall imaging in the detection of internal carotid artery dissection. Front Neurol 2023; 14:1165453. [PMID: 37251240 PMCID: PMC10213939 DOI: 10.3389/fneur.2023.1165453] [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: 02/14/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Cervical artery dissection (CAD) is one of the major causes of stroke and most commonly occurs at the site of the extracranial internal carotid artery (ICA). This study aimed to assess the value of routine brain MRI, clinical information, and high-resolution, multi-contrast vessel wall MR imaging (hrVWI) for the timely detection of ICA dissection. Methods A total of 105 patients with CAD and 105 without CAD were recruited for this study. The lesion type in the patients was determined based on images from different modalities, including brain MRI, magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA), ultrasonography, and hrVWI and clinical information. Each lesion was reviewed to determine the type following a stepwise procedure by referring to (1) brain MRI only; (2) brain MRI and clinical information; (3) hrVWI only; and (4) hrVWI, CTA, DSA, and clinical information. Results Typical clinical presentations of patients with potential CAD include headache, neck pain, and/or Horner's syndrome. Representative imaging signs in the brain MRI included a crescentic or circular iso- or hyperintensity around the lumen, a curvilinear and isointense line crossing the lumen, or aneurysmal vessel dilation. Based on brain MRI alone, 54.3% (57/105) of the patients with CAD were correctly classified, and the accuracy increased to 73.3% (77/105) when clinical information was combined (P < 0.001) with high specificity and low sensitivity. Further analysis showed that hrVWI had the superior capability in detecting CAD, with a sensitivity and a specificity of 95.1% and 97.0%, respectively. Conclusion The combination of brain MRI and clinical information could be used for the diagnosis of CAD; however, hrVWI should be sought for uncertain cases.
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Affiliation(s)
- Shanshan Xie
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qichang Fu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Ren
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfang Liu
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Rodriguez A, Nunez L, Riascos R. Vascular Injuries in Head and Neck Trauma. Radiol Clin North Am 2023; 61:467-477. [PMID: 36931763 DOI: 10.1016/j.rcl.2023.01.012] [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] [Indexed: 02/21/2023]
Abstract
Blunt and penetrating vascular injuries of the head and neck can represent life-threatening emergencies that require accurate detection to prevent devastating and long-lasting consequences. Implementing appropriate screening criteria to indicate imaging studies is crucial as there is a variable latent time before the onset of clinical manifestations. Computed tomography angiography, MR imaging, and digital subtraction angiography represent the imaging modalities of choice to evaluate vascular injuries. The aim of this review is to provide a description of the different types of vascular injuries, describe the importance of each imaging modality, and recognize the imaging appearance of traumatic vessel injury.
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Affiliation(s)
- Andres Rodriguez
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, Neuroradiology Section, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Luo J, Liu F, Zhao L, Cheng B, Hu Y, Wang X. Endovascular treatment of intracranial vertebral artery dissecting aneurysm, a case series study with two years follow up on complications. Heliyon 2023; 9:e15568. [PMID: 37153412 PMCID: PMC10160516 DOI: 10.1016/j.heliyon.2023.e15568] [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: 07/21/2022] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023] Open
Abstract
Background This study is aimed to analyze the clinical outcomes of endovascular treatments for patients with intracranial vertebral artery dissecting aneurysms. Methods Clinical data of 32 patients with vertebral artery dissecting aneurysms who underwent endovascular procedures in the Department of Neurosurgery of our University from January 2016 to December 2019 were retrospectively analyzed. Nine cases were treated with endovascular occlusion; 23 cases received reconstructive treatment, including 20 cases of stent combined with coil embolization, and 3 cases of stent implantation. The angiography taken at 3-22 months after surgery was reviewed. Results The endovascular treatments for all 32 cases were successful. Thirty-one cases had no postoperative complications during index hospital. Mid-term follow-up showed that: 27 cases (84%) had embolism; 5 cases (16%) had recurrence, of which 4 cases were treated again with endovascular procedures followed with no further complications and no recurrence, and 1 case received closely monitor but no reoperation. During an average follow-up of 10.5 months, except for one case that was self-discharged due to end-stage brainstem compression and respiratory failure, the rest of the patients were in stable conditions without bleeding or infarction. Conclusion Endovascular treatment of intracranial vertebral artery dissecting aneurysms is safe and effective. Recurrent vertebral artery dissecting aneurysms can be treated with endovascular reoperations with satisfactory outcomes.
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Lopez G, Cataldi F, Bellin G, Dunning J, Fernández-de-las-Peñas C, Galeno E, Meroni R, Maselli F, Mourad F. Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report. Healthcare (Basel) 2023; 11:1165. [PMID: 37107999 PMCID: PMC10138410 DOI: 10.3390/healthcare11081165] [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: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Neck pain is a common musculoskeletal disorder encountered by physiotherapists. However, it may be the early manifestation of more alarming conditions, such as cardiovascular diseases mimicking musculoskeletal pain. Patent foramen ovale (PFO) is a congenital heart defect consisting of a small opening between the right and the left atrium. A 56-year-old male presented with neck pain and head heaviness as primary complaints. The cardiovascular profile and the behavioral symptoms led the physiotherapist to find an exaggerated blood pressure response during exercise; in addition to subtle neurological signs, this prompted the physiotherapist to make an urgent referral. At the emergency department a PFO was diagnosed. To the best of the authors' knowledge, this is the first case to describe a rare clinical presentation of a PFO presenting neck pain as primary complaint. This case report emphasizes the importance for physiotherapists to be able to triage patients for conditions outside their scope suggestive of further medical investigation.
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Affiliation(s)
- Giovanni Lopez
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Kinesis, Department of Physiotherapy, 70126 Bari, Italy
| | - Fabio Cataldi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Manual Therapy Laboratory—MTLab, Department of Physiotherapy, 70123 Bari, Italy
| | - Giuseppe Bellin
- Centro Diagnostico Veneto, Department of Physical Therapy, 36030 Vicenza, Italy
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL 36104, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL 36104, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra de Clínica, Investigación y Docencia en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Erasmo Galeno
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
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Lange KS, Tuloup G, Duflos C, Gobron C, Burcin C, Corti L, Roos C, Ducros A, Mawet J. Complications of reversible cerebral vasoconstriction syndrome in relation to age. J Neurol 2023:10.1007/s00415-023-11708-z. [PMID: 37052670 DOI: 10.1007/s00415-023-11708-z] [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: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Reversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether RCVS complications vary according to age. PATIENTS AND METHODS In a pooled French cohort of 345 patients with RCVS, we assessed (1) rates of clinical and radiological complications, and (2) the functional outcome at 3 months according to age as a continuous variable, and in young patients aged ≤ 49 years versus those aged ≥ 50 years. The Commission Nationale Informatique et Liberté and the local ethics committee approved this study (registration number: 202100733). RESULTS The risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1-1.8; p = 0.014, and OR 1.6, 95% CI 1.2-2.1; p < 0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.7, 95% CI 1.3-2.3; p < 0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1-2.2; p = 0.023). Frequency of cervical artery dissections peaked at age 30-39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4-76.6; p = 0.003). Age had no impact on the functional outcome, with a modified Rankin scale score of 0-1 in > 96% of patients. CONCLUSION Age seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in cases of RCVS and vice versa.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France.
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany.
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gabrielle Tuloup
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Department of Neurology, CHU Caen-Normandie, Caen, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, CHU Montpellier, Montpellier University, Montpellier, France
| | - Claire Gobron
- Department of Clinical Physiology, APHP, Lariboisière-St Louis Hospitals, DMU DREAM, 75010, Paris, France
| | - Cécilia Burcin
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucas Corti
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Caroline Roos
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Ducros
- Department of Neurology, CHU Montpellier, Gui de Chauliac Hospital, Montpellier, France
- Charles Coulomb Laboratory, CNRS UMR5221, Montpellier University, Montpellier, France
| | - Jérôme Mawet
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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Salehi Omran S. Cervical Artery Dissection. Continuum (Minneap Minn) 2023; 29:540-565. [PMID: 37039409 DOI: 10.1212/con.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cervical artery dissection is a common cause of stroke in young adults. This article reviews the pathophysiology, etiology and risk factors, evaluation, management, and outcomes of spontaneous cervical artery dissection. LATEST DEVELOPMENTS Cervical artery dissection is believed to be a multifactorial disease, with environmental factors serving as possible triggers in patients who have a genetic predisposition to dissection formation. Cervical artery dissection can cause local symptoms or ischemic events, such as ischemic stroke or transient ischemic attack. Neuroimaging is used to confirm the diagnosis; classic findings include a long tapered arterial stenosis or occlusion, dissecting aneurysm, intimal flap, double lumen, or intramural hematoma. Patients with cervical artery dissection who present with an acute ischemic stroke should be evaluated for IV thrombolysis, endovascular therapy eligibility, or both. Antithrombotic therapy with either anticoagulation or antiplatelet treatment is used to prevent stroke from cervical artery dissection. The risk of recurrent ischemia appears low and is mostly limited to the first two weeks after symptom onset. ESSENTIAL POINTS Cervical artery dissection is a known cause of ischemic strokes. Current data show no difference between the benefits and risks of anticoagulation versus antiplatelet therapy in the acute phase of symptomatic extracranial cervical artery dissection, thereby supporting the recommendation that clinicians can prescribe either treatment. Further research is warranted to better understand the pathophysiology and long-term outcomes of cervical artery dissection.
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Lloyd ML, Billingslea S, Slama R. Atraumatic Vertebral Artery Dissection in a Patient With a Migraine Headache. Mil Med 2023; 188:e848-e851. [PMID: 33876248 DOI: 10.1093/milmed/usab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/10/2021] [Accepted: 03/31/2021] [Indexed: 11/12/2022] Open
Abstract
This case discusses a 34-year-old active duty male who presented to the emergency department with a 2-week persistent headache. His initial review of symptoms was reassuring until a detailed neurologic examination on his second visit revealed a visual deficit in the left upper quadrant. Additionally, he complained of intermittent tension headaches for the last several years but had no history of diagnosed migraines until he was seen 4 days prior for empiric migraine therapy in the same emergency department and left without improvement in symptoms. On his return visit, computerized tomography scan with intravenous contrast revealed a left vertebral artery dissection and hematoma. The patient was admitted for medical management and subsequently found to have suffered a small infarction of right lingual gyrus cortex on magnetic resonance imaging. This case illustrates the importance of maintaining a broad differential diagnosis and high index of suspicion in the patient with new focal neurologic findings in order to diagnose a potentially fatal disease.
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Affiliation(s)
- Michael L Lloyd
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | | | - Richard Slama
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
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