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Gutierrez J, Bos D, Turan TN, Hoh B, Hilal S, Arenillas JF, Schneider JA, Chimowitz I M, Morgello S. Pathology-based brain arterial disease phenotypes and their radiographic correlates. J Stroke Cerebrovasc Dis 2024; 33:107642. [PMID: 38395095 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107642] [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: 12/05/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Brain arterial diseases, including atherosclerosis, vasculitis, and dissections, are major contributors to cerebrovascular morbidity and mortality worldwide. These diseases not only increase the risk of stroke but also play a significant role in neurodegeneration and dementia. Clear and unambiguous terminology and classification of brain arterial disease phenotypes is crucial for research and clinical practice. MATERIAL AND METHODS This review aims to summarize and harmonize the terminology used for brain large and small arterial phenotypes based on pathology studies and relate them to imaging phenotypes used in medical research and clinical practice. CONCLUSIONS AND RESULTS Arteriosclerosis refers to hardening of the arteries but does not specify the underlying etiology. Specific terms such as atherosclerosis, calcification, or non-atherosclerotic fibroplasia are preferred. Atherosclerosis is defined pathologically by an atheroma. Other brain arterial pathologies occur and should be distinguished from atherosclerosis given therapeutic implications. On brain imaging, intracranial arterial luminal stenosis is usually attributed to atherosclerosis in the presence of atherosclerotic risk factors but advanced high-resolution arterial wall imaging has the potential to more accurately identify the underlying pathology. Regarding small vessel disease, arteriosclerosis is ambiguous and arteriolosclerosis is often used to denote the involvement of arterioles rather than arteries. Lipohyalinosis is sometimes used synonymously with arteriolosclerosis, but less accurately describes this common small vessel thickening which uncommonly shows lipid. Specific measures of small vessel wall thickness, the relationship to the lumen as well as changes in the layer composition might convey objective, measurable data regarding the status of brain small vessels.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 710 W 168th Street, 6th floor, Suite 639, New York, NY 10032, United States.
| | - Daniel Bos
- Department of Epidemiology, ErasmusMC, Dr. Molewaterplein 40, 3015 GD Rotterdam, Room NA-2710,Postbus 2040, Rotterdam 3000, the Netherlands; Department of Radiology & Nuclear Medicine and Epidemiology, ErasmusMC, Rotterdam, the Netherlands.
| | - Tanya N Turan
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Brian Hoh
- Department of Neurosurgery, University of Florida, Gainsville, FL, United States
| | - Saima Hilal
- Memory Aging and Cognition Center, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario, Valladolid; Department of Medicine, University of Valladolid, Spain
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Marc Chimowitz I
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Mount Sinai Medical Center, New York, NY, United States
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Chen LH, Spagnolo-Allende A, Yang D, Qiao Y, Gutierrez J. Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease. Stroke 2024; 55:311-323. [PMID: 38252756 PMCID: PMC10827355 DOI: 10.1161/strokeaha.123.043630] [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] [Indexed: 01/24/2024]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of stroke worldwide. Among people with stroke, those of East Asia descent and non-White populations in the United States have a higher burden of ICAD-related stroke compared with Whites of European descent. Disparities in the prevalence of asymptomatic ICAD are less marked than with symptomatic ICAD. In addition to stroke, ICAD increases the risk of dementia and cognitive decline, magnifying ICAD societal burden. The risk of stroke recurrence among patients with ICAD-related stroke is the highest among those with confirmed stroke and stenosis ≥70%. In fact, the 1-year recurrent stroke rate of >20% among those with stenosis >70% is one of the highest rates among common causes of stroke. The mechanisms by which ICAD causes stroke include plaque rupture with in situ thrombosis and occlusion or artery-to-artery embolization, hemodynamic injury, and branch occlusive disease. The risk of stroke recurrence varies by the presumed underlying mechanism of stroke, but whether techniques such as quantitative magnetic resonance angiography, computed tomographic angiography, magnetic resonance perfusion, or transcranial Doppler can help with risk stratification beyond the degree of stenosis is less clear. The diagnosis of ICAD is heavily reliant on lumen-based studies, such as computed tomographic angiography, magnetic resonance angiography, or digital subtraction angiography, but newer technologies, such as high-resolution vessel wall magnetic resonance imaging, can help distinguish ICAD from stenosing arteriopathies.
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Affiliation(s)
- Li Hui Chen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Antonio Spagnolo-Allende
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, Rush University, Chicago, IL, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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3
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Abstract
Cryptogenic strokes are symptomatic cerebral ischemic infarcts without a clear etiology identified following standard diagnostic evaluation and currently account for 10% to 40% of stroke cases. Continued research is needed to identify and bridge gaps in knowledge of this stroke grouping. Vessel wall imaging has increasingly shown its utility in the diagnosis and characterization of various vasculopathies. Initial promising evidence suggests rational use of vessel wall imaging in stroke workup may unravel pathologies that otherwise would have been occult and further improve our understanding of underlying disease processes that can translate into improved patient outcomes and secondary stroke prevention.
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Affiliation(s)
- Bhagya Sannananja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast Suite BG20, Atlanta, GA 30322, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA.
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Chaudhary N, Gupta BK, Poudel A, Kafle M, Singh N, Chaudhary HP. Stroke in a child with pulmonary tuberculosis and pleural effusion-An important clue for the diagnosis of disseminated central nervous system tuberculosis. Clin Case Rep 2023; 11:e6945. [PMID: 36789297 PMCID: PMC9914082 DOI: 10.1002/ccr3.6945] [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: 03/02/2022] [Revised: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Central nervous system tuberculosis (CNS-TB) is one of the most devastating and life-threatening conditions having high mortality and morbidity. Here, we report a 12-year-old child with pulmonary tuberculosis and pleural effusion presenting with ischemic stroke as an important manifestation of central nervous system tuberculosis.
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Affiliation(s)
- Nagendra Chaudhary
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Binod Kumar Gupta
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Astha Poudel
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Manish Kafle
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Neeva Singh
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
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Sanchez S, Raghuram A, Fakih R, Wendt L, Bathla G, Hickerson M, Ortega-Gutierrez S, Leira E, Samaniego EA. 3D Enhancement Color Maps in the Characterization of Intracranial Atherosclerotic Plaques. AJNR Am J Neuroradiol 2022; 43:1252-1258. [PMID: 35953278 PMCID: PMC9451620 DOI: 10.3174/ajnr.a7605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/24/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging allows the identification of culprit symptomatic plaques after the administration of gadolinium. Current high-resolution MR imaging methods are limited by 2D multiplanar views and manual sampling of ROIs. We analyzed a new 3D method to objectively quantify gadolinium plaque enhancement. MATERIALS AND METHODS Patients with stroke due to intracranial atherosclerotic disease underwent 7T high-resolution MR imaging. 3D segmentations of the plaque and its parent vessel were generated. Signal intensity probes were automatically extended from the lumen into the plaque and the vessel wall to generate 3D enhancement color maps. Plaque gadolinium (Gd) uptake was quantified from 3D color maps as gadolinium uptake = (µPlaque T1 + Gd -µPlaque T1/SDPlaque T1). Additional metrics of enhancement such as enhancement ratio, variance, and plaque-versus-parent vessel enhancement were also calculated. Conventional 2D measures of enhancement were collected for comparison. RESULTS Thirty-six culprit and 44 nonculprit plaques from 36 patients were analyzed. Culprit plaques had higher gadolinium uptake than nonculprit plaques (P < .001). Gadolinium uptake was the most accurate metric for identifying culprit plaques (OR, 3.9; 95% CI 2.1-8.3). Gadolinium uptake was more sensitive (86% versus 70%) and specific (71% versus 68%) in identifying culprit plaques than conventional 2D measurements. A multivariate model, including gadolinium uptake and plaque burden, identified culprit plaques with an 83% sensitivity and 86% specificity. CONCLUSIONS The new 3D color map method of plaque-enhancement analysis is more accurate for identifying culprit plaques than conventional 2D methods. This new method generates a new set of metrics that could potentially be used to assess disease progression.
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Affiliation(s)
- S Sanchez
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
| | - A Raghuram
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
| | - R Fakih
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
| | - L Wendt
- Institute for Clinical and Translational Science (L.W.), University of Iowa, Iowa City, Iowa
| | - G Bathla
- Radiology (G.B., S.O.-G., E.A.S.)
| | - M Hickerson
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
| | - S Ortega-Gutierrez
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
- Radiology (G.B., S.O.-G., E.A.S.)
- Neurosurgery (S.O.-G., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - E Leira
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
| | - E A Samaniego
- From the Department of Neurology (S.S., A.R., R.F., M.H., S.O.-G., E.L., E.A.S.)
- Radiology (G.B., S.O.-G., E.A.S.)
- Neurosurgery (S.O.-G., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, Iowa
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6
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Tang X, Niimi M, Zhou H, Chen L, Chen Y, Yan H, Shiomi M, Fan J. Pathological Investigations of Intracranial Atherosclerosis Using Multiple Hypercholesterolemic Rabbit Models. Front Endocrinol (Lausanne) 2022; 13:834207. [PMID: 35712258 PMCID: PMC9196249 DOI: 10.3389/fendo.2022.834207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Intracranial atherosclerosis (ICAS) is one of the most common causes of ischemic stroke, but there are few animal models that can recapitulate its pathological features. In this study, we examined ICAS pathological features and anatomic distributions using three types of hyperlipidemic rabbit models. We also investigated the effect of different lipoprotein profiles and hypertension on ICAS. MATERIALS AND METHODS We examined Watanabe heritable hyperlipidemic (WHHL) rabbits, apoE knockout (KO) rabbits and wild-type rabbits (WT) fed a cholesterol diet, in addition to WT rabbits fed a standard diet as a control. The whole brain was dissected and embedded in paraffin. Serial sections were stained with either hematoxylin/eosin or elastica van Gieson, or immunohistochemically stained with monoclonal antibodies against macrophages and smooth muscle cells. We investigated (1) the presence of cerebral atherosclerosis; (2) the lesion locations in the cerebral arteries; (3) the degree of lumen stenosis; (4) pathological features and cellular components of the lesions in these rabbits; and (5) whether hypertension affects ICAS. RESULTS ICAS was detected in apoE and WHHL rabbits, but not in WT rabbits. Compared with apoE KO rabbits, WHHL rabbits had greater ICAS. The lesions of cerebral atherosclerosis were mainly distributed at the bifurcations of the posterior cerebral artery, basilar artery and vertebral artery, and they were basically characterized by smooth muscle cells and extracellular matrix with few macrophages. The extent of the ICAS in WHHL rabbits was significantly increased by hypertension. CONCLUSIONS ICAS was detected in WHHL and apoE KO rabbits, and occurred in specific locations in the cerebral arteries. Hypertension promotes the development of ICAS in the setting of hypercholesterolemia.
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Affiliation(s)
- Xiangming Tang
- Department of Molecular Pathology, Faculty of Medicine, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Manabu Niimi
- Department of Molecular Pathology, Faculty of Medicine, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Huanjin Zhou
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen, China
| | - Lu Chen
- Department of Molecular Pathology, Faculty of Medicine, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yajie Chen
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen, China
| | - Haizhao Yan
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell, Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Masashi Shiomi
- Institute for Experimental Animals, Kobe University School of Medicine, Kobe, Japan
| | - Jianglin Fan
- Department of Molecular Pathology, Faculty of Medicine, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen, China
- *Correspondence: Jianglin Fan,
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7
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Spagnolo-Allende A, Gutierrez J. Role of Brain Arterial Remodeling in HIV-Associated Cerebrovascular Outcomes. Front Neurol 2021; 12:593605. [PMID: 34239489 PMCID: PMC8258100 DOI: 10.3389/fneur.2021.593605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
As the life expectancy of people living with HIV (PLWH) on combination antiretroviral therapy (cART) increases, so does morbidity from cerebrovascular disease and neurocognitive disorders. Brain arterial remodeling stands out as a novel investigational target to understand the role of HIV in cerebrovascular and neurocognitive outcomes. We therefore conducted a review of publications in PubMed, EMBASE, Web of Science and Wiley Online Library, from inception to April 2021. We included search terms such as HIV, cART, brain, neuroimmunity, arterial remodeling, cerebrovascular disease, and neurocognitive disorders. The literature shows that, in the post-cART era, PLWH continue to experience an increased risk of stroke and neurocognitive disorders (albeit milder forms) compared to uninfected populations. PLWH who are immunosuppressed have a higher proportion of hemorrhagic strokes and strokes caused by opportunistic infection and HIV vasculopathy, while PLWH on long-term cART have higher rates of ischemic strokes, compared to HIV-seronegative controls. Brain large artery atherosclerosis in PLWH is associated with lower CD4 nadir and higher CD4 count during the stroke event. HIV vasculopathy, a form of non-atherosclerotic outward remodeling, on the other hand, is associated with protracted immunosuppression. HIV vasculopathy was also linked to a thinner media layer and increased adventitial macrophages, suggestive of non-atherosclerotic degeneration of the brain arterial wall in the setting of chronic central nervous system inflammation. Cerebrovascular architecture seems to be differentially affected by HIV infection in successfully treated versus immunosuppressed PLWH. Brain large artery atherosclerosis is prevalent even with long-term immune reconstitution post-cART. HIV-associated changes in brain arterial walls may also relate to higher rates of HIV-associated neurocognitive disorders, although milder forms are more prevalent in the post-cART era. The underlying mechanisms of HIV-associated pathological arterial remodeling remain poorly understood, but a role has been proposed for chronic HIV-associated inflammation with increased burden on the vasculature. Neuroimaging may come to play a role in assessing brain arterial remodeling and stratifying cerebrovascular risk, but the data remains inconclusive. An improved understanding of the different phenotypes of brain arterial remodeling associated with HIV may reveal opportunities to reduce rates of cerebrovascular disease in the aging population of PLWH on cART.
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Affiliation(s)
| | - Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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8
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Song JW, Wasserman BA. Vessel wall MR imaging of intracranial atherosclerosis. Cardiovasc Diagn Ther 2020; 10:982-993. [PMID: 32968655 DOI: 10.21037/cdt-20-470] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.
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Affiliation(s)
- Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Scutelnic A, Mordasini P, Bervini D, El-Koussy M, Heldner MR. Management of Symptomatic Intracranial Atherosclerotic Stenosis. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Briones-Claudett KH, Briones-Claudett MH, Briones Zamora KH, Nieves Velez RD, Martinez Alvarez ME, Grunauer Andrade M. Ischemic Stroke and Disseminated Tuberculosis in Intensive Care: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920410. [PMID: 32499476 PMCID: PMC7295316 DOI: 10.12659/ajcr.920410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient: Male, 73-year-old Final Diagnosis: Ischemic stroke and disseminated tuberculosis Symptoms: Aphasia • deterioration of the level of consciousness • deviation of the labial commissure Medication: — Clinical Procedure: — Specialty: Critical Care Medicine
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Affiliation(s)
- Killen H Briones-Claudett
- Faculty of Medical Sciences, Universidad de Guayaquil, Guayaquil, Ecuador.,Physiology and Respiratory Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | - Mónica H Briones-Claudett
- Physiology and Respiratory Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | - Rubén D Nieves Velez
- Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | - Michelle Grunauer Andrade
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.,Pediatric Critical Care Unit, Hospital de los Valles, Quito, Ecuador
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Abstract
PURPOSE OF REVIEW Intracranial atherosclerosis (ICAS) is the most common cause of stroke throughout the world. It also increases the risk of recurrent stroke and dementia. As a complex and multifactorial disease, ICAS is influenced by multiple genetic, biological, and environmental factors. This review summarizes the candidate gene and genome-wide studies aimed at discovering genetic risk factors of ICAS. RECENT FINDINGS Numerous studies have focused on the association between single-nucleotide polymorphisms (SNPs) of atherosclerosis-related genes and the risk of ICAS. Variants in adiponectin Q (ADIPOQ), ring finger protein 213 (RNF213), apolipoprotein E (APOE), phosphodiesterase 4D (PDE4D), methylenetetrahydrofolate reductase (MTHFR), lipoprotein lipase (LPL), α-adducin (ADD1) genes, angiotensin-converting enzyme (ACE), and other genes related to renin-angiotensin-aldosterone system have been associated with ICAS. We review the available evidences on the candidate genes and SNPs associated with genetic susceptibility to ICAS, and point out future developments of this field. Genetic discoveries could have clinical implications for intracranial atherosclerotic disease.
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Affiliation(s)
- Minghua Liu
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA.
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12
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Gutierrez J, Byrd D, Yin MT, Morgello S. Relationship Between Brain Arterial Pathology and Neurocognitive Performance Among Individuals With Human Immunodeficiency Virus. Clin Infect Dis 2020; 68:490-497. [PMID: 30107467 DOI: 10.1093/cid/ciy501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background Human immunodeficiency virus-positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND). Methods Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death. We used five cognitive domains (motor, processing speed, working memory, verbal fluency, and executive functioning) to assess ante mortem performance. We quantified the diameter of the lumen and arterial wall thickness obtained during autopsy. The diagnoses of HAND were attributed using the American Academy of Neurology nosology. We used generalized linear mixed model to account for repeated measures, follow-up time, and codependence between arteries. Models were adjusted for demographics, viral loads, CD4 counts, history of opportunistic infections, and vascular risks. Results We included 94 HIV+ individuals (mean age 56 ± 8.3, 68% men, 54% African American). In adjusted models, there was an association between arterial wall thickness and global cognitive score (B = -0.176, P value = .03), processing speed (B = -0.175, P = .05), and verbal fluency (B = -0.253, P = .02). Participants with incident or worsening HAND had thicker brain arterial walls (B = 0.523 ± 0.234, P = .03) and smaller arterial lumen (B = -0.633 ± 0.252, P = .01). Conclusions We report here a novel association between brain arterial wall thickening and poorer ante mortem cognitive performance and diagnosis of incident or worsening HAND at death. Strategies to preserve the arterial lumen or to prevent wall thickening may impact HAND.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Stroke Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Desiree Byrd
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
| | - Michael T Yin
- Department of Medicine, Infectious Disease Division, New York Presbyterian/Columbia University Medical Center, New York
| | - Susan Morgello
- Departments of Neurology and Pathology, Mount Sinai School of Medicine, New York Presbyterian/Columbia University Medical Center, New York
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13
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Increased Stroke Risk in Children and Young Adults on Extracorporeal Life Support with Carotid Cannulation. ASAIO J 2019; 65:718-724. [DOI: 10.1097/mat.0000000000000912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Samaniego EA, Shaban A, Ortega-Gutierrez S, Roa JA, Hasan DM, Derdeyn C, Dai B, Adams H, Leira E. Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis. Stroke Vasc Neurol 2019; 4:189-197. [PMID: 32030202 PMCID: PMC6979872 DOI: 10.1136/svn-2019-000246] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023] Open
Abstract
Background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown. Methods We reviewed our prospective institutional database to identify patients with ≥50% symptomatic basilar artery (BA) stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries. Stroke mechanism, collateral circulation, and degree and length of stenosis were analysed. The primary outcome was time from index event to new transient ischaemic attack (TIA), acute ischaemic stroke (AIS) or death. Other outcome variables included modified Rankin Scale (mRS) score on discharge and last follow-up. Results Of 6369 patients with AIS/TIA, 91 (1.43%) had ISBAS. Seventy-three (80.2%) patients presented with AIS and 18 (19.8%) with TIA. Twenty-nine (31.9%) were women and the median age was 66.8±13.6 years. The mean follow-up time was 2.7 years. The most common stroke mechanism was artery-to-artery thromboembolism (45.2%), followed by perforator occlusion (28.7%) and flow-dependent/hypoperfusion (15.1%). The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge (78.3±14.3 vs 86.9±14.5, p=0.007). Kaplan-Meier curves showed higher recurrence/death rates in patients with ≥80% stenosis, mid-basilar location and poor collateral circulation. Approximately 13% of patients with ISBAS presented with complete BA occlusion. Conclusion ISBAS is an uncommon (1.43%) cause of TIA and AIS. Men in their 60s are mostly affected, and artery-to-artery embolism is the most common stroke mechanism. Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.
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Affiliation(s)
- Edgar A Samaniego
- Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amir Shaban
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jorge A Roa
- Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David M Hasan
- Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Colin Derdeyn
- Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Biyue Dai
- Biostatistics and Public Health, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Harold Adams
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Enrique Leira
- Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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15
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Lange MC, Ribas G, Scavasine V, Ducci RDP, Mendes DC, Zétola VDHF, Cabral N, Rundek T. Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:649-653. [PMID: 30427503 DOI: 10.1590/0004-282x20180095] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. METHODS All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. RESULTS The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. CONCLUSION Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.
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Affiliation(s)
- Marcos C Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Gustavo Ribas
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Valeria Scavasine
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Renata Dal-Prá Ducci
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | - Danielle C Mendes
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Neurologia, Curitiba PR, Brasil
| | | | - Norberto Cabral
- Universidade da Região de Joinville, Departamento de Medicina, Joinville SC, Brasil
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Department of Neurology, Miami, FL, USA
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16
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Gutierrez J, DiTullio M, K Cheung YK, Alperin N, Bagci A, L Sacco R, B Wright C, Sv Elkind M, Rundek T. Brain arterial dilatation modifies the association between extracranial pulsatile hemodynamics and brain perivascular spaces: the Northern Manhattan Study. Hypertens Res 2019; 42:1019-1028. [PMID: 30932017 DOI: 10.1038/s41440-019-0255-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 11/09/2022]
Abstract
Pulsatile hemodynamics are associated with brain small perivascular spaces (SPVS). It is unknown whether the stiffness of intermediary arteries connecting the aorta and brain modifies this association. Participants from the Northern Manhattan Study were assessed for SPVS (defined as ≤3 mm T1 voids) and white matter hyperintensity volume (WMH) using MRI. Middle (MCA) and anterior cerebral arterial (ACA) diameters (measured on time-of-flight MRA) and CCA strain (assessed by ultrasound) were used as surrogates of stiffness. Brachial and aortic pulse pressure (PP) and aortic augmentation index (Aix, assessed by applanation tonometry) were used as markers of pulsatility. We tested whether stiffness in intermediary arteries modifies the association between extracranial pulsatility with SPVS and WMH. We found that among 941 participants (mean age 71 ± 9 years, 60% women, 66% Hispanic), the right MCA/ACA diameter was associated with right anterior SPVS (B = 0.177, P = 0.002). Brachial PP was associated with right anterior SPVS (B = 0.003, P = 0.02), and the effect size was bigger with right MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). The association between right CCA strain and ipsilateral SPVS was modified by MCA/ACA diameter, with the largest effect size in those with ipsilateral MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). Similar dose-effects and statistical interactions were replicated using aortic AIx or aortic PP. We found no evidence of effect modification between pulsatile measures and WMH by stiffness measures. In summary, pulsatile hemodynamics relate to brain SPVS, and the association is the strongest among individuals with dilated brain arteries.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Marco DiTullio
- Department of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Ying Kuen K Cheung
- Division of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Noam Alperin
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ahmet Bagci
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mitchell Sv Elkind
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
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17
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Quantitative score of the vessel morphology in middle cerebral artery atherosclerosis. J Neurol Sci 2019; 399:111-117. [PMID: 30798108 DOI: 10.1016/j.jns.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to quantitatively assess the vessel morphology of middle cerebral artery (MCA) atherosclerosis and explore its value in discriminating plaque types. METHODS Patients were selected from a high-resolution magnetic resonance imaging (HRMRI) study from January 2007 to December 2015. One hundred and three patients with acute cerebral infarcts due to MCA stenosis (>50%) and eighty-nine patients with asymptomatic MCA stenosis (>50%) were included. Quantitative measurements of MCA morphology, including lumen area, outer-wall and wall area at stenotic site and reference site, stenotic degree, plaque length, remodeling index and plaque eccentricity, were performed on HRMRI with observers blinded to clinical presentations. Firth's penalized logistic regression analysis was used to construct a symptomatic plaque score (SPS) model. Then, the HRMRI data of 39 patients prospectively enrolled from January 2016 to January 2017 were used to validate the SPS model. RESULTS The HRMRI data of 103 patients with symptomatic MCA stenosis and 89 patients with asymptomatic MCA stenosis in the construction cohort were analyzed. Four main factors were found to be associated with symptomatic plaques: stenotic lumen area ≥ 2.28 mm2, stenotic wall area ≥ 8.88 mm2, plaque length and presence of an eccentric plaque. Summation of each logistic regression coefficient multiplying the corresponding score produced the SPS with an area under curve (AUC) of 0.890 on receiver operating characteristics analysis. Validation of the score of 39 plaques (19 symptomatic and 20 asymptomatic) revealed an AUC of 0.862, confirming the continued diagnostic ability. When the data were pooled in all 235 plaques, the optimal cutoff score of discriminating symptomatic and asymptomatic plaques was 2.79 (SPS ≥ 2.79 indicating a symptomatic plaque) with AUC = 0.886, sensitivity 81.1% and specificity 80.5%. CONCLUSIONS The quantitative analysis of MCA morphology can independently and accurately discriminate plaque types, suggesting its close association with the underlying pathophysiology. Further prospective studies are required to verify whether the SPS model is clinically valuable in monitoring plaque progression and assessing the vulnerability.
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18
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Song JW, Obusez EC, Raymond SB, Rafla SD, Schaefer PW, Romero JM. Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies. J Neuroimaging 2019; 29:454-457. [PMID: 30761654 DOI: 10.1111/jon.12607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE We hypothesized that vessel wall MR imaging (VWI) with 3D-time-of-flight magnetic resonance imaging (3D-TOF-MRA) together increases the ability to detect abnormal intracranial vessel segments compared to 3D-TOF-MRA alone. METHODS Ninety-three consecutive subjects with a clinical history of suspected vasculopathy imaged with both VWI and 3D-TOF-MRAs were retrospectively reviewed. The 3D-TOF-MRAs were reviewed by two independent neuroradiologists classifying arterial segments as normal or abnormal based on caliber changes. Following a 2-week wash-out period, the 3D-TOF-MRAs with VWI together were re-evaluated for caliber changes and/or vessel wall enhancement. A third neuroradiologist served as consensus. Significance was assessed by McNemar's test. RESULTS Forty-two subjects with VWI and 3D-TOF-MRAs met the inclusion criteria. By 3D-TOF-MRA alone, 12.3% (95% confidence interval [CI], 10.7-15.1) of the arterial segments were identified as abnormal compared to 20.8% (95% CI, 18.2-23.4) by VWI and 3D-TOF-MRA together (P < .0001). CONCLUSIONS 3D-TOF-MRA and VWI together identifies a higher number of abnormal vessel segments than 3D-TOF-MRA alone and may provide a more accurate assessment of disease burden.
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Affiliation(s)
- Jae W Song
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Emmanuel C Obusez
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Scott B Raymond
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Samuel D Rafla
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Pamela W Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Javier M Romero
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Shapiro SD, Goldman J, Morgello S, Honig L, Elkind MSV, Marshall RS, Mohr JP, Gutierrez J. Pathological correlates of brain arterial calcifications. Cardiovasc Pathol 2018; 38:7-13. [PMID: 30399527 DOI: 10.1016/j.carpath.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In clinical practice, calcifications seen on computed tomographic studies within the large brain arteries are often referred to as a surrogate marker for cholesterol-mediated atherosclerosis. However, limited data exist to support the association between calcification and atherosclerosis. In this study, we examined if intracranial arterial calcifications were associated with cholesterol-mediated intracranial large artery atherosclerosis (ILAA) within the arteries of the circle of Willis in an autopsy-based sample. METHODS We carried out a cross-sectional analysis of histopathological characteristics of brain large arteries obtained from autopsy cases. Brain large arteries were examined for evidences of calcifications, which were rated as macroscopic (coalescent) and microscopic (scattered). In addition to calcification, we also obtained measurement of the arterial wall and the presence of ILAA and nonatherosclerotic arterial fibrosis. We built hierarchical models adjusted for demographic and vascular risk factors to assess the relationship between calcification and ILAA. RESULTS In univariate analysis, the presence of any arterial calcifications was associated with cerebral infarcts (29% vs. 14%, P<.01). Multivariate analysis revealed that among all calcifications, coalescent calcifications were not associated with ILAA. In contrast, scattered calcifications were associated with ILAA (P<.001), decreased lumen diameter (-1.87 +/- 0.41 mm, P≤.001), and increased luminal stenosis (0.03% +/- 0.01%, P≤.006). These findings were independent of age, sex, or other vascular risk factors. CONCLUSIONS This study demonstrates that coalescent calcifications in brain large arteries, although associated with morbidity, are not synonymous with cholesterol-driven ILAA. Understanding the precise pathological components of cerebrovascular disease, including nonatherosclerotic arterial calcifications, will help develop individualized therapies beyond amelioration of traditional risk factors such as hyperlipidemia.
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Affiliation(s)
- Steven D Shapiro
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University
| | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai
| | - Lawrence Honig
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jay P Mohr
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
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20
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Yu YN, Li ML, Xu YY, Meng Y, Trieu H, Villablanca JP, Gao S, Feng F, Liebeskind DS, Xu WH. Middle cerebral artery geometric features are associated with plaque distribution and stroke. Neurology 2018; 91:e1760-e1769. [PMID: 30291186 DOI: 10.1212/wnl.0000000000006468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/29/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to investigate the geometric features of the middle cerebral artery (MCA) and their relevance to plaque distribution and ischemic stroke. METHODS We reviewed our institutional vessel wall imaging database. Patients with symptomatic MCA atherosclerosis, asymptomatic MCA atherosclerosis, or without MCA atherosclerosis were included. The MCA geometric features, including M1 segment shape and M1 curve orientation, were defined on magnetic resonance angiography. Plaque distribution and other plaque parameters were identified on vessel wall imaging. The association among MCA geometric features, plaque distribution, and ischemic stroke were analyzed. RESULTS A total of 977 MCAs were analyzed (87 atherosclerotic symptomatic MCAs, 459 atherosclerotic asymptomatic MCAs, and 431 plaque-free MCAs). Overall, curved M1 segments were the predominant shape across all groups. In 91.1% of curved atherosclerotic MCAs, the plaque involved the inner wall of the curve. Plaque not involving the inner wall was shorter (p < 0.0001) and thinner (p = 0.005) compared to plaque involving the inner wall. Inferior plaque was observed in 39.9% of inferior-oriented M1 curves compared to 21.7% in non-inferior-oriented M1 curves (p < 0.0001). The absence of an inferior-oriented M1 curve (odds ratio 0.45, 95% confidence interval 0.27-0.77) and presence of superior plaque (odds ratio 2.67, 95% confidence interval 1.52-4.67) were independently associated with stroke after adjusting for plaque length and thickness, degree of stenosis, and remodeling ratio. CONCLUSIONS MCA geometric features are associated with plaque distribution and stroke. Our findings provide insight into the vascular pathophysiology of MCA atherosclerosis.
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Affiliation(s)
- Yan Nan Yu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Ming-Li Li
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Yu-Yuan Xu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Yao Meng
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Harry Trieu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - J Pablo Villablanca
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Shan Gao
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Feng Feng
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - David S Liebeskind
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA
| | - Wei-Hai Xu
- From the Departments of Neurology (Y.-N.Y., Y.-Y.X., Y.M., S.G., W.-H.X.) and Radiology (M.-L.L., F.F.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Neurovascular Imaging Research Core and UCLA Stroke Center (Y.-N.Y., H.T., D.S.L.), Los Angeles; and Department of Radiology (J.P.V.), UCLA, Los Angeles, CA.
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Abstract
OBJECTIVE To test whether HIV is associated with brain large artery vulnerable intima. DESIGN Cross-sectional study of autopsied HIV-positive (HIV+) cases sex and age-matched to HIV-negative (HIV-) controls. METHODS Brain large arteries from 302 autopsied cases (50% HIV+) were evaluated morphometrically for the presence of atherosclerosis, size of necrotic core, and fibrous cap thickness. Intima vulnerability was measured as intima elastolytic score [0-5, based on intimal metalloproteinases (MMP)-2, MMP-3, and MMP-9, and tissue inhibitor for MMP-1 and MMP-2 staining], intima inflammatory score (0-3, based on intimal presence of CD3 and CD68 cells and TNF-α staining), neoangiogenesis (factor VIII staining), and apoptosis (caspase 3 staining). Hierarchical generalized linear models were used to obtain the beta estimates and their 95% confidence intervals, adjusting for demographics and vascular risk factors. RESULTS The prevalence of atherosclerosis did not differ by HIV status. Necrotic cores filled larger proportions of the intima in HIV+ individuals with CD4 cell count above 200 cells/μl at death compared to HIV- controls (adjusted B = 11.6%, P = 0.04). HIV+ individuals had greater elastolytic scores (adjusted B = 0.34, P = 0.02), especially those with less than 200 CD4 cells/μl at death (adjusted B = 0.41, P = 0.01). Intima inflammation, neoangiogenesis, and apoptosis were not different among HIV+ cases versus HIV- controls. CONCLUSION Individuals with HIV and CD4 cell count at least 200 cells/μl at death had relatively larger necrotic cores, whereas those with HIV and CD4 cell count below 200 cells/μl at death had evidence of increased connective tissue remodeling in the intima. These findings suggest an increased potential for endothelial erosion, thrombosis, and plaque rupture that may relate to higher risk for vascular events.
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22
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Yamaguchi S, Hamabe J, Horie N, Yamashita A, Irie J, Tokuda Y, Mutsukura K, Yagi N, Suyama K. Iatrogenic Removal of the Intima in the Middle Cerebral Artery by a Stent Retriever: A Report of Two Cases. World Neurosurg 2018; 118:203-208. [PMID: 30048785 DOI: 10.1016/j.wneu.2018.07.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage. CASE DESCRIPTION We present 2 cases of patients with acute internal carotid artery occlusion who experienced removal of the intima by a stent retriever. In both patients, a 6 × 30-mm Solitaire stent was fully deployed from the M2 portion and slowly withdrawn. White membranes were retrieved outside the strut in both patients. Histopathologic examination showed that one membrane consisted of thickened intima and internal elastic lamina and the other consisted of calcified intima and internal elastic lamina. One patient who suffered embolic stroke experienced recurrent infarction within 24 hours after operation, and the damaged vessel was occluded on magnetic resonance angiography 21 days after stroke. In another patient with carotid artery dissection, the damaged vessel showed asymptomatic stenosis on magnetic resonance angiography 90 days after stroke. Arteries with both atherosclerosis and vessel dissection may be vulnerable to high radial expansion force. CONCLUSIONS Full deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan.
| | - Junpei Hamabe
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Aya Yamashita
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Yoshihiro Tokuda
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuo Mutsukura
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobuhiro Yagi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuhiko Suyama
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
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Wang SY, Zha XJ, Zhu XY, Li WB, Ma J, Wu ZW, Wu H, Jiang MF, Wen YF. Metabolic syndrome and its components with neuron-specific enolase: a cross-sectional study in large health check-up population in China. BMJ Open 2018; 8:e020899. [PMID: 29643166 PMCID: PMC5898352 DOI: 10.1136/bmjopen-2017-020899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study was aimed at investigating the relationship between neuron-specific enolase (NSE) and components of metabolic syndrome (MS). DESIGN Cross-sectional study. SETTING Chinese health check-up population. PARTICIPANTS 40 684 health check-up people were enrolled in this study from year 2014 to 2016. MAIN OUTCOME MEASURES OR and coefficient for MS. RESULTS The percentage of abnormal NSE and MS was 26.85% and 8.85%, respectively. There were significant differences in sex, body mass index, drinking habit, triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), blood pressure and MS between low-NSE and high-NSE groups. In logistic regression analysis, elevated NSE was present in MS, higher body mass index, hypertriglyceridaemia, hypertension and low-HDL groups. Stepwise linear analysis showed a negative correlation between NSE and fasting blood glucose (FBG) (<6.0 mmol/L), and a positive correlation between NSE and TGs (<20 mmol/L), systolic blood pressure (75-200 mm Hg), HDL-C (0.75-2.50 mmol/L), diastolic blood pressure (<70 mm Hg) and FBG (6.00-20.00 mmol/L). Furthermore, MS was positively correlated with NSE within the range of 2.00-7.50 ng/mL, but had a negative correlation with NSE within the range of 7.50-23.00 ng/mL. CONCLUSION There are associations between NSE with MS and its components. The result suggests that NSE may be a potential predictor of MS. Further research could be conducted in discussing the potential mechanism involved.
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Affiliation(s)
- Shu-Yi Wang
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Xiao-Juan Zha
- Medical Examination Center, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui Province, China
| | - Xin-Ying Zhu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wen-Bo Li
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Jun Ma
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Ze-Wei Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Huan Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Ming-Fei Jiang
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yu-Feng Wen
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
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Yang WJ, Fisher M, Zheng L, Niu CB, Paganini-Hill A, Zhao HL, Xu Y, Wong KS, Ng HK, Chen XY. Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study. Front Neurol 2017; 8:488. [PMID: 28993752 PMCID: PMC5622314 DOI: 10.3389/fneur.2017.00488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background Anterior and posterior circulation atherosclerosis differ in vascular risk factors and stroke mechanisms. However, few studies have compared the pathological features between these lesions. Using a series of intracranial artery specimens, we characterized the intracranial atherosclerotic lesions and compared pathological features among different arteries of the intracranial vasculature. Methods Intracranial large arteries of 32 consecutively recruited autopsy cases of Chinese adults aged 45 years or older were examined pathologically using routine histology and immunostaining, to characterize the pathological features of the atherosclerotic lesions. We analyzed middle cerebral arteries (MCAs) (both left and right), vertebral arteries (VAs) (side more affected), and basilar arteries (BAs). Results Progressive atherosclerotic lesions were present in 91(71%) of the 128 arteries examined. Features of complicated plaques were infrequently detected: plaque hemorrhage was encountered in 12%, neovasculature in 12%, lumen thrombi in 13%, macrophage infiltration in 20%, and calcification in 25% of arteries. Luminal narrowing of MCA was the most severe, followed by VA; the BA least stenotic (37 ± 25 vs. 30 ± 24 vs. 20 ± 20%, all p < 0.05). MCA had more eccentric (vs. concentric) plaques than VA (69 vs. 25%, p = 0.003) and BA (69 vs. 38%; p = 0.03). Lumen thrombi were more frequent in BA, and calcification most commonly occurred in VA atherosclerotic lesions. Conclusion Intracranial atherosclerotic plaques were commonly present in this sample, but the lesions generally lacked features of complicated plaques. MCA lesions had demonstrable differences compared with VA and BA lesions. Further studies are needed to determine whether these characteristics indicate a distinctive atherosclerotic phenotype for the intracranial vasculature.
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Affiliation(s)
- Wen Jie Yang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mark Fisher
- Department of Neurology, University of California Irvine, Irvine, CA, United States.,Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, United States
| | - Lu Zheng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Bo Niu
- Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China
| | - Annlia Paganini-Hill
- Department of Neurology, University of California Irvine, Irvine, CA, United States
| | - Hai Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
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Yang WJ, Wong KS, Chen XY. Intracranial Atherosclerosis: From Microscopy to High-Resolution Magnetic Resonance Imaging. J Stroke 2017; 19:249-260. [PMID: 28877564 PMCID: PMC5647638 DOI: 10.5853/jos.2016.01956] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/26/2017] [Accepted: 03/31/2017] [Indexed: 12/22/2022] Open
Abstract
Intracranial atherosclerosis is one of the leading causes of ischemic stroke and occurs more commonly in patients of Asian, African or Hispanic origin than in Caucasians. Although the histopathology of intracranial atherosclerotic disease resembles extracranial atherosclerosis, there are some notable differences in the onset and severity of atherosclerosis. Current understanding of intracranial atherosclerotic disease has been advanced by the high-resolution magnetic resonance imaging (HRMRI), a novel emerging imaging technique that can directly visualize the vessel wall pathology. However, the pathological validation of HRMRI signal characteristics remains a key step to depict the plaque components and vulnerability in intracranial atherosclerotic lesions. The purpose of this review is to describe the histological features of intracranial atherosclerosis and to state current evidences regarding the validation of MR vessel wall imaging with histopathology.
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Affiliation(s)
- Wen-Jie Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Ka-Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Xiang-Yan Chen
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
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26
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Roth W, Morgello S, Goldman J, Mohr JP, Elkind MSV, Marshall RS, Gutierrez J. Histopathological Differences Between the Anterior and Posterior Brain Arteries as a Function of Aging. Stroke 2017; 48:638-644. [PMID: 28196941 DOI: 10.1161/strokeaha.116.015630] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We tested the hypothesis that posterior brain arteries differ pathologically from anterior brain arteries and that this difference varies with age. METHODS Brain large arteries from 194 autopsied individuals (mean age 56±17 years, 63% men, 25% nonwhite, 17% with brain infarcts) were analyzed to obtain the areas of arterial layers and lumen as well as the relative content of elastin, collagen, and amyloid. Visual rating was used to determine the prevalence of atheroma, calcification, vasa vasorum, pattern of intima thickening, and internal elastic lamina gaps. We used multilevel models adjusting for age, sex, ethnicity, vascular risk factors, artery type and location, and multiple comparisons. RESULTS Of 1362 large artery segments, 5% had vasa vasorum, 5% had calcifications, 15% had concentric intimal thickening, and 11% had atheromas. Posterior brain arteries had thinner walls, less elastin, and more concentric intima thickening than anterior brain arteries. Compared to anterior brain arteries, the basilar artery had higher arterial area encircled by the internal elastic lamina, whereas the vertebral arteries had higher prevalence of elastin loss, concentric intima thickening, and nonatherosclerotic stenosis. In younger individuals, vertebral artery calcifications were more likely than calcification in anterior brain arteries, but this difference attenuated with age. CONCLUSIONS Posterior brain arteries differ pathologically from anterior brain arteries in the degree of wall thickening, elastin loss, and concentric intimal thickening.
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Affiliation(s)
- William Roth
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Susan Morgello
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - James Goldman
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jay P Mohr
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Mitchell S V Elkind
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Randolph S Marshall
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jose Gutierrez
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.).
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Lee DH, Park JH. Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
| | - Jong-Ho Park
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
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Gonzalez L, Trigatti BL. Macrophage Apoptosis and Necrotic Core Development in Atherosclerosis: A Rapidly Advancing Field with Clinical Relevance to Imaging and Therapy. Can J Cardiol 2016; 33:303-312. [PMID: 28232016 DOI: 10.1016/j.cjca.2016.12.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular diseases represent 1 of the main causes of death worldwide, and atherosclerosis is 1 of the major contributors leading to ischemic heart disease. Macrophages actively participate in all stages of atherosclerosis development, from plaque initiation to the transition to vulnerable plaques. Macrophage apoptosis, in particular, has been recognized as a critical step in the formation of the necrotic core, a key characteristic of unstable lesions. In this review, we discuss the role of macrophage apoptosis and clearance of apoptotic cells by efferocytosis in the development of atherosclerosis, with particular emphasis on their contribution to the development of the necrotic core and the clinical implications of this process for plaque stabilization. We consider the molecular triggers of macrophage apoptosis during atherogenesis, the role of endoplasmic reticulum (ER) stress, the roles of key cellular mediators of apoptosis and efferocytosis, and mechanisms of defective efferocytosis in the progression of atherosclerotic plaques. Finally, we discuss the important clinical implications of rapidly evolving macrophage science, such as novel approaches to imaging vulnerable atherosclerotic plaques with macrophage-sensitive positron emission tomography and magnetic resonance imaging, the role of macrophages in mediating beneficial pleiotropic actions of lipid-lowering therapies, and novel therapeutic modalities targeting ER stress, autophagy, and deficient efferocytosis. Advances in understanding the critical role of macrophages in the progression and destabilization of atherosclerosis have the potential to greatly improve the prevention and management of atherosclerotic diseases over the next decade.
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Affiliation(s)
- Leticia Gonzalez
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Bernardo Louis Trigatti
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
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van den Wijngaard IR, Holswilder G, van Walderveen MAA, Algra A, Wermer MJH, Zaidat OO, Boiten J. Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 2016; 6:e00536. [PMID: 27843693 PMCID: PMC5102638 DOI: 10.1002/brb3.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis is a common cause of stroke worldwide. It results in ischemic stroke due to different mechanisms including artery-to-artery embolism, in situ thrombo-occlusion, occlusion of perforating arteries, and hemodynamic failure. In this review, we present an overview of current treatment and imaging modalities in intracranial atherosclerotic stenosis. METHODS PubMed was searched for relevant articles in English that evaluated the treatment and imaging of intracranial atherosclerotic stenosis (ICAS). RESULTS Aggressive medical management, consisting of dual antiplatelet therapy and intensive risk factor management, is important in patients with ICAS because of a substantial risk of recurrent stroke, approximately 20% in the first year, in patients on aspirin or warfarin alone. Recent trials have suggested that, aggressive medical therapy results in better outcome as compared with intracranial stenting. However, the question remains what the optimal treatment strategy would be in patients with recurrent strokes in the setting of failed aggressive medical therapy. Moreover, controversy exists whether a subgroup of patients with symptomatic ICAS could benefit from intracranial stenting if selection is based on radiological evidence of hemodynamic failure. With regard to imaging, transcranial Doppler ultrasound and magnetic resonance angiography are useful screening tests for exclusion of ICAS, but need confirmation by other imaging modalities when stenosis is suggested. Computed tomography angiography has a high positive and negative predictive value for detection of intracranial luminal stenosis of 50% or higher, but performs worse than digital subtraction angiography with regard to establishing the exact degree of luminal stenosis. Novel imaging techniques including high-resolution CT and MRI better identify plaque characteristics than conventional imaging methods. CONCLUSIONS Currently, aggressive medical management remains the standard of care for patients with ICAS. Further research is needed to identify high-risk subgroups and to develop more effective treatments for ICAS patients.
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Affiliation(s)
- Ido R. van den Wijngaard
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
| | | | | | - Ale Algra
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Osama O. Zaidat
- Department of NeurologyMedical College of Wisconsin/Froedtert HospitalMilwaukeeWIUSA
| | - Jelis Boiten
- Department of NeurologyMedical Center Haaglandenthe Haguethe Netherlands
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Gutierrez J, Menshawy K, Goldman J, Dwork AJ, Elkind MSV, Marshall RS, Morgello S. Metalloproteinases and Brain Arterial Remodeling Among Individuals With and Those Without HIV Infection. J Infect Dis 2016; 214:1329-1335. [PMID: 27549585 DOI: 10.1093/infdis/jiw385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study tests the hypothesis that increased elastolytic activity is associated differentially with dolichoectasia in individuals with and those without human immunodeficiency virus (HIV) infection. METHODS Large arteries from 84 autopsied brains from HIV-positive individuals and 78 autopsied brains from HIV-negative individuals were stained for metalloproteinase 2 (MMP-2), MMP-3, MMP-9, tissue inhibitor of metalloproteinases 1 (TIMP-1), TIMP-2, CD68, and caspase 3. Average pixel intensity was automatically obtained and categorized as high, moderate, or low. Dolichoectasia was defined as a lumen to wall ratio ≥95th percentile. RESULTS High MMP-9 staining alone (P = .001) or coexistent with low TIMP-2 staining was associated with dolichoectasia only in HIV-negative individuals (P = <.001). In HIV-positive individuals, MMP-9 was associated with dolichoectasia only when coexpressed with caspase 3 (P = .01). Thinning of the media was associated with CD68 staining (P = <.001) in HIV-negative individuals, while caspase 3 was associated with a thinner media only in HIV-positive individuals (P = .01). Media thickness modified the association between lumen to wall ratio and MMP expression. CONCLUSIONS A role for MMP/TIMP balance in dolichoectasia appears more prominent in HIV-negative individuals, while apoptosis, mediated by caspase 3, is the most important determinant of media thinning in HIV-infected individuals. Furthermore, apoptosis and media thickness appear to mediate the effects of MMP in the HIV-infected population.
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Affiliation(s)
| | - Khaled Menshawy
- Alexandria Faculty of Medicine, Alexandria University, Egypt
| | - James Goldman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons
| | - Andrew J Dwork
- Department of Pathology and Cell Biology, College of Physicians and Surgeons
- Department of Psychiatry, Columbia University Medical Center
| | - Mitchell S V Elkind
- Department of Neurology
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | | | - Susan Morgello
- Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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Yang WJ, Chen XY, Zhao HL, Niu CB, Zhang B, Xu Y, Wong KS, Ng HK. Postmortem Study of Validation of Low Signal on Fat-Suppressed T1-Weighted Magnetic Resonance Imaging as Marker of Lipid Core in Middle Cerebral Artery Atherosclerosis. Stroke 2016; 47:2299-304. [PMID: 27462119 PMCID: PMC4991347 DOI: 10.1161/strokeaha.116.013398] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022]
Abstract
Background and Purpose— High signal on T1-weighted fat-suppressed images in middle cerebral artery plaques on ex vivo magnetic resonance imaging was verified to be intraplaque hemorrhage histologically. However, the underlying plaque component of low signal on T1-weighted fat-suppressed images (LST1) has never been explored. Based on our experience, we hypothesized that LST1 might indicate the presence of lipid core within intracranial plaques. Methods— 1.5 T magnetic resonance imaging was performed in the postmortem brains to scan the cross sections of bilateral middle cerebral arteries. Then middle cerebral artery specimens were removed for histology processing. LST1 presence was identified on magnetic resonance images, and lipid core areas were measured on the corresponding histology sections. Results— Total 76 middle cerebral artery locations were included for analysis. LST1 showed a high specificity (96.9%; 95% confidence interval, 82.0%–99.8%) but a low sensitivity (38.6%; 95% confidence interval, 24.7%–54.5%) for detecting lipid core of all areas. However, the sensitivity increased markedly (81.2%; 95% confidence interval, 53.7%–95.0%) when only lipid cores of area ≥0.80 mm2 were included. Mean lipid core area was 5× larger in those with presence of LST1 than in those without (1.63±1.18 mm2 versus 0.32±0.31 mm2; P=0.003). Conclusions— LST1 is a promising imaging biomarker of identifying intraplaque lipid core, which may be useful to distinguish intracranial atherosclerotic disease from other intracranial vasculopathies and to assess plaque vulnerability for risk stratification of patients with intracranial atherosclerotic disease. In vivo clinical studies are required to explore the correlation between LST1 and clinical outcomes of patients with intracranial atherosclerotic disease.
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Affiliation(s)
- Wen-Jie Yang
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Xiang-Yan Chen
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China.
| | - Hai-Lu Zhao
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Chun-Bo Niu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Bing Zhang
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Yun Xu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Ka-Sing Wong
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Ho-Keung Ng
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
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Chung JW, Bang OY, Lee MJ, Hwang J, Cha J, Choi JH, Choe YH. Echoing Plaque Activity of the Coronary and Intracranial Arteries in Patients With Stroke. Stroke 2016; 47:1527-33. [DOI: 10.1161/strokeaha.116.013122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Jong-Won Chung
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Oh Young Bang
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Mi Ji Lee
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jaechun Hwang
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jihoon Cha
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jin-Ho Choi
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Yeon Hyeon Choe
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
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Denswil NP, van der Wal AC, Ritz K, de Boer OJ, Aronica E, Troost D, Daemen MJAP. Atherosclerosis in the circle of Willis: Spatial differences in composition and in distribution of plaques. Atherosclerosis 2016; 251:78-84. [PMID: 27288902 DOI: 10.1016/j.atherosclerosis.2016.05.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/26/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerosis is one of the main causes of ischemic stroke. However, the characteristics of intracranial arteries and atherosclerosis have rarely been studied. Therefore, we systematically investigated atherosclerotic changes in all arteries of the Circle of Willis (CoW). METHODS Sixty-seven CoWs obtained at autopsy from randomly chosen hospital patients (mean age, 67.3 ± 12.5 years), of which a total of 1220 segments were collected from 22 sites. Atherosclerotic plaques were classified according to the revised American Heart Association classification and were related to local vessel characteristics, such as the presence of an external and internal elastic lamina and the elastic fibre density of the media. RESULTS 181 out of the 1220 segments had advanced plaques (15%), which were mainly observed in large arteries such as the internal carotid, middle cerebral, basilar and vertebral artery. Only 11 out of 1220 segments (1%) showed complicated plaques (p < 0.001). Six of these were intraplaque hemorrhages (IPH) and observed only in patients who had cardiovascular-related events (p = 0.015). The frequency of characteristics such as the external elastic lamina and a high elastin fibre density in the media was most often associated with the vertebral artery. Only 3% (n = 33) of the CoW arteries contained calcification (p < 0.001), which were mostly observed in the vertebral artery (n = 13, 12%). CONCLUSIONS Advanced atherosclerotic plaques in the CoW are relatively scarce and mainly located in the 4 large arteries, and mostly characterized by an early and stable phenotype, a low calcific burden, and a low frequency of IPH.
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Affiliation(s)
- Nerissa P Denswil
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Allard C van der Wal
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Katja Ritz
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Onno J de Boer
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Eleonora Aronica
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dirk Troost
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mat J A P Daemen
- Academic Medical Center, Department Pathology, Cardiovascular Research, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Gutierrez J, Elkind MSV. Letter by Gutierrez and Elkind Regarding Article, "Patterns and Implications of Intracranial Arterial Remodeling in Patients With Stroke". Stroke 2016; 47:e86. [PMID: 27079808 DOI: 10.1161/strokeaha.116.012965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY
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Gutierrez J, Honig L, Elkind MSV, Mohr JP, Goldman J, Dwork AJ, Morgello S, Marshall RS. Brain arterial aging and its relationship to Alzheimer dementia. Neurology 2016; 86:1507-15. [PMID: 26984942 DOI: 10.1212/wnl.0000000000002590] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that brain arterial aging is associated with the pathologic diagnosis of Alzheimer disease (AD). METHODS Brain large arteries were assessed for diameter, gaps in the internal elastic lamina (IEL), luminal stenosis, atherosclerosis, and lumen-to-wall ratio. Elastin, collagen, and amyloid were assessed with Van Gieson, trichrome, and Congo red staining intensities, and quantified automatically. Brain infarcts and AD (defined pathologically) were assessed at autopsy. We created a brain arterial aging (BAA) score with arterial characteristics associated with aging after adjusting for demographic and clinical variables using cross-sectional generalized linear models. RESULTS We studied 194 autopsied brains, 25 (13%) of which had autopsy evidence of AD. Brain arterial aging consisted of higher interadventitial and lumen diameters, thickening of the wall, increased prevalence of IEL gaps, concentric intima thickening, elastin loss, increased amyloid deposition, and a higher IEL proportion without changes in lumen-to-wall ratio. In multivariable analysis, a high IEL proportion (B = 1.96, p = 0.030), thick media (B = 3.50, p = 0.001), elastin loss (B = 6.16, p < 0.001), IEL gaps (B = 3.14, p = 0.023), and concentric intima thickening (B = 7.19, p < 0.001) were used to create the BAA score. Adjusting for demographics, vascular risk factors, atherosclerosis, and brain infarcts, the BAA score was associated with AD (B = 0.022, p = 0.002). CONCLUSIONS Aging of brain large arteries is characterized by arterial dilation with a commensurate wall thickening, elastin loss, and IEL gaps. Greater intensity of arterial aging was associated with AD independently of atherosclerosis and brain infarcts. Understanding the drivers of arterial aging may advance the knowledge of the pathophysiology of AD.
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Affiliation(s)
- Jose Gutierrez
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Lawrence Honig
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mitchell S V Elkind
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jay P Mohr
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - James Goldman
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew J Dwork
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Morgello
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Randolph S Marshall
- From the Departments of Neurology (J.G., L.H., M.S.V.E., J.P.M.) and Psychiatry (A.J.D.), College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (M.S.V.E., R.S.M.), and Department of Pathology and Cell Biology (J.G., A.J.D.), Columbia University; Division of Molecular Imaging and Neuropathology (A.J.D.), New York State Psychiatric Institute; and the Departments of Neurology, Neuroscience, and Pathology (S.M.), Icahn School of Medicine at Mount Sinai, New York, NY
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Abstract
OBJECTIVE To test the hypothesis that brain arteries from HIV+ cases have a greater degree of inflammation than brain arteries from HIV- cases, and that inflammation is associated with brain arterial remodeling. DESIGN Case-control study, cross-sectional. METHODS Brain arteries from 162 autopsy cases (84 with HIV) were systematically analyzed for thickness of the intima, media, and adventitia, and atherosclerosis and dolichoectasia. Inflammation was assessed with CD68 immunohistochemistry, and measured with a semiquantitative score reflecting the number and location (i.e., arterial layer) of activated macrophages infiltrating the arterial wall. Latent varicella zoster virus (VZV) was assessed with anti-VZV gene 63 product immunohistochemistry. Demographic and clinical variables were available in all cases, and longitudinal data about CD4 cell counts were available among cases with HIV. Multilevel generalized linear models were used to test the association between inflammation and HIV. RESULTS Arteries from HIV+ cases had a higher inflammation score (B = 0.36, P = 0.05) compared with arteries from HIV- cases, although the association was attenuated after controlling for demographic variables, vascular risk factors, and latent VZV (B = 0.20, P = 0.18). Although intimal inflammation was similar in cases with and without HIV, adventitial inflammation was associated with HIV. Intimal inflammation was associated with intracranial atherosclerosis independent of HIV status, but adventitial inflammation was associated with HIV-associated dolichoectasia in arteries with a thin media. CONCLUSIONS Adventitial inflammation is associated with HIV and dolichoectasia independent of intracranial atherosclerosis. This suggests that differential inflammatory responses may play a role in intracranial atherosclerosis and dolichoectasia.
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Bang OY, Chung JW, Ryoo S, Moon GJ, Kim GM, Chung CS, Lee KH. Brain microangiopathy and macroangiopathy share common risk factors and biomarkers. Atherosclerosis 2015; 246:71-7. [PMID: 26761770 DOI: 10.1016/j.atherosclerosis.2015.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/12/2015] [Accepted: 12/25/2015] [Indexed: 01/25/2023]
Abstract
AIMS Besides carotid or cardiac embolism, stroke can occur via microangiopathy (small arterial disease [SAD]) and macroangiopathy (intracranial atherosclerotic stroke [ICAS]) of the intracranial vasculature. There have been efforts to identify risk factors specific to microangiopathy and macroangiopathy, including vascular risk factors, and protein and genetic biomarkers. We hypothesized that despite the anatomic and pathophysiological differences between microvessels and macrovessels, microangiopathy and macroangiopathy share common risk factors during disease progression. METHODS Among 714 patients with acute infarctions within middle cerebral artery territory, 126 with SAD and 116 with ICAS were included in this study. Subclinical microangiopathy (degree of leukoaraiosis) and macroangiopathy (number of tandem stenosis) was graded in each patient. Inflammatory biomarkers (C-reactive protein, E-selectin, and LpPLA2), endothelial dysfunction (asymmetric dimethylarginine, urinary albumin-to-creatinine ratio, endostatin, and homocysteine), atherogenesis (lipoprotein(a), adiponectin, and resistin), and renal function (creatinine clearance and estimated glomerular filtration rate) were assessed. RESULTS Compared with the patients with isolated SAD, those with isolated ICAS were younger, were current smokers, and showed higher apoB levels (p < 0.05 in all cases). However, with the progression of subclinical microangiopathy, asymptomatic macroangiopathy worsened and vice versa. No significant differences in risk factors were observed between advanced SAD and ICAS. Decreased renal function was independently associated with progression of microangiopathy and macroangiopathy. Markers of endothelial dysfunction, but not the other markers, were significantly related to creatinine clearance level. CONCLUSIONS Mild to moderate loss of renal function is strongly associated with both intracranial microangiopathy and macroangiopathy. Endothelial dysfunction may be associated with this relationship.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sookyung Ryoo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Gutierrez J, Cheung K, Bagci A, Rundek T, Alperin N, Sacco RL, Wright CB, Elkind MSV. Brain Arterial Diameters as a Risk Factor for Vascular Events. J Am Heart Assoc 2015; 4:e002289. [PMID: 26251284 PMCID: PMC4599479 DOI: 10.1161/jaha.115.002289] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events. Methods and Results Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, called the brain arterial remodeling (BAR) score, was obtained by averaging the measured diameters within each individual. Individuals with a BAR score <−2 SDs were considered to have the smallest diameters, individuals with a BAR score >−2 and <2 SDs had average diameters, and individuals with a BAR score >2 SDs had the largest diameters. All vascular events were recorded prospectively after the brain magnetic resonance imaging. Spline curves and incidence rates were used to test our hypothesis. The association of the BAR score with death (P=0.001), vascular death (P=0.02), any vascular event (P=0.05), and myocardial infarction (P=0.10) was U-shaped except for ischemic stroke (P=0.74). Consequently, incidence rates for death, vascular death, myocardial infarction, and any vascular event were higher in individuals with the largest diameters, whereas individuals with the smallest diameters had a higher incidence of death, vascular death, any vascular event, and ischemic stroke compared with individuals with average diameters. Conclusions The risk of death, vascular death, and any vascular event increased at both extremes of brain arterial diameters. The pathophysiology linking brain arterial remodeling to systemic vascular events needs further research.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.)
| | - Ken Cheung
- Division of Biostatistics, Columbia University, New York, NY (K.C.)
| | - Ahmet Bagci
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.)
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.)
| | - Noam Alperin
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.)
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.)
| | - Clinton B Wright
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.) Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL (C.B.W.) Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL (C.B.W.)
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.) Department of Epidemiology, Columbia University, New York, NY (M.V.E.)
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Menshawi K, Mohr JP, Gutierrez J. A Functional Perspective on the Embryology and Anatomy of the Cerebral Blood Supply. J Stroke 2015; 17:144-58. [PMID: 26060802 PMCID: PMC4460334 DOI: 10.5853/jos.2015.17.2.144] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 11/11/2022] Open
Abstract
The anatomy of the arterial system supplying blood to the brain can influence the development of arterial disease such as aneurysms, dolichoectasia and atherosclerosis. As the arteries supplying blood to the brain develop during embryogenesis, variation in their anatomy may occur and this variation may influence the development of arterial disease. Angiogenesis, which occurs mainly by sprouting of parent arteries, is the first stage at which variations can occur. At day 24 of embryological life, the internal carotid artery is the first artery to form and it provides all the blood required by the primitive brain. As the occipital region, brain stem and cerebellum enlarge; the internal carotid supply becomes insufficient, triggering the development of the posterior circulation. At this stage, the posterior circulation consists of a primitive mesh of arterial networks that originate from projection of penetrators from the distal carotid artery and more proximally from carotid-vertebrobasilar anastomoses. These anastomoses regress when the basilar artery and the vertebral arteries become independent from the internal carotid artery, but their persistence is not uncommon in adults (e.g., persistent trigeminal artery). Other common remnants of embryological development include fenestration or duplication (most commonly of the basilar artery), hypoplasia (typically of the posterior communicating artery) or agenesis (typically of the anterior communicating artery). Learning more about the hemodynamic consequence that these variants may have on the brain territories they supply may help understand better the underlying physiopathology of cerebral arterial remodeling and stroke in patients with these variants.
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Affiliation(s)
- Khaled Menshawi
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jay P Mohr
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
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