1
|
Zhang X, Chen L, Li S, Shi Z, Tian X, Peng W, Chen S, Zhan Q, Liu Q, Lu J. Enhancement Characteristics of Middle Cerebral Arterial Atherosclerotic Plaques Over Time and Their Correlation With Stroke Recurrence. J Magn Reson Imaging 2020; 53:953-962. [PMID: 33034113 DOI: 10.1002/jmri.27351] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Xuefeng Zhang
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Luguang Chen
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Shuai Li
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Zhang Shi
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Xia Tian
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Wenjia Peng
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Shiyue Chen
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Qian Zhan
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Qi Liu
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| | - Jianping Lu
- Department of Radiology Changhai Hospital, Second Military Medical University Shanghai China
| |
Collapse
|
2
|
Rong C, Xing Y, Jiang X, Wang J, Gao B, Zhao J, Liu K. Angiotensin-converting enzyme gene polymorphism and middle cerebral artery stenosis in a Chinese Han population. Neural Regen Res 2014; 8:1410-7. [PMID: 25206436 PMCID: PMC4107760 DOI: 10.3969/j.issn.1673-5374.2013.15.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
The angiotensin-converting enzyme gene is a candidate gene of stroke. The present study involved 62 healthy volunteers and 148 patients with middle cerebral artery stenosis as confirmed by brain color ultrasound from a Han population in North China, and determined the peripheral blood angiotensin-converting enzyme genotype using PCR-restriction fragment length polymorphism analysis. The results showed that the frequencies of the DD genotype and D allele were increased in patients with middle cerebral artery stenosis, but the difference was not statistically significant compared with healthy controls. The findings of this study on the relationship between stroke genes and middle cerebral artery stenosis indicate no significant correlation between the frequencies of the DD genotype and D allele of angiotensin-converting enzyme and middle cerebral artery stenosis in this Han population from North China. In the future, studies will be carried out to investigate correlations between multiple stroke candidate gene synergy and middle cerebral artery stenosis to provide a foundation for the development of gene therapy.
Collapse
Affiliation(s)
- Chunshu Rong
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130021, Jilin Province, China ; Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yingqi Xing
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xinmei Jiang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Juan Wang
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Baoshan Gao
- Department of Urinary Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jianjun Zhao
- Department of Encephalopathy, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130021, Jilin Province, China
| | - Kangding Liu
- Department of Neurology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
3
|
Boulon C, Baud JM, Kercret G, Pichot O, Poggi JN, Saby JC, Sprynger M. [Detection of micro-embolic signals: a review of the literature]. JOURNAL DES MALADIES VASCULAIRES 2012; 37:311-319. [PMID: 23146344 DOI: 10.1016/j.jmv.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/28/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The detection of micro-embolic signals (MES), by transcranial Doppler sonography might be useful for risk stratification in patients with symptomatic and asymptomatic carotid or cerebral artery stenosis, dissections, aortic atheroma, interventional procedures, and right to left cardiac shunts. AIM Review of the technique and clinical situations of MES detection. METHODS PubMed search from 1990 to 2012. RESULTS MES were found in 0,19, 48% versus 0,3, and 12% of patients with symptomatic and asymptomatic inferior than 30, 30 to 69, and 70 to 99% carotid stenosis, respectively. MES were related to the risk of recurrent stroke or transient ischemic attack (TIA). In the ACES study, the absolute annual risk of stroke or TIA after 2 years was 7% with vs 3% without MES. In patients with intracranial stenosis, the risk of stroke recurrence was 48% with vs 7% without MES at 13.6 months follow-up. MES were reported in 25% of the symptomatic versus none of the asymptomatic patients with intracranial stenosis. CONCLUSION Detection of MES is feasible and reproducible for multicenter studies, using rigourous methodology and long lasting recordings. It may contribute to risk stratification, especially in patients with extra- or intracranial stenosis.
Collapse
Affiliation(s)
- C Boulon
- Service de Médecine Vasculaire, Hôpital St-André, 1, rue Jean-Burguet, 33075 Bordeaux, France.
| | | | | | | | | | | | | |
Collapse
|
4
|
Boddu DB, Sharma VK, Bandaru VCSS, Jyotsna Y, Padmaja D, Suvarna A, Kaul S. Validation of transcranial Doppler with magnetic resonance angiography in acute cerebral ischemia. J Neuroimaging 2011; 21:e34-40. [PMID: 20002971 DOI: 10.1111/j.1552-6569.2009.00412.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Transcranial Doppler (TCD) is often used as a screening tool for detecting intracranial stenosis. Since TCD results may vary among laboratories and sonographers, it requires validation against an imaging modality. We evaluated diagnostic accuracy of TCD performed in our laboratory against time-of-flight (TOF) magnetic resonance angiography (MRA) in detecting intracranial stenosis in patients with acute cerebral ischemia. METHODS Consecutive patients with acute (<24 hours) cerebral ischemia and intracranial arterial stenosis on MRA underwent both TCD and MRA within 5 hours of each other. TCD was performed by credentialed neurosonologists according to standardized protocol. An independent neuroradiologist interpreting MRA was blinded to TCD findings. We evaluated TCD peak systolic velocities (PSV) in proximal intracranial arteries as predictive of moderate (>50%) and severe (>70%) stenosis on TOF-MRA. RESULTS One hundred and fifty patients (74% males; mean age 53 years) underwent neurovascular evaluation with TCD and MRA. Twenty-two (14.6%) patients were excluded due to absent temporal acoustic windows. Middle cerebral artery TCD PSV values of >140 cm/s and >180 cm/s were found to predict a >50% and >70% focal stenosis, respectively. Optimal cut-off PSV values for other major proximal intracranial arteries were also established. CONCLUSIONS TCD performed in our laboratory shows satisfactory agreement with TOF-MRA in diagnosis and grading of proximal intracranial stenosis in patients with acute cerebral ischemia.
Collapse
Affiliation(s)
- Demudu Babu Boddu
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | | | | |
Collapse
|
5
|
Ni J, Yao M, Gao S, Cui LY. Stroke risk and prognostic factors of asymptomatic middle cerebral artery atherosclerotic stenosis. J Neurol Sci 2011; 301:63-5. [DOI: 10.1016/j.jns.2010.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/28/2022]
|
6
|
Potential relevance of low-intensity microembolic signals by TCD monitoring. Neurol Sci 2010; 32:107-11. [DOI: 10.1007/s10072-010-0429-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 09/10/2010] [Indexed: 11/30/2022]
|
7
|
Guo JJ, Xu E, Lin QY, Zeng GL, Xie HF. Effect of cilostazol on cerebral arteries in secondary prevention of ischemic stroke. Neurosci Bull 2010; 25:383-90. [PMID: 19927175 DOI: 10.1007/s12264-009-6192-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. METHODS Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography (MRA) and transcranial doppler ultrasonography (TCD) at the beginning of the study and after 12-month medication. RESULTS During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication (27.5%) (P = 0.04). Furthermore, as a major side effect of antiplatelet therapy, the frequency of bleeding was much less in cilostazol group (0 case in cilostazol group vs 5 in aspirin, P< 0.05). CONCLUSION Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.
Collapse
Affiliation(s)
- Jian-Jun Guo
- Department of Neurology, the 2nd Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | | | | | | | | |
Collapse
|
8
|
Huh PW, Yoo DS. Intracranial atherosclerotic disease; current options for surgical or medical treatment. J Korean Neurosurg Soc 2008; 42:427-35. [PMID: 19096584 DOI: 10.3340/jkns.2007.42.6.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 11/12/2007] [Indexed: 11/27/2022] Open
Abstract
Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the treatment with anti-platelet agents. When the symptoms develop, ischemic stroke can not be recovered readily. Therefore, aggressive treatments such as endovascular therapy and bypass surgery are required in addition to medical treatment for the intracranial artery stenosis. Recent intracranial stenting and drug eluting stenting have shown as very advanced effective therapeutic modalities. Nevertheless, until now, a randomized controlled study has not been conducted. Regarding bypass surgery, since the failed EC-IC bypass surgery study performed 20 years ago, extensive studies on its efficacy has not been conducted yet, and thus it has to be performed strictly only in hemodynamically compromised patients. Unless breakthrough drugs that suppress the progression of intracranial atherosclerosis and the formation of thrombi, and facilitate the regression of the arterial stenosis, the treatment concept of the recovery of the blood flow of stenotic arterial territory by mechanical recanalization or bypass surgery would be remained for the prevention as well as treatment of ischemic stroke caused by intracranial atherosclerosis.
Collapse
Affiliation(s)
- Pil-Woo Huh
- Department of Neurosurgery, The Catholic University of Korea, College of Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | | |
Collapse
|
9
|
Del Saz-Saucedo P, Maestre-Moreno JF, Arenillas-Lara JF. [Intracranial atherosclerosis]. Med Clin (Barc) 2008; 131:141-52. [PMID: 18601827 DOI: 10.1157/13124100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Until recently, intracranial atheromatosis was a probably underdiagnosed clinicopathological entity that was rarely studied in depth. In the last years the advance and expansion in the use of non-invasive diagnostic tools have led intracranial atheromatosis to the front page among the most prevalent causes of stroke worldwide. Important efforts have been accomplished with the aim of identifying markers of poor outcome, which, besides the underlying mechanisms of cerebral ischemia in these patients, are the most important factors on which clinical and therapeutic decisions should be based. To date, the therapeutic armamentarium is scarce and far from optimun, regarding medical and endovascular measures. In this review we address the most important aspects of the natural history and cure treatment of intracranial atheromatosis.
Collapse
Affiliation(s)
- Pablo Del Saz-Saucedo
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | | | | |
Collapse
|
10
|
Tan TY, Chen TY. Detection of microembolic signals using power M-mode Doppler sonography in acute stroke patients with intracranial artery stenosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:422-426. [PMID: 18615673 DOI: 10.1002/jcu.20515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Microembolic signals (MES) can be detected in a variety of clinical situations using conventional transcranial Doppler (TCD) sonography. We studied the prevalence of positive MESs in acute stroke patients with intracranial artery stenosis using power M-mode Doppler (PMD) sonography and also tested the feasibility of this new technique. METHOD Thirty-three consecutive acute ischemic stroke or transient ischemic attack patients with intracranial large artery occlusive disease were enrolled. PMD/TCD monitoring for 30 minutes was used for MES detection downstream of the stenotic artery within 1 week after stroke onset. Clinical risk factors in emboli-positive and emboli-negative patients were assessed. RESULTS MESs were detected in 21% (7/33) of patients. No significant differences were found in clinical risk factors between emboli-positive and emboli-negative patients. CONCLUSION PMD sonography to detect MESs in acute stroke patients is feasible and may be used in future clinical trials regarding MES detection.
Collapse
Affiliation(s)
- Teng-Yeow Tan
- Department of Neurology, Cerebrovascular Disease Section, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan
| | | |
Collapse
|
11
|
Jung KH, Lee YS. Clinical-Sonographic Index (CSI): A Novel Transcranial Doppler Diagnostic Model for Middle Cerebral Artery Stenosis. J Neuroimaging 2008; 18:256-61. [DOI: 10.1111/j.1552-6569.2007.00181.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
12
|
Ritter MA, Dittrich R, Thoenissen N, Ringelstein EB, Nabavi DG. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. J Neurol 2008; 255:953-61. [PMID: 18458865 DOI: 10.1007/s00415-008-0638-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 04/06/2007] [Accepted: 04/30/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Martin A Ritter
- Dept. of Neurology, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
| | | | | | | | | |
Collapse
|
13
|
Azarpazhooh MR, Chambers BR. Clinical application of transcranial Doppler monitoring for embolic signals. J Clin Neurosci 2006; 13:799-810. [PMID: 16908159 DOI: 10.1016/j.jocn.2005.12.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 12/20/2005] [Indexed: 12/12/2022]
Abstract
A major advantage of transcranial ultrasound is its suitability for continuous monitoring. Microembolic signals (MES) are brief, high-intensity transients that occur when particulate microemboli or gaseous microbubbles pass through the ultrasound beam. These MES have been detected in several clinical scenarios, but rarely in age-matched controls. The detection of MES provides important pathophysiological information in a variety of disorders, but their clinical importance and possible therapeutic implications are still under debate. The present article summarizes the significance of MES in different clinical settings and outlines some of the problems to be resolved so that transcranial ultrasound can be applied in clinical practice.
Collapse
Affiliation(s)
- M R Azarpazhooh
- National Stroke Research Institute, University of Melbourne, Austin Health, Heidelberg Heights, Victoria, Australia
| | | |
Collapse
|
14
|
Esagunde RU, Wong KS, Lee MP, Gan HY, Wong MC, Chang HM, Chen CLH. Efficacy of Dual Antiplatelet Therapy in Cerebrovascular Disease as Demonstrated by a Decline in Microembolic Signals. Cerebrovasc Dis 2006; 21:242-6. [PMID: 16446537 DOI: 10.1159/000091221] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 09/20/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The presence of microembolic signals (MES) may indicate an increased risk of recurrent ischemic events in patients with stroke. The optimal management of such patients is uncertain. We report the effect of clopidogrel in addition to aspirin on the number of MES in a series of patients with ischemic stroke and transient ischemic attack (TIA) due to large-vessel disease. METHODS 8 patients with either extracranial or intracranial artery stenosis were identified in 30-min MES studies by transcranial Doppler sonography as having MES. All patients were on antiplatelet therapy prior to baseline transcranial Doppler monitoring. The patients were subsequently treated with clopidogrel in addition to aspirin. Repeat MES studies were performed between day 3 and 7 with aspirin and clopidogrel. RESULTS All patients were Chinese. The median interval time from symptom onset to initial MES study was 7 days (range of 2-30). MES donor sites included 4 severely stenosed or occluded internal carotid arteries and 4 stenosed middle cerebral arteries. The median MES number at baseline was 8 (range 3-51). Repeat MES studies showed a significant decrease in MES (p = 0.012, Wilcoxon signed ranks test). 4 patients had complete cessation of MES and all patients showed a decline in MES. No patient had recurrent strokes or bleeding complications. CONCLUSION The rapid and significant decline of MES in our stroke and TIA patients suggests the possible efficacy of dual antiplatelet therapy with aspirin and clopidogrel in patients with MES and symptomatic large-artery occlusive disease. Randomized controlled trials should be conducted to confirm this preliminary observation.
Collapse
Affiliation(s)
- Romulo Urgel Esagunde
- Neurovascular Laboratory, Brain Center, National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore.
| | | | | | | | | | | | | |
Collapse
|
15
|
Bang OY, Lee PH, Yoon SR, Lee MA, Joo IS, Huh K. Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis. J Neurol Neurosurg Psychiatry 2005; 76:1128-34. [PMID: 16024892 PMCID: PMC1739734 DOI: 10.1136/jnnp.2004.054403] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The apparent differences in risk factors for intra- and extracranial atherosclerosis are unclear and the mechanisms that underlie strokes in patients with intracranial atherosclerosis are not well known. We investigated the conventional vascular risk factors as well as other factors in stroke patients with large artery atherosclerosis. METHODS Using diffusion weighted imaging (DWI) and vascular and cardiologic studies, we selected patients with acute non-cardioembolic cerebral infarcts within the middle cerebral artery (MCA) territory. Patients were divided into two groups: those with atherosclerotic lesions on the carotid sinus (n = 112) and those with isolated lesions on the proximal MCA (n = 160). Clinical features, risk factors, and DWI patterns were compared between groups. RESULTS There were no differences in conventional risk factors, but markers for inflammation were significantly higher in patients with carotid atherosclerosis than in those with isolated MCA atherosclerosis (p < 0.01 for both). After adjustments for age/sex and the severity of stroke, an inverse correlation was observed between C-reactive protein levels and MCA atherosclerosis (odds ratio 0.57 per 1 mg/dl increase; 95% confidence interval 0.35 to 0.92; p = 0.02). Internal borderzone infarcts suggestive of haemodynamic causes were the most frequent DWI pattern in patients with MCA occlusion, whereas territorial infarcts suggesting plaque ruptures were most common in those with carotid occlusion. CONCLUSIONS Our results indicate that inflammatory markers, rather than conventional risk factors, reveal clinical and radiological differences between patients with carotid and MCA atherosclerosis. Plaques associated with MCA atherosclerosis may be more stable than those associated with carotid atherosclerosis.
Collapse
Affiliation(s)
- O Y Bang
- Department of Neurology, College of Medicine, Ajou University, Woncheon-dong San 5, Suwon, Kyungki-do, 442-749, Republic of Korea.
| | | | | | | | | | | |
Collapse
|
16
|
Kremer C, Schaettin T, Georgiadis D, Baumgartner RW. Prognosis of asymptomatic stenosis of the middle cerebral artery. J Neurol Neurosurg Psychiatry 2004; 75:1300-3. [PMID: 15314120 PMCID: PMC1739243 DOI: 10.1136/jnnp.2003.017863] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk of ischaemic events in asymptomatic intracranial atherosclerosis is unknown. OBJECTIVE To follow up patients with asymptomatic atherosclerotic middle cerebral artery stenosis (MCAS) to evaluate the long term stroke risk in its territory. METHODS Consecutive white patients with asymptomatic atherosclerotic MCAS were enrolled. Patients with MCAS of possible or proven non-atherosclerotic origin were excluded. MCAS was assessed by transcranial colour duplex sonography according to published angiography validated criteria. Medical treatment was given at the discretion of the treating physician. RESULTS 50 patients were included and followed for (mean (SD)) 815 (351) days; three were lost to follow up. MCAS was < 50% in 38 and > or = 50% in 12. No patient suffered an ischaemic event in the MCAS territory; one had a transient ischaemic attack in the contralateral hemisphere. Three patients died, one from a subdural haematoma in the contralateral hemisphere, and two from non-stroke-related causes. Medical treatment at baseline included antithrombotic drugs in 42 cases (antiplatelet agent, n = 39; warfarin, n = 3), and statins in 22; at the end of follow up 45 of the 47 survivors were on antithrombotic drugs (antiplatelet agent, n = 37; warfarin, n = 8), and 30 were on statins. CONCLUSIONS Asymptomatic MCAS of atherosclerotic origin appears to have a benign long term prognosis with a low risk of ipsilateral stroke in medically treated white patients.
Collapse
Affiliation(s)
- C Kremer
- Department of Neurology, University Hospital of Zürich, Switzerland.
| | | | | | | |
Collapse
|
17
|
|
18
|
Babikian VL, Wijman CA. Brain Embolism Monitoring with Transcranial Doppler Ultrasound. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2003; 5:221-232. [PMID: 12777200 DOI: 10.1007/s11936-003-0006-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Embolism is considered to be the main mechanism leading to brain infarction today; with the introduction of sophisticated neuroimaging tools, its impact is increasingly appreciated. Transcranial Doppler ultrasound allows noninvasive monitoring of in vivo embolism. Acute stroke, internal carotid artery stenosis, several cardiac conditions, internal carotid endarterectomy, and coronary artery bypass graft surgery have been extensively monitored. These investigations and other clinical and neuroimaging studies have expanded the understanding of brain embolism; they suggest it may be appropriate to think of it as a process that occurs in the context of other hemodynamic factors. Differences have been identified among several conditions regarding the temporal profile of embolism and the characteristics of embolic particles. This article presents a brief review of brain embolism monitoring with transcranial Doppler ultrasound.
Collapse
Affiliation(s)
- Viken L. Babikian
- Stroke Service, Department of Neurology, Boston University School of Medicine, 715 Albany Street, D-315, Boston, MA 02118, USA.
| | | |
Collapse
|
19
|
Gao S, Wong KS. Characteristics of Microembolic Signals Detected Near Their Origins in Middle Cerebral Artery Stenoses. J Neuroimaging 2003. [DOI: 10.1111/j.1552-6569.2003.tb00168.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
20
|
Dittrich R, Ritter MA, Droste DW. Microembolus detection by transcranial doppler sonography. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 2002; 16:21-30. [PMID: 12470847 DOI: 10.1016/s0929-8266(02)00046-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Microembolic signals can be detected by transcranial ultrasound as signals of high intensity and short duration. These signals represent circulating gaseous or solid particles. To optimize the differentiation from artefacts and the background signal and to facilitate the clinical use, several attempts have been made to automatize the detection of microemboli. Microemboli occur spontaneously in various clinical situations but their clinical impact and possible therapeutical implications are still under debate. This article provides a review of the actual literature concerning the current state of technical and clinical aspects of microembolus detection.
Collapse
Affiliation(s)
- Ralf Dittrich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Str 33, D-48129, Münster, Germany.
| | | | | |
Collapse
|
21
|
Diehl RR, Samii C, Diehl A. Dynamics and embolic activity of symptomatic intra-cranial cerebral artery stenoses. Acta Neurol Scand 2002; 106:173-81. [PMID: 12174178 DOI: 10.1034/j.1600-0404.2002.01359.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the occurrence of microembolic signals (MES) and hemodynamic features in patients with acute symptomatic intracranial cerebral artery stenoses by transcranial Doppler (TCD). MATERIAL AND METHODS Twelve patients with acute hemispheric ischemic events and corresponding intracranial cerebral artery stenoses as identified by TCD, and exclusion of extracranial or cardiac emboli sources were repeatedly studied by TCD monitoring of the affected and the contralateral vessel. The occurrence of MES and MES clusters (> or =3 MES per second) and of flow velocity changes was examined. RESULTS Nine patients presented with MES in the affected artery during the first measurement. In seven patients sudden flow velocity changes could be detected in the affected vessel. In five patients these changes were accompanied by MES clusters. MES and velocity changes disappeared in all patients during follow-up, and the degree of stenosis decreased in nine patients. CONCLUSIONS The high prevalence of MES and sudden velocity changes in acute intracranial cerebral artery stenoses indicates that acute intracranial stenoses may be formed at least in part by mobile thrombotic material.
Collapse
Affiliation(s)
- R R Diehl
- Department of Neurology, Krupp Hospital, Essen, Germany.
| | | | | |
Collapse
|
22
|
Wong KS, Gao S, Chan YL, Hansberg T, Lam WWM, Droste DW, Kay R, Ringelstein EB. Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study. Ann Neurol 2002; 52:74-81. [PMID: 12112050 DOI: 10.1002/ana.10250] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although most therapeutic efforts and experimental stroke models focus on the concept of complete occlusion of the middle cerebral artery as a result of embolism from the carotid artery or cardiac chamber, relatively little is known about the stroke mechanism of intrinsic middle cerebral artery stenosis. Differences in stroke pathophysiology may require different strategies for prevention and treatment. We prospectively studied 30 consecutive acute ischemic stroke patients with middle cerebral artery stenosis detected by transcranial Doppler and magnetic resonance angiography. Patients underwent microembolic signal monitoring by transcranial Doppler and diffusion-weighted magnetic resonance imaging. Characteristics of acute infarct on diffusion-weighted magnetic resonance imaging were categorized according to the number (single or multiple infarcts) and the pattern of cerebral infarcts (cortical, border zone, or perforating artery territory infarcts). The data of microembolic signals and diffusion-weighted magnetic resonance imaging were assessed blindly and independently by separate observers. Diffusion-weighted magnetic resonance imaging showed that 15 patients (50%) had single acute cerebral infarcts and 15 patients had multiple acute cerebral infarcts. Among patients with multiple acute infarcts, unilateral, deep, chainlike border zone infarcts were the most common pattern (11 patients, 73%), and for single infarcts, penetrating artery infarcts were the most common (10 patients, 67%). Microembolic signals were detected in 10 patients (33%). The median number of microembolic signals per 30 minutes was 15 (range, 3-102). Microembolic signals were found in 9 patients with multiple infarcts and in 1 patient with a single infarct (p = 0.002, chi(2)). The number of microembolic signals predicted the number of acute infarcts on diffusion-weighted magnetic resonance imaging (linear regression, adjusted R(2) =0.475, p < 0.001). Common stroke mechanisms in patients with middle cerebral artery stenosis are the occlusion of a single penetrating artery to produce a small subcortical lacuna-like infarct and an artery-to-artery embolism with impaired clearance of emboli that produces multiple small cerebral infarcts, especially along the border zone region.
Collapse
Affiliation(s)
- Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong, SAR.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Gao S, Lam WWM, Chan YL, Liu J, Wong KS. Optimal Values of Flow Velocity on Transcranial Doppler in Grading Middle Cerebral Artery Stenosis in Comparison With Magnetic Resonance Angiography. J Neuroimaging 2002. [DOI: 10.1111/j.1552-6569.2002.tb00123.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
24
|
Samii C, Diehl RR, Berlit P. Intermittent drop in blood flow velocity in the internal carotid artery and its branches. JOURNAL OF CLINICAL ULTRASOUND : JCU 2002; 30:98-102. [PMID: 11857515 DOI: 10.1002/jcu.10037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Extracranial Doppler sonography and transcranial Doppler sonography (TCD) allow the assessment and monitoring of hemodynamic and embolic events in cerebrovascular diseases. We describe an unusual hemodynamic phenomenon in a patient with intracranial carotid siphon stenosis and no clinical symptoms of stenosis. TCD examination suggested and angiography confirmed stenosis of the left internal carotid artery siphon. TCD examination revealed a sudden, intermittent drop in blood flow velocity in both the prestenotic and poststenotic segments of the internal carotid artery, whereas cardiac hemodynamic parameters were unaffected. Embolic signals were detected in the poststenotic vessels only. We speculate that such sonographic findings may be caused by intermittent vessel occlusions due to the reversible displacement of an intraluminal thrombus in relation to the cardiac cycle.
Collapse
Affiliation(s)
- Cirus Samii
- Department of Neurology with Clinical Neurophysiology, Alfried Krupp Hospital, Alfried Krupp Street 21, D-45117 Essen, Germany
| | | | | |
Collapse
|
25
|
Kandarpa K, Becker GJ, Ferguson RD, Connors JJ, Wojak JC, Landow WJ. Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part II. J Vasc Interv Radiol 2001; 12:807-12. [PMID: 11435536 DOI: 10.1016/s1051-0443(07)61504-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Transcatheter endovascular procedures are increasingly used to treat symptomatic peripheral atherosclerosis. This second part of a two-part review assesses the existing supportive evidence for the application of recently introduced transcatheter treatments for lesions that cause cerebrovascular ischemia and stroke. Studies were identified via MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective randomized trials or other high-quality studies were unavailable, studies with at least 50 patients per treated group and a minimum follow-up duration of 6 months were included. For each application, the authors assessed the quality of evidence (efficacy, safety, and, where available, cost-effectiveness) and made recommendations with appropriate caveats. Although recommendations based on proven efficacy and cost-effectiveness cannot be made in general, the use of transcatheter therapies can be supported in specific circumstances based on expected reduction in procedure-related morbidity and/or mortality. It is hoped that the identification of deficiencies in the literature will inform and inspire critically needed research in this area.
Collapse
Affiliation(s)
- K Kandarpa
- Department of Radiology, Weill Medical College, Cornell University, New York, New York 10021, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Wong KS, Gao S, Lam WW, Chan YL, Kay R. A pilot study of microembolic signals in patients with middle cerebral artery stenosis. J Neuroimaging 2001; 11:137-40. [PMID: 11296582 DOI: 10.1111/j.1552-6569.2001.tb00023.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There has been limited data on the frequency of microembolic signals in patients with middle cerebral artery (MCA) stenosis, especially during the acute phase of stroke. Using transcranial Doppler, the authors prospectively monitored the MCA segments distal to stenosis in 4 groups of patients for 30 minutes: (1) symptomatic patients with acute ischemic stroke and MCA stenosis, (2) asymptomatic group patients with asymptomatic MCA stenosis, (3) control patients with acute ischemic stroke of undetermined etiology, and (4) normal people. A total of 60 patients completed the study. There were no microembolic signals in the asymptomatic, control, and normal groups. Among 20 patients in the symptomatic group, microembolic signals were detected in 3 patients (15%). The number of emboli ranged from 1 to 6 per 30 minutes. This is the first report of the presence of microembolic signals in acute stroke patients with MCA stenosis.
Collapse
Affiliation(s)
- K S Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | | | | | | | | |
Collapse
|
27
|
Klötzsch C, Popescu O, Sliwka U, Mull M, Noth J. Detection of stenoses in the anterior circulation using frequency-based transcranial color-coded sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:579-584. [PMID: 10856620 DOI: 10.1016/s0301-5629(00)00144-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Atherosclerotic stenoses of the intracranial vessels are less frequent than those of the extracranial vessels, but they are associated with a considerable annual stroke rate. The aim of the present study was to investigate the usefulness of frequency-based transcranial color-coded sonography (TCCS), transcranial Doppler sonography (TCD) and digital subtraction angiography (DSA) in patients with middle cerebral artery (MCA) and intracranial internal carotid artery (ICA) stenosis. Forty patients presenting with 48 intracranial stenoses of the anterior circulation were involved in the study. The stenoses were detected in the neurovascular laboratory during routine TCD examinations. All patients underwent an additional frequency-based TCCS examination. Both the axial and coronal planes were obtained to allow the exact localization of MCA stenosis and differentiation from intracranial ICA stenosis. Angle-corrected flow velocity measurements were performed if straight vessel compartments were 20 mm or more in length. A total of 18 stenoses (44%) were investigated additionally with DSA. According to the investigation with TCD, 20 (42%) stenoses were low-grade, 12 (25%) were moderate, and the remaining 16 (33%) were severe. Angle-corrected flow velocity measurements obtained with the integrated pulse-wave Doppler device of the TCCS machine were highly correlated (0.912, p < 0.001) with those obtained with TCD. TCCS achieved a reliable differentiation of MCA main stem stenosis vs. intracranial ICA stenosis in 7 patients and vs. MCA branch stenosis in 4 patients, but TCD failed in these two subgroups. The agreement between DSA and TCCS to evaluate semiquantitatively 18 intracranial stenoses resulted in a weighted-kappa value of 0.764. The major clinically relevant advantages of TCCS over TCD in MCA stenosis are its ability to differentiate MCA trunk stenosis from terminal ICA or MCA branch stenosis reliably and to perform angle-corrected flow velocity measurements.
Collapse
Affiliation(s)
- C Klötzsch
- Department of Neurology, Aachen, Germany
| | | | | | | | | |
Collapse
|