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Saldaña-Inda I, Garcés-Antón E, Navasa-Melado JM, Bernal-Lafuente C, Tejada-Meza H. Direct carotid puncture for the endovascular treatment of acute ischaemic stroke associated to aortic arch atheroma. Neurologia 2023; 38:606-607. [PMID: 37802553 DOI: 10.1016/j.nrleng.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 12/18/2022] [Indexed: 10/10/2023] Open
Affiliation(s)
- I Saldaña-Inda
- Stroke Unit - Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - E Garcés-Antón
- Stroke Unit - Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J M Navasa-Melado
- Interventional Neuroradiology Unit - Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C Bernal-Lafuente
- Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - H Tejada-Meza
- Stroke Unit - Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain; Interventional Neuroradiology Unit - Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) de Aragón. Universidad de Zaragoza, Spain
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2
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Faletra FF, Agricola E, Flachskampf FA, Hahn R, Pepi M, Ajmone Marsan N, Wunderlich N, Elif Sade L, Donal E, Zamorano JL, Cosyns B, Vannan M, Edvardsen T, Berrebi A, Popescu BA, Lancellotti P, Lang R, Bäck M, Bertrand PB, Dweck M, Keenan N, Stankovic I. Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2023; 24:e119-e197. [PMID: 37259019 DOI: 10.1093/ehjci/jead090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/02/2023] Open
Abstract
Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a 'standard part' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers.
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Affiliation(s)
- Francesco F Faletra
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Eustachio Agricola
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Frank A Flachskampf
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Rebecca Hahn
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Mauro Pepi
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Nina Ajmone Marsan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Nina Wunderlich
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Leyla Elif Sade
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Erwan Donal
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Jose-Luis Zamorano
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Bernard Cosyns
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Mani Vannan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Thor Edvardsen
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Alain Berrebi
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Bogdan A Popescu
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Patrizio Lancellotti
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Roberto Lang
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Magnus Bäck
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Philippe B Bertrand
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Marc Dweck
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Niall Keenan
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
| | - Ivan Stankovic
- Division of Cardiology, ISMETT: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Lugano 6900, Switzerland
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3
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Fletcher AJ, Tew YY, Tzolos E, Joshi SS, Kaczynski J, Nash J, Debono S, Lembo M, Kwiecinski J, Bing R, Syed MBJ, Doris MK, van Beek EJR, Moss AJ, Jenkins WS, Walker NL, Joshi NV, Pawade TA, Adamson PD, Whiteley WN, Wardlaw JM, Slomka PJ, Williams MC, Newby DE, Dweck MR. Thoracic Aortic 18F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease. JACC Cardiovasc Imaging 2022; 15:1274-1288. [PMID: 35183477 PMCID: PMC9252920 DOI: 10.1016/j.jcmg.2021.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aortic atherosclerosis represents an important contributor to ischemic stroke risk. Identifying patients with high-risk aortic atheroma could improve preventative treatment strategies for future ischemic stroke. OBJECTIVES The purpose of this study was to investigate whether thoracic 18F-sodium fluoride positron emission tomography (PET) could improve the identification of patients at the highest risk of ischemic stroke. METHODS In a post hoc observational cohort study, we quantified thoracic aortic and coronary 18F-sodium fluoride activity in 461 patients with stable cardiovascular disease undergoing PET combined with computed tomography (CT). Progression of atherosclerosis was assessed by change in aortic and coronary CT calcium volume. Clinical outcomes were determined by the occurrence of ischemic stroke and myocardial infarction. We compared the prognostic utility of 18F-sodium fluoride activity for predicting stroke to clinical risk scores and CT calcium quantification using survival analysis and multivariable Cox regression. RESULTS After 12.7 ± 2.7 months, progression of thoracic aortic calcium volume correlated with baseline thoracic aortic 18F-sodium fluoride activity (n = 140; r = 0.31; P = 0.00016). In 461 patients, 23 (5%) patients experienced an ischemic stroke and 32 (7%) a myocardial infarction after 6.1 ± 2.3 years of follow-up. High thoracic aortic 18F-sodium fluoride activity was strongly associated with ischemic stroke (HR: 10.3 [95% CI: 3.1-34.8]; P = 0.00017), but not myocardial infarction (P = 0.40). Conversely, high coronary 18F-sodium fluoride activity was associated with myocardial infarction (HR: 4.8 [95% CI: 1.9-12.2]; P = 0.00095) but not ischemic stroke (P = 0.39). In a multivariable Cox regression model including imaging and clinical risk factors, thoracic aortic 18F-sodium fluoride activity was the only variable associated with ischemic stroke (HR: 8.19 [95% CI: 2.33-28.7], P = 0.0010). CONCLUSIONS In patients with established cardiovascular disease, thoracic aortic 18F-sodium fluoride activity is associated with the progression of atherosclerosis and future ischemic stroke. Arterial 18F-sodium fluoride activity identifies localized areas of atherosclerotic disease activity that are directly linked to disease progression and downstream regional clinical atherothrombotic events. (DIAMOND-Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND], NCT02110303; Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis [SALTIRE II], NCT02132026; Novel Imaging Approaches To Identify Unstable Coronary Plaques, NCT01749254; and Role of Active Valvular Calcification and Inflammation in Patients With Aortic Stenosis, NCT01358513).
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Affiliation(s)
- Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Yong Y Tew
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shruti S Joshi
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jakub Kaczynski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Lembo
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Maaz B J Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alistair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - William S Jenkins
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Niki L Walker
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Scottish Adult Congenital Cardiology Service, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom
| | - Nikhil V Joshi
- Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, United Kingdom
| | - Tania A Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - William N Whiteley
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Cedars-Sinai Medical Centre, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, USA
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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Mayerhofer E, Kanz D, Guschlbauer B, Anderson CD, Asmussen A, Grundmann S, Strecker C, Harloff A. Bubble Test and Carotid Ultrasound to Guide Indication of Transesophageal Echocardiography in Young Patients With Stroke. Front Neurol 2022; 13:836609. [PMID: 35309558 PMCID: PMC8931264 DOI: 10.3389/fneur.2022.836609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Indication of transesophageal echocardiography (TEE) in patients ≤60 years with brain ischemia is uncertain. Methods This prospective double-blinded study included patients with cryptogenic acute ischemic stroke or transient ischemic attack (TIA) ≥18 and ≤60 years. After routine diagnostics, all patients underwent patent foramen ovale (PFO) screening by transcranial Doppler (TCD) bubble test, carotid ultrasound for atherosclerosis screening (intima-media-thickness >0.90 mm or plaques), and TEE. We calculated sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the combined non-invasive ultrasound to predict therapy-relevant TEE findings. Results We included 240 consecutive patients (median 51 years, 39% women) of which 68 (28.3%) had both a negative bubble test and no carotid atherosclerosis. Of these, 66 (97.1%) had unremarkable TEE findings; in one patient a small PFO was found and closed subsequently, in another patient a 4.9 mm thick aortic atheroma was found, and double platelet inhibition initiated. Of the other 172 (71.7%) patients, 93 (54%) had PFO and 9 (5.2%) complex aortic plaques. No other therapy-relevant findings were present in both groups. Non-invasive ultrasound had a sensitivity of 98.0%, specificity of 47.8%, NPV of 97.1%, and PPV of 58.1% for therapy-relevant TEE findings. Conclusions Bubble test and carotid ultrasound could be used for the individual decision for/against TEE in patients with cryptogenic stroke ≤60 years. If they are unremarkable, TEE can be omitted with high safety regarding secondary prevention. If bubble test is positive and/or carotid ultrasound shows atherosclerosis, TEE should be carried out if PFO or aortic atheroma are potentially relevant for further patient management.
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Affiliation(s)
- Ernst Mayerhofer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Dirk Kanz
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Brigitte Guschlbauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Alexander Asmussen
- Department of Cardiology and Angiology I Heart Center, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Sebastian Grundmann
- Department of Cardiology and Angiology I Heart Center, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Strecker
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- *Correspondence: Andreas Harloff
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5
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Kulesh AA, Demin DA, Vinogradov OI. Pathogenetic mechanisms of ischemic stroke: from verification to secondary prevention. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ischemic stroke is an extremely heterogeneous disease: there are more than 200 causes of cerebral catastrophe. Early identification of the pathogenetic mechanism (subtype) of ischemic stroke allows planning an individual secondary prevention strategy, which includes a wide range of pharmaceutical and surgical methods. The article presents the characteristics of cardioembolic (associated with atrial fibrillation and flutter, prosthetic valves, chronic heart failure, left ventricle thrombus, infective endocarditis, open foramen ovale, etc.), atherothrombotic (due to extra- and intracranial atherosclerosis), lacunar and cryptogenic stroke, as well as less common causes of the disease, in particular cervical or cerebral artery dissection. Issues of secondary prevention of stroke according to the pathogenetic subtype are described and summarized as an algorithm. The article is illustrated with clinical examples.
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Danese A, Mugnai G, Prevedello F, Morra M, Bilato C. The role of echocardiography in the embolic stroke of undetermined source. J Cardiovasc Med (Hagerstown) 2021; 21:547-555. [PMID: 32628421 DOI: 10.2459/jcm.0000000000001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Echocardiography plays an important role both in the diagnosis and the treatment/prevention of embolic stroke of undetermined source and should be performed as soon as possible for preventing ischemic stroke recurrencies, which occur more frequently during the first week after the first ischemic event. Early identification of the cause of a transient ischemic attack or stroke is indeed a primary goal for the neurologist in the Stroke Unit and requires specific diagnostic strategies. Echocardiography, together with other diagnostic tools such as carotid and transcranial ultrasounds, provides this information promptly. In particular, echocardiography might be able to detect the main sources of the embolic stroke, such as atrial fibrillation, ventricular akinesia, aortic atheroma plaques and/or cardiac shunts. The present review discusses the importance and the practical role of echocardiography as a crucial diagnostic tool for detecting the main source of emboli in the setting of the acute stroke.
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Affiliation(s)
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | | | | | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
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7
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Nicot F, Charbonnel C, Jego C, Jourda F, Vinsonneau U, Garçon P, Turlotte G, Rivière JF, Maurin M, Lubret R, Meimoun P, Akret C, Cournot M, Sokic C, Michel L, Lescure M, Kenizou D, Melay M, Fayard M, Chauvat A, Fouché R, Cartigny G, Dijoux N, Martin AC, Tho-Agostini A, Mann H, Magnin D, Goralski M, Pico F, Georges JL, Belle L. Use of ADAM-C and CHA2DS2-VASc scores to predict complex aortic atheroma after brain ischemia: A prospective observational study. Echocardiography 2021; 38:612-622. [PMID: 33764608 DOI: 10.1111/echo.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Complex aortic atheroma (CAA) is a common cause of acute brain ischemia (BI), including ischemic stroke (IS) and transient ischemic attack (TIA), and is associated with recurrence. The CHA2DS2-VASc score is a useful tool for predicting stroke in patients with atrial fibrillation (AF), and can also predict cardiovascular events in other populations, including non-AF populations. The ADAM-C score is a new risk score for predicting the diagnostic yield of transesophageal echocardiography (TEE) after BI. We aimed to evaluate the ability of CHA2DS2-VASc and ADAM-C scores to predict CAA after BI. METHODS This prospective, multicenter, observational study included 1479 patients aged over 18 years who were hospitalized for BI. CAA was defined as the presence of one or more of the following criteria: thrombus, ulcerated plaque, or plaque thickening ≥ 4 mm. RESULTS CAA was diagnosed in 216 patients (14.6%). CHA2DS2-VASc and ADAM-C scores were significantly higher in the CAA group versus the non-CAA group (P < .0001 for both). The CHA2DS2-VASc and ADAM-C scores appear to be good predictors of CAA (AUC 0.699 [0.635, 0.761] and 0.759 [0.702, 0.814], respectively). The sensitivity, specificity, predictive positive value (PPV), and negative predictive value (NPV) of the scores for detecting CAA were 94%, 22%, 17%, and 96%, respectively, for a CHA2DS2-VASc score < 2, and 90%, 46%, 22%, and 96%, respectively, for an ADAM-C score < 3 CONCLUSIONS: CHA2DS2-VASc and ADAM-C scores are able to predict CAA after BI. CHA2DS2-VASc < 2 and ADAM-C < 3 both have an interesting NPV of 96%.
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Affiliation(s)
- Florence Nicot
- Department of Cardiology, Versailles Hospital, Le Chesnay, France
| | | | - Christophe Jego
- Department of Cardiology, Toulon inter-armée Hospital, Toulon, France
| | | | - Ulric Vinsonneau
- Department of Cardiology, Brest inter-armée Hospital, Brest, France
| | - Philippe Garçon
- Department of Cardiology, Saint Joseph Hospital, Paris, France
| | - Guillaume Turlotte
- Department of Cardiology, La Roche sur Yon Hospital, La Roche sur Yon, France
| | | | - Marion Maurin
- Department of Cardiology, CHU Grenoble-Alpes, Grenoble, France
| | - Rémy Lubret
- Department of Cardiology, Boulogne sur mer Hospital, Boulogne sur mer, France
| | - Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Chrystelle Akret
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
| | - Maxime Cournot
- Department of Cardiology, Saint Paul Hospital, Saint Paul, France
| | - Charles Sokic
- Department of Cardiology, Haguenau Hospital, Haguenau, France
| | - Laurent Michel
- Department of Cardiology, Saint Lo Hospital, Saint Lo, France
| | | | - David Kenizou
- Department of Cardiology, Mulhouse Hospital, Mulhouse, France
| | - Marie Melay
- Department of Cardiology, Vichy Hospital, Vichy, France
| | - Maxime Fayard
- Department of Cardiology, Chalon sur Saone Hospital, Chalon sur Saone, France
| | - Anthony Chauvat
- Department of Cardiology, Argenteuil Hospital, Argenteuil, France
| | - Renaud Fouché
- Department of Cardiology, Montbéliard Hospital, Montbéliard, France
| | | | - Nicolas Dijoux
- Department of Cardiology, Saint Pierre Hospital, Saint Pierre, France
| | - Anne Céline Martin
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Hubert Mann
- Department of Cardiology, Voiron Hospital, Voiron, France
| | | | - Marc Goralski
- Department of Cardiology, Orléans Hospital, Orléans, France
| | - Fernando Pico
- Department of Cardiology, Versailles Hospital, Le Chesnay, France.,Department of Neurology, Université Versailles Saint-Quentin en Yvelines et Paris Saclay, Le Chesnay, France
| | | | - Loïc Belle
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
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8
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Viedma-Guiard E, Guidoux C, Amarenco P, Meseguer E. Aortic Sources of Embolism. Front Neurol 2021; 11:606663. [PMID: 33519684 PMCID: PMC7843443 DOI: 10.3389/fneur.2020.606663] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022] Open
Abstract
Aortic arch atheroma is a frequent finding in ischemic stroke patients. Its role as a source of cerebral emboli or a marker of atherosclerosis is unclear. Transesophageal echography is considered the gold standard for its detection, whereas computed tomography angiography is a good alternative; magnetic resonance and positron emission tomography could be proposed to better analyze plaque vulnerability. Despite the interest in this condition, the optimal antithrombotic treatment remains uncertain, while intensive lipid-lowering therapy should be recommended. This review aims to offer guidance on patients with aortic arch atheroma, about its causal role in stroke, diagnosis, and treatment based on current available evidence.
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Affiliation(s)
- Elena Viedma-Guiard
- Department of Neurology and Stroke Center, APHP Bichat Hospital, Paris, France Université de Paris, LVTS, Inserm U1148, Paris, France
| | - Celine Guidoux
- Department of Neurology and Stroke Center, APHP Bichat Hospital, Paris, France Université de Paris, LVTS, Inserm U1148, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, APHP Bichat Hospital, Paris, France Université de Paris, LVTS, Inserm U1148, Paris, France
| | - Elena Meseguer
- Department of Neurology and Stroke Center, APHP Bichat Hospital, Paris, France Université de Paris, LVTS, Inserm U1148, Paris, France
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9
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Perera KS, Ng KKH, Nayar S, Catanese L, Dyal L, Sharma M, Connolly SJ, Yusuf S, Bosch J, Eikelboom JW, Hart RG. Association Between Low-Dose Rivaroxaban With or Without Aspirin and Ischemic Stroke Subtypes: A Secondary Analysis of the COMPASS Trial. JAMA Neurol 2020; 77:43-48. [PMID: 31524941 DOI: 10.1001/jamaneurol.2019.2984] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) randomized clinical trial was stopped early owing to the efficacy of low-dose rivaroxaban plus aspirin in preventing major cardiovascular events. The main reason for early trial termination was the effect of combination therapy on reducing ischemic strokes. Objective To analyze the association between low-dose rivaroxaban with or without aspirin and different ischemic stroke subtypes. Design, Setting, and Participants This is a secondary analysis of a multicenter, double-blind, randomized, placebo-controlled study that was performed in 33 countries from March 12, 2013, to May 10, 2016. Patients with stable atherosclerotic vascular disease were eligible, and a total of 27 395 participants were randomized and followed up to February 6, 2017. All first ischemic strokes and uncertain strokes that occurred by this date were adjudicated using TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The analysis of ischemic stroke subtypes was evaluated using an intention-to-treat principle. Statistical analysis was performed from March 12, 2013, to February 6, 2017. Interventions Participants received rivaroxaban (2.5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban (5 mg twice a day), or aspirin (100 mg once a day). Main Outcomes and Measures Risk of ischemic stroke subtypes during follow-up. Results A total of 291 patients (66 women; mean [SD] age, 69.4 [8.5] years; 43 [14.8%] had a previous nonlacunar stroke) experienced an ischemic stroke. During the study, 49 patients (16.8%) received a diagnosis of atrial fibrillation. Applying TOAST criteria, 59 strokes (20.3%) were cardioembolic, 54 strokes (18.6%) were secondary to greater than 50% stenosis of the ipsilateral internal carotid artery, 42 strokes (14.4%) had a negative evaluation that met criteria for embolic stroke of undetermined source, and 21 strokes (7.2%) were secondary to small vessel disease. There were significantly fewer cardioembolic strokes (hazard ratio [HR], 0.40 [95% CI, 0.20-0.78]; P = .005) and embolic strokes of undetermined source (HR, 0.30 [95% CI, 0.12-0.74]; P = .006) in the combination therapy group compared with the aspirin-only group. A trend for reduction in strokes secondary to small vessel disease (HR, 0.36 [95% CI, 0.12-1.14]; P = .07) was not statistically significant. No significant difference was observed between the 2 groups in strokes secondary to greater than 50% carotid artery stenosis (HR, 0.85 [95% CI, 0.45-1.60]; P = .61). Rivaroxaban, 5 mg, twice daily showed a trend for reducing cardioembolic strokes compared with aspirin (HR, 0.57 [95% CI, 0.31-1.03]; P = .06) but was not associated with reducing other stroke subtypes. Conclusions and Relevance For patients with systemic atherosclerosis, low-dose rivaroxaban plus aspirin was associated with large, significant reductions in cardioembolic strokes and embolic strokes of undetermined source. However, these results of exploratory analysis need to be independently confirmed before influencing clinical practice. Trial Registration ClinicalTrials.gov identifier: NCT01776424.
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Affiliation(s)
- Kanjana S Perera
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kelvin K H Ng
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sumiti Nayar
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Luciana Catanese
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Leanne Dyal
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Robert G Hart
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Ducasse E, Caradu C, Brochier C, Midy D, Bérard X, Poirier M, Ottaviani N. Midterm Results with the Open Chimney Technique during Endovascular Aneurysm Repair. J Vasc Interv Radiol 2019; 30:511-520.e1. [PMID: 30876807 DOI: 10.1016/j.jvir.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To report the midterm experience with chimney-endovascular aneurysm repair (Ch-EVAR) with the use of open self-expending stents for branch vessel preservation. MATERIALS AND METHODS From July 2010 to May 2017, 67 patients underwent open Ch-EVAR because their proximal landing zones were adjacent to, or covered, the renal or mesenteric arteries (Zones 7-9), and they were not suitable for standard or fenestrated endovascular aneurysm repair. The proximal landing zone was relocated below the highest renal artery in 46 cases, the superior mesenteric artery in 17 cases, and the celiac artery in 4 cases, using 84 open chimneys (131 stents). A subgroup analysis was performed between an early (2010-2014) and a later (2015-2017) time period. Thirty-two patients were treated during the early period, and 35 were treated during the later period. In the later period, open chimneys were strengthened by a second self-expanding stent. RESULTS The primary technical success rate was 89.6%; the early mortality rate was 9.0%; and the median follow-up duration was 13 months (range, 1-76 months). The estimated actuarial survival rate was 85.7% in year 1 and 79.2% in year 2, and the estimated patency rate of open chimneys reached 95.2% at 2 years. Aneurysm sac regression >5 mm and sac stability rates were 39.0% and 57.6%, respectively. Freedom from aneurysm-related reintervention was lower in the later period (log-rank P = .04), while type Ia endoleaks tended to be twice as likely. CONCLUSIONS Midterm results of open Ch-EVAR show high technical success with acceptable midterm patency and lack of endoleak in appropriately selected patients. The advantages over covered stents are lower-profile delivery systems and maintenance of branch vessel patency in early bifurcations and overlying visceral vessels.
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Affiliation(s)
- Eric Ducasse
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France.
| | - Caroline Caradu
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France
| | - Coline Brochier
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France
| | - Dominique Midy
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France
| | - Xavier Bérard
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France
| | - Mathieu Poirier
- Unit of Vascular Surgery, CH de Mont-de-Marsan, Mont-de-Marsan, France
| | - Nicolas Ottaviani
- Unit of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, Place Amélie Raba Léon, CHU Pellegrin Tripode, Bordeaux, France
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11
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Harloff A, Hagenlocher P, Lodemann T, Hennemuth A, Weiller C, Hennig J, Vach W. Retrograde aortic blood flow as a mechanism of stroke: MR evaluation of the prevalence in a population-based study. Eur Radiol 2019; 29:5172-5179. [PMID: 30877458 DOI: 10.1007/s00330-019-06104-z] [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: 11/15/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Retrograde blood flow from complex atheroma in the descending aorta (DAo) has only recently been described as a potential mechanism of stroke. However, prevalence of this mechanism in the general population and the exact factors influencing stroke risk are unclear. METHODS One hundred twenty-six consecutively recruited inhabitants of Freiburg, Germany, between 20 and 80 years of age prospectively underwent 3-T MRI. Aortic plaque location and thickness were determined by 3D T1 MRI (1 mm3). 4D flow MRI (spatial/temporal resolution 2 mm3/20 ms) and dedicated software were used to determine prevalence and extent of flow reversal and potential embolization from DAo plaques. Flow was correlated with baseline characteristics and echocardiographic and MRI parameters (aortic diameter, wall thickness, and pulse wave velocity). RESULTS The maximum length of retrograde blood flow connecting the DAo with the left subclavian artery (LSA) increased from 16.1 ± 8.3 mm in 20-29-year-old to 24.7 ± 11.7 mm in 70-80-year-old subjects, correlated with age (r = 0.37; p < 0.001), and was lower in females (p = 0.003). Age was the only independent predictor of increased flow reversal. Complex DAo plaques ≥ 4-mm thickness were found in eight subjects (6.3%) and were connected with the LSA, left common carotid artery, and brachiocephalic trunk in 8 (100%), 1 (12.5%), and 0 (0%) cases, respectively. CONCLUSIONS Retrograde blood flow from the DAo was very frequent. However, potential retrograde embolization was rare due to the low incidence of complex DAo plaques. The magnitude of flow reversal and prevalence of complex atheroma increased with age. Thus, older patients with aortic atherosclerosis are especially vulnerable to this stroke mechanism. KEY POINTS • 4D flow MRI allows in vivo visualization and quantification of individual and three-dimensional blood flow patterns within the thoracic aorta including retrograde components. • This population-based study showed that blood flow reversal from the proximal descending aorta to the brain-supplying great arteries is very frequent and able to reach all brain territories. The extent of such flow reversal increases with age and with the extent of aortic atherosclerosis. • The combination of blood flow reversal with plaque rupture in the proximal descending aorta constitutes a potential stroke mechanism that should be considered in future trials and in the management of stroke patients in clinical routine.
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Affiliation(s)
- Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany. .,Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Paul Hagenlocher
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lodemann
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anja Hennemuth
- Institute for Cardiovascular Computer-Assisted Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelius Weiller
- Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Diagnostic Radiology, MR Physics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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12
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Kargiotis O, Psychogios K, Safouris A, Magoufis G, Zervas PD, Stamboulis E, Tsivgoulis G. The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review. J Neuroimaging 2019; 29:309-322. [DOI: 10.1111/jon.12602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
| | | | - Apostolos Safouris
- Stroke UnitMetropolitan Hospital Piraeus Greece
- Second Department of NeurologyNational & Kapodistiran University of Athens, School of Medicine, “Attikon” University Hospital Athens Greece
| | | | - Paschalis D. Zervas
- Second Department of NeurologyNational & Kapodistiran University of Athens, School of Medicine, “Attikon” University Hospital Athens Greece
| | | | - Georgios Tsivgoulis
- Second Department of NeurologyNational & Kapodistiran University of Athens, School of Medicine, “Attikon” University Hospital Athens Greece
- Department of NeurologyThe University of Tennessee Health Science Center Memphis TN
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13
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14
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Abstract
Patients who have had a stroke are at high risk for recurrent stroke, myocardial infarction, and vascular death. Prevention of these events should be initiated promptly after stroke, because many recurrent events occur early, and should be tailored to the precise cause of stroke, which may require specific treatment. Lifestyle advice including abstinence from smoking, regular exercise, Mediterranean-style diet, and reduction of salt intake and alcohol consumption are recommended for all patients with stroke. For most patients with ischemic stroke or TIA, control of risk factors, including lowering blood pressure under 140/90mmHg and LDL cholesterol under 1g/L, together with antiplatelet or oral anticoagulant therapy, depending on the cause of stroke, have been shown to decrease the risk of recurrent stroke and cardiovascular events. Aspirin, clopidogrel, or the combination of aspirin and dipyridamole, are all acceptable options for secondary prevention in patients with ischemic stroke or TIA of arterial origin. Dual therapy with aspirin and clopidogrel might be considered for 3 weeks after a minor ischemic stroke or TIA and for 3 months in patients with stroke due to severe intracranial stenosis. Oral anticoagulants are very effective to prevent cardioembolic stroke. Non-VKA oral anticoagulants have a favorable risk-benefit profile compared with VKAs, with significant reductions in stroke, intracranial hemorrhage, mortality, with similar major bleeding, but increased gastrointestinal bleeding. Carotid endarterectomy reduces the risk of ipsilateral stroke in patients with recent (<6 months) non disabling ischemic stroke or TIA in the territory and severe carotid artery stenosis. Carotid stenting is a potential alternative to surgery in patients younger than ≈70 years or patients with greater risk of surgery due to anatomic or medical conditions or specific circumstances such as radiation-induced stenosis or restenosis after surgery. For patients with hemorrhagic stroke due to hypertension-associated small vessel disease or cerebral amyloid angiopathy, strict control of blood pressure is essential. Restarting oral anticoagulants in patients after intracranial hemorrhage is a difficult decision that should weigh the risks of recurrent ischemic and hemorrhage stroke with and without oral anticoagulants. Several areas of uncertainty persist including the optimal target of blood pressure in patients with cerebrovascular disease, the benefit of PFO closure in patients with PFO-associated stroke, of stenting procedures in patients with atherosclerotic intracranial artery or extracranial vertebral artery stenosis, and of interventional procedures in patients with brain arteriovenous or cavernous malformations.
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15
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Kong Q, Ma X. Contributing Mechanisms of Aortic Atheroma in Ischemic Cerebrovascular Disease. J Stroke Cerebrovasc Dis 2015; 24:2653-9. [PMID: 26522269 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
In recent years, the correlation between aortic atheroma (AA) and the occurrence and recurrence of ischemic cerebrovascular disease (ICVD) has attracted much attention, but the contributory mechanisms remain controversial. This review analyzes related research on the roles of AA in ICVD, and demonstrates the correlation between the formation and development of AA and abnormal metabolism, inflammation, hemodynamic changes, and other contributory factors. The presence of complex aortic plaque (CAP) in the ascending aorta and aortic arch increases the risk of cerebral embolism and degree of injury, while the association between CAP in the descending aorta and cerebral embolism remains ambiguous. AA also functions as an indicator of atherosclerosis burden as well as hypercoagulability, which may further increase the risk of ICVD. Further study on the relationship of AA to ICVD will improve diagnosis and treatment in clinical practice.
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Affiliation(s)
- Qi Kong
- Department of Neurology, Xuanwu Hospital, the Capital Medical University, Beijing, China
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, the Capital Medical University, Beijing, China.
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16
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Xiong TY, Liao YB, Zhao ZG, Xu YN, Wei X, Zuo ZL, Li YJ, Cao JY, Tang H, Jilaihawi H, Feng Y, Chen M. Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002096. [PMID: 26391132 PMCID: PMC4599496 DOI: 10.1161/jaha.115.002096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Jia-Yu Cao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J.)
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
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