1
|
Toudou-Daouda M, Chausson N, Smadja D, Alecu C. Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:43-52. [PMID: 38314017 PMCID: PMC10836233 DOI: 10.1177/1742271x231195723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/01/2023] [Indexed: 02/06/2024]
Abstract
Background Intracranial atherosclerotic stenosis is a common cause of ischemic cerebrovascular events and is associated with a high risk of stroke recurrence. This study aimed to assess the diagnostic accuracy of transcranial color-coded duplex sonography for moderate-to-severe middle cerebral artery stenosis in stroke patients. Methods A retrospective analysis was carried out, including 31 patients aged ⩾18 years hospitalized for ischemic cerebrovascular event in whom middle cerebral artery stenosis ⩾30% was identified on computed tomography angiography. Transcranial color-coded duplex sonography findings were compared to the degree of stenosis blindly identified on the computed tomography angiography used as the reference method. Results Overall, 27 patients had M1 stenosis and the other 4 had M2 stenosis. To detect M2 stenosis ⩾ 50% and ⩾ 70%, stenotic to pre-stenotic ratio ⩾ 2 and ⩾ 3 had a sensitivity of 100%, respectively. To detect M1 stenosis ⩾ 70%, peak systolic velocity ⩾ 300 cm/s had a sensitivity of 53.8% and specificity of 85.7% with area under the receiver-operating characteristic curve of 0.753 (95% confidence interval: 0.568-0.938; p = 0.026), and stenotic to pre-stenotic ratio ⩾ 3 had a sensitivity of 84.6% and a specificity of 78.6% (area under the curve = 0.854; 95% confidence interval: 0.707-1; p = 0.002). Middle cerebral artery/anterior cerebral artery velocity ratio < 0.7 had a sensitivity of 57.1% and specificity of 90% to detect dampened pre-stenotic flow in middle cerebral artery secondary to downstream M1 stenosis ⩾ 70% (area under the curve = 0.800; 95% confidence interval: 0.584-1; p = 0.040). Conclusion This study showed that stenotic to pre-stenotic ratio ⩾ 3 was more sensitive than peak systolic velocity ⩾ 300 cm/s to screen M1 stenosis ⩾ 70%. Middle cerebral artery/anterior cerebral artery ratio < 0.7 was a good indirect sign to detect dampened pre-stenotic flow due to M1 stenosis ⩾ 70%.
Collapse
Affiliation(s)
- Moussa Toudou-Daouda
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Nicolas Chausson
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Didier Smadja
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Cosmin Alecu
- Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
- Department of Neurology, Centre Hospitalier Universitaire de Nice, Nice, France
| |
Collapse
|
2
|
Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [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: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
Collapse
Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| |
Collapse
|
3
|
Liu WJ. The diagnosis of intracranial artery stenosis in patients with stroke by transcranial Doppler ultrasound: A meta-analysis. Technol Health Care 2024; 32:639-649. [PMID: 37661896 DOI: 10.3233/thc-220844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Strokes are the most common cause of death and the leading cause of acquired disability in adults worldwide. OBJECTIVE The present study aimed to investigate the value of transcranial Doppler ultrasound (TCD) in the diagnosis of intracranial vascular stenosis in patients with a history of stroke. METHODS This is a meta-analysis study of diagnostic tests. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched. Diagnostic tests using TCD or transcranial colour Doppler ultrasound (TCCD) for detecting intracranial arterial stenosis in patients with a history of stroke were included, with reference standards of intracranial angiography, computed tomography angiography (CTA), or magnetic resonance angiography. The risk bias map was drawn by Revman v5.3, the sensitivity and specificity forest plot was drawn by Stata v16.0, the receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated. RESULTS A total of 812 patients with stroke in 12 studies were included in the meta-analysis. The estimated sensitivity of TCD or TCCD for the detection of intracranial vascular stenosis was 0.77-1.00, and the combined sensitivity was 0.96 (95% confidence interval [CI]: 0.88-0.99); the estimated specificity was 0.32-1.00, and the combined specificity was 0.94 (95% CI: 0.82-0.98); the positive likelihood ratio was 15.8 (95% CI: 5.1-48.6); and the negative likelihood ratio was 0.04 (95% CI: 0.01-0.14). The AUC was 0.99 (95% CI: 0.97-0.99). CONCLUSION Doppler ultrasound has good consistency with conventional methods for the diagnosis of intracranial artery stenosis in patients with a history of stroke. Different reference standards may affect sensitivity and specificity; when CTA was used as the reference standard, the consistency of the TCD in the diagnosis of intracranial artery stenosis in stroke patients was relatively good.
Collapse
|
4
|
Malferrari G, Merli N, Inchingolo V, Siniscalchi A, Laterza D, Monaco D, Arnone G, Zini A, Prada F, Azzini C, Pugliatti M. Role of Advanced Hemodynamic Ultrasound Evaluation in the Differential Diagnosis of Middle Cerebral Artery Stenosis: Introducing Morphological Criteria. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2428-2435. [PMID: 37550172 DOI: 10.1016/j.ultrasmedbio.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine the possible impact of the new technique advanced hemodynamic ultrasound evaluation (AHUSE) in identification of severe intracranial stenosis. Transcranial Doppler (TCD) and transcranial color-coded Doppler (TCCD) provide reliable velocimetric data, the indirect analysis of which allows us to obtain information on the patency of vessels and assumed stenosis range. However, very tight stenoses (>95%) cannot be detected with velocimetric criteria because of spectrum drops and the absence of high velocities, so that the right curve of the Spencer equation cannot be solved. Likewise, high velocities are not detected when analyzing morphologically long stenosis. Furthermore, the current classifications based on velocimetric criteria do not provide any categorization on stenoses with multiple acceleration points (MAPs). METHODS With this Technical Note we aim to introduce, in addition to velocimetric criteria, more morphological criteria based on TCCD with the algorithm of AHUSE to optimize the characterization of intracranial stenosis (IS). TCCD-AHUSE relies on intensity-based next-generation techniques and can be used to identify IS with MAPs and simultaneously perform a morphological assessment of the stenosis length. RESULTS We introduce a new technical ultrasound (U) approach that we tested in a sample of four different types of stenoses combining velocimetric data and AHUSE using Esaote Microvascularization (MicroV) technique to the M1 tract of the middle cerebral artery (MCA). CONCLUSION The authors believe that a multiparametric evaluation is more sensitive and supports the clinician by introducing the morphological concept, not just the velocimetric concept, to differentiate the IS pattern of MCA. The potential for developing a diagnostic/prognostic algorithm is discussed.
Collapse
Affiliation(s)
- Giovanni Malferrari
- Stroke Unit and Neurology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
| | - Nicola Merli
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Vincenzo Inchingolo
- Neurology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Siniscalchi
- Department of Neurology and Stroke Unit, Annunziata Hospital, Cosenza, Italy
| | - Domenico Laterza
- Neurology and Stroke Unit, Nuovo Ospedale degli Infermi, Biella (BI), Italy
| | - Daniela Monaco
- Department of Emergency Neurology and Stroke Unit, "S. Spirito" Hospital, Pescara, Italy
| | - Giorgia Arnone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Francesco Prada
- Acoustic Neuroimaging and Therapy Lab, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy; Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA; Focused Ultrasound Foundation, Charlottesville, VA, USA
| | - Cristiano Azzini
- Stroke Unit and Neurology Unit, S. Anna University Hospital, Ferrara Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Italy; S. Anna University Hospital, Ferrara Italy
| |
Collapse
|
5
|
Zhao W, Ma X, Ju J, Zhao Y, Wang X, Li S, Sui Y, Sun Q. Association of visceral adiposity index with asymptomatic intracranial arterial stenosis: a population-based study in Shandong, China. Lipids Health Dis 2023; 22:64. [PMID: 37198613 DOI: 10.1186/s12944-023-01831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The visceral adiposity index (VAI), as a composite indictor to evaluate visceral adipose function, has been demonstrated to be correlated with atherosclerosis. The study objective was to explore the association between asymptomatic intracranial arterial stenosis (aICAS) and VAI in Chinese rural dwellers. METHODS The cross-sectional study consisted of 1942 participants ≥ 40 years old who were living in Pingyin County, Shandong Province and free from history of clinical stroke and transient ischemic attack. The aICAS in the study was diagnosed by transcranial doppler ultrasound combined with magnetic resonance angiography. The multivariate logistic regression models were deployed to explore the correlation of VAI with aICAS, and receiver operating characteristic (ROC) curve were plotted to compare the performance of models. RESULTS The participants with aICAS comparing to those without had a significantly higher VAI. After adjusting for confounding factors including age, hypertension, DM, sex, drinking habit, LDL-C, hsCRP, and smoking habit, the VAI-Tertile 3 (vs. VAI-Tertile 1) was positively associated with aICAS (OR, 2.15; 95% CI, 1.25-3.65; P = 0.005). The VAI-Tertile 3 was still markedly associated with aICAS among the underweight and normal weight (BMI ≤ 23.9 kg/m2) participants (OR, 3.17; 95% CI, 1.15-8.71; P = 0.026) with an AUC = 0.684. A similar relationship between VAI and aICAS was obtained among the participants with no abdominal obesity (WHR < 1, OR, 2.03; 95% CI, 1.14-3.62; P = 0.017). CONCLUSIONS The possible correlation between VAI and aICAS was found to be positive for the first time among Chinese rural residents over 40 years old. A higher VAI was found to be significantly associated with aICAS among the participants who were underweight or normal weight, and these results may provide additional risk stratification information for aICAS.
Collapse
Affiliation(s)
- Weihua Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaotong Ma
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Jiachen Ju
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Yanling Sui
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, P.R. China.
| |
Collapse
|
6
|
Azevedo E. Diagnostic Ultrasonography in Neurology. Continuum (Minneap Minn) 2023; 29:324-363. [PMID: 36795882 DOI: 10.1212/con.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Ultrasonography allows neurologists to complement clinical information with additional useful, easily acquired, real-time data. This article highlights its clinical applications in neurology. LATEST DEVELOPMENTS Diagnostic ultrasonography is expanding its applications with smaller and better devices. Most indications in neurology relate to cerebrovascular evaluations. Ultrasonography contributes to the etiologic evaluation and is helpful for hemodynamic diagnosis of brain or eye ischemia. It can accurately characterize cervical vascular atherosclerosis, dissection, vasculitis, or other rarer disorders. Ultrasonography can aid in the diagnosis of intracranial large vessel stenosis or occlusion and evaluation of collateral pathways and indirect hemodynamic signs of more proximal and distal pathology. Transcranial Doppler (TCD) is the most sensitive method for detecting paradoxical emboli from a systemic right-left shunt such as a patent foramen ovale. TCD is mandatory for sickle cell disease surveillance, guiding the timing for preventive transfusion. In subarachnoid hemorrhage, TCD is useful in monitoring vasospasm and adapting treatment. Some arteriovenous shunts can be detected by ultrasonography. Cerebral vasoregulation studies are another developing field of interest. TCD enables monitoring of hemodynamic changes related to intracranial hypertension and can diagnose cerebral circulatory arrest. Optic nerve sheath measurement and brain midline deviation are ultrasonography-detectable signs of intracranial hypertension. Most importantly, ultrasonography allows for easily repeated monitoring of evolving clinical conditions or during and after interventions. ESSENTIAL POINTS Diagnostic ultrasonography is an invaluable tool in neurology, used as an extension of the clinical examination. It helps diagnose and monitor many conditions, allowing for more data-driven and rapid treatment interventions.
Collapse
|
7
|
Li X, Du H, Li J, Chen X. Intracranial artery calcification as an independent predictor of ischemic stroke: a systematic review and a meta-analysis. BMC Neurol 2023; 23:21. [PMID: 36647035 PMCID: PMC9841662 DOI: 10.1186/s12883-023-03069-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND PURPOSE The association between intracranial artery calcification (IAC) and the risk of ischemic stroke occurrence or poor prognosis had not yet been fully understood. In this study, we conducted a meta-analysis of existing studies aimed to assess whether IAC can be used to predict future ischemic stroke and post-stroke mortality. METHODS Medline, Cochrane, Web of Science and Google Scholar databases were searched up to June 30, 2022. Studies were included if they reported risk ratio (RR) or odds ratios (OR) and corresponding 95% confidence intervals (CI) of stroke concerning the presence of IAC. Random or fixed effects model meta-analyses were performed. Meta-analysis was conducted by using Stata version 16.0. RESULTS Twelve studies involving 9346 participants were included. Compared with those without IAC, patients with IAC had a higher risk of stroke occurrence (adjusted OR 1.62, 95% CI 1.18-2.23, P = 0.001) and stroke recurrence (adjusted OR 1.77, 95% CI 1.25-2.51, P = 0.003). However, we did not find a significant correlation between IAC and post-stroke mortality (pooled OR 1.12, 95% CI 0.80-1.56, P = 0.504). CONCLUSIONS Our meta-analysis demonstrated that the presence of IAC was identified as an independent risk factor for ischemic stroke occurrence and recurrence but is not a predictor of post-stroke mortality.
Collapse
Affiliation(s)
- Xuelong Li
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Heng Du
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jia Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xiangyan Chen
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
8
|
Dimas GG, Zilakaki M, Giannopoulos A, Daios S, Kakaletsis N, Kaiafa G, Didangelos T, Savopoulos C, Ktenidis K, Tegos T. Assessment of Atherosclerosis in Ischemic Stroke by means of Ultrasound of Extracranial/Intracranial Circulation and Serum, Urine, and Tissue Biomarkers. Curr Med Chem 2023; 30:1107-1121. [PMID: 35980067 DOI: 10.2174/0929867329666220817123442] [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: 12/30/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
It is a common practice to take into consideration age, diabetes, smoking, treated and untreated systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol for the prediction of atherosclerosis and stroke. There are, however, ultrasound markers in use for the assessment of atherosclerosis and the evaluation of stroke risk. Two areas of investigation are of interest: the carotid artery and the intracranial arterial circulation. Again, within the domain of the carotid artery, two ultrasonic markers have attracted our attention: intima media thickness of the carotid artery and the presence of carotid plaque with its various focal characteristics. In the domain of intracranial circulation, the presence of arterial stenosis and the recruitment of collaterals are considered significant ultrasonic markers for the above-mentioned purpose. On the other hand, a series of serum, urine, and tissue biomarkers are found to be related to atherosclerotic disease. Future studies might address the issue of whether the addition of proven ultrasonic carotid indices to the aforementioned serum, urine, and tissue biomarkers could provide the vascular specialist with a better assessment of the atherosclerotic load and solidify their position as surrogate markers for the evaluation of atherosclerosis and stroke risk.
Collapse
Affiliation(s)
- Grigorios G Dimas
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Maria Zilakaki
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| | - Argyrios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki ,Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Kyriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital of Thessaloniki, Greece
| | - Thomas Tegos
- First Neurology Department, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| |
Collapse
|
9
|
Zhang J, Wang S, Chen Y, Li C, Wang L. Neck-brain integrated ultrasound as a noninvasive screening tool to identify morphological features of middle cerebral artery disease. Atherosclerosis 2022; 363:85-93. [PMID: 36210242 DOI: 10.1016/j.atherosclerosis.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Endovascular treatment is suitable for middle cerebral artery (MCA) with focal lesion. Therefore, accurate evaluation of the morphological features of MCA disease is critical. Ultrasonography is commonly used to screen for MCA lesions. However, there are few studies on lesion length. Using ultrasonography, we aimed to prospectively evaluate MCA disease with focal stenosis, long stenosis, focal occlusion, and long occlusion. METHODS Patients with symptomatic MCA disease scheduled for digital subtraction angiography were enrolled. The ultrasonic parameters recorded included mean flow velocity at MCA (VMCA) and extracranial internal carotid artery (VICA), bilateral VMCA ratio, bilateral VICA ratio, and MCA flow continuity. RESULTS A total of 278 MCAs were included. Compared to normal vessels, the bilateral VMCA ratio increased in the focal stenosis group and decreased in the long lesion and focal occlusion groups (all p < 0.05); the VICA and bilateral VICA ratio decreased in the long lesion group (all p < 0.01), and there was no significant difference in the focal lesion group (all p > 0.05). The optimal cut-offs were bilateral VMCA ratio <0.80 to predict long lesions and focal occlusions (sensitivity: 0.898, specificity: 0.975), and bilateral VICA ratio <0.84 to predict long lesions (sensitivity: 0.704, specificity: 0.879). The sensitivity and specificity to predict long occlusions were 96.7% and 94.8%, respectively, in the absence of MCA flow continuity. CONCLUSIONS Neck-brain integrated ultrasound is an appropriate screening method for identifying MCA lesions with different morphologies. Endovascular treatment might not be recommended when bilateral VICA ratio <0.84 in patients with MCA lesions.
Collapse
Affiliation(s)
- Jie Zhang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Shouchun Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ying Chen
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Cong Li
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lijuan Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China.
| |
Collapse
|
10
|
Ishaque N, Khan K, Shuaib A. Monitoring intracranial atherosclerosis with transcranial and extracranial carotid Doppler: A promising initial step. Atherosclerosis 2022; 363:73-74. [PMID: 36418212 DOI: 10.1016/j.atherosclerosis.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Noman Ishaque
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.
| |
Collapse
|
11
|
Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound. Bioengineering (Basel) 2022; 9:bioengineering9090422. [PMID: 36134968 PMCID: PMC9495671 DOI: 10.3390/bioengineering9090422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Atherosclerotic intracranial internal carotid artery stenosis (IICAS) is a leading cause of strokes. Due to the limitations of major cerebral imaging techniques, the early diagnosis of IICAS remains challenging. Clinical studies have revealed that arterial stenosis may have complicated effects on the blood flow’s velocity from a distance. Therefore, based on a patient-specific one-dimensional hemodynamic model, we quantitatively investigated the effects of IICAS on extracranial internal carotid artery (ICA) flow velocity waveforms to identify sensitive hemodynamic indices for IICAS diagnoses. Classical hemodynamic indices, including the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were calculated on the basis of simulations with and without IICAS. In addition, the first harmonic ratio (FHR), which is defined as the ratio between the first harmonic amplitude and the sum of the amplitudes of the 1st−20th order harmonics, was proposed to evaluate flow waveform patterns. To investigate the diagnostic performance of the indices, we included 52 patients with mild-to-moderate IICAS (<70%) in a case−control study and considered 24 patients without stenosis as controls. The simulation analyses revealed that the existence of IICAS dramatically increased the FHR and decreased the PSV and EDV in the same patient. Statistical analyses showed that the average PSV, EDV, and RI were lower in the stenosis group than in the control group; however, there were no significant differences (p > 0.05) between the two groups, except for the PSV of the right ICA (p = 0.011). The FHR was significantly higher in the stenosis group than in the control group (p < 0.001), with superior diagnostic performance. Taken together, the FHR is a promising index for the early diagnosis of IICAS using carotid Doppler ultrasound methods.
Collapse
|
12
|
Gajjar B, Sharma S, Khan E, Sharma P, Jain P, Goel V, Neral A, Patel J, Parmar M, Sharma K, Sharma VK, Sharma AK. Cerebral hemodynamics in children with sickle cell disease in India: An observational cohort study. Medicine (Baltimore) 2022; 101:e29882. [PMID: 35801747 PMCID: PMC9259145 DOI: 10.1097/md.0000000000029882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
India has the second highest number of cases of sickle cell disease (SCD) and affects the most socioeconomically disadvantaged communities living in a horizontal belt from Gujarat to Odisha state. Despite high prevalence, information about cerebral hemodynamics among children with SCD in India remains scarcely described. We performed transcranial Doppler (TCD) to assess cerebral hemodynamics among Indian children with SCD and evaluated their association with clinical and hematological parameters. Children aged 3-18years, diagnosed with SCD living in Raipur in Chhattisgarh and Ahmedabad in Gujarat state were recruited. TCD was performed to obtain flow velocities from middle cerebral (MCA), intracranial internal carotid (ICA) and basilar artery. Associations were evaluated between timed-average-mean-maximum velocities (TAMMV) and various clinical and hematological parameters. Our prospective study included 62 consecutive children with known SCD. Mean ± SD age of the study population was 9.8 ± 3.9 years and 31 (50%) were male. Mean ± SD hemoglobin was 8.64 ± 1.34 Gm/dL while the mean HbSS ± SD was 70.25 ± 15.27%. While 6 (9.6%) children had suffered from stroke during previous 2 years, 7 (11%) demonstrated abnormal TAMMV. Higher HbSS level along with history of iron chelation therapy, blood transfusion and/or stroke showed a trend towards having higher TAMMV. Stroke and cerebral hemodynamic alterations are common among Indian children with SCD. Larger studies with detailed neuroimaging and genetic evaluations are needed for better understanding, characterization, risk stratification as well as optimization of the timing of blood transfusion to reduce physical disabilities among Indian children with SCD.
Collapse
Affiliation(s)
- Bhakti Gajjar
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Sanjay Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
- Department of Neurology, Ramkrishna Care Hospitals, Raipur, Chhattisgarh, India
| | - Erum Khan
- BJ Medical College, Ahmedabad, Gujarat, India
| | | | - Pawan Jain
- Department of Pediatrics, Ramkrishna Care Hospitals, Raipur, Chhattisgarh, India
| | - Vikas Goel
- Department of Hematology, Ramkrishna Care Hospitals, Raipur, Chhattisgarh, India
| | | | | | - Mamta Parmar
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Kanika Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Vijay K. Sharma
- YLL School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore
- *Correspondence: Vijay K. Sharma, Yong Loo Lin School of Medicine, National University of Singapore, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228 (e-mail: )
| | - Arvind K. Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
- BJ Medical College, Ahmedabad, Gujarat, India
| |
Collapse
|
13
|
Shi X, Huang J, Su X, Chang X, Dang Z, Yang G. Application of Transcranial Doppler in Patients after Stent-Assisted Coil Embolization. Clin Neurol Neurosurg 2022; 220:107347. [DOI: 10.1016/j.clineuro.2022.107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/03/2022]
|
14
|
Abstract
PURPOSE OF REVIEW This article gives a broad overview of vascular cognitive impairment and dementia, including epidemiology, pathophysiology, clinical approach, and management. Emphasis is placed on understanding the common underlying types of cerebrovascular disease (including atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy) and awareness of rare inherited cerebrovascular disorders. RECENT FINDINGS The pathophysiology of vascular cognitive impairment and dementia is heterogeneous, and the most recent diagnostic criteria for vascular cognitive impairment and dementia break down the diagnosis of major vascular dementia into four phenotypic categories, including subcortical ischemic vascular dementia, poststroke dementia, multi-infarct dementia, and mixed dementia. Control of cardiovascular risk factors, including management of midlife blood pressure, cholesterol, and blood sugars, remains the mainstay of prevention for vascular cognitive impairment and dementia. Cerebral amyloid angiopathy requires special consideration when it comes to risk factor management given the increased risk of spontaneous intracerebral hemorrhage. Recent trials suggest some improvement in global cognitive function in patients with vascular cognitive impairment and dementia with targeted cognitive rehabilitation. SUMMARY Thorough clinical evaluation and neuroimaging form the basis for diagnosis. As vascular cognitive impairment and dementia is the leading nondegenerative cause of dementia, identifying risk factors and optimizing their management is paramount. Once vascular brain injury has occurred, symptomatic management should be offered and secondary prevention pursued.
Collapse
|
15
|
Krementz NA, Gardener HE, Torres L, Alkhalifah M, Campo-Bustillo I, Campo N, Koch S, Alvarez O, Rundek T, Romano JG. Accuracy of transcranial Doppler in detecting intracranial stenosis in patients with sickle cell anemia when compared to magnetic resonance angiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:480-486. [PMID: 35244950 DOI: 10.1002/jcu.23182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Stroke, the most devastating consequence of sickle cell anemia (SCA), is associated with endothelial damage and intracranial artery stenosis. We aimed to assess transcranial Doppler (TCD) ultrasound accuracy in detecting intracranial stenosis when compared to magnetic resonance angiography (MRA). METHODS Children with SCA and at least one TCD and MRA within 1 month were identified from a retrospectively collected database. Sensitivity and specificity were obtained to assess the overall accuracy of TCD mean flow velocity (mFV) ≥200 cm/s in detecting vessel stenosis of ≥50%. Multivariate analysis identified independent factors associated with MRA stenosis. RESULTS Among 157 patients in the database, 64 had a TCD and MRA within 1 month (age 11.8 ± 5.3 years, 56% female, 20% with cerebral infarcts on MRI, 8 or 13% had mFV ≥200 cm/s and 20% or 21%, had intracranial stenosis ≥50% on MRA). TCD mFV ≥200 cm/s had a high specificity (95%) but low sensitivity (29%) to detecting intracranial stenosis. As a continuous variable, TCD mFV of 137.5 cm/s had maximal specificity (77%) and sensitivity (72%). After adjustment for age, hemoglobin level, transfusion status, hydroxyurea treatment, and vessel, for every increase in cm/sec on TCD, there was a 2% increase in the odds of ≥50% stenosis on MRA (p < 0.001). CONCLUSION Our study reports TCD mFV is a positive predictor of MRA stenosis in SCA, independent of patient characteristics, including hemoglobin. A mFV ≥200 cm/s is highly specific but less sensitive in detecting stenosis ≥50%. Lower mFV cut points may be needed for the early detection of intracranial stenosis.
Collapse
Affiliation(s)
- Nastajjia A Krementz
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hannah E Gardener
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Luis Torres
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Moayd Alkhalifah
- Department of Neurology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Iszet Campo-Bustillo
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Nelly Campo
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sebastian Koch
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ofelia Alvarez
- Department of Pediatrics, Division of Pediatric Hematology, University of Miami, Miami, Florida, USA
| | - Tatjana Rundek
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jose G Romano
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| |
Collapse
|
16
|
Abdelghany WM, Zoheir N, Abd Elhamid S, Ahmed S, Gomaa K. Pre-microRNAs single nucleotide variants (rs3746444 A > G and rs2910164 C > G) increase the risk of ischemic stroke in the Egyptian population: a case–control study. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
Ischemic stroke (IS) is the most leading cause of morbidity and mortality worldwide. Micro RNA (miRNA) genetic variants have been identified as a part of IS non-modifiable risk markers. This study aims to identify the possible association of rs2910164 C > G of pre-miRNA-146a and rs3746444 A > G of pre-miRNA-499 with increased IS risk. C-reactive protein (CRP) was studied as one of the mediators of the genetic disturbance in IS. The study included 100 patients with atherosclerotic IS and 100 age and sex matched healthy controls with more than one risk factor for IS. Variants were evaluated by the real-time polymerase chain reaction technique using TaqMan probes. CRP levels were assayed by immunoturbidimetry method on COBAS analyzer.
Results
Regarding rs3746444 A > G, the G allele, and its containing genotypes (GG and GG + AG) were associated with high IS incidence. Increased CRP levels were found to induce IS by GG and GG + AG genotypes, with a cut value of 7.5 mg/ L in differentiation between AA genotype and GG + AG genotypes. Combining the G allele of rs3746444 A > G with either G or C allele of rs2910164 C > G had enhanced the risk. For rs2910164 C > G, the G allele, and the combined GG + GC genotypes were associated with IS risk elevation with no correlation to CRP levels.
Conclusion
The G involving genetic variants of rs3746444 A > G and rs2910164 C > G were associated with an enhanced IS risk. CRP showed higher levels in GG and AG genotypes of rs3746444 with no relation to rs2910164 genotypes.
Collapse
|
17
|
Low Vertebrobasilar Velocity Is Associated with a Higher Risk of Posterior Circulation Ischemic Lesions. J Clin Med 2022; 11:jcm11051396. [PMID: 35268487 PMCID: PMC8911347 DOI: 10.3390/jcm11051396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Transcranial color-coded sonography (TCCS) is used as a real-time tool to evaluate patients suspected of having vertebrobasilar insufficiency (VBI). However, the sonographic criteria for VBI remain inconclusive. The purpose of this study was to analyze the velocity in the vertebrobasilar system, which links the risk for posterior circulation infarction (POCI) and total ischemic stroke (TIS) in patients with VBI. Methods: Patients’ data were retrospectively reviewed if they were suspected of having VBI within a 2-year period. Baseline characteristics, brain images, and a series of sonography data were recorded and analyzed. We compared vertebrobasilar (VB) velocities in different age groups and in patients with infarctions. Results: A total of 875 patients were enrolled, with 112 and 427 candidates in the POCI and TIS groups, respectively. The mean velocity (MV)s of BA and bilateral VAs were all negatively correlated with age (all p < 0.001). The adjusted odds ratio was 2.55 (1.58−4.13, p < 0.001) in POCI and 1.75 (1.15−2.67, p = 0.009) in TIS if the mean velocity of the VB arteries was below 15 cm/s. Conclusions: Low VB velocity detected in TCCS was more commonly associated with ageing-related changes and a higher risk of both POCI and TIS. Recognition and aggressive treatment for these patients are necessary.
Collapse
|
18
|
Zhang J, Wang L, Chen Y, Wang S, Cui L. Non-invasive Detection of Diffuse Intracranial Vertebrobasilar Artery Stenosis: A Prospective Comparison with Digital Subtraction Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:554-564. [PMID: 34996653 DOI: 10.1016/j.ultrasmedbio.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to prospectively evaluate diffuse intracranial vertebrobasilar artery stenosis by ultrasonic examination with digital subtraction angiography as the reference. Five hundred forty-one vertebrobasilar arteries with a normal lumen or intracranial stenosis were enrolled. Peak systolic velocity, mean flow velocity and end-diastolic velocity (EDV) at the intracranial vertebrobasilar arteries and extracranial vertebral arteries (VAs) were measured. The resistance index (RI) at extracranial VAs and the difference between the RI of extracranial VAs and the RI of the extracranial internal carotid artery (RIica) were calculated. Compared with normal arteries, all stenotic arteries were divided into the high-velocity group (focal stenosis, multiple-segment stenosis and multiple-artery stenosis) and low-velocity group (critical stenosis and long stenosis). The consistency between ultrasonic examination and digital subtraction angiography for evaluation of vertebrobasilar arteries with multiple-segment stenosis and multiple-artery stenosis was not favorable when applying the widely used Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis criteria (κ = 0.442 and 0.438, respectively). The optimal low-velocity criteria for identifying intracranial vertebrobasilar arteries with critical stenosis and long stenosis were determined by receiver operating characteristic curve analysis and were as follows: EDV ≤15 cm/s and RI ≥0.68 at the extracranial VA and RIica ≥0.10.
Collapse
Affiliation(s)
- Jie Zhang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lijuan Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ying Chen
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Sibo Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Li Cui
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China.
| |
Collapse
|
19
|
Pravdivtseva MS, Gaidzik F, Berg P, Ulloa P, Larsen N, Jansen O, Hövener JB, Salehi Ravesh M. Influence of Spatial Resolution and Compressed SENSE Acceleration Factor on Flow Quantification with 4D Flow MRI at 3 Tesla. Tomography 2022; 8:457-478. [PMID: 35202203 PMCID: PMC8880336 DOI: 10.3390/tomography8010038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Four-dimensional (4D) flow MRI allows quantifying flow in blood vessels–non invasively and in vivo. The clinical use of 4D flow MRI in small vessels, however, is hampered by long examination times and limited spatial resolution. Compressed SENSE (CS-SENSE) is a technique that can accelerate 4D flow dramatically. Here, we investigated the effect of spatial resolution and CS acceleration on flow measurements by using 4D flow MRI in small vessels in vitro at 3 T. We compared the flow in silicon tubes (inner diameters of 2, 3, 4, and 5 mm) measured with 4D flow MRI, accelerated with four CS factors (CS = 2.5, 4.5, 6.5, and 13) and three voxel sizes (0.5, 1, and 1.5 mm3) to 2D flow MRI and a flow sensor. Additionally, the velocity field in an aneurysm model acquired with 4D flow MRI was compared to the one simulated with computational fluid dynamics (CFD). A strong correlation was observed between flow sensor, 2D flow MRI, and 4D flow MRI (rho > 0.94). The use of fewer than seven voxels per vessel diameter (nROI) resulted in an overestimation of flow in more than 5% of flow measured with 2D flow MRI. A negative correlation (rho = −0.81) between flow error and nROI were found for CS = 2.5 and 4.5. No statistically significant impact of CS factor on differences in flow rates was observed. However, a trend of increased flow error with increased CS factor was observed. In an aneurysm model, the peak velocity and stagnation zone were detected by CFD and all 4D flow MRI variants. The velocity difference error in the aneurysm sac did not exceed 11% for CS = 4.5 in comparison to CS = 2.5 for all spatial resolutions. Therefore, CS factors from 2.5–4.5 can appear suitable to improve spatial or temporal resolution for accurate quantification of flow rate and velocity. We encourage reporting the number of voxels per vessel diameter to standardize 4D flow MRI protocols.
Collapse
Affiliation(s)
- Mariya S. Pravdivtseva
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
- Correspondence: ; Tel.: +49-(0)-431-500-16-533
| | - Franziska Gaidzik
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Research Campus STIMULATE, Magdeburg University, 39106 Magdeburg, Germany; (F.G.); (P.B.)
| | - Patricia Ulloa
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, 24105 Kiel, Germany; (N.L.); (O.J.)
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, 24105 Kiel, Germany; (P.U.); (J.-B.H.); (M.S.R.)
| |
Collapse
|
20
|
Kim SJ, Schneider DJ, Feldmann E, Liebeskind DS. Intracranial atherosclerosis: Review of imaging features and advances in diagnostics. Int J Stroke 2022; 17:599-607. [PMID: 34983259 DOI: 10.1177/17474930211066427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Song J Kim
- Vascular Neurology and Neurocritical Care, Sutter Health Comprehensive Stroke Care Center, San Francisco, CA, USA
| | - David J Schneider
- Cardiovascular Research Institute of Vermont, The University of Vermont, Colchester, VT, USA
| | - Edward Feldmann
- Neurosciences and Rehabilitation, Baystate Health, Springfield, MA, USA
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
| |
Collapse
|
21
|
Tsivgoulis G, Safouris A, Alexandrov AV. Ultrasonography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
22
|
Wang JZ, Zhang S, Wei X, Zhang D, Zhao YH, Zhu X. Transcranial color Doppler sonography as an alternative tool for evaluation of terminal internal carotid artery steno-occlusion in moyamoya disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:33-40. [PMID: 34674277 DOI: 10.1002/jcu.23091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate color Doppler ultrasonography criteria and its value in assessing the steno-occlusion of the terminal internal carotid artery in moyamoya disease. METHODS According to the digital subtraction angiography findings, patients were divided into three groups: occlusion of the terminal internal carotid artery, >50% stenosis, and ≤50% stenosis. We measured the terminal and proximal internal carotid artery parameters of each group using transcranial and cervical color Doppler sonography. RESULTS Blood flow signals in 12 terminal internal carotid arteries were absent, which were verified as occlusion by digital subtraction angiography. Parameters were obtained in the remaining 159 terminal/proximal internal carotid arteries to predict cutoffs for >50% stenosis and occlusion. For >50% stenosis, mean flow velocity >88.50 cm/s in the terminal internal carotid artery could achieved the highest receiver operating characteristic curve area of 0.776 with 62.50% sensitivity, 88.15% specificity, 48.39% positive predictive values, 92.97% negative predictive value, and 84.27% overall accuracy. For the occlusion, mean flow velocity <49.50 cm/s in the terminal internal carotid artery achieve the highest receiver operating characteristic curve area of 0.734 with 55.56% sensitivity, 83.81% specificity, 63.83% positive predictive values, 78.57% negative predictive value, and 74.21% overall accuracy. The area under receiver operating characteristic curve cutoffs for other parameters were less than 0.7. CONCLUSION Mean flow velocity of terminal internal carotid artery provides useful diagnostic information for detecting steno-occlusion in moyamoya disease. It may be used as an alternative tool to evaluate steno-occlusion of the terminal internal carotid artery in moyamoya disease.
Collapse
Affiliation(s)
- Jing-Zhe Wang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ya-Hui Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Zhu
- Department of Neurosurgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| |
Collapse
|
23
|
Edjlali M, Gobin‐Metteil M, Mélé N, Maïer B, Habibi A, Kauv P, Hosseini H, Mas J, Oppenheim C, Galactéros F, Bartolucci P, Calvet D. Transcranial color-coded duplex sonography reliably identifies intracranial vasculopathy in adult patients with sickle cell disease. Am J Hematol 2021; 96:961-967. [PMID: 33971039 DOI: 10.1002/ajh.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/08/2022]
Abstract
In order to prevent stroke, screening for disease-related intracranial vasculopathy using Doppler ultrasound is recommended in sickle-cell disease (SCD) children. How to screen such vasculopathy in adults remains largely unknown. The objective of this study was to assess whether transcranial color-coded duplex sonography (TCCD) is sensitive and specific enough to identify SCD adult patients with vasculopathy, compared with magnetic resonance angiography (MRA). Sickle cell disease adults followed in referral centers at high risk of vasculopathy were included in this study. Transcranial color-coded duplex sonography examination and 3-D time-of-flight MRA were performed on the same day. On MRA, vasculopathy was defined by the presence of at least one ≥50% arterial stenosis. On TCCD, vasculopathy was defined by a time-averaged mean of the maximum velocity (TAMx) stenotic/prestenotic ratio ≥ 3, an occlusion, or a Moyamoya pattern. Vasculopathy was also considered as present when TAMx ratio could not be calculated because of the presence of severe cervical lesions. Among 80 included patients, quality of MRA was insufficient in three patients. Among the 38 patients with vasculopathy on MRA, 37 had a vasculopathy according to TCCD criteria: TAMx ratio ≥ 3 or intracranial occlusion in 33 patients and cervical lesion in four patients. A Moyamoya pattern was identified with TCCD in all 17 patients with Moyamoya on MRA. Sensitivity and specificity of TCCD to identify patients with ≥50% vasculopathy on MRA were (n = 37/38) 97% and (n = 28/34) 82%, respectively. Positive and negative predictive values were (n = 37/43) 86% and (n = 28/29) 97%, respectively. Note, TCCD may be used to identify SCD adult patients with vasculopathy.
Collapse
Affiliation(s)
- Myriam Edjlali
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Marie‐Pierre Gobin‐Metteil
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Nicolas Mélé
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Benjamin Maïer
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Anoosha Habibi
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Paul Kauv
- Department of Imaging Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Hassan Hosseini
- Department of Neurology Henri‐Mondor Hospital, UPEC, Assistance Publique‐Hopitaux de Paris, Creteil Créteil France
| | - Jean‐Louis Mas
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| | - Catherine Oppenheim
- Service d'Imagerie, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Médecine Interne, Hôpital Henri‐Mondor, UPEC Créteil France
- INSERM U955, team 2, Laboratoire d'Excellence GRex Créteil France
| | - David Calvet
- INSERM 1266 Institut de Psychiatrie et Neurosciences de Paris ‐ FHU Neurovasc—Paris Sorbonne Paris France
- Service de Neurologie et Unité Neurovasculaire, GHU Paris Psychiatrie et Neurosciences (Sainte‐Anne) Université de Paris Paris France
| |
Collapse
|
24
|
Klissurski M, Petrov I, Tasheva I, Penev L, Grozdinski L. A rare case of non-conventional risk factors for ischemic stroke: A long pathogenic sequence, neurointervention combined with IV acetylsalicylic acid and secondary prevention. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100909] [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] Open
|
25
|
Liu R, Li J, Hua Y, Yang J, Zhao Y, Tian X, Ma Y, Zhao W. Transcranial Color-Coded Sonography Criteria for Moderate and Severe Middle Cerebral Artery Stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:25-32. [PMID: 33069442 DOI: 10.1016/j.ultrasmedbio.2020.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/29/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to establish optimal criteria for evaluation of moderate (50%-69%) and severe (70%-99%) middle cerebral artery (MCA) stenosis with transcranial color-coded sonography (TCCS). A total of 375 cases provided 409 TCCS/digital subtraction angiography vessel pairs. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and mean flow velocity (MFV) of the MCA were measured. The stenotic/distal MFV ratios (SDRs) were calculated. With digital subtraction angiography as a reference, for 50%-69% MCA stenosis, the optimal combined criteria were PSV ≥180 cm/s (sensitivity 95.7%, specificity 64.9% and overall accuracy 69.7%); EDV ≥75 cm/s (90.0%, 66.4% and 68.7%); MFV ≥110 cm/s (95.7%, 64.0% and 69.4%); and SDR ≥2.5 (88.6%, 71.3% and 76.3%). Criteria for 70%-99% MCA stenosis were PSV ≥240 cm/s (93.5%, 89.9% and 85.5%); EDV ≥100 cm/s (96.8%, 89.0% and 87.3%); MFV≥160 cm/s (91.9%, 92.8% and 92.2%); and SDR ≥4 (87.1%, 92.2% and 91.4%). Parameters of the MCA detected by TCCS, especially SDR, may increase accuracy in diagnosis of 50%-69% and 70%-99% MCA stenosis.
Collapse
Affiliation(s)
- Ran Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingzhi Li
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Jie Yang
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China
| | - Yue Zhao
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Tian
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
26
|
Callen A, Narvid J, Chen X, Gregath T, Meisel K. Neurovascular disease, diagnosis, and therapy: Cervical and intracranial atherosclerosis, vasculitis, and vasculopathy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:249-266. [PMID: 33272399 DOI: 10.1016/b978-0-444-64034-5.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stroke is a leading cause of death, disability, and financial burden in the United States. Perhaps more than any other disease process, the rapidity with which the diagnosis and treatment of stroke are successfully achieved is paramount to the reduction of its associated morbidity and mortality. Steno-occlusive intracranial vascular disease, the most notorious culprit of cerebral ischemia and/or hemorrhage, traces its etiology to native and embolic atherosclerosis as well as various forms of vascular inflammation, insult, and dysfunction. Distinguishing between these causes is a critical first step in the diagnosis and treatment of a patient presenting with cerebrovascular compromise. In this chapter, we delineate the clinical and imaging features of cervical and intracranial atherosclerosis, vasculitis, and vasculopathy, along with the evidence behind the treatments which comprise their current-day standard of care. The modern imaging armamentarium is diverse and complex, with contrast-enhanced and non-contrast MR angiography, CT angiography, digital subtraction angiography, and ultrasound; each playing an important role in providing rapid insight into the patient's disease process. Understanding these imaging techniques and their application in the acute setting is critical for the provider caring for stroke patients.
Collapse
Affiliation(s)
- Andrew Callen
- Department of Radiology, University of Colorado, Boulder, CO, United States
| | - Jared Narvid
- Department of Radiology, University of California San Francisco, San Francisco, CA, United States
| | - Xiaolin Chen
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Trevor Gregath
- Department of Neurology, Bryan Health, Lincoln, NE, United States
| | - Karl Meisel
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States.
| |
Collapse
|
27
|
Xiang L, Zhang T, Zhang B, Zhang C, Cui W, Yue W. Positive syphilis serology contributes to intracranial stenosis in ischemic stroke patients. Brain Behav 2021; 11:e01906. [PMID: 33089668 PMCID: PMC7821556 DOI: 10.1002/brb3.1906] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The risk of ischemic stroke is increased among people living with syphilis infection; however, whether syphilis is an independently risk for stenosis is unclear. We investigated the clinical, laboratory, and vascular stenosis features of ischemic stroke patients living with positive syphilis serology to evaluate the role of syphilis in cerebral artery stenosis. METHODS The demographic, clinical characteristics, and the distribution of cerebral artery stenosis were compared between 668 syphilis-positive and 785 syphilis-negative ischemic stroke patients. Multivariate logistic regression analysis was performed to determine the degree and distribution of stenosis associated with positive syphilis serology and estimate the factors related to artery stenosis in the syphilis-positive ischemic stroke patients. RESULTS Syphilis-positive ischemic stroke patients were distinct from the nonsyphilis population, with a younger age, fewer women, and a different risk factor profile. Positive syphilis serology was independently associated with moderate stenosis (OR, 2.31; 95% CI 2.02-2.69; p = .003) and severe stenosis (OR, 6.15; 95% CI, 2.85-8.94; p < .001), mainly intracranial stenosis (OR, 1.49; 95% CI, 1.15-1.92; p = .002) rather than extracranial stenosis. Among stroke patients with positive syphilis serology, the higher RPR titer (OR, 1.18, 95% CI, 1.07-1.89 for RPR titer 1:16; OR, 5.16, 95% CI 2.99-8.89 for RPR titer > 1:32) and previous unknown or untreated syphilis (OR, 3.63; 95% CI, 2.72-4.03; p < .001) were the factors related to stenosis. CONCLUSIONS Syphilis infection, especially when less well controlled, may play an important role in intracranial stenosis of ischemic stroke patients.
Collapse
Affiliation(s)
- Lei Xiang
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Tao Zhang
- Department of Intensive Care Unit, Tianjin Huanhu Hospital, Tianjin, China
| | - Biao Zhang
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Chao Zhang
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Wanzhen Cui
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Yue
- Department of Neurology, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| |
Collapse
|
28
|
Nassef AM, Awad EM, El-bassiouny AA, Afify HEM, Yousef RA, Shafik MA. Endovascular stenting of medically refractory intracranial arterial stenotic (ICAS) disease (clinical and sonographic study). THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. Patients with a recent transient ischemic attack (TIA) or stroke and severe stenosis (70 to 99% of the diameter of a major intracranial artery) are at particularly high risk for recurrent stroke in the territory of the stenotic artery (approximately 23% at 1 year) despite medical treatment. Therefore, alternative therapies are urgently needed for these patients.
Objective
To determine the efficacy and safety of angioplasty with stenting in medically refractory ICAS and to compare its effectiveness with optimal medical treatment.
Subjects and methods
Fifty patients with symptomatic ICAS despite medical treatment (i.e, recurrent stroke or TIA) were enrolled and equally randomized in a prospective study where twenty-five patients underwent angioplasty with stenting and twenty-five patients received optimal medical treatment. Clinical assessment with NIHSS and mRS were done at 0, 3, and 6 months, and transracial Doppler (TCD) assessment of ICAS was done at 0 and 3 months after treatment.
Results
The interventional group had a better clinical outcome with mean NIHSS scores (5.2 ± 4.2, 4.43 ± 4.28 and 3.9 ± 4.7) at baseline, 3 and 6 months, respectively, in comparison to the medical group with mean NIHSS (4.5 ± 4.2, 11.42 ± 6.3, and 8.5 ± 5.1) and better functional outcome with mean mRS scores (1.3 ± 0.96, 1.2 ± 1.13, and 1.0 ± 1.13) at baseline, 3 and 6 months, respectively, in comparison to the medical group (0.84 ± 0.75, 2.28 ± 1.2, and 2 ± 1.24). TCD assessment of ICAS showed a marked reduction of the percentage of stenosis on 3 months of follow-up among the interventional groups (only 5.6% had > 70% stenosis) in comparison to the medical group (85.7% had > 70% stenosis). Recurrent ischemic events on 6 months of follow-up were 16% among interventional groups in comparison to 84% among medical groups. The mortality rate was 8% among interventional groups due to subarachnoid hemorrhages (SAH) related to procedure in comparison to 28% among medical groups secondary to ischemic events. The intraoperative success rate was 96% with the failure of stent deployment in 1 patient due to the tortuous anatomy of vessels. Early post interventional complication rate, i.e, SAH was 8%. Late post interventional restenosis and occlusion rates were 8% on 3 months of follow-up.
Conclusion
Endovascular stenting of medically refractory ICAS is more efficacious and effective with better clinical and functional outcomes than optimal medical treatment; however, its safety is still debatable.
Trial registration
Done at ClinicalTrials.gov. Trial ID (NCT Number) NCT04393025.
Collapse
|
29
|
Mahmoud D, El-Sisi O, Sheta M, Ahmed S, Fathy M, Gomaa K, Ramzy T. Association of miR-196a2 and miR-149 single-nucleotide polymorphisms with atherosclerotic ischemic stroke susceptibility. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Beside common risk factors for stroke such as diabetes and hypertension, single-nucleotide variants occurring within micro RNA genes have been identified as susceptibility loci for ischemic stroke risk.
Objectives
Investigate the possible association of two variants in pre miRNA sequences, rs11614913 within miR-196a2 C > T and rs2292832 within miR-149 T > C, with ischemic stroke.
Subjects and methods
One hundred ischemic stroke patients and 100 age and sex-matched controls having > 1 risk factor for atherosclerosis were enrolled in a case-control study. Degree of atherosclerosis was assessed using ultrasonography. Micro RNA variants were assessed by real-time PCR TaqMan probe assay.
Results
The TT genotype and T allele frequencies of miR-196a2 C > T were protective against ischemic stroke (OR 0.168, P 0.001; OR 0.482, P < 0.001 respectively). While among miR-149 T > C variants, CC genotype was associated with increased risk by threefold (OR 3.061, P 0.005) and C allele was associated with about 1.9 fold risk of stroke (OR 1.909, P 0.002). Haplotypes analysis revealed miR-196a2T/-149 T allele combination was significantly lower among stroke patients than the controls (P < 0.001) with a protective effect (OR 0.196, 95% CI 0.083-0.466).
Conclusion
A decrease in the incidence of ischemic stroke is associated with miR-196a2 TT genotype and T allele and increases in the likelihood risk of ischemic stroke are associated with CC genotype and C allele within miR-149, and the two miRNAs under study are closely associated with vascular damage responses.
Collapse
|
30
|
Youn SW, Lee J. From 2D to 4D Phase-Contrast MRI in the Neurovascular System: Will It Be a Quantum Jump or a Fancy Decoration? J Magn Reson Imaging 2020; 55:347-372. [PMID: 33236488 DOI: 10.1002/jmri.27430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
Considering the crosstalk between the flow and vessel wall, hemodynamic assessment of the neurovascular system may offer a well-integrated solution for both diagnosis and management by adding prognostic significance to the standard CT/MR angiography. 4D flow MRI or time-resolved 3D velocity-encoded phase-contrast MRI has long been promising for the hemodynamic evaluation of the great vessels, but challenged in clinical studies for assessing intracranial vessels with small diameter due to long scan times and low spatiotemporal resolution. Current accelerated MRI techniques, including parallel imaging with compressed sensing and radial k-space undersampling acquisitions, have decreased scan times dramatically while preserving spatial resolution. 4D flow MRI visualized and measured 3D complex flow of neurovascular diseases such as aneurysm, arteriovenous shunts, and atherosclerotic stenosis using parameters including flow volume, velocity vector, pressure gradients, and wall shear stress. In addition to the noninvasiveness of the phase contrast technique and retrospective flow measurement through the wanted windows of the analysis plane, 4D flow MRI has shown several advantages over Doppler ultrasound or computational fluid dynamics. The evaluation of the flow status and vessel wall can be performed simultaneously in the same imaging modality. This article is an overview of the recent advances in neurovascular 4D flow MRI techniques and their potential clinical applications in neurovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
Collapse
Affiliation(s)
- Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology and Biomedical Engineering, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
31
|
Jaiswal SK, Fuling Y, Li M. Prevalence of Intracranial Artery Stenosis in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital of China. ACTA ACUST UNITED AC 2020; 58:634-639. [PMID: 33068081 PMCID: PMC7580323 DOI: 10.31729/jnma.5201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Indexed: 11/03/2022]
Abstract
Introduction: Intracranial artery stenosis is the most common cause of acute ischemic stroke, especially among people in Asia. About its epidemiology, however little is understood. The goal of our research is to establish the prevalence of intracranial artery stenosis in patients with acute ischemic stroke in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in 1006 acute ischemic stroke patients at Affiliated Zhongda Hospital, School of Medicine, Southeast University China from May 2018 to May 2019. Ethical approval was taken from the Ethical review committee of the institution. A convenient sampling method was done. Intracranial artery stenosis was diagnosed when evidence of acute ischemic stroke was found in the territory of approximately ≥50% stenosis identified by Transcranial Doppler ultrasound and confirmed by magnetic resonance angiography or computed tomography. Statistical analysis was done using the Statistical Package for the Social Sciences version 20. Results: The prevalence of intracranial artery stenosis was found in 331 (32.90%) patients at 95% Confidence interval (0.24-0.42%). Among 331 cases the anterior circulation artery stenosis was present on 201 (19.98%) patients, followed by posterior circulation artery stenosis on 80 (7.95%) patients, then anterior plus posterior circulation artery stenosis on 50 (4.97%) patients. Conclusions: Intracranial artery stenosis is one of the most causes of acute ischemic stroke in China. The proportion of anterior circulation artery stenosis was higher than that in the posterior circulation.
Collapse
Affiliation(s)
- Sandip Kumar Jaiswal
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Southeast University China
| | - Yan Fuling
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Southeast University China
| | - Min Li
- Department of Cardiology, Affiliated Zhongda Hospital, School of Medicine, Southeast University China
| |
Collapse
|
32
|
Wang X, Zhao Y, Ji X, Sang S, Shao S, Yan P, Li S, Li J, Wang G, Lu M, Du Y, Xue F, Qiu C, Sun Q. Kongcun Town Asymptomatic Intracranial Artery Stenosis study in Shandong, China: cohort profile. BMJ Open 2020; 10:e036454. [PMID: 32665348 PMCID: PMC7359188 DOI: 10.1136/bmjopen-2019-036454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The population-based Kongcun Town Asymptomatic Intracranial Artery Stenosis (KT-aICAS) study aims to investigate the prevalence of aICAS and major cardiovascular risk factors (CRFs) or biomarkers related to the development and prognosis of aICAS. PARTICIPANTS The KT-aICAS study included 2311 rural residents who were aged ≥40 years and living in Kongcun Town, Shandong Province, China. Baseline examination was conducted from October 2017 to October 2018, during which information on demographics, socioeconomics, personal and family medical history, and lifestyle factors was collected through face-to-face interviews, physical examination and blood tests. aICAS was initially screened using transcranial Doppler examination and then diagnosed using magnetic resonance angiography. Atherosclerosis in carotid arteries was diagnosed via carotid ultrasonography. High-resolution MRI was further used to evaluate the vessel wall of aICAS. Neuropsychological assessments were performed in the participants diagnosed with aICAS and the age-matched and sex-matched controls. FINDINGS TO DATE Of the 2311 participants, 2027 (87.7%) completed the diagnostic procedure and aICAS was detected in 154 persons, resulting in an overall prevalence of 7.6%. The prevalence of aICAS increased with advancing age from 5.1% in participants aged 40-49 years to 12.7% in those aged ≥70 years (p<0.001). aICAS was detected in 305 intracranial arteries, including 221 (72.5%) in the anterior circulation and 84 (27.5%) in the posterior circulation (p<0.001). In addition, major CRFs were highly prevalent among middle-aged and elderly rural dwellers who were free of clinical stroke. FUTURE PLANS Follow-up examinations will be performed every 3 years following the baseline examination. This study will increase our knowledge about the natural history of aICAS and facilitate studies of aICAS-associated disorders among rural-dwelling Chinese adults, such as ischaemic stroke and vascular cognitive impairment. TRIAL REGISTRATION NUMBER ChiCTR1800017197.
Collapse
Affiliation(s)
- Xiang Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaokang Ji
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Shaowei Sang
- Department of Clinical Epidemiology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Sai Shao
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Peng Yan
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jifeng Li
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guangbin Wang
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan, Shandong, China
| | - Ming Lu
- Department of Clinical Epidemiology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| |
Collapse
|
33
|
Elvira Soler E, Serrano Serrano B, López Hernández N, Guevara Dalrymple N, Moliner Castellano S, Gallego León JI. Transcranial duplex ultrasound monitoring of intracranial arterial stenosis treated with ELUTAX "3" drug-eluting balloon. Interv Neuroradiol 2020; 26:800-804. [PMID: 32475193 DOI: 10.1177/1591019920929812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report the results of transcranial ultrasound monitoring in three patients with intracranial arterial stenosis of the middle cerebral artery treated with the only drug-eluting balloon certificated for intracranial use in highly symptomatic intracranial arterial stenosis, ELUTAX "3" (AR Baltic Medical). We performed transcranial Doppler ultrasounds 24 h, 72 h, 10 days, 15 days and 30 days after the angioplasty, thereby measuring mean flow velocity (MFV) in the maximum stenosis area in patients with symptomatic steno-occlusive disease of the middle cerebral artery treated with ELUTAX "3". Two patients were treated during mechanical thrombectomy (MT) due to acute ischemic stroke and one patient was treated on elective basis due to symptomatic pre-occlusive stenosis, with recurrent transient ischemic attacks (TIAs) refractory to medical therapy. In Case 1, the first transcranial Doppler ultrasounds evidenced MFV of 348 cm/s, with progressive MFV reduction until 15 days post-treatment, with MFV of 177 cm/s. In Case 2, 24 h after angioplasty had an MFV of 258 cm/s, decreasing to 103 cm/s at 30 days. Case 3 had an MFV of 436 cm/s before angioplasty that immediately decreased after the procedure to 364 cm/s, with a final MFV of 260 cm/s at 30 days. We have recorded a progressive MFV reduction in intracranial arterial stenosis, with better outcomes in patients treated during MT. In our experience, the use of ELUTAX "3" for the treatment of symptomatic intracranial arterial stenosis achieves a progressive improvement of stenosis, evident in the first weeks, to a higher extent in cases of occlusive thrombosis. More studies are needed to provide more information about this device.
Collapse
Affiliation(s)
- Elena Elvira Soler
- Department of Neurology, 16802Alicante General University Hospital, Alicante, Spain
| | | | | | | | | | | |
Collapse
|
34
|
Wang S, Wang X, Zhao Y, Ji X, Sang S, Shao S, Xiang Y, Wang G, Lv M, Xue F, Du Y, Qiu C, Sun Q. Characterizing lipid profiles associated with asymptomatic intracranial arterial stenosis in rural-dwelling adults: A population-based study. J Clin Lipidol 2020; 14:371-380. [PMID: 32389549 DOI: 10.1016/j.jacl.2020.04.005] [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] [Received: 01/02/2020] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although individual lipid parameters have been frequently examined in association with asymptomatic intracranial arterial stenosis (aICAS), few population-based studies have investigated the lipid profiles associated with aICAS among Chinese adults. OBJECTIVE This study aims to characterize the lipid profiles associated with aICAS in rural-dwelling adults in China. METHODS This population-based study included 2027 persons who were aged ≥40 years and free of stroke. Data were collected via interviews, clinical examinations, and laboratory testing. We diagnosed aICAS by integrating transcranial color Doppler with magnetic resonance angiography. Data were analyzed using binary and multinomial logistic regression models. RESULTS Of the 2027 participants, 154 were detected with aICAS. The multiadjusted odds ratio (95% confidence interval) of aICAS was 1.41 (0.997-2.00) for high small dense low-density lipoprotein cholesterol, 1.44 (1.02-2.04) for high lipoprotein(a), 1.71 (1.21-2.44) for low apolipoprotein A-1, 1.43 (1.00-2.04) for low high-density lipoprotein cholesterol (HDL-C), 1.61 (1.14-2.27) for high apolipoprotein B/apolipoprotein A-1 ratio, 1.95 (1.38-2.76) for high low-density lipoprotein cholesterol/HDL-C ratio, and 1.51 (1.06-2.14) for high total cholesterol/HDL-C ratio. When severity of aICAS was analyzed, high levels of lipoprotein(a), small dense low-density lipoprotein cholesterol, and lipid ratios were significantly associated with an increased likelihood of moderate-to-severe aICAS (P < .05). An increasing number of abnormal lipid measurements was associated with an increased likelihood of aICAS (P for trend <.001). CONCLUSION These findings suggest that lipid profiles for aICAS among rural residents in China are characterized by high atherogenic cholesterol, low antiatherogenic cholesterol, and high ratios of atherogenic-to-antiatherogenic cholesterol or lipoproteins.
Collapse
Affiliation(s)
- Shaoying Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuanyuan Zhao
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaokang Ji
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Shaowei Sang
- Department of Clinical Epidemiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Sai Shao
- Department of Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, Shandong, China
| | - Yuanyuan Xiang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Guangbin Wang
- Department of Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, Shandong, China
| | - Ming Lv
- Department of Clinical Epidemiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| |
Collapse
|
35
|
Liu B, Zhou F, Hua Y, Liu Y, Ji X. Evaluation of intracranial and extracranial atherosclerotic lesions in patients with symptomatic coronary artery disease. Neurol Res 2020; 42:547-553. [PMID: 32284016 DOI: 10.1080/01616412.2020.1754653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Patients with coronary artery disease (CAD) concomitant with extracranial and intracranial atherosclerotic disease (EICAD) may have an increased risk of stroke and myocardial ischemic events. This study aimed to evaluate the concomitant atherosclerotic lesions in extra- and intracranial arterial beds in patients with CAD. METHODS A total of 1274 patients who underwent coronary angiography due to ischemic heart disease were included. All patients underwent ultrasound screening of the extra- and intracranial arteries before coronary angiography, and the degrees of extracranial carotid artery disease (ECAD) and intracranial cerebral artery disease (ICAD) were recorded. RESULTS A total of 1062 cases of CAD were confirmed. The prevalence of ECAD, ICAD, and EICAD (ECAD combined with ICAD) in patients with CAD was 15.6%, 11.2% and 11.9%, respectively. For patients with 3-vessel disease, the prevalence was 20.5%, 13.8% and 18.1%, and for patients with severe coronary artery stenosis, the prevalence was 15.8%, 12.1% and 13.2%, respectively. The presence and extent of ECAD and ICAD were positively correlated with the number of lesion vessels and degree of CAD. The posterior circulation arteries were more prone to lesions in patients with ECAD, while the anterior circulation arteries were more vulnerable to lesions in patients with ICAD. CONCLUSIONS The prevalence of ECAD, ICAD and EICAD is high in patients with CAD, and the presence of these conditions is positively correlated with the extent and degree of CAD. Evaluations of ECAD and ICAD should be highly recommended for CAD patients to reduce the future risk of cardiovascular diseases.
Collapse
Affiliation(s)
- Beibei Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University , Beijing, China
| | - Fubo Zhou
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University , Beijing, China.,Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders , Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University , Beijing, China.,Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders , Beijing, China
| | - Yumei Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University , Beijing, China.,Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders , Beijing, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University , Beijing, China
| |
Collapse
|
36
|
Kamtchum-Tatuene J, Mwandumba HC, Mwangalika Kachingwe G, Bonnett LJ, Kayange N, Solomon T, Benjamin LA. A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome. PLoS One 2020; 15:e0229033. [PMID: 32032392 PMCID: PMC7006928 DOI: 10.1371/journal.pone.0229033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023] Open
Abstract
Background In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, therefore, represent a reasonable alternative to fill this knowledge gap. We explored the feasibility of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome to inform the design of future large stroke studies comparing its diagnostic performance to that of gold standard vascular imaging techniques in sub-Saharan Africa. Methods We enrolled consecutive patients diagnosed with acute stroke-like syndrome based on the World Health Organization definition. Clinical and demographic data were recorded, and a comprehensive neurovascular ultrasound was performed. Fisher’s exact and Kruskal-Wallis tests were used to study the relationship between atherosclerosis and potential risk factors. Results Sixty-six patients were enrolled (mean age: 58.7 years). The frequency of extracranial atherosclerosis was 39.4% (n = 26, 95% CI: 28.6–52.2). There were 12 patients with abnormal carotid intima media thickness (18.2%, 95% CI: 9.8–29.6) and 14 patients with a carotid plaque (21.2%, 95% CI: 12.1–33.0). The frequency of intracranial atherosclerosis was 19.2% (95%CI: 6.6–39.4) in 26 patients with successful transcranial insonation. Hypertension (80.8 versus 52.5%, p = 0.03) and hypercholesterolemia (11.5 versus 0.0%, p = 0.05) were more prevalent in patients with extracranial atherosclerosis. Conclusions This study demonstrates the feasibility of neurovascular ultrasound to assess cervical arteries in adults with stroke-like syndrome in sub-Saharan Africa. There is a high rate of transcranial insonation failure in this setting, highlighting the need for echocontrast agents.
Collapse
Affiliation(s)
- Joseph Kamtchum-Tatuene
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Henry C. Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| | - Gloria Mwangalika Kachingwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Laura J. Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, England, United Kingdom
| | - Noel Kayange
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England, United Kingdom
| | - Laura A. Benjamin
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England, United Kingdom
| |
Collapse
|
37
|
Vali A, Aristova M, Vakil P, Abdalla R, Prabhakaran S, Markl M, Ansari SA, Schnell S. Semi-automated analysis of 4D flow MRI to assess the hemodynamic impact of intracranial atherosclerotic disease. Magn Reson Med 2019; 82:749-762. [PMID: 30924197 DOI: 10.1002/mrm.27747] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/03/2019] [Accepted: 03/02/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE This study evaluated the feasibility of using 4D flow MRI and a semi-automated analysis tool to assess the hemodynamic impact of intracranial atherosclerotic disease (ICAD). The ICAD impact was investigated by evaluating pressure drop (PD) at the atherosclerotic stenosis and changes in cerebral blood flow distribution in patients compared to healthy controls. METHODS Dual-venc 4D flow MRI was acquired in 25 healthy volunteers and 16 ICAD patients (ICA, N = 3; MCA, N = 13) with mild (<50%), moderate (50-69%), or severe (>70%) intracranial stenosis. A semi-automated analysis tool was developed to quantify velocity and flow from 4D flow MRI and to evaluate cerebral blood flow redistribution. PD at stenosis was estimated using the Bernoulli equation. The PD calculation was examined by an in vitro phantom study against flow simulations. RESULTS Flow analysis in controls indicated symmetry in blood flow rate (FR) and peak velocity (PV) between the brain hemispheres. For patients, PV in the affected hemisphere was significantly (65%) higher than the normal side (P = 0.002). However, FR to both hemispheres of the brain was the same. The PD depicted significant correlation with PV asymmetry in patients (ρ = 0.67 and P = 0.02), and it was significantly higher for severe compared to moderate stenosis (3.73 vs. 2.30 mm Hg, P = 0.02). CONCLUSION 4D flow MRI quantification enables assessment of the hemodynamic impact of ICAD. The significant difference of the PD between patients with severe and moderate stenosis and its correlation with PV asymmetry suggest that PD may be a pertinent hemodynamic biomarker to evaluate ICAD.
Collapse
Affiliation(s)
- Alireza Vali
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Maria Aristova
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Parmede Vakil
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Ramez Abdalla
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, Illinois
| |
Collapse
|
38
|
Hua Y, Jia L, Xing Y, Hui P, Meng X, Yu D, Pan X, Fang Y, Song B, Wu C, Zhang C, Sui X, Jin Y, Zhang J, Li J, Wang L, Mu Y, Zhong J, Zhu Y, Zhang H, Cai X. Distribution Pattern of Atherosclerotic Stenosis in Chinese Patients with Stroke: A Multicenter Registry Study. Aging Dis 2019; 10:62-70. [PMID: 30705768 PMCID: PMC6345329 DOI: 10.14336/ad.2018.0602] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/02/2018] [Indexed: 11/07/2022] Open
Abstract
The aim of this multicenter study was to demonstrate the distribution pattern of atherosclerotic stenosis and its trend with aging between extracranial and intracranial arteries and its distribution between the anterior and posterior circulations in Chinese patients hospitalized with ischemic stroke. In addition, the risk factors for the distribution pattern were illustrated. From June 2015 to May 2016, 9,346 patients with ischemic stroke from 20 hospitals were enrolled. Carotid artery ultrasonography and transcranial color-coded sonography/transcranial Doppler were used to evaluate the extracranial and intracranial arteries. The distribution pattern of atherosclerotic stenosis and its trend with aging were analyzed. Logistic regression was used to analyze the risk factors for the distribution pattern. Among the 9,346 patients, 2,882 patients (30.8%) had at least one artery with a degree of stenosis ≥50%. Among patients with arterial stenosis, the proportion of patients with intracranial artery stenosis was higher than those with extracranial artery stenosis (52.6% vs. 27.6%), and the proportion of anterior circulation artery stenosis was higher than that in the posterior circulation (52.2% vs.26.2%). With aging, the proportion of intracranial artery stenosis alone decreased; at the same time, the proportion of extracranial artery stenosis and extracranial plus intracranial artery stenosis increased (trend χ2=6.698, P=0.001). Hypertension (OR 1.416, P=0.008) and family history of stroke (OR 1.479, P=0.014) were risk factors for intracranial artery stenosis. Male, aging, and smoking were factors more related to extracranial artery stenosis. Aging (OR 1.022, P<0.001) and hypertension (OR 1.392, P=0.019) were related to posterior circulation artery stenosis. Intracranial arteries and anterior circulation arteries were susceptible to stenosis in Chinese patients with ischemic stroke. However, the distribution pattern of atherosclerotic stenosis was dynamic and varied with aging. Aging and different risk factors contribute to this distribution pattern.
Collapse
Affiliation(s)
- Yang Hua
- 1Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, China
| | - Lingyun Jia
- 1Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, China
| | - Yingqi Xing
- 2Department of Neurology, First Hospital of Jilin University, China
| | - Pinjing Hui
- 3Department of Ultrasonography, The First Affiliated Hospital of Soochow University, China
| | - Xuan Meng
- 4Department of Ultrasonography, Lanzhou University Second Hospital, China
| | - Delin Yu
- 5Department of Ultrasonography, Tianjin Huanhu Hospital, China
| | - Xiaofang Pan
- 6Department of Ultrasonography, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, China
| | - Yalan Fang
- 7Department of Ultrasonography, The First Affiliated Hospital of Shanxi Medical University, China
| | - Binbin Song
- 8Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, China
| | - Chunxia Wu
- 9Department of Ultrasonography, Liaocheng Brain Hospital, China
| | - Chunmei Zhang
- 10Department of Ultrasonography, First Affiliated Hospital of Harbin Medical University, China
| | - Xiufang Sui
- 11Department of Ultrasonography, Anhui Provincial Hospital, China
| | - Youhe Jin
- 12Department of Ultrasonography, First Hospital of China Medical University, China
| | - Jingfen Zhang
- 13Department of Neurology, Baotou City Central Hospital, China
| | - Jianwei Li
- 14Department of Ultrasonography, Fujian Provincial Hospital, China
| | - Ling Wang
- 15Department of Ultrasonography, Mianyang Central Hospital, China
| | - Yuming Mu
- 16Department of Ultrasonography, First Affiliated Hospital of Xinjiang Medical University, China
| | - Jingxin Zhong
- 17Department of Ultrasonography, Guangdong Provincial Hospital of Traditional Chinese Medicine, China
| | - Yuhong Zhu
- 18Department of Neurology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Heng Zhang
- 19Department of Ultrasonography, Zhuhai People's Hospital, China
| | - Xiaoyu Cai
- 20Department of Ultrasonography, Brain Hospital of Hunan Province, China
| |
Collapse
|
39
|
Intracranial atherosclerotic disease. Neurobiol Dis 2018; 124:118-132. [PMID: 30439443 DOI: 10.1016/j.nbd.2018.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is a progressive pathological process that causes progressive stenosis and cerebral hypoperfusion and is a major cause of stroke occurrence and recurrence around the world. Multiple factors contribute to the development of ICAS. Angiography imaging techniques can improve the diagnosis of and the selection of appropriate treatment regimens for ICAS. Neither aggressive medication nor endovascular interventions can eradicate stroke recurrence in patients with ICAS. Non-pharmacological therapies such as remote ischemic conditioning and hypothermia are emerging. Comprehensive therapy with medication in combination with endovascular intervention and/or non-pharmacological treatment may be a potential strategy for ICAS treatment in the future. We summarized the epidemiology, pathophysiological mechanisms, risk factors, biomarkers, imaging and management of ICAS.
Collapse
|
40
|
Caliandro P, Reale G, Demchuk AM, Caso V, Arsovska A, Iacovelli C, Giovannini S, Rossini PM. Symptomatic intracranial atherosclerotic disease: an ultrasound 2-year follow-up pilot study. Neurol Sci 2018; 39:1955-1959. [DOI: 10.1007/s10072-018-3484-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022]
|
41
|
Chi HY, Hsu CF, Chen AC, Su CH, Hu HH, Fu WM. Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1605-1610. [PMID: 29193196 DOI: 10.1002/jum.14501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Patients with posterior circulation infarction are at higher risk of early recurrent stroke, especially those with vertebrobasilar stenosis or hypoplasia. The clinical presentations of this condition vary over a broad range, making diagnosis and treatment a challenge. Hemodynamic changes and stenosis detected by ultrasonography (US) are sensitive and important indicators for further evaluation. In this study, we correlated extracranial and intracranial US characteristics with brain magnetic resonance imaging (MRI) in patients with posterior circulation infarction. METHODS Inpatients with acute ischemic stroke who received both MRI and US were enrolled. Baseline characters, underlying disorders, the ischemic territory, and vascular stenosis on MRI were recorded. Series of US data, including flow volume, diameter, mean velocity, and pulsatility index, were analyzed. Patients with new infarction over the medulla, pons, midbrain, or cerebellum were enrolled as the posterior circulation infarction group. Patients with pure anterior circulation infarction were also enrolled. RESULTS A total of 210 patients with anterior circulation infarction (mean age ± SD, 66.24 ± 12.88 years) and 143 with posterior circulation infarction (mean age, 65.82 ± 11.39 years) were enrolled. Significant higher frequencies of vertebral artery hypoplasia and decreased intracranial vertebrobasilar velocity in the posterior circulation infarction group (44.75% and 64.33%, respectively) were documented (P < .0001; P = .035). Ischemic lesion distributions were correlated with vertebral artery hypoplasia (55.56 %) and low vertebral and basilar artery velocities (44.44% and 25.53%), as documented by US. A low vertebrobasilar velocity was highly correlated with MRI-documented vascular stenosis (53.06%). CONCLUSIONS Vertebral artery hypoplasia and a low velocity in the intracranial vertebrobasilar system on US might change the treatment of patients with posterior circulation infarction for primary and secondary prevention.
Collapse
Affiliation(s)
- Hsin-Yi Chi
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Fu Hsu
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Su
- Department of Internal Medicine, Division of Cardiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Wen-Mei Fu
- Pharmacological Institute, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
42
|
Yang J, Hua Y, Li X, Gao M, Li Q, Liu B, Jiao L. The Assessment of Diagnostic Accuracy for Basilar Artery Stenosis by Transcranial Color-Coded Sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:995-1002. [PMID: 29503019 DOI: 10.1016/j.ultrasmedbio.2018.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
This study aimed to determine the optimal criteria for evaluating basilar artery stenosis (BAS) by transcranial color-coded sonography (TCCS). A total of 403 cases with both TCCS and digital subtraction angiography (DSA) were enrolled. Peak systolic velocity (PSV), end diastolic velocity (EDV) and mean flow velocity (MFV) of the basilar artery (BA), intracranial vertebral artery (IVA) and posterior cerebral artery (PCA) were measured. The ratios PSVBA/PSVIVA and PSVBA/PSVPCA were calculated. With DSA as the reference, the optimal criteria for grading BAS were determined by receiver operating characteristic analysis. They were as follows: PSV ≥110 cm/s, MFV ≥70 cm/s and PSVBA/PSVIVA ≥1.5 for <50% BAS; PSV ≥150 cm/s, MFV ≥90 cm/s and PSVBA/PSVIVA ≥2.0 for 50%-69% BAS; PSV ≥210 cm/s, MFV ≥120 cm/s and PSVBA/PSVIVA ≥3.0 for 70%-99% BAS. The combination of PSV, MFV and PSVBA/PSVIVA may increase the accuracy for diagnosing 70%-99% BAS.
Collapse
Affiliation(s)
- Jie Yang
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xiang Li
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingjie Gao
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiuping Li
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
43
|
Perren F, Kargiotis O, Pignat JM, Pereira VM. Hemodynamic Changes May Indicate Vessel Wall Injury After Stent Retrieval Thrombectomy for Acute Stroke. J Neuroimaging 2018; 28:412-415. [DOI: 10.1111/jon.12513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabienne Perren
- HUG, University Hospital and Medical Faculty of Geneva, Department of Neurology; Neurovascular and Neurosonology Unit; Geneva Switzerland
| | - Odysseas Kargiotis
- HUG, University Hospital and Medical Faculty of Geneva, Department of Neurology; Neurovascular and Neurosonology Unit; Geneva Switzerland
- Metropolitan Hospital; Athens Greece
| | - Jean-Michel Pignat
- HUG, University Hospital and Medical Faculty of Geneva, Department of Neurology; Neurovascular and Neurosonology Unit; Geneva Switzerland
- CHUV, University Hospital; Deptartment of Neurology; Lausanne Switzerland
| | - Vitor Mendes Pereira
- University of Toronto University Health Network; Interventional Neuroradiology; Toronto Canada
| |
Collapse
|
44
|
Abstract
Transcranial Doppler (TCD) is useful in stroke prevention for at least three purposes: diagnosis of intracranial stenosis, detection of right-to-left shunt in patients with suspected paradoxical embolism, and detection of microemboli in patients with carotid stenosis. Other uses may include assessment of cerebral blood flow, which is not discussed in this review. TCD saline studies are more sensitive than transesophageal echocardiography, and more strongly predictive of risk of recurrent events. TCD embolus detection is the best-validated method for identifying among patients with asymptomatic carotid stenosis the few who could benefit from carotid endarterectomy or stenting.
Collapse
Affiliation(s)
- J. David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| |
Collapse
|
45
|
Aghoram R, Narayan SK. Patterns of Transcranial Doppler Flow Velocities in Recent Ischemic Stroke Patients. Ann Indian Acad Neurol 2018; 21:193-196. [PMID: 30258261 PMCID: PMC6137640 DOI: 10.4103/aian.aian_417_17] [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: 11/14/2022] Open
Abstract
Context: Intracranial atherosclerosis is a common cause of stroke in India. Transcranial Doppler (TCD) provides a noninvasive way to study basal intracranial blood vessels. The Oxfordshire Community Stroke Project (OCSP) classification is a simple clinical stroke classification system that has prognostic significance and has been associated with size and location of the infarct. Aim: This study was undertaken to identify patterns of TCD abnormalities in our stroke population particularly in relation to the OCSP classification. Setting and Design: A cross-sectional study was conducted at a tertiary care center in South India. Methods: Recent nondisabling ischemic stroke patients were studied. TCD was used to insonate bilateral middle cerebral, bilateral anterior cerebral, bilateral vertebral, and basilar arteries. Mean flow velocity was used to define normal or abnormal flow as per standard criteria. Statistical Methods: Association between abnormal flow velocities and OCSP classification was studied using Chi-square tests. Univariate and multivariate analysis was performed to determine factors associated with abnormal flow velocities. Results: Of the 59 participants studied, 42 (71%; 95% confidence interval [CI]: 57.3-84.7%) had abnormal flow velocities in one or more vessels and this was significantly associated with smoking (odds ratio = 5; 95% CI: 1.2–21.8). All abnormal flow velocities were blunted flow velocities. Anterior circulation flow velocity abnormalities were seen among all OCSP stroke subtypes, but posterior circulation flow abnormalities were associated with posterior circulation infarcts (P = 0.03). Conclusion: Intracranial flow velocity abnormalities are frequent among Indian stroke population. Further studies are needed to characterize these abnormalities fully.
Collapse
|
46
|
Wang J, Zhong C, Zhang Y, Wei Y, Liu H, Wu C, Yan Y. Seven years' follow-up of comparative study between stenting and medication for treatment of symptomatic vertebrobasilar artery stenosis. Interv Neuroradiol 2017; 24:43-50. [PMID: 29058985 DOI: 10.1177/1591019917736032] [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] [Indexed: 11/16/2022] Open
Abstract
Objective Endovascular stent-assistant angioplasty (ESAA) is a valid treatment for symptomatic vertebrobasilar artery stenosis (SVAS), but the long-term effect and the improvement of condition compared with medication treatment are unknown. This study investigated the long-term efficacy of ESAA in patients with moderate and severe SVAS, and compared the efficacy with medication treatment. Materials and methods We conducted a retrospective analysis of clinical data of 43 patients with moderate and severe SVAS hospitalized in our department. According to different treatment methods they were divided into 29 cases in an ESAA group and 14 cases in a medication treatment group. During the follow-up period, the degree of vascular stenosis, vascular blood flow velocity, restenosis rate, recovery of neurological function and the incidence of cerebral ischemic events in the two groups were analyzed. Results The average clinical follow-up period was 89.4 ± 10.2 months. Before treatment, the stenosis rate and average blood flow velocity of the two groups were not statistically significant ( p > 0.05). During the follow-up period, both were significantly lower than the medication treatment group ( p < 0.01). In the ESAA group, three cases of stent stenosis, and three cases in the medication treatment group were completely occluded. The total ischemic events in ESAA group were three cases, compared with nine cases in the medication treatment group; the difference was statistically significant ( p < 0.05). Conclusion ESAA has a long-term effect in the treatment of symptomatic moderate and severe vertebrobasilar artery stenosis. It is superior to medication therapy in preventing posterior circulation ischemia (PCI), but a larger sample size is still needed to confirm the study.
Collapse
Affiliation(s)
- Jun Wang
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Changyang Zhong
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yan Zhang
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yingnan Wei
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Huili Liu
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Chunli Wu
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yongxing Yan
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| |
Collapse
|
47
|
Wang Y, Meng R, Song H, Liu G, Hua Y, Cui D, Zheng L, Feng W, Liebeskind DS, Fisher M, Ji X. Remote Ischemic Conditioning May Improve Outcomes of Patients With Cerebral Small-Vessel Disease. Stroke 2017; 48:3064-3072. [PMID: 29042490 DOI: 10.1161/strokeaha.117.017691] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the efficacy of remote ischemic conditioning (RIC) in patients with cerebral small-vessel disease. METHODS Thirty patients with cerebral small-vessel disease-related mild cognitive impairment were enrolled in this prospective, randomized controlled study for 1 year. Besides routine medical treatment, participants were randomized into the experimental group (n=14) undergoing 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on both upper limbs twice daily for 1 year or the control group (n=16) who were treated with sham ischemia-reperfusion cycles. The primary outcome was the change of brain lesions, and secondary outcomes were changes of cognitive function, plasma biomarkers, and cerebral hemodynamic parameters both at baseline and at the end of 1-year follow-up. RESULTS Compared with pretreatment, the post-treatment white matter hyperintensities volume in the RIC group was significantly reduced (9.10±7.42 versus 6.46±6.05 cm3; P=0.020), whereas no significant difference was observed in the sham-RIC group (8.99±6.81 versus 8.07±6.56 cm3; P=0.085). The reduction of white matter hyperintensities volume in the RIC group was more substantial than that in sham group (-2.632 versus -0.935 cm3; P=0.049). No significant difference was found in the change of the number of lacunes between 2 groups (0 versus 0; P=0.694). A significant treatment difference at 1 year on visuospatial and executive ability was found between the 2 groups (0.639 versus 0.191; P=0.048). RIC showed greater effects compared with sham-RIC on plasma triglyceride (-0.433 versus 0.236 mmol/L; P=0.005), total cholesterol (-0.975 versus 0.134 mmol/L; P<0.001), low-density lipoprotein (-0.645 versus -0.029 mmol/L; P=0.034), and homocysteine (-4.737 versus -1.679 µmol/L; P=0.044). Changes of the pulsation indices of middle cerebral arteries from the baseline to 1 year were different between the 2 groups (right: -0.075 versus 0.043; P=0.030; left: -0.085 versus 0.043; P=0.010). CONCLUSIONS RIC seems to be potentially effective in patients with cerebral small-vessel disease in slowing cognition decline and reducing white matter hyperintensities. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01658306.
Collapse
Affiliation(s)
- Yuan Wang
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Ran Meng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Haiqing Song
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Gang Liu
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Yang Hua
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Dehua Cui
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Lemin Zheng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Wuwei Feng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - David S Liebeskind
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Marc Fisher
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Xunming Ji
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.).
| |
Collapse
|
48
|
Xu Z, Leng C, Yang B, Wang H, Sun J, Liu Z, Yang L, Ge W, Zhu J. Serum cystatin C is associated with large cerebral artery stenosis in acute ischemic stroke. Oncotarget 2017; 8:67181-67188. [PMID: 28978025 PMCID: PMC5620165 DOI: 10.18632/oncotarget.18061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023] Open
Abstract
Large cerebral artery stenosis is a major cause of acute ischemic stroke (AIS); however, the correlation between serum cystatin C (CysC) and the stenosis of large cerebral arteries in patients with AIS has not been established. We performed a retrospective review of acute ischemic stroke patients, who were examined by cerebral digital subtraction angiography(DSA). Participants (252 cases) included 131 patients without stenosis and 121 patients with large cerebral artery stenosis. Serum CysC levels in patients with large cerebral artery stenosis were much higher than that of control subjects (p<0.001). However, serum CysC levels were not related to the location of stenosis. Further, logistic regression analyses showed that increased serum CysC was an independent risk factor of large cerebral artery stenosis in patients with acute ischemic stroke. Total participants were subdivided into quintiles based on serum CysC levels. Compared with the first quintile, the odds ratios of risk for large cerebral artery stenosis in the fourth and the fifth quintile were 1.26 (p<0.05) and 4.71(p<0.05) respectively, after the adjustment for age, sex, and smoking, hypertension, type 2 diabetes mellitus(DM), dyslipidemia, creatinine(Cr), urea, uric acid, and C reactive protein(CRP). Therefore, a significant positive correlation was observed between elevated serum CysC levels and large cerebral artery stenosis in patients with acute ischemic stroke. In summary, our findings provide new insights into the correlation between increased serum CysC and large cerebral artery stenosis in patients with acute ischemic stroke.
Collapse
Affiliation(s)
- Zhiqiang Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Cuihua Leng
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Bo Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Haili Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jing Sun
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Zhaoxia Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Lingli Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Wei Ge
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jiangtao Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| |
Collapse
|
49
|
Koh W, Kallenberg K, Karch A, Frank T, Knauth M, Bähr M, Liman J. Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study. BMC Neurol 2017; 17:89. [PMID: 28490351 PMCID: PMC5426050 DOI: 10.1186/s12883-017-0872-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography. Methods We analyzed data of 104 examinations of the basilar artery. The association between sonographic peak systolic velocity (PSV) and degree of stenosis obtained by cerebral angiography was evaluated applying Spearman’s correlation coefficient. Receiver Operating Characteristics (ROC) curves and areas under the curve (AUC) were calculated for the detection of a ≥50% stenosis defined by angiography. Optimal cut-off was derived using the Youden-index. Results A weak but statistically significant correlation between PSV and the degree of stenosis was found (n=104, rho=0.35, p<0.001). ROC analysis for a detection of ≥50% stenosis showed an AUC of 0.70, a sensitivity of 74.0% and a specificity of 65.0% at the optimal cut off of 124 cm/s. Results were consistent when analyzing examinations done in stented and unstented arteries separately (TCD VS DSA/CTA in unstented artery: AUC=0.66, sensitivity 61.0%, specificity 65.0%, TCD/TCCS VS DSA in stented artery: AUC=0.63, sensitivity 71.0%, specificity 82.0%). Comparing TCCS measurements exclusively to angiography, ROC analysis showed an AUC of 1.00 for the detection of an in-stent-restenosis ≥50% with a sensitivity and specificity of 100% when a PSV of 132 cm/s was used as a cut off value. Conclusion Validity of TCD in the assessment of basilar artery stenosis or in-stent restenosis is poor. First results for TCCS are promising, but due to the small samplesize further studies with larger samples sizes are warranted.
Collapse
Affiliation(s)
- Woori Koh
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Kai Kallenberg
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - André Karch
- Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Tobias Frank
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Michael Knauth
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Mathias Bähr
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Jan Liman
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| |
Collapse
|
50
|
Anzola GP, Brighenti R, Cobelli M, Giossi A, Mazzucco S, Olivato S, Pari E, Piras MP, Padovani A, Rinaldi F, Turri G. Cerebral haemodynamics in early puerperium: A prospective study. ULTRASOUND (LEEDS, ENGLAND) 2017; 25:107-114. [PMID: 28567105 PMCID: PMC5438056 DOI: 10.1177/1742271x17690942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/08/2017] [Indexed: 11/15/2022]
Abstract
AIM Prospective study on 900 consecutive puerperae to assess normal values and range of the blood flow velocity in the middle cerebral artery in both hemispheres. MATERIAL AND METHOD M1 and M2 segments of both middle cerebral arteries were assessed in all subjects within 96 hours of delivery. Mean flow velocity was recorded after adjusting for insonation angle. Lindegaard index (LI = middle cerebral artery-Internal Carotid Artery mean flow velocity ratio) was calculated whenever the mean flow velocity exceeded 100 cm/second. Asymmetry indexes were calculated inter hemispherically for M1 and M2 segments separately. RESULTS Mean flow velocities were 74 ± 17 and 72 ± 17 in right and 73 ± 17 and 72 ± 17 cm/second in the left M1 and M2, respectively. A total of 136 subjects (12.1%) exceeded the threshold of 100 cm/second, but LI was consistently <3 in all of them. Mean flow velocity was inversely and independently correlated to haemoglobin levels and to parity. Mean asymmetry indexes were 0.25 ± 23 in M1 and 0.45 ± 25 in M2. CONCLUSION Mean flow velocity in the middle cerebral artery of healthy subjects in early puerperium is higher than in age-matched non-puerperal women and may exceed the threshold of 100 cm/second with no evidence of intracranial spasm, because of blood loss during delivery. Mean flow velocity is independently correlated with parity. Right-to-left mean flow velocity asymmetry may reach 50% as a consequence of a transient imbalance in vascular tone regulation.
Collapse
Affiliation(s)
- GP Anzola
- Consultant Neurologist, Villa Gemma Hospital, Gardone Riviera, Italy
| | - R Brighenti
- Department of Obstetrics and Gynaecology, Poliambulanza Hospital, Brescia, Italy
| | - M Cobelli
- Department of Radiology, Poliambulanza Hospital, Brescia, Italy
| | - A Giossi
- Department of Neurology, Azienda Socio Sanitaria Territoriale, Cremona, Italy
| | - S Mazzucco
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - E Pari
- Deparment of Neurology, Spedali Civili, University of Brescia, Brescia, Italy
| | - MP Piras
- Deparment of Neurology, Poliambulanza Hospital, Brescia, Italy
| | - A Padovani
- Deparment of Neurology, Spedali Civili, University of Brescia, Brescia, Italy
| | - F Rinaldi
- Deparment of Neurology, Spedali Civili, University of Brescia, Brescia, Italy
| | - G Turri
- Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| |
Collapse
|