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Feng L, Yang XZ, Zhang DD, Zhai FF, Li ML, Zhou LX, Ni J, Yao M, Jin ZY, Cui LY, Zhang SY, Han F, Zhu YC. Correlation between Circle of Willis configuration and intracranial arterial dolichoectasia, and genetic contributions. J Stroke Cerebrovasc Dis 2024; 33:107955. [PMID: 39179190 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107955] [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: 12/25/2023] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVES Intracranial arterial dolichoectasia (IADE) is characterized by the dilation, elongation, and tortuosity of intracranial arteries. We aimed to investigate the association between variations of the Circle of Willis (COW) and IADE in the general population, as well as estimate the genetic correlation between COW variations and IADE. METHODS A total of 981 individuals from a population-based cohort were included. Brain magnetic resonance angiography was performed to assess COW variants and measure the diameters of intracranial arteries. IADE was defined as a total intracranial volume-adjusted diameter ≥ 2 standard deviations. Logistic regression models were used to analyze the association between COW variations and IADE. The heritability and genetic correlation were estimated using genome-wide complex trait analysis (GCTA) based on single nucleotide polymorphism (SNP) array data. RESULTS The prevalence of IADE was 6.2 %. Hypoplastic/absent A1 segments were associated with an increase in contralateral ICA diameter (β ± SE, 0.279 ± 0.049; p = 0.001) and a decrease in ipsilateral ICA diameter (β ± SE, -0.300 ± 0.050; p = 0.001). Fetal-type posterior cerebral artery (FTP) was associated with a larger ICA diameter (β ± SE, 0.326 ± 0.048; p = 0.001) and a smaller BA diameter (β ± SE, -0.662 ± 0.043; p = 0.001). FTP revealed a positive genetic correlation with ICA dilation (rG = 0.259 ± 0.175; p = 0.0009) and a negative genetic correlation with BA dilation (rG = -0.192 ± 0.153, p = 0.015). CONCLUSIONS There was an association between COW variations and larger intracranial arterial diameters in the general population. Genetic factors may play a role in the development of intracranial arterial dilation and the formation of COW variants.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Xin-Zhuang Yang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Ding-Ding Zhang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Fei-Fei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
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Del Brutto VJ, Khasiyev F, Liu M, Spagnolo-Allende A, Qiao Y, Melgarejo Arias JD, Guzman VA, Igwe KC, Sanchez DL, Andrews H, Morales CD, Farrell MT, Bassil DT, Seshadri S, Wagner RG, Mngomezulu V, Manly J, Elkind MSV, Berkman L, Romero JR, Maestre GE, Del Brutto OH, Brickman AM, Venketasubramanian N, Chen C, Robert C, Hilal S, Rundek T, Wasserman BA, Gutierrez J. Association of brain arterial diameters with demographic and anatomical factors in a multi-national pooled analysis of cohort studies. Neuroradiol J 2024; 37:304-313. [PMID: 38148489 PMCID: PMC11138338 DOI: 10.1177/19714009231224429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Brain arterial diameters are markers of cerebrovascular disease. Demographic and anatomical factors may influence arterial diameters. We hypothesize that age, sex, height, total cranial volume (TCV), and persistent fetal posterior cerebral artery (fPCA) correlate with brain arterial diameters across populations. METHODS Participants had a time-of-flight MRA from nine international cohorts. Arterial diameters of the cavernous internal carotid arteries (ICA), middle cerebral arteries (MCA), and basilar artery (BA) were measured using LAVA software. Regression models assessed the association between exposures and brain arterial diameters. RESULTS We included 6,518 participants (mean age: 70 ± 9 years; 41% men). Unilateral fPCA was present in 13.2% and bilateral in 3.2%. Larger ICA, MCA, and BA diameters correlated with older age (Weighted average [WA] per 10 years: 0.18 mm, 0.11 mm, and 0.12 mm), male sex (WA: 0.24 mm, 0.13 mm, and 0.21 mm), and TCV (WA: for one TCV standard deviation: 0.24 mm, 0.29 mm, and 0.18 mm). Unilateral and bilateral fPCAs showed a positive correlation with ICA diameters (WA: 0.39 mm and 0.73 mm) and negative correlation with BA diameters (WA: -0.88 mm and -1.73 mm). Regression models including age, sex, TCV, and fPCA explained on average 15%, 13%, and 25% of the ICA, MCA, and BA diameter interindividual variation, respectively. Using height instead of TCV as a surrogate of head size decreased the R-squared by 3% on average. CONCLUSION Brain arterial diameters correlated with age, sex, TCV, and fPCA. These factors should be considered when defining abnormal diameter cutoffs across populations.
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Affiliation(s)
| | | | | | | | - Ye Qiao
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | - Meagan T Farrell
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Darina T Bassil
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Lisa Berkman
- Harvard University, Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | | | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Institute of Neuroscience, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | | | | | | | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Caroline Robert
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore
- Memory Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Bruce A Wasserman
- Johns Hopkins University, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
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Zhou S, Qiao Y, Zhou X, Wasserman BA, Caughey MC. Detection of Dolichoectasia and Atherosclerosis by Automated MRA Tortuosity Metrics in a Population-Based Study. J Magn Reson Imaging 2024; 59:1612-1619. [PMID: 37515312 DOI: 10.1002/jmri.28923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Intracranial vessel tortuosity is a key component of dolichoectasia and has been associated with atherosclerosis and adverse neurologic outcomes. However, the evaluation of tortuosity is mainly a descriptive assessment. PURPOSE To compare the performance of three automated tortuosity metrics (angle metric [AM], distance metric [DM], and distance-to-axis metric [DTA]) for detection of dolichoectasia and presence of segment-specific plaques. STUDY TYPE Observational, cross-sectional metric assessment. POPULATION 1899 adults from the general population; mean age = 76 years, female = 59%, and black = 29%. FIELD STRENGTH/SEQUENCE 3-T, three-dimensional (3D) time-of-flight MRA and 3D vessel wall MRI. ASSESSMENT Tortuosity metrics and mean luminal area were quantified for designated segments of the internal carotid artery, middle cerebral artery, anterior cerebral artery, posterior cerebral artery, vertebral artery, and entire length of basilar artery (BA). Qualitative interpretations of BA dolichoectasia were assessed based on Smoker's visual criteria. STATISTICAL TESTS Descriptive statistics (2-sample t-tests, Pearson chi-square tests) for group comparisons. Receiver operating characteristics area under the curve (AUC) for detection of BA dolichoectasia or segment-specific plaque. Model inputs included 1) tortuosity metrics, 2) mean luminal area, and 3) demographics (age, race, and sex). RESULTS Qualitative dolichoectasia was identified in 336 (18%) participants, and atherosclerotic plaques were detected in 192 (10%) participants. AM-, DM-, and DTA-calculated tortuosity were good individual discriminators of basilar dolichoectasia (AUCs: 0.76, 0.74, and 0.75, respectively), with model performance improving with the mean lumen area: (AUCs: 0.88, 0.87, and 0.87, respectively). Combined characteristics (tortuosity and mean luminal area) identified plaques with better performance in the anterior (AUCs ranging from 0.66 to 0.78) than posterior (AUCs ranging from 0.54 to 0.65) circulation, with all models improving by the addition of demographics (AUCs ranging from 0.62 to 0.84). DATA CONCLUSION Quantitative vessel tortuosity metrics yield good diagnostic accuracy for the detection of dolichoectasia. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Shang Zhou
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Xinwei Zhou
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland, USA
- Department of Radiology, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa C Caughey
- Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
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Thiankhaw K, Ozkan H, Ambler G, Werring DJ. Relationships between intracranial arterial dolichoectasia and small vessel disease in patients with ischaemic stroke: a systematic review and meta-analysis. J Neurol 2024; 271:772-781. [PMID: 38019295 PMCID: PMC10827828 DOI: 10.1007/s00415-023-12094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Intracranial arterial dolichoectasia (IADE) is a common arterial finding of dilation, elongation, or both, affecting large intracranial vessels, and associated with vascular risk factors, including hypertension. Associations of IADE with neuroimaging cerebral small vessel disease (CSVD) may be relevant for diagnosis and prognosis in patients with stroke. The study aimed to conduct an updated systematic review and meta-analysis of observational studies to investigate the relationships of IADE with well-defined CSVD markers in patients with ischaemic stroke. METHODS We systematically searched PubMed, Embase, and Scopus for studies on IADE in ischaemic stroke patients with fulfilling predefined inclusion criteria. We pooled data to conduct a meta-analysis to compare the prevalence of SVD markers between patients with and without IADE groups using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS From 157 retrieved abstracts, we included six studies from seven publications comprising 6102 patients with ischaemic stroke. The mean age of patients was 52.8 years, and 3691 (60.5%) were male. IADE was diagnosed in 11.4% (95% CI 8.9-13.9) (761) of included patients; 51.8% (3160) had hypertension. Compared to patients without IADE, individuals diagnosed with IADE had a significantly increased prevalence of lacune (RR 1.67, 95% CI 1.36-2.06, P < 0.01, I2 = 0.00%), cerebral microbleeds (CMBs) (RR 2.56, 95% CI 1.53-4.28, P < 0.01, I2 = 84.95%) and white matter hyperintensities (WMHs) (RR 2.17, 95% CI 1.84-2.56, P < 0.01, I2 = 0.00%). CONCLUSIONS In patients with ischaemic stroke, IADE is associated with a higher prevalence of CSVD markers, including lacunes, CMBs, and WMHs. Further studies are needed to clarify the mechanisms underlying these associations and their potential relevance for the understanding, diagnosis, and treatment of CSVD.
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Affiliation(s)
- Kitti Thiankhaw
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Hatice Ozkan
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gareth Ambler
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.
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Kwiatkowska M, Rzepliński R, Ciszek B. Anatomy of the pontine arteries and perforators of the basilar artery in humans. J Anat 2023; 243:997-1006. [PMID: 37415277 PMCID: PMC10641037 DOI: 10.1111/joa.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
Cerebral blood flow constitutes a critical area of interest for neurologists, neurosurgeons, and interventional radiologists as a social burden related to ischemic stroke, hemorrhagic stroke, and vascular dementia is expected to intensify. There is a great need to develop new and effective therapies, therefore deepening understanding of cerebrovascular anatomy, physiology, and pathology is crucial. The main aim of the study was to develop a comprehensive classification of the pontine arteries considering their typology, relations to the cranial nerves, branching schemes, and superficial pontine blood supply areas. We prepared 100 anatomical specimens of the human brainstem with the basilar artery, the pontine arteries, and the terminal perforating arteries. With the use of microsurgical microscope, we analyzed morphometry of the basilar artery, origins, courses, and branching patterns of the pontine arteries as well as distribution of the terminal perforators in relation to pontine superficial vascular areas and the cranial nerves. Additionally, we studied presence of pontine branches of the superior cerebellar artery (SCA) and anterior inferior cerebellar artery (AICA). Repetitive branching patterns, origins, and courses led us to distinguish five types of the pontine arteries: type 1-the paramedian branches, type 2-the short circumflex branches, type 3-composition of the paramedian and the short circumflex branches, type 4-long circumflex branches, and type 5-median branches penetrating the pons along the basilar sulcus. Types 1, 2, and 4 were described in the literature previously, but the classification did not include the median branches (the most prevalent branches) and frequently occurring combinations of the types 1 and 2. There were seven pontine arteries on both sides on average that presented the following general pattern: the first pontine artery below the SCA is a type 4 vessel called the posterolateral pontine artery and it is followed by a type 2 vessel-the superolateral pontine artery; the next three arteries represent the types 1, 2, and 3 and supply most of the ventral pontine surface; the sixth artery-the anterolateral pontine artery-is a short circumflex branch and the seventh artery, originating below the AICA, represents long circumflex arteries. Occlusion of each of the abovementioned vessels relates to a specific pontine vascular syndrome. As explained by the phylogenesis and ontogenesis of the central nervous system, the pontine arteries are subject to variability. The SCA and the AICA took part in the pontine blood supply in 2.5% and 12.5% of cases, respectively, therefore neurovascular interventions involving the SCA, or the AICA may lead to pontine ischemia. Contact of the pontine arteries with the cranial nerves depends on the vessel type and origin location.
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Affiliation(s)
| | - Radosław Rzepliński
- Department of Descriptive and Clinical AnatomyMedical University of WarsawWarsawPoland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical AnatomyMedical University of WarsawWarsawPoland
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Lam YLT, Sheng B, Kwok HM, Yu ELM, Ma KFJ. Basilar artery diameter as neuroimaging biomarker in Chinese Fabry disease patients. Orphanet J Rare Dis 2023; 18:186. [PMID: 37430370 DOI: 10.1186/s13023-023-02759-6] [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: 09/24/2022] [Accepted: 06/04/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disease resulting from mutations of α-galactosidase A gene, and has been emphasized as one of the etiologies of young stroke and leukoencephalopathy. Vertebrobasilar dolichoectasia (VBD) is a highlighted finding in FD. We aim to examine the utility of VBD in Chinese FD by comparing the differences in basilar artery (BA) diameter of Chinese FD patients against age-matched controls with and without stroke. METHODS This was a matched case-control study involving 37 Chinese FD patients. The BA diameters were evaluated on axial T2-weighted magnetic resonance imaging and compared to two age-and-gender matched control groups, one with stroke and one without. The association between BA diameter and stroke occurrences and white matter hyperintensities (WMH) were analyzed among all FD patients. RESULTS Patients with FD had significantly increased BA diameter compared to controls with and without stroke (p < 0.001). A BA diameter of 4.16 mm could distinguish FD from controls in the stroke subgroup (ROC AUC 0.870, p = 0.001, sensitivity 80% specificity 100%), and with a cut-off of 3.21 mm in the non-stroke subgroup (ROC AUC 0.846, p < 0.001, sensitivity 77.8% specificity 88.9%). Larger BA diameter had more stroke occurrences and was moderately associated with heavier WMH load in terms of higher total FAZEKAS scores. (Spearman's rho = 0.423, p = 0.011). CONCLUSION VBD was also present in Chinese FD patients. BA diameter has high diagnostic utility in identifying FD from a mixed cohort of stroke and normal controls, and carried predictive value in evaluating neurological complications of FD.
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Affiliation(s)
- Yan Lok Tiffany Lam
- Department of Medicine & Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Hong Kong Special Administrative Region, Hong Kong.
| | - Bun Sheng
- Department of Medicine & Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Hong Kong Special Administrative Region, Hong Kong
| | - Hoi Ming Kwok
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, Lai Chi Kok, Hong Kong
| | - Ellen Lok Man Yu
- Clinical Research Centre, Kowloon West Cluster, Hong Kong Special Administrative Region, Kowloon, Hong Kong
| | - Ka Fai Johnny Ma
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong Special Administrative Region, Lai Chi Kok, Hong Kong
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Tang M, Zhou D, He J, Bai H, Li Q, Xu H. Chitinase-3 like-protein-1, matrix metalloproteinase -9 and positive intracranial arterial remodelling. Front Aging Neurosci 2023; 15:1154116. [PMID: 37091521 PMCID: PMC10119585 DOI: 10.3389/fnagi.2023.1154116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
IntroductionPositive intracranial arterial remodelling is a dilated lesion of the large intracranial vessels; however, its pathogenesis is currently unknown. Some studies have identified chitinase-3 like-protein-1 (YKL-40) and matrix metalloproteinase (MMP)-9 as circulating inflammatory factors involved in positive vascular remodelling. Herein, we aimed to investigate the relationship between changes in serum YKL-40 and MMP-9 levels and positive intracranial arterial remodelling in patients with cerebral small vessel disease (CSVD).MethodsA total of 110 patients with CSVD were selected. Patients with brain arterial remodelling (BAR) scores >1 times the standard deviation were defined as the positive intracranial artery remodelling group (n = 21 cases), and those with BAR scores ≤1 times the standard deviation were defined as the non-positive intracranial artery remodelling group (n = 89 cases). Serum YKL-40 and MMP-9 levels were measured using an enzyme-linked immunosorbent assay kit. Factors influencing positive intracranial artery remodelling using binary logistic regression analysis and predictive value of YKL-40 and MMP-9 for positive intracranial arterial remodelling in patients with CSVD were assessed by a subject receiver operating characteristic curve.ResultsStatistically significant differences in serum YKL-40 and MMP-9 levels were observed between the positive and non-positive remodelling groups (p < 0.05). The integrated indicator (OR = 9.410, 95% CI: 3.156 ~ 28.054, P<0.01) of YKL-40 and MMP-9 levels were independent risk factors for positive intracranial arterial remodelling. The integrated indicator (OR = 3.763, 95% CI: 1.884 ~ 7.517, p < 0.01) of YKL-40 and MMP-9 were independent risk factors for positive arterial remodelling in posterior circulation, but were not significantly associated with positive arterial remodelling in anterior circulation (p > 0.05). The area under the curve for YKL-40 and MMP-9 diagnostic positive remodelling was 0.778 (95% CI: 0.692–0.865, p < 0.01) and 0.736 (95% CI: 0.636–0.837, p < 0.01), respectively.DiscussionElevated serum YKL-40 and MMP-9 levels are independent risk factors for positive intracranial arterial remodelling in patients with CSVD and may predict the presence of positive intracranial arterial remodelling, providing new ideas for the mechanism of its occurrence and development and the direction of treatment.
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Affiliation(s)
- Ming Tang
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongyang Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhui He
- Department of Cardiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongying Bai
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Hongying Bai,
| | - Qianqian Li
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Qianqian Li,
| | - Hui Xu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Del Brutto VJ, Khasiyev F, Omran SS, Purohit M, Liu M, Wright C, Rundek T, Elkind MSV, Sacco RL, Gutierrez J. Association of Brain Arterial Elongation With Risk of Stroke and Death in Stroke-Free Individuals: Results From NOMAS. Arterioscler Thromb Vasc Biol 2023; 43:474-481. [PMID: 36727517 PMCID: PMC9974766 DOI: 10.1161/atvbaha.122.318819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brain arterial dilation and elongation characterize dolichoectasia, an arteriopathy associated with risk of stroke and death. We aim to determine whether brain arterial elongation increases the risk of stroke and death independent of brain arterial diameters. METHODS We analyzed 1210 stroke-free participants (mean age 71±9 years, 41% men, 65% Hispanic) with available time-of-flight magnetic resonance angiogram from the Northern Manhattan Study, a population-based cohort study across a multiethnic urban community. We obtained baseline middle cerebral artery M1-segment (MCA-M1) and basilar artery (BA) mean lengths and diameters using a semi-automated software. Cox proportional hazards models adjusted for brain arterial diameters and potential confounders yielded adjusted hazards ratios with 95% CIs for the primary outcomes of incident stroke and all-cause mortality, as well as secondary outcomes including noncardioembolic stroke, vascular death, and any vascular event. RESULTS Neither MCA-M1 nor BA lengths correlated with incident stroke or all-cause mortality. Both MCA-M1 and BA larger diameters correlated with all-cause mortality (MCA-M1 aHR, 1.52 [95% CI, 1.03-2.23], BA aHR, 1.28 [95% CI, 1.02-1.61]), as well as larger MCA-M1 diameters with vascular death (aHR, 1.84 [95% CI, 1.02-3.31]). Larger MCA-M1 and BA diameters did not correlate with incident stroke. However, larger BA diameters were associated with posterior circulation noncardioembolic stroke (aHR, 2.93 [95% CI, 1.07-8.04]). There were no statistical interactions between brain arterial lengths and diameters in relation to study outcomes. CONCLUSIONS In a multiethnic cohort of stroke-free adults, brain arterial elongation did not correlate with risk of stroke or death, nor influenced the significant association between brain arterial dilation and vascular risk.
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Affiliation(s)
- Victor J. Del Brutto
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meghan Purohit
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Minghua Liu
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Clinton Wright
- National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Sun J, Feng XR, Yang X, Feng PY, Liu YB, Yang HX, Zhang TZ. Correlation between characteristics of intracranial atherosclerotic plaques and ischemic stroke in high-resolution vascular wall MRI. Acta Radiol 2023; 64:732-740. [PMID: 35345899 DOI: 10.1177/02841851221088917] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis is a major cause of ischemic stroke, accounting for 30% of ischemic strokes in Asian populations. PURPOSE To investigate the relationship between the degree of arterial stenosis and enhancement grade of intracranial atherosclerotic disease (ICAD), the plaque characteristics in different remodeling patterns, and its potential impact. MATERIAL AND METHODS A total of 210 patients diagnosed with ICAD were enrolled in this retrospective study. Patients were divided into the middle cerebral artery (MCA) group (101 cases), posterior cerebral artery (PCA) group (14 cases), basilar artery (BA) group (71 cases), and intracranial segment of vertebral artery (VA) group (90 cases) according to the difference of diseased vessels. Data on presence or absence of ischemic infarction, intracranial vascular position of lesions, plaque characteristics, ICAD enhancement grade, remodeling index, and degree of arterial stenosis were collected for analysis. RESULTS The incidence of ischemic infarction in enhancement grade 2 was significantly higher than that in enhancement grade 1 in MCA group (P = 0.019). Enhancement grade 2 of ICAD was an independent risk factor for the development of ischemic infarction (odds ratio = 4.60; 95% confidence interval: 1.91-11.03; P = 0.001). There was no significant statistical difference in infarct rate between different remodeling modalities (P>0.05). CONCLUSION Enhancement grade of ICAD is significantly associated with the degree of stenosis and the occurrence of ischemic stroke, which varies in different intracranial vessels. The pattern of vascular remodeling varies among different intracranial vessels, and the pattern of vascular remodeling has a significant impact on plaque characteristics.
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Affiliation(s)
- Jie Sun
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xu-Ran Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xuan Yang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Ping-Yong Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Yu-Bo Liu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Hai-Xiao Yang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Tian-Zi Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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10
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Yu L, Xinmiao Z, Yawei W, Wentao F, Jing J, Zhunjun S, Bitian W, Yongjun W, Yubo F. Effects of abnormal vertebral arteries and the circle of Willis on vertebrobasilar dolichoectasia: A multi-scale simulation study. Clin Biomech (Bristol, Avon) 2023; 101:105853. [PMID: 36508951 DOI: 10.1016/j.clinbiomech.2022.105853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vertebrobasilar dolichoectasia is a rare cerebrovascular disease characterized by obvious extension, dilation and tortuosity of vertebrobasilar artery, and its pathophysiological mechanism is not clear. This study focused on local hemodynamic changes in basilar arteries with typical vertebrobasilar dolichoectasia, together with unbalanced vertebral arteries and abnormal structures of the circle of Willis, through multi-scale modeling. METHODS Three-dimensional models of 3 types of vertebrobasilar arteries were constructed from magnetic resonance images. The first type has no vertebrobasilar dolichoectasia, the second type has vertebrobasilar dolichoectasia and balanced vertebral arteries, and the third type has vertebrobasilar dolichoectasia and unbalanced vertebral arteries. A lumped parameter model of the circle of Willis was established and coupled to these three-dimensional models. FINDINGS The results showed that unbalanced bilateral vertebral arteries, especially single vertebral artery deletion mutation, might associate with higher wall shear stress on anterior wall of basilar artery in patients with vertebrobasilar dolichoectasia. And unbalanced bilateral vertebral arteries would increase the blood pressure in basilar artery. Meanwhile, missing communicating arteries in the circle of Willis, especially bilateral posterior communicating arteries absences, would significantly increase blood pressure in basilar artery. The unilateral absence of posterior communicating arteries would increase differences in blood flow between the left and right posterior cerebral arteries. INTERPRETATION This study provided a multi-scale modeling method and some preliminary results for helping understand the role of hemodynamics in occurrence and development of vertebrobasilar dolichoectasia.
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Affiliation(s)
- Liu Yu
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China
| | - Zhang Xinmiao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wang Yawei
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China.
| | - Feng Wentao
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Sun Zhunjun
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China
| | - Wang Bitian
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China
| | - Wang Yongjun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fan Yubo
- Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing University, Beijing 100083, China
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Dumais F, Caceres MP, Janelle F, Seifeldine K, Arès-Bruneau N, Gutierrez J, Bocti C, Whittingstall K. eICAB: A novel deep learning pipeline for Circle of Willis multiclass segmentation and analysis. Neuroimage 2022; 260:119425. [PMID: 35809887 DOI: 10.1016/j.neuroimage.2022.119425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/22/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The accurate segmentation, labeling and quantification of cerebral blood vessels on MR imaging is important for basic and clinical research, yet results are not generalizable, and often require user intervention. New methods are needed to automate this process. PURPOSE To automatically segment, label and quantify Circle of Willis (CW) arteries on Magnetic Resonance Angiography images using deep convolutional neural networks. MATERIALS AND METHODS MRA images were pooled from three public and private databases. A total of 116 subjects (mean age 56 years ± 21 [standard deviation]; 72 women) were used to make up the training set (N=101) and the testing set (N=15). In each image, fourteen arterial segments making up or surrounding the CW were manually annotated and validated by a clinical expert. Convolutional neural network (CNN) models were trained on a training set to be finally combined in an ensemble to develop eICAB. Model performances were evaluated using (1) quantitative analysis (dice score on test set) and (2) qualitative analysis (external datasets, N=121). The reliability was assessed using multiple MRAs of healthy participants (ICC of vessel diameters and volumes on test-retest). RESULTS Qualitative analysis showed that eICAB correctly predicted the large, medium and small arteries in 99±0.4%, 97±1% and 88±7% of all images, respectively. For quantitative assessment, the average dice score coefficients for the large (ICAs, BA), medium (ACAs, MCAs, PCAs-P2), and small (AComm, PComm, PCAs-P1) vessels were 0.76±0.07, 0.76±0.08 and 0.41±0.27, respectively. These results were similar and, in some cases, statistically better (p<0.05) than inter-expert annotation variability and robust to image SNR. Finally, test-retest analysis showed that the model yielded high diameter and volume reliability (ICC=0.99). CONCLUSION We have developed a quick and reliable open-source CNN-based method capable of accurately segmenting and labeling the CW in MRA images. This method is largely independent of image quality. In the future, we foresee this approach as a critical step towards fully automated analysis of MRA databases in basic and clinical research.
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Affiliation(s)
- Félix Dumais
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada.
| | - Marco Perez Caceres
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Félix Janelle
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Kassem Seifeldine
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Science, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec J1H 5H3, Canada
| | - Noémie Arès-Bruneau
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christian Bocti
- Department of Medecine, Université de Sherbrooke, Sherbrooke, Québec, Canada; Research Center on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Québec, Canada; Department of Neurology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Kevin Whittingstall
- Department of Radiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Kang DW, Kim S, Sunwoo W. Correlation of Neutrophil-to-Lymphocyte Ratio and the Dilation of the Basilar Artery with the Potential Role of Vascular Compromise in the Pathophysiology of Idiopathic Sudden Sensorineural Hearing Loss. J Clin Med 2022; 11:jcm11195943. [PMID: 36233809 PMCID: PMC9570553 DOI: 10.3390/jcm11195943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic sudden sensorineural hearing loss (SSNHL) currently lacks a clear etiology, as well as an effective treatment. One of the most probable explanations for SSNHL is impairment of the cochlear blood flow. However, dissimilar to a fundoscopic examination, direct observation of cochlear blood vessels is not possible. To indirectly support an ischemic etiology of SSNHL, we investigated whether the degree of initial hearing loss is associated with two atherosclerotic risk factors: dilatation of the basilar artery (BA) and a chronic subclinical inflammatory status measured by the neutrophil-to-lymphocyte ratio (NLR). This retrospective study collected data from 105 consecutive patients diagnosed with idiopathic SSNHL. Then, the patients were divided into two groups according to their NLR as “abnormally high NLR (>3.53, n = 22)” and “NLR within the normal range (0.78−3.53, n = 83)”. The BA diameter and severity of initial hearing loss were significantly correlated with each other in the abnormally high NLR group (p < 0.001). However, there was no significant correlation between initial hearing loss and the BA diameter in the normal NLR group (p = 0.299). Therefore, the NLR may serve as a marker for SSNHL of vascular etiology and a rationale for magnetic resonance imaging examinations based on the pathophysiology.
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Affiliation(s)
- Dae-Woong Kang
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seul Kim
- Department of Otorhinolaryngology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
| | - Woongsang Sunwoo
- Department of Otorhinolaryngology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
- Correspondence: or
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13
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Deshpande A, Elliott J, Kari N, Jiang B, Michel P, Toosizadeh N, Fahadan PT, Kidwell C, Wintermark M, Laksari K. Novel imaging markers for altered cerebrovascular morphology in aging, stroke, and Alzheimer's disease. J Neuroimaging 2022; 32:956-967. [PMID: 35838658 PMCID: PMC9474631 DOI: 10.1111/jon.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Altered brain vasculature is a key phenomenon in several neurologic disorders. This paper presents a quantitative assessment of the anatomical variations in the Circle of Willis (CoW) and vascular morphology in healthy aging, acute ischemic stroke (AIS) and Alzheimer's Disease (AD). METHODS We used our novel automatic method to segment and extract geometric features of the cerebral vasculature from MR angiography scans of 175 healthy subjects, which were used to create a probabilistic atlas of cerebrovasculature and to study normal aging and intersubject variations in CoW anatomy. Subsequently, we quantified and analyzed vascular alterations in 45AIS and 50 AD patients, two prominent cerebrovascular and neurodegenerative disorders. RESULTS In the sampled cohort, we determined that the CoW is fully formed in only 35% of healthy adults and found significantly (p < .05) increased tortuosity and fractality, with increasing age and also with disease in both AIS and AD. We also found significantly lower vessel length, volume, and number of branches in AIS patients, as expected. The AD cerebral vessels exhibited significantly smaller diameter and more complex branching patterns, compared to age-matched healthy adults. These changes were significantly heightened (p < .05) among healthy, early onset mild AD, and moderate/severe dementia groups. CONCLUSION Although our study does not include longitudinal data due to paucity of such datasets, the specific geometric features and quantitative comparisons demonstrate the potential for using vascular morphology as a noninvasive imaging biomarker for neurologic disorders.
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Affiliation(s)
| | - Jordan Elliott
- Department of Biomedical Engineering, University of Arizona
| | - Nitya Kari
- Department of Biomedical Engineering, University of Arizona
| | - Bin Jiang
- Department of Radiology, Stanford University
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona
- Arizona Center on Aging, Department of Medicine, University of Arizona
| | - Pouya Tahsili Fahadan
- Neuroscience Intensive Care Unit, Medical Critical Care Service and Department of Medical Education, University of Virginia School of Medicine, Inova Fairfax Medical Campus
- Departments of Neurology, Johns Hopkins University School of Medicine
| | | | | | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona
- Department of Aerospace and Mechanical Engineering, University of Arizona
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14
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Rezai Jahromi B, Niemelä M. “Dolichoectatic Vertebrobasilar Artery Aneurysms”. Neurosurg Clin N Am 2022; 33:419-429. [DOI: 10.1016/j.nec.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Sudre CH, Moriconi S, Rehwald R, Smith L, Tillin T, Barnes J, Atkinson D, Ourselin S, Chaturvedi N, Hughes AD, Jäger HR, Cardoso MJ. Accelerated vascular aging: Ethnic differences in basilar artery length and diameter, and its association with cardiovascular risk factors and cerebral small vessel disease. Front Cardiovasc Med 2022; 9:939680. [PMID: 35966566 PMCID: PMC9366336 DOI: 10.3389/fcvm.2022.939680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Risk of stroke and dementia is markedly higher in people of South Asian and African Caribbean descent than white Europeans in the UK. This is unexplained by cardiovascular risk factors (CVRF). We hypothesized this might indicate accelerated early vascular aging (EVA) and that EVA might account for stronger associations between cerebral large artery characteristics and markers of small vessel disease. Methods 360 participants in a tri-ethnic population-based study (120 per ethnic group) underwent cerebral and vertebral MRI. Length and median diameter of the basilar artery (BA) were derived from Time of Flight images, while white matter hyperintensities (WMH) volumes were obtained from T1 and FLAIR images. Associations between BA characteristics and CVRF were assessed using multivariable linear regression. Partial correlation coefficients between WMH load and BA characteristics were calculated after adjustment for CVRF and other potential confounders. Results BA diameter was strongly associated with age in South Asians (+11.3 μm/year 95% CI = [3.05; 19.62]; p = 0.008), with unconvincing relationships in African Caribbeans (3.4 μm/year [-5.26, 12.12]; p = 0.436) or Europeans (2.6 μm/year [-5.75, 10.87]; p = 0.543). BA length was associated with age in South Asians (+0.34 mm/year [0.02; 0.65]; p = 0.037) and African Caribbeans (+0.39 mm/year [0.12; 0.65]; p = 0.005) but not Europeans (+0.08 mm/year [-0.26; 0.41]; p = 0.653). BA diameter (rho = 0.210; p = 0.022) and length (rho = 0.261; p = 0.004) were associated with frontal WMH load in South Asians (persisting after multivariable adjustment for CVRF). Conclusions Compared with Europeans, the basilar artery undergoes more accelerated EVA in South Asians and in African Caribbeans, albeit to a lesser extent. Such EVA may contribute to the higher burden of CSVD observed in South Asians and excess risk of stroke, vascular cognitive impairment and dementia observed in these ethnic groups.
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Affiliation(s)
- Carole H. Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom,Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom,*Correspondence: Carole H. Sudre
| | - Stefano Moriconi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Rafael Rehwald
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom,Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lorna Smith
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Josephine Barnes
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom
| | - Sébastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - H. Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - M. Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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16
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Omran SS, Khasiyev F, Zhang C, Rundek T, Sacco RL, Wright CB, Elkind MS, Gutierrez J. Anatomical effects on the relationship between brain arterial diameter and length: The Northern Manhattan Study. J Neuroimaging 2022; 32:735-743. [PMID: 35083811 PMCID: PMC9308622 DOI: 10.1111/jon.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND PURPOSE In patients with dolichoectasia, it is uncertain how dilatation and/or elongation relate to each other. We aimed to examine the correlation between arterial diameter and length within arteries and across the circle of Willis (COW). METHODS We included stroke-free participants in the Northern Manhattan Study who underwent magnetic resonance angiography. Intracranial artery diameters and lengths were obtained with semiautomated commercial software and were adjusted for head size. We first investigated the correlation between diameters and length using Pearson's correlation coefficient. We then built generalized linear models adjusted for demographics and risk factors. RESULTS Among 1210 participants included in the analysis (mean age 71 ± 9 years, 59% women, 65% Hispanic), a larger basilar artery (BA) diameter correlated with greater BA length (r = .3), and left and right middle cerebral artery (MCA) diameters correlated with one another (r = .4). Across the COW, BA diameter correlated with MCA diameters (r = .3 for both). In adjusted analyses, MCA diameters were associated with larger posterior circulation diameters (β = 0.07), MCA and BA lengths (β = 0.003 and β = 0.002, respectively), presence of fetal posterior cerebral artery (PCA), (β = 0.11), and a complete COW (β = -0.02). Similarly, BA length was associated with a fetal PCA (β = 1.1), and BA diameter was associated with anterior circulation diameters (β = 0.15) and presence of fetal PCA (β = -0.4). CONCLUSIONS COW configuration should be considered when using arterial diameter cutoffs to define dolichoectasia. Further studies are needed to discern whether arterial diameter or length best identify individuals at risk of vascular events attributable to dolichoectasia.
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Affiliation(s)
- Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Cen Zhang
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tatjana Rundek
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, FL, USA
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Ralph L. Sacco
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, FL, USA
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Clinton B. Wright
- National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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Anirudh EE, Omotoso BR, Lazarus L. Radiological anatomy of the vertebrobasilar artery in a select South African population. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Claassen JAHR, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev 2021; 101:1487-1559. [PMID: 33769101 PMCID: PMC8576366 DOI: 10.1152/physrev.00022.2020] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Brain function critically depends on a close matching between metabolic demands, appropriate delivery of oxygen and nutrients, and removal of cellular waste. This matching requires continuous regulation of cerebral blood flow (CBF), which can be categorized into four broad topics: 1) autoregulation, which describes the response of the cerebrovasculature to changes in perfusion pressure; 2) vascular reactivity to vasoactive stimuli [including carbon dioxide (CO2)]; 3) neurovascular coupling (NVC), i.e., the CBF response to local changes in neural activity (often standardized cognitive stimuli in humans); and 4) endothelium-dependent responses. This review focuses primarily on autoregulation and its clinical implications. To place autoregulation in a more precise context, and to better understand integrated approaches in the cerebral circulation, we also briefly address reactivity to CO2 and NVC. In addition to our focus on effects of perfusion pressure (or blood pressure), we describe the impact of select stimuli on regulation of CBF (i.e., arterial blood gases, cerebral metabolism, neural mechanisms, and specific vascular cells), the interrelationships between these stimuli, and implications for regulation of CBF at the level of large arteries and the microcirculation. We review clinical implications of autoregulation in aging, hypertension, stroke, mild cognitive impairment, anesthesia, and dementias. Finally, we discuss autoregulation in the context of common daily physiological challenges, including changes in posture (e.g., orthostatic hypotension, syncope) and physical activity.
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Affiliation(s)
- Jurgen A H R Claassen
- Department of Geriatrics, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- >National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Frank M Faraci
- Departments of Internal Medicine, Neuroscience, and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Del Brutto VJ, Prabhakaran S, Liebeskind DS, Campo-Bustillo I, Cotsonis G, Nizam A, Romano JG. Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease: Results from the MYRIAD study. J Neuroimaging 2021; 31:931-939. [PMID: 33942908 DOI: 10.1111/jon.12872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. METHODS We analyzed 98 participants (mean age 63.8 ± 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. RESULTS IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. CONCLUSIONS IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | | | - Iszet Campo-Bustillo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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20
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Yang H, Ji C, Wang H, Lin L, Yuan X, Liu B, Wang X. Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall MRI. Clin Radiol 2021; 76:392.e21-392.e26. [PMID: 33610287 DOI: 10.1016/j.crad.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
AIM To characterise symptomatic intracranial plaque without substantial stenosis using three-dimensional (3D) high-resolution contrast-enhanced black-blood magnetic resonance imaging (BBMRI) and to determine plaque features associated with recent cerebrovascular events. MATERIALS AND METHODS The institutional review board approved this retrospective study. The case notes from patients with evidence of intracranial atherosclerosis in a large intracranial artery with preceding BBMRI were reviewed retrospectively. Symptomatic and asymptomatic plaques with substantial luminal stenosis (<50%) were matched by plaque location and patient age. All MRI images were de-identified and interpreted by two neuroradiologists who were blinded to the history of symptoms. Qualitative analyses including the presence of intraplaque haemorrhage (IPH), eccentricity, surface irregularity, and grade of plaque enhancement were recorded. Quantitative analyses including normal wall index and degree of contrast enhancement were calculated. Multivariate regression analysis was performed to identify the association with cerebrovascular ischaemic events. RESULTS A total of 38 pairs of symptomatic and asymptomatic plaques from 74 patients were analysed. Compared to asymptomatic plaques, symptomatic plaques demonstrated higher degree of contrast enhancement (29.77 ± 19.23 versus 18.21 ± 12.18%, p=0.039) and presence of IPH (26% versus 8%, p=0.032). No significant differences were detected regarding eccentricity, surface irregularity, and normal wall index. Events were associated with contrast enhancement (OR, 1.212; 95% confidence interval [CI], 1.086-1.352) after controlling for age, sex, cardiovascular risk factors, and stenosis degree. IPH was not associated with events. CONCLUSION Contrast enhancement in the intracranial plaque without substantial stenosis is associated with previous events, and may serve as the vulnerable feature, thereby stratifying stroke risk not achievable by luminal stenosis.
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Affiliation(s)
- H Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - C Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - H Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - L Lin
- MSC Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - X Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - B Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - X Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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21
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Takeuchi M, Miwa K, Tanaka M, Zhou Y, Todo K, Sasaki T, Sakaguchi M, Kitagawa K, Mochizuki H. A 9-Year Longitudinal Study of Basilar Artery Diameter. J Am Heart Assoc 2020; 8:e011154. [PMID: 30798648 PMCID: PMC6474931 DOI: 10.1161/jaha.118.011154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Dilatation of the basilar artery ( BA ) has been recognized as a predictor of cardiovascular events ( CVE s). However, it is unclear if the longitudinal change in BA diameter (Δ BA ) is associated with CVE s. Methods and Results In a cohort of Japanese participants with vascular risk factors in an observational study, we evaluated the relationship of Δ BA to CVE s and the time course of the BA diameter. The short axis of the BA diameter was measured at the midpons level in T2-weighted images. Brain magnetic resonance imaging measurements included cerebral small-vessel disease, lacunars, and white matter hyperintensities. First, 493 patients were analyzed by the time-dependent Cox proportional hazards model to evaluate the association between Δ BA and CVE s, with adjustment for age, sex, vascular risk factors, and magnetic resonance imaging parameters. Second, we assessed the longitudinal Δ BA in 164 patients who underwent long-term follow-up magnetic resonance imaging, by linear regression analysis. In the mean follow-up of 8.7 years, 105 patients developed CVE s. A smaller Δ BA was independently associated with the high incidence of CVE s (hazard ratio, 0.36; 95% CI, 0.16-0.78; P=0.010; n=493). After a mean interval of 9.4 years, the average Δ BA was 0.41±0.46 mm (excluding patients with fetal-type circle of Willis). Progression of BA dilatation was associated with men but inversely associated with initial BA diameter and fetal-type circle of Willis (n=164). Conclusions BA diameter increased over time (excluding the patients with fetal-type circle of Willis), whereas Δ BA was inversely associated with the incidence of CVE s.
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Affiliation(s)
- Mariko Takeuchi
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Kaori Miwa
- 2 Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita, Osaka Japan
| | - Makiko Tanaka
- 3 Department of Stroke Medicine Hoshigaoka Medical Center Osaka Japan
| | - Yi Zhou
- 4 Laboratory of Pharmainformatics and Pharmacometrics Osaka University Graduate School of Pharmaceutical Sciences Suita, Osaka Japan
| | - Kenichi Todo
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Tsutomu Sasaki
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Manabu Sakaguchi
- 5 Department of Neurology Osaka General Medical Center Osaka Japan
| | - Kazuo Kitagawa
- 6 Department of Neurology Tokyo Women's Medical University Tokyo Japan
| | - Hideki Mochizuki
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
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22
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Zhang DP, Yin S, Zhang HL, Li D, Song B, Liang JX. Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms. J Stroke 2020; 22:173-184. [PMID: 32635683 PMCID: PMC7341005 DOI: 10.5853/jos.2019.02985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/06/2020] [Indexed: 12/29/2022] Open
Abstract
Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IAD-Erelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry’s disease and late-onset Pompe’s disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (COL4A1/COL4A2) and forkhead box C1 (FOXC1) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.
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Affiliation(s)
- Dao Pei Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Suo Yin
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Dan Li
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jia Xu Liang
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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23
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Miwa K, Yagita Y, Sakaguchi M, Kitagawa K, Sakai N, Mochizuki H. Effect of Enzyme Replacement Therapy on Basilar Artery Diameter in Male Patients With Fabry Disease. Stroke 2020; 50:1010-1012. [PMID: 30852964 DOI: 10.1161/strokeaha.118.024426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background and Purpose- The effect of enzyme replacement therapy (ERT) on cerebrovascular complications remains largely unexplored. We aimed to investigate the relationship between basilar artery (BA) diameter and long-term ERT in patients with Fabry disease. Methods- We obtained baseline magnetic resonance imaging data from 30 patients (40.5±16.3 years, male: 14) in the single institution; among them, 21 patients prospectively had follow-up magnetic resonance imaging assessments. The short axis of BA diameter was measured at the midpons level on axial T2-weighted images. Brain magnetic resonance imaging measurements included markers of cerebral small vessel disease (lacunas, white matter hyperintensities, and cerebral microbleeds). We assessed variables associated with baseline BA diameter and annual BA diameter change using linear regression analyses. Results- Hypertension, left ventricular hypertrophy, estimated glomerular filtration rate, and white matter hyperintensities correlated with the initial BA diameter. After a mean interval of 7.2±4.6 years, the annual BA diameter change correlated positively with severe white matter hyperintensities and inversely with the duration of ERT (β=-0.48, P=0.033). After stratifying patients by sex, a significant correlation between the duration of ERT and BA diameter was found only in men (β=-0.72, P=0.019). Conclusions- Our results show a possible relationship between ERT and changes in BA diameter. Future studies to elucidate the clinical impact of BA changes as a potential surrogate marker are needed.
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Affiliation(s)
- Kaori Miwa
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.M.).,Department of Neurology (K.M., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (Y.Y.)
| | - Manabu Sakaguchi
- Department of Neurology (K.M., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Japan (K.K.)
| | - Norio Sakai
- Department of Paediatrics (N.S.), Osaka University Graduate School of Medicine, Japan
| | - Hideki Mochizuki
- Department of Neurology (K.M., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
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24
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Rathore L, Yamada Y, Kawase T, Kato Y, Senapati SB. A 5-Year Follow-up of Intracranial Arterial Dolichoectasia: A Case Report and Review of Literature. Asian J Neurosurg 2019; 14:1302-1307. [PMID: 31903384 PMCID: PMC6896615 DOI: 10.4103/ajns.ajns_282_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient with multiple dolichoectasia of the intracranial cerebral artery was followed sequentially with clinical and radiological progression of disease in the past 5 years. The patient was treated in multiple stages in the past 5 years with the endovascular and microsurgical clipping method. The maximum diameter of each major intracranial artery segment was recorded and compared in the follow-up year. The progression in size of the dolichoectatic segment was observed in spite of surgical intervention. In review diagnostic criteria, etiopathogenesis and treatment options have been discussed.
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Affiliation(s)
- Lavlesh Rathore
- Department of Neurosurgery, Shri Balaji Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yashiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
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25
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Yagita Y, Sakai N, Miwa K, Ohara N, Tanaka M, Sakaguchi M, Kitagawa K, Mochizuki H. Magnetic Resonance Imaging Findings Related to Stroke Risk in Japanese Patients With Fabry Disease. Stroke 2019; 50:2571-2573. [PMID: 31337300 DOI: 10.1161/strokeaha.119.025528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and Purpose- Stroke is the most frequent severe clinical event in patients with Fabry disease. We aimed to evaluate the cerebral magnetic resonance imaging findings of patients with Fabry disease and assess their association with future stroke risk after enzyme replacement therapy (ERT) induction. Methods- We retrospectively reviewed the magnetic resonance imaging findings of 25 patients with Fabry disease. Of these, 12 adult patients without prior stroke or ERT were enrolled to evaluate the association between baseline magnetic resonance imaging findings and stroke occurrence after ERT initiation. We assessed white matter hyperintensities, periventricular hyperintensities, and basilar artery diameter as neuroimaging markers. Results- The mean age of participants was 38.8±16.8 years. Fourteen patients (56.0%) were women. White matter hyperintensities and periventricular hyperintensities were observed in 15 and 13 cases, respectively. The mean basilar artery diameter was 3.2±0.55 mm. Two patients demonstrated old infarct lesions. Three of 12 patients in whom ERT was initiated had symptomatic stroke after baseline magnetic resonance imaging. Of these, 2 developed stroke within 6-month post-ERT initiation. The baseline basilar artery diameter was larger in patients who developed stroke than in those who did not (4.0±0.40 versus 2.9±0.49 mm, P=0.02). Conclusions- Basilar artery diameter may be associated with stroke risk after ERT initiation among Japanese patients with Fabry disease.
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Affiliation(s)
- Yoshiki Yagita
- From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (Y.Y.).,Department of Neurology (Y.Y., K.M., H.M.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Norio Sakai
- Child Healthcare and Genetic Science Laboratory, Division of Health Science (N.S.), Osaka University Graduate School of Medicine, Suita, Japan.,Department of Pediatrics (N.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Kaori Miwa
- Department of Neurology (Y.Y., K.M., H.M.), Osaka University Graduate School of Medicine, Suita, Japan.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.M.)
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan (N.O.)
| | - Makiko Tanaka
- Department of Stroke Medicine, JCHO Hoshigaoka Medical Center, Hirakata, Japan (M.T.)
| | - Manabu Sakaguchi
- Department of Neurology, Osaka General Medical Center, Japan (M.S.)
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Japan (K.K.)
| | - Hideki Mochizuki
- Department of Neurology (Y.Y., K.M., H.M.), Osaka University Graduate School of Medicine, Suita, Japan
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26
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Gutierrez J, DiTullio M, K Cheung YK, Alperin N, Bagci A, L Sacco R, B Wright C, Sv Elkind M, Rundek T. Brain arterial dilatation modifies the association between extracranial pulsatile hemodynamics and brain perivascular spaces: the Northern Manhattan Study. Hypertens Res 2019; 42:1019-1028. [PMID: 30932017 DOI: 10.1038/s41440-019-0255-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 11/09/2022]
Abstract
Pulsatile hemodynamics are associated with brain small perivascular spaces (SPVS). It is unknown whether the stiffness of intermediary arteries connecting the aorta and brain modifies this association. Participants from the Northern Manhattan Study were assessed for SPVS (defined as ≤3 mm T1 voids) and white matter hyperintensity volume (WMH) using MRI. Middle (MCA) and anterior cerebral arterial (ACA) diameters (measured on time-of-flight MRA) and CCA strain (assessed by ultrasound) were used as surrogates of stiffness. Brachial and aortic pulse pressure (PP) and aortic augmentation index (Aix, assessed by applanation tonometry) were used as markers of pulsatility. We tested whether stiffness in intermediary arteries modifies the association between extracranial pulsatility with SPVS and WMH. We found that among 941 participants (mean age 71 ± 9 years, 60% women, 66% Hispanic), the right MCA/ACA diameter was associated with right anterior SPVS (B = 0.177, P = 0.002). Brachial PP was associated with right anterior SPVS (B = 0.003, P = 0.02), and the effect size was bigger with right MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). The association between right CCA strain and ipsilateral SPVS was modified by MCA/ACA diameter, with the largest effect size in those with ipsilateral MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). Similar dose-effects and statistical interactions were replicated using aortic AIx or aortic PP. We found no evidence of effect modification between pulsatile measures and WMH by stiffness measures. In summary, pulsatile hemodynamics relate to brain SPVS, and the association is the strongest among individuals with dilated brain arteries.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Marco DiTullio
- Department of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Ying Kuen K Cheung
- Division of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Noam Alperin
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ahmet Bagci
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mitchell Sv Elkind
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
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27
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Zhai FF, Yan S, Li ML, Han F, Wang Q, Zhou LX, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Intracranial Arterial Dolichoectasia and Stenosis. Stroke 2018; 49:1135-1140. [PMID: 29581240 DOI: 10.1161/strokeaha.117.020130] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial arterial dolichoectasia (IADE) is a poorly understood arteriopathy compared with intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of IADE and ICAS and their relationship with neuroimaging markers of cerebral small vessel disease in a population-based study.
Methods—
This study comprised 1237 participants (aged 57.2±9.4 years, 37.6% men) who underwent brain magnetic resonance imaging and magnetic resonance angiography. IADE was assessed based on basilar artery dolichoectasia (diameter, height of bifurcation, and laterality of basilar artery) and dilation of basilar artery and internal carotid artery (intracranial volume-adjusted diameter ≥2 SD). ICAS was defined as any degree of stenosis in at least 1 intracranial artery. The neuroimaging markers of cerebral small vessel disease, including lacunes, white matter hyperintensities, microbleeds, dilated perivascular spaces, and brain atrophy, were evaluated.
Results—
Basilar arterial dolichoectasia was observed in 3.6% (45/1237); intracranial arterial dilation in 5.9% (67/1142); and ICAS in 15.7% (194/1237). Older age, higher systolic blood pressure, diabetes mellitus, higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) were associated with the presence of ICAS (all
P
<0.001), whereas only older age was associated with IADE. ICAS was associated with lacunes (odds ratio, 2.91; 95% confidence interval, 1.96–4.34;
P
<0.001), increased white matter hyperintensities volume (β±SE, 0.54±0.13;
P
<0.001), and brain atrophy (β±SE, −1.16±0.21;
P
<0.001), whereas basilar arterial dolichoectasia was mainly associated with dilated perivascular spaces in basal ganglia (odds ratio, 2.20; 95% confidence interval, 1.20–4.02;
P
=0.01) and, to a lesser extent, associated with lacunes and microbleeds.
Conclusions—
IADE and ICAS had different risk factor profiles and associated with different imaging phenotypes of cerebral small vessel disease, suggesting different underlying mechanisms.
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Affiliation(s)
- Fei-Fei Zhai
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shuang Yan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Fei Han
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Quan Wang
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Li-Xin Zhou
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Jun Ni
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Ming Yao
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.-Y.Z.)
| | - Li-Ying Cui
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Yi-Cheng Zhu
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
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28
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Decreased outlet angle of the superior cerebellar artery as indicator for dolichoectasia in late onset Pompe disease. Orphanet J Rare Dis 2018; 13:57. [PMID: 29653542 PMCID: PMC5899367 DOI: 10.1186/s13023-018-0794-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lysosomal α-glucosidase deficiency (Pompe disease) not only leads to glycogen accumulation in skeletal muscle, but also in the cerebral arteries. Dolichoectasia of the basilar artery (BA) has been frequently reported. Therefore progression of BA dolichoectasia in late onset Pompe patients (LOPD) was studied. METHODS BA length, diameter and volume, and cerebral lesions were analysed by MRI/TOF-MR angiography or CT/CT angiography in 20 LOPD patients and 40 controls matching in age, sex- and cardiovascular risk factors. The height of BA bifurcation was assessed semi-quantitatively using the Smoker's criteria and quantitatively by measuring the outlet angle of the superior cerebellar artery (SUCA). Nine patients were followed over 5 years. RESULTS The height of the BA bifurcation was abnormal in 12/20 (60%) LOPD patients and in 12/40 (30%) matched controls. The SUCA outlet angle was reduced in LOPD patients compared to controls (127 ± 33° vs. 156 ± 32°, p = 0.0024). The diameter, length and volume of the BA were significantly increased in LOPD patients compared to controls. 12/20 (60%) LOPD patients and 27/40 (68%) controls presented white matter lesions. During 5 years 2/9 LOPD patients developed an abnormal height of BA bifurcation according to the Smoker's criteria and in all patients the SUCA outlet angle decreased (138 ± 34° vs. 128 ± 32°, p = 0.019). One patient with prominent basilar dolichoectasia experienced a thalamic hemorrhage. CONCLUSION Pompe disease is associated with BA dilation, elongation and elevated bifurcation height of the BA which might result in cerebrovascular complications. The SUCA outlet angle seems to be useful for monitoring the progression of BA dolichoectasia.
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29
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Zhang X, Jing J, Zhao X, Liu L, Meng X, Wang A, Pan Y, Wang D, Wang Y, Wang Y. Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke. Neurol Res 2018; 40:452-458. [PMID: 29600887 DOI: 10.1080/01616412.2018.1451016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives This study aimed to estimate the prognosis of dolichoectasia in non-cardioembolic transient ischemic attack (TIA) and minor stroke patients. Methods Data were derived from the imaging subgroup of patients in the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Dolichoectasia was defined as ectasia (basilar artery diameter >4.5 mm) and dolichosis (either basilar artery bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae). The prognosis included ischemic stroke recurrence and poor functional outcome (modified Rankin scale 2-6) at 12-month follow-up. The association of dolichoectasia with risk factors and prognosis of patients were assessed using multivariable Cox regression models. Results Overall, 1089 patients with magnetic resonance images in the CHANCE trial were included in this subanalysis. A total of 98 (9.0%) patients were detected with dolichoectasia, and 106 (9.7%) patients had a recurrent ischemic stroke at 12 months. Small artery occlusion (SAO) was more prevalent in patients with dolichoectasia compared with those without dolichoectasia (29.6% vs. 22.7%, hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.59-5.17, p < 0.001). However, multivariate analysis showed no association of dolichoectasia with 12-month recurrent stroke (9.2% vs. 9.8%, HR, 1.15; 95%CI, 0.32-4.12; p = 0.83) and poor functional outcome (7.6% vs. 8.4%, odds ratio, 1.22; 95%CI, 0.24-6.08; p = 0.81) in the current subgroup analysis. Conclusions Dolichoectasia was significantly associated with SAO. There was no relationship between dolichoectasia and 12-month prognosis of patients with non-cardioembolic TIA or minor stroke.
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Affiliation(s)
- Xinmiao Zhang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Jing Jing
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Xingquan Zhao
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Liping Liu
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Xia Meng
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Anxin Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yuesong Pan
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - David Wang
- e Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System , University of Illinois College of Medicine , Peoria , IL , USA
| | - Yilong Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yongjun Wang
- a Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b China National Clinical Research Center for Neurological Diseases , Beijing , China.,c Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,d Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
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Yang F, Yue H, Wu L, Qin X, Shi L, Qu W. Ischemic stroke due to intracranial arterial dolichoectasia coexisting with spontaneous dissection of the basilar artery: A case report. Medicine (Baltimore) 2017; 96:e8422. [PMID: 29095279 PMCID: PMC5682798 DOI: 10.1097/md.0000000000008422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We present a rarely seen case of cerebral infarction due to intracranial dolichoectasia coexisting with spontaneous dissection of the basilar artery. A definition of dolichoectasia, its pathology, and imaging findings, as well as the clinical management and prognosis are briefly reviewed. CONCLUSION We discuss in general terms the diagnosis of basilar artery dissection and its probable relationship with the occurrence of dolichoectasia.
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Affiliation(s)
| | - Hong Yue
- Department of Public Health, Rizhao People's Hospital, Rizhao, China
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31
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Del Brutto OH, Mera RM, Costa AF, Del Brutto VJ. Basilar Artery Diameter Is Inversely Associated with Fetal Type Circle of Willis. Eur Neurol 2017; 78:217-220. [PMID: 28903104 DOI: 10.1159/000480430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The relationship between basilar artery (BA) diameter and Circle of Willis (CoW) configuration has been scarcely investigated. We aimed to assess this association in community-dwelling older adults. METHODS MRAs of 346 individuals were reviewed. Using generalized linear models adjusted for demographics and cardiovascular risk factors, we assessed the relationship between BA diameter and fetal and non-fetal types CoW, as well as the impact of this relationship on BA ectasia prevalence. RESULTS In the total population, the mean BA diameter was 3.13 ± 0.68 mm and 7 subjects (2%) had ectasia (BA diameter >4.5 mm). In 248 subjects with non-fetal types CoW, the mean BA diameter was 3.32 ± 0.62 mm, and 2.8% had ectasia. In 98 subjects with fetal type CoW, the mean BA diameter was 2.66 ± 0.58 mm, and no individual had ectasia. The BA diameter was smaller in subjects with fetal type CoW than in those with non-fetal types (β 0.65; 95% CI 0.51-0.79; p < 0.001). Individuals with fetal type CoW have an 18% reduction in BA diameter compared to those with non-fetal types, independently of demographics and cardiovascular risk factors. CONCLUSION This study shows an inverse relationship between the BA diameter and the presence of fetal type CoW.
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Affiliation(s)
| | - Robertino M Mera
- University of Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Aldo F Costa
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Victor J Del Brutto
- Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA
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32
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Pichiecchio A, Sacco S, De Filippi P, Caverzasi E, Ravaglia S, Bastianello S, Danesino C. Late-onset Pompe disease: a genetic-radiological correlation on cerebral vascular anomalies. J Neurol 2017; 264:2110-2118. [PMID: 28856460 DOI: 10.1007/s00415-017-8601-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
Pompe disease is an autosomal recessive disorder in which deficiency of the lysosomal enzyme acid alpha-glucosidase results in the accumulation of glycogen mostly in muscle tissues. Several reports suggest a higher incidence of intracranial vascular abnormalities (IVAs) in this condition, as well as brain microbleeds and cerebral vasculopathy. The aim of our study was to evaluate through neuroimaging studies the incidence of these anomalies in our cohort of late-onset Pompe disease (LOPD) patients asymptomatic for cerebrovascular disease, looking for correlations with clinical and genetic data. We studied 18 LOPD patients with brain magnetic resonance angiography (MRA), or contrast-enhanced computed tomography (CECT). Diameters of individual arteries were measured and compared with average values as proposed in the literature. We found IVAs in 13 of the 18 patients, mostly dilatative arteriopathy affecting the vertebrobasilar system. The anterior circle was involved in seven of the 18 patients. The diameter of the basilar artery at 1 cm was found to correlate both with age (spearman rho, p = 0.037) and disease duration (p = 0.004), but no other statistically significant correlation was documented. The incidence of intracranial dilatative arteriopathy in LOPD was higher than in the general population, confirming the literature data. However, we did not find intracranial aneurysms microbleeds or significant cerebrovascular disease. Abnormalities in the anterior and the posterior circle of Willis correlated with age and disease duration, but not with the severity of muscle/respiratory involvement or with genetic data. Further studies in larger cohorts of patients are needed to confirm these findings.
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Affiliation(s)
- A Pichiecchio
- Neuroradiology Department, C. Mondino National Neurological Institute, Pavia, Italy
| | - S Sacco
- Institute of Radiology, University of Pavia, Pavia, Italy.
| | - P De Filippi
- Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - E Caverzasi
- Neurology, University of California, San Francisco, San Francisco, CA, United States.,Biomedical Sciences PhD, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - S Ravaglia
- Department of Public Health and Neurosciences, University of Pavia, Pavia, Italy
| | - S Bastianello
- Neuroradiology Department, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Danesino
- Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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33
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Del Brutto VJ, Ortiz JG, Biller J. Intracranial Arterial Dolichoectasia. Front Neurol 2017; 8:344. [PMID: 28769872 PMCID: PMC5511833 DOI: 10.3389/fneur.2017.00344] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
Abstract
An increased diameter (ectasis) and/or long and tortuous course (dolichosis) of at least one cerebral artery define intracranial arterial dolichoectasia (IADE). IADE could be detected incidentally or may give rise to an array of neurological complications including ischemic stroke, intracranial hemorrhage, or compression of surrounding neural structures. The basilar artery is preferentially affected and has been studied in more detail, mainly due to the presence of accepted diagnostic criteria proposed by Smoker and colleagues in 1986 (1). Criteria for the diagnoses of dolichoectasia in other cerebral arteries have been suggested. However, they lack validation across studies. The prevalence of IADE is approximately 0.08–6.5% in the general population, while in patients with stroke, the prevalence ranges from 3 to 17%. Variations among case series depend on the characteristics of the studied population, diagnostic tests used, and diagnostic criteria applied. In rare instances, an underlying hereditary condition, connective tissue disorder, or infection predispose to the development of IADE. However, most cases are sporadic and associated with traditional vascular risk factors including advanced age, male gender, and arterial hypertension. The link between this dilative arteriopathy and other vascular abnormalities, such as abdominal aortic aneurysm, coronary artery ectasia, and cerebral small vessel disease, suggests the underlying diffuse vascular process. Further understanding is needed on the physiopathology of IADE and how to prevent its progression and clinical complications.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jorge G Ortiz
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Gutierrez J, Rundek T, Cheung K, Bagci A, Alperin N, Sacco RL, Wright CB, Elkind MSV, Di Tullio MR. Systemic Atherosclerosis Relate to Brain Arterial Diameters: The Northern Manhattan Study. Cerebrovasc Dis 2017; 43:124-131. [PMID: 28049199 DOI: 10.1159/000454867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Phenotypic expressions of arterial disease vary throughout the body and it is not clear to what extent systemic atherosclerosis influences brain arterial remodeling. We aim to test the hypothesis that systemic atherosclerosis is associated with brain arterial diameters. METHODS Stroke-free participants in the Northern Manhattan Study MRI subcohort in whom carotid ultrasound, transthoracic echocardiogram, and brain MRA (n = 482) were performed were included in this analysis. Brain arterial diameters were measured with semi-automated software as continuous and categorical variables. Ultrasound and echocardiography provided the sum of maximum carotid plaque thickness (sMCPT) and aortic plaque thickness. Associations between brain arterial diameters and aortic and carotid plaque thickness were assessed with semi-parametric generalized additive models. RESULTS Aortic plaque thickness was inversely and linearly associated with brain arterial diameters (B per mm = -0.073 ± 0.034, p = 0.03), while sMCPT was associated nonlinearly in a u-shaped curve with anterior brain arterial diameters (spline regression χ2 = 9.19, p = 0.02). Coexisting carotid and aortic atherosclerosis were more prevalent in participants with small luminal diameters (40%) compared with participants with average (30%) or with large (13%) luminal diameters, while carotid atherosclerosis without aortic atherosclerosis was more prevalent among participants with large luminal diameters (31%) compared with those with average (12%) or small luminal diameters (2%, p < 0.001 for both trends). CONCLUSIONS We confirmed the hypothesis that systemic arterial disease is associated with brain arterial diameters. Gaining knowledge about the origin of these phenotypic expressions of atherosclerosis in the human body may lead to a better understanding of the cerebrovascular consequences of the systemic arterial disease.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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35
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Abstract
Background Cerebrovascular disease is the most common cause of death worldwide, with millions of deaths annually. Interest is increasing toward understanding the geometric factors that influence cerebrovascular diseases, such as stroke. Cerebrovascular shape analyses are essential for the diagnosis and pathological identification of these conditions. The current study aimed to provide a stable and consistent methodology for quantitative Circle of Willis (CoW) analysis and to identify geometric changes in this structure. Method An entire pipeline was designed with emphasis on automating each step. The stochastic segmentation was improved and volumetric data were obtained. The L1 medial axis method was applied to vessel volumetric data, which yielded a discrete skeleton dataset. A B-spline curve was used to fit the skeleton, and geometric values were proposed for a one-dimensional skeleton and radius. The calculations used to derive these values were illustrated in detail. Result In one example(No. 47 in the open dataset) all values for different branches of CoW were calculated. The anterior communicating artery(ACo) was the shortest vessel, with a length of 2.6mm. The range of the curvature of all vessels was (0.3, 0.9) ± (0.1, 1.4). The range of the torsion was (−12.4,0.8) ± (0, 48.7). The mean radius value range was (3.1, 1.5) ± (0.1, 0.7) mm, and the mean angle value range was (2.2, 2.9) ± (0, 0.2) mm. In addition to the torsion variance values in a few vessels, the variance values of all vessel characteristics remained near 1. The distribution of the radii of symmetrical posterior cerebral artery(PCA) and angle values of the symmetrical posterior communicating arteries(PCo) demonstrated a certain correlation between the corresponding values of symmetrical vessels on the CoW. Conclusion The data verified the stability of our methodology. Our method was appropriate for the analysis of large medical image datasets derived from the automated pipeline for populations. This method was applicable to other tubular organs, such as the large intestine and bile duct. Electronic supplementary material The online version of this article (doi:10.1186/s12880-016-0170-8) contains supplementary material, which is available to authorized users.
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36
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Montagnese F, Granata F, Musumeci O, Rodolico C, Mondello S, Barca E, Cucinotta M, Ciranni A, Longo M, Toscano A. Intracranial arterial abnormalities in patients with late onset Pompe disease (LOPD). J Inherit Metab Dis 2016; 39:391-398. [PMID: 26830551 DOI: 10.1007/s10545-015-9913-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Pompe disease is a rare metabolic disorder due to lysosomal alpha-glucosidase (GAA) deficiency. It is considered as a multi-systemic disease since, although glycogen accumulation is largely prominent in heart, skeletal and respiratory muscles, other organs can also be affected. As regards the vascular system, few reports have documented cerebrovascular malformations in Pompe patients. The aim of this study was to define the presence and type of intracranial arterial abnormalities in a cohort of late onset Pompe disease (LOPD) patients. METHODS We have studied 21 LOPD patients with cerebral CT angiography (CTA), using maximum intensity projection and volume rendering technique for 3D-image reconstruction. RESULTS We found intracranial arterial abnormalities in 13/21 patients (62 %), of whom: 2/21 patients (9.5 %) showed an unruptured intracranial aneurysm (respectively 2 and 4 mm), 10/21 (47 %) had a vertebrobasilar dolichoectasia (VBD) and 1/21 a basilar artery fenestration. Signs of lacunar encephalopathy (insular, capsular and frontal subcortical lesions) were detected in 13/21 patients (62 %) and this correlated with the presence of respiratory impairment (p = 0.017). CONCLUSIONS These findings differ from what has been previously observed in healthy, aged-matched populations and confirm that cerebral arteries abnormalities, mainly involving the posterior circle, are not so rare in LOPD patients and are often accompanied by a lacunar encephalopathy that might represent a hypoxic-ischemic origin. A CTA or an MRA is recommended, in LOPD patients, for early detection of cerebrovascular malformations as they could lead to life-threatening events such as sub-arachnoid haemorrhage or brainstem compression.
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Affiliation(s)
- Federica Montagnese
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Francesca Granata
- Department of Radiological Sciences, University of Messina, Messina, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Stefania Mondello
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emanuele Barca
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Ciranni
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marcello Longo
- Department of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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37
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Qiao Y, Anwar Z, Intrapiromkul J, Liu L, Zeiler SR, Leigh R, Zhang Y, Guallar E, Wasserman BA. Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients. Stroke 2016; 47:434-40. [PMID: 26742795 DOI: 10.1161/strokeaha.115.009955] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Preliminary studies suggest that intracranial arteries are capable of accommodating plaque formation by remodeling. We sought to study the ability and extent of intracranial arteries to remodel using 3-dimensional high-resolution black blood magnetic resonance imaging and investigate its relation to ischemic events. METHODS Forty-two patients with cerebrovascular ischemic events underwent 3-dimensional time-of-flight magnetic resonance angiography and contrast-enhanced black blood magnetic resonance imaging examinations at 3 T for intracranial atherosclerotic disease. Each plaque was classified by location (eg, posterior versus anterior circulation) and its likelihood to have caused a stroke identified on magnetic resonance imaging (culprit, indeterminate, or nonculprit). Lumen area, outer wall area, and wall area were measured at the lesion and reference sites. Plaque burden was calculated as wall area divided by outer wall area. The arterial remodeling ratio (RR) was calculated as outer wall area at the lesion site divided by outer wall area at the reference site after adjusting for vessel tapering. Arterial remodeling was categorized as positive if RR>1.05, intermediate if 0.95≤RR≤1.05, and negative if RR<0.95. RESULTS One hundred and thirty-seven plaques were identified in 42 patients (37% [50] posterior and 63% [87] anterior). Compared with anterior circulation plaques, posterior circulation plaques had a larger plaque burden (77.7±15.7 versus 69.0±14.0; P=0.008), higher RR (1.14±0.38 versus 0.95±0.32; P=0.002), and more often exhibited positive remodeling (54.0% versus29.9%; P=0.011). Positive remodeling was marginally associated with downstream stroke presence when adjusted for plaque burden (odds ratio 1.34, 95% confidence interval: 0.99-1.81). CONCLUSIONS Intracranial arteries remodel in response to plaque formation, and posterior circulation arteries have a greater capacity for positive remodeling and, consequently, may more likely elude angiographic detection. Arterial remodeling may provide insight into stroke risk.
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Affiliation(s)
- Ye Qiao
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Zeeshan Anwar
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Jarunee Intrapiromkul
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Li Liu
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Steven R Zeiler
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Richard Leigh
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Yiyi Zhang
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Eliseo Guallar
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.)
| | - Bruce A Wasserman
- From The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD (Y.Q., Z.A., J.I., L.L., B.A.W.); Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (S.R.Z., R.L.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.Z., E.G.).
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Pico F, Labreuche J, Hauw JJ, Seilhean D, Duyckaerts C, Amarenco P. Coronary and Basilar Artery Ectasia Are Associated. Stroke 2016; 47:224-7. [DOI: 10.1161/strokeaha.115.010797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial artery dolichoectasia (IADE) and coronary artery ectasia have been associated with stroke and myocardial infarction, respectively. Only rarely have cases of coexisting IADE and coronary artery ectasia been reported. We investigated this association in a large consecutive autopsy series.
Methods—
Sixteen stroke patients with IADE were identified among 381 stroke patients and were matched with 16 stroke patients without IADE. The heart and coronary arteries from all patients were examined after a prespecified protocol.
Results—
Coronary artery ectasia was observed in 8 of the stroke patients with IADE, and in none of the stroke patients without IADE (
P
=0.008). The diameters of basilar and right coronary arteries were positively correlated (IADE patients,
r
=0.51;
P
=0.003 and coronary artery ectasia patients,
P
=0.006).
Conclusions—
This autopsy study examining the association of coronary artery ectasia and IADE in stroke patients suggests a common pathogenesis.
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Affiliation(s)
- Fernando Pico
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Julien Labreuche
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Jean-Jacques Hauw
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Danielle Seilhean
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Charles Duyckaerts
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
| | - Pierre Amarenco
- From AP-HP Pitié Salpêtrière Hospital, Department of Neuropathology Raymond Escourolle, Pierre et Marie Curie University, Paris, France (F.P., J-J.H., D.S, C.D., P.A.); Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, Le Chesnay, France (F.P.); INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France (F.P., P.A); Department of Neurology and Stroke Centre, AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France (J
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Pico F, Labreuche J, Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol 2015. [PMID: 26194931 DOI: 10.1016/s1474-4422(15)00089-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Up to 12% of patients with stroke have intracranial arterial dolichoectasia (IADE) and the basilar artery is affected in 80% of these cases. Diagnostic criteria and prognosis studies of IADE are based on basilar artery diameter, which is a good quantitative marker for the severity of the disease. The pathophysiology is largely unknown, but IADE can be viewed as a common final pathway of arterial wall response or damage in the tunica media due to various mechanisms, such as matrix metalloproteinase dysfunction or muscle cell or elastic fibre injury. No randomised controlled trials have been undertaken in IADE and thus little high-level evidence is available on which to base treatment guidelines. IADE management depends on clinical presentation and disease severity, and includes blood pressure control, antithrombotic treatments, endovascular procedures, and surgery. Further studies are needed to better define IADE in the general population, to establish its prevalence and pathophysiology, to identify subgroups at risk of life-threatening complications, and to offer effective treatment options.
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Affiliation(s)
- Fernando Pico
- Neurology Department and Stroke Centre, Centre Hospitalier de Versailles, Le Chesnay and Université de Versailles Saint-Quentin-en-Yvelines, Île-de-France, France; INSERM Laboratory for Vascular Translational Science, Paris, France
| | - Julien Labreuche
- Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France
| | - Pierre Amarenco
- INSERM Laboratory for Vascular Translational Science, Paris, France; Department of Neurology and Stroke Centre, Paris, France; AP-HP Bichat University Hospital, Paris-Diderot University and Medical School, Paris, France.
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Gutierrez J, Cheung K, Bagci A, Rundek T, Alperin N, Sacco RL, Wright CB, Elkind MSV. Brain Arterial Diameters as a Risk Factor for Vascular Events. J Am Heart Assoc 2015; 4:e002289. [PMID: 26251284 PMCID: PMC4599479 DOI: 10.1161/jaha.115.002289] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events. Methods and Results Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, called the brain arterial remodeling (BAR) score, was obtained by averaging the measured diameters within each individual. Individuals with a BAR score <−2 SDs were considered to have the smallest diameters, individuals with a BAR score >−2 and <2 SDs had average diameters, and individuals with a BAR score >2 SDs had the largest diameters. All vascular events were recorded prospectively after the brain magnetic resonance imaging. Spline curves and incidence rates were used to test our hypothesis. The association of the BAR score with death (P=0.001), vascular death (P=0.02), any vascular event (P=0.05), and myocardial infarction (P=0.10) was U-shaped except for ischemic stroke (P=0.74). Consequently, incidence rates for death, vascular death, myocardial infarction, and any vascular event were higher in individuals with the largest diameters, whereas individuals with the smallest diameters had a higher incidence of death, vascular death, any vascular event, and ischemic stroke compared with individuals with average diameters. Conclusions The risk of death, vascular death, and any vascular event increased at both extremes of brain arterial diameters. The pathophysiology linking brain arterial remodeling to systemic vascular events needs further research.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.)
| | - Ken Cheung
- Division of Biostatistics, Columbia University, New York, NY (K.C.)
| | - Ahmet Bagci
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.)
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.)
| | - Noam Alperin
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.)
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.)
| | - Clinton B Wright
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.) Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL (C.B.W.) Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL (C.B.W.)
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.) Department of Epidemiology, Columbia University, New York, NY (M.V.E.)
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Abstract
Dolichoectasia (DE) in cerebral arteries is a poorly understood arteriopathy that has been associated with increased risk of vascular morbidity and mortality. Dolichoectasia tends to affects older individuals with vascular risk factors, but it can also be secondary to specific conditions related with extracellular matrix health. The range of methods used to study DE and the biases inherent to hospital-based samples weaken the generalizability of DE study results to the general population. Within the context of these limitations, there is growing evidence that DE is a serious condition that can increase the risk of vascular death. Recurrent strokes and compressive symptoms are among the major causes of morbidity, but cardiac ischemic disease and aortic aneurysms are not uncommon in populations with DE. The devastating outcomes of patients with DE are a call to action aimed at improving the quality of research on the topic and discovering therapies that can palliate the burden of DE in the population.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA,
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Vertebrobasilar ectasia in patients with lacunar stroke: the secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis 2015; 24:1052-8. [PMID: 25817614 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/15/2014] [Accepted: 12/31/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The clinical implications of vertebrobasilar ectasia (VBE) in patients with cerebral small-artery disease are not well defined. We investigated whether VBE is associated with recurrent stroke, major hemorrhage, and death in a large cohort of patients with recent lacunar stroke. METHODS Maximum diameters of the vertebral and basilar arteries were measured by magnetic resonance angiography and computed tomographic angiography in 2621 participants in the Secondary Prevention of Small Subcortical Strokes trial. VBE was defined a priori as basilar artery greater than 4.5 mm and/or vertebral artery greater than 4.0 mm. Patient characteristics and risks of stroke recurrence and mortality during follow-up (median, 3.5 years) were compared between patients with and without VBE. RESULTS VBE affecting 1 or more arteries was present in 200 (7.6%) patients. Patient features independently associated with VBE were increasing age, male sex, white race ethnicity, hypertension, and higher baseline diastolic blood pressure. Baseline systolic blood pressure was inversely associated with VBE. After adjustment for other risk factors, VBE was not predictive of recurrent stroke (hazard ratio [HR], 1.3; 95% confidence interval [CI], .85-1.9) or major hemorrhage (HR, 1.5; CI, .94-2.6), but was of death (HR, 1.7; CI, 1.1-2.7). CONCLUSIONS In this large well-characterized cohort of patients with recent lacunar stroke, VBE was predictive of death but not of recurrent stroke or major hemorrhage. In these exploratory analyses, the frequency of VBE was directly related to diastolic blood pressure but inversely related to systolic blood pressure.
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Tykocki T, Kostkiewicz B. Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features. Acta Neurochir (Wien) 2014; 156:1647-54. [PMID: 25034507 PMCID: PMC4137168 DOI: 10.1007/s00701-014-2173-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
Background Intracranial aneurysms (IAs) located in the posterior circulation are considered to have higher annual bleed rates than those in the anterior circulation. The aim of the study was to compare the morphometric factors differentiating between IAs located in the anterior and posterior cerebral circulation. Methods A total number of 254 IAs diagnosed between 2009 and 2012 were retrospectively analyzed. All patients qualified for diagnostic, three-dimensional rotational angiography. IAs were assigned to either the anterior or posterior cerebral circulation subsets for the analysis. Means were compared with a t-test. The univariate and stepwise logistic regression analyses were used to determine the predictors of morphometric differences between the groups. For the defined predictors, ROC (receiver-operating characteristic) curves and interactive dot diagrams were calculated with the cutoff values of the morphometric factors. Results The number of anterior cerebral circulation IAs was 179 (70.5 %); 141 (55.5 %) aneurysms were ruptured. Significant differences between anterior and posterior circulation IAs were found for: the parent artery size (5.08 ± 1.8 mm vs. 3.95 ± 1.5 mm; p < 0.05), size ratio (2.22 ± 0.9 vs. 3.19 ± 1.8; p < 0.045) and aspect ratio (AR) (1.91 ± 0.8 vs. 2.75 ± 1.8; p = 0.02). Predicting factors differentiating anterior and posterior circulation IAs were: the AR (OR = 2.20; 95 % CI 1.80–270; Is 270 correct or should it be 2.70 and parent artery size (OR = 0.44; 95 % CI 0.38–0.54). The cutoff point in the ROC curve was 2.185 for the AR and 4.89 mm for parent artery size. Conclusions Aspect ratio and parent artery size were found to be predictive morphometric factors in differentiating between anterior and posterior cerebral IAs.
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Swartz RH. Moving vessel wall research beyond the plaque: basilar artery dilation as a window to systemic cardiovascular events. Arterioscler Thromb Vasc Biol 2013; 33:2051-2. [PMID: 23946466 DOI: 10.1161/atvbaha.113.301837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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