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Kim J, Chang CH. Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series. Clin Neurol Neurosurg 2024; 246:108558. [PMID: 39326282 DOI: 10.1016/j.clineuro.2024.108558] [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: 05/25/2024] [Revised: 08/08/2024] [Accepted: 09/15/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVE To compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD). METHODS We retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method. RESULTS Among the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, p = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, p=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, p=0.097). CONCLUSION In the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.
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Affiliation(s)
- Jonghoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
| | - Chul-Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Wang MJ, Wang J, Zhang H, Hao FB, Gao G, Liu SM, Wang XP, Li JJ, Zou ZX, Guo QB, Fu HG, Han YQ, Han C, Duan L. High Level of Serum Complement C3 Expression is Associated with Postoperative Vasculopathy Progression in Moyamoya Disease. J Inflamm Res 2024; 17:1721-1733. [PMID: 38523687 PMCID: PMC10959296 DOI: 10.2147/jir.s451538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background The immune system plays an important role in the onset and development of moyamoya disease (MMD), but the specific mechanisms remain unclear. This study aimed to explore the relationship between the expression of complements and immunoglobulin in serum and progression of MMD. Methods A total of 84 patients with MMD and 70 healthy individuals were enrolled. Serum immunoglobulin and complement C3 and C4 expression were compared between healthy individuals and MMD patients. Follow-up was performed at least 6 months post-operation. Univariate and multivariate analysis after adjusting different covariates were performed to explore predictive factors associated with vasculopathy progression. A nomogram basing on the results of multivariate analysis was established to predict vasculopathy progression. Results Compared to healthy individuals, MMD patients had significantly lower expression of serum complements C3 (P = 0.003*). Among MMD patients, C3 was significantly lower in those with late-stage disease (P = 0.001*). Of 84 patients, 27/84 (32.1%) patients presented with vasculopathy progression within a median follow-up time of 13.0 months. Age (P=0.006*), diastolic blood pressure (P=0.004*) and serum complement C3 expression (P=0.015*) were associated with vasculopathy progression after adjusting different covariables. Conclusion Complement C3 is downregulated in moyamoya disease and decreases even further in late-Suzuki stage disease. Age, diastolic blood pressure and serum complement C3 expression are associated with vasculopathy progression, suggesting that the complement might be involved in the development of moyamoya disease.
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Affiliation(s)
- Min-Jie Wang
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jiayu Wang
- Department of Immunology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, People’s Republic of China
| | - Houdi Zhang
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Fang-Bin Hao
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Gan Gao
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Si-Meng Liu
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiao-Peng Wang
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jing-Jie Li
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Zheng-Xing Zou
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qing-Bao Guo
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - He-Guan Fu
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yi-Qin Han
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Cong Han
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Lian Duan
- Department of Neurosurgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
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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.
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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
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Yu LB, Shen M, Zhang Q, Zhang D. A Vessel Wall MRI Investigation in Patients With Moyamoya or Quasi-Moyamoya Disease: Diagnosis, Features, and Outcomes. J Craniofac Surg 2024; 35:e24-e28. [PMID: 37622552 DOI: 10.1097/scs.0000000000009681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND PURPOSE None of the previous studies have investigated the pathologic authenticity of affected arteries in moyamoya disease (MMD) and Quasi-MMD diagnosed by angiography. This study aimed to confirm the angiographic diagnosis of moyamoya as well as investigate the pathologic mechanisms in angiographically proven MMD and Quasi-MMD using high-resolution magnetic resonance imaging (MRI) in a large sample. METHODS We prospectively studied 116 patients who had angiographically proven MMD and Quasi-MMD. Each affected internal carotid artery, and middle cerebral artery was independently evaluated. In addition, clinical features and postoperative outcomes were compared between hemispheres with MMD and moyamoya syndrome (MMS). RESULTS Among 116 patients analyzed, 88 and 22 patients had angiographically proven MMD and Quasi-MMD, respectively. high-resolution magnetic resonance imaging confirmed bilateral MMD in 73 (83.0%) patients, 1 hemisphere with MMD and the other with intracranial atherosclerotic disease (ICAD) in 10 (11.4%) patients, and bilateral hemispheres with different vasculopathies in 5 (5.7%) patients. Detailed analysis of 204 affected hemispheres showed that several combinations of different vasculopathies were observed in the internal carotid artery and middle cerebral artery of the same hemisphere, such as ICAD-ICAD, ICAD-MMD, dissection-ICAD, and dissection-MMD. Hemispheres were assigned to MMD and MMS groups according to their vasculopathies. Transient ischemic attack occurred more frequently in hemispheres with MMD (48.1% versus 21.1%, P =0.024), whereas symptomatic ischemia was more common in hemispheres with MMS (57.9% versus 24.9%, P =0.002). However, postoperative cerebral infarction, symptom improvement and neo-formative collaterals showed no significant difference between hemispheres with MMD and MMS ( P >0.05). CONCLUSIONS Patients with angiographically proven MMD or Quasi-MMD needed more accurate evaluation combined with high-resolution magnetic resonance imaging. Highly selected patients with MMS might also obtain benefits from surgical revascularization.
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Affiliation(s)
- Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Mi Shen
- China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases (NCRC-ND)
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
- Department of Neurosurgery, Beijing Hospital, Beijing, China
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Wang P, Zhang L, Zhang W, Shi T, Sun Y, Cui S, Zhang D, Kong F, Wang T. Dural arteriovenous fistula with spinal dural arteriovenous fistula: a case report and review of the literature. J Med Case Rep 2023; 17:467. [PMID: 37872601 PMCID: PMC10594680 DOI: 10.1186/s13256-023-04170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 09/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This paper analyzed the cases of dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) in the diagnosis and treatment process. CASE PRESENTATION One case involving dural arteriovenous fistula (DAVF) with spinal dural arteriovenous fistula (SDAVF) from the 306th Hospital of PLA was retrospectively analyzed. The patient consulted the doctor due to lower limb sensory and motor disorders while exhibiting symptoms of urinary dysfunction. A computed tomographic angiography (CTA) and cerebral angiography confirmed the diagnosis of dural arteriovenous fistula (DAVF), necessitating surgical treatment. The patient was referred to our hospital for an magnetic resonance imaging (MRI) and a spinal angiography to obtain a confirmed diagnosis for spinal arteriovenous fistula, after which they underwent surgical fistula resection. The invasive intracranial dural arteriovenous fistula (DAVF) resection proceeded smoothly but did not ease the patient's symptoms. However, postoperative symptoms were partially relieved by the lumbar open spinal dural arteriovenous fistula adminstration. CONCLUSIONS Since not enough is understood about these two diseases, the rate of misdiagnosis is significantly increased. Early diagnosis and treatment of spinal dural arteriovenous fistula (SDAVF) can play a positive role during the recovery from neural function damage.
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Affiliation(s)
- Peixin Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Lele Zhang
- Department of Spine Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Wenqian Zhang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, 100101, China
| | - Tiejun Shi
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Yikun Sun
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Shaojie Cui
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Dan Zhang
- Core Facility, Center of Biomedical Analysis, Tsinghua University, Beijing, 100091, China
| | - Fanxuan Kong
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China.
| | - Tao Wang
- Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China.
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Kuroda S, Yamamoto S, Funaki T, Fujimura M, Kataoka H, Hishikawa T, Takahashi J, Endo H, Nariai T, Osato T, Saito N, Sato N, Hori E, Ito YM, Miyamoto S. Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE). Stroke 2023; 54:1494-1504. [PMID: 37216455 DOI: 10.1161/strokeaha.122.041932] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/30/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Long-term outcomes are unknown in patients with asymptomatic moyamoya disease. In this report, we aimed to clarify their 5-year risk of stroke and its predictors. METHODS We are conducting a multicenter, prospective cohort study (Asymptomatic Moyamoya Registry) in Japan. Participants were eligible if they were 20 to 70 years, had bilateral or unilateral moyamoya disease, experienced no episodes suggestive of TIA and stroke; and were functionally independent (modified Rankin Scale score 0-1). Demographic and radiological information was collected at enrollment. In this study, they are still followed up for 10 years. In this interim analysis, we defined the primary end point as a stroke occurring during a 5-year follow-up period. Independent predictors for stroke were also determined, using a stratification analysis method. RESULTS Between 2012 and 2015, we enrolled 109 patients, of whom 103 patients with 182 involved hemispheres completed the 5-year follow-up. According to the findings on DSA and MRA, 143 hemispheres were judged as moyamoya disease and 39 hemispheres as questionable manifestations (isolated middle cerebral artery stenosis). The patients with questionable hemispheres were significantly older, more often male, and more frequently had hypertension than those with moyamoya hemisphere. Moyamoya hemispheres developed 7 strokes, including 6 hemorrhagic and 1 ischemic stroke, during the first 5 years. The annual risk of stroke was 1.4% per person, 0.8% per hemisphere, and 1.0% per moyamoya hemisphere. Independent predictor for stroke was Grade-2 choroidal anastomosis (hazard ratio, 5.05 [95% CI, 1.24-20.6]; P=0.023). Furthermore, microbleeds (hazard ratio, 4.89 [95% CI, 1.13-21.3]; P=0.0342) and Grade-2 choroidal anastomosis (hazard ratio, 7.05 [95% CI, 1.62-30.7]; P=0.0093) significantly predicted hemorrhagic stroke. No questionable hemispheres developed any stroke. CONCLUSIONS The hemispheres with asymptomatic moyamoya disease may carry a 1.0% annual risk of stroke during the first 5 years, the majority of which are hemorrhagic stroke. Grade-2 choroidal anastomosis may predict stroke, and the microbleeds and Grade-2 choroidal anastomosis may carry the risk for hemorrhagic stroke. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: UMIN000006640.
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Affiliation(s)
- Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Shusuke Yamamoto
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (T.F., S.M.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (M.F.)
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.K.)
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Japan (T.H.)
| | - Jun Takahashi
- Department of Neurosurgery, Kindai University School of Medicine, Sayama, Japan (J.T.)
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan (H.E.)
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan (T.N.)
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (T.O.)
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan (N. Saito)
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center (N. Sato), Hokkaido University Hospital, Sapporo, Japan
| | - Emiko Hori
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care (Y.M.I.), Hokkaido University Hospital, Sapporo, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (T.F., S.M.)
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Li X, Liu C, Zhu L, Wang M, Liu Y, Li S, Deng Q, Zhou J. The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review. Brain Sci 2023; 13:brainsci13040677. [PMID: 37190642 DOI: 10.3390/brainsci13040677] [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: 03/07/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
High-resolution magnetic resonance imaging (HRMRI) is the most important and popular vessel wall imaging technique for the direct assessment of vessel wall and cerebral arterial disease. It can identify the cause of stroke in high-risk plaques and differentiate the diagnosis of head and carotid artery dissection, including inflammation, Moya Moya disease, cerebral aneurysm, vasospasm after subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, blunt cerebrovascular injury, cerebral arteriovenous malformations, and other stenosis or occlusion conditions. Through noninvasive visualization of the vessel wall in vitro, quantified assessment of luminal stenosis and pathological features of the vessel wall can provide clinicians with further disease information. In this report, technical considerations of HRMRI are discussed, and current clinical applications of HRMRI are reviewed.
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Affiliation(s)
- Xiaohui Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Chengfang Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Shuo Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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He WW, Lu SS, Ge S, Gu P, Shen ZZ, Wu FY, Shi HB. Impact on etiology diagnosis by high-resolution vessel wall imaging in young adults with ischemic stroke or transient ischemic attack. Neuroradiology 2023; 65:1015-1023. [PMID: 36806972 DOI: 10.1007/s00234-023-03131-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The etiological features of stroke in young adults are different from those in older adults. We aimed to investigate the impact of high-resolution vessel wall imaging (HRVWI) on etiologic diagnosis in young adults with ischemic stroke or transient ischemic attack (TIA). METHODS A total of 253 young adults (aged 18-45 years) who consecutively underwent HRVWI for clarifying stroke etiology were retrospectively recruited. Two experienced neurologists classified stroke etiology for each patient using Trial of Org 10,172 in Acute Stroke Treatment categories with and without the inclusion of HRVWI diagnosis. Multivariate logistic regression was performed to determine which etiologic category would be significantly impacted after including HRVWI. RESULTS The etiologic classification was altered in 39.1% (99/253) of patients after including HRVWI in the conventional investigations. The proportion of patients classified as having stroke of undetermined etiology (SUE) and the proportion of patients classified as having small-artery occlusion (SAO) both significantly decreased (36.4 to 13.8% and 9.1 to 2.0%), whereas the proportion of patients classified as having large artery atherosclerosis (LAA) significantly increased (28.5 to 58.1%) (all P < 0.001). The inclusion of HRVWI had a significant diagnostic impact on young adults who were primarily classified as SAO (odds ratio [OR] 14.4, 95% confidence interval [CI] [2.9, 71.8], P < 0.001) or SUE (OR 8.3, 95% CI [2.2, 31.5], P < 0.01). CONCLUSIONS HRVWI had a substantial impact on etiologic classification in young adults with ischemic stroke or TIA, particularly for those primarily classified as having SAO or SUE. This impact of HRVWI will be beneficial for therapeutic decision-making.
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Affiliation(s)
- Wen-Wen He
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shan-Shan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Song Ge
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ping Gu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zi-Zhen Shen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
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HR-MRI findings of intracranial artery stenosis and distribution of atherosclerotic plaques caused by different etiologies. Neurol Sci 2022; 43:5421-5430. [DOI: 10.1007/s10072-022-06132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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10
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Characterization of Moyamoya and Middle Cerebral Artery Diseases by Carotid Canal Diameter and RNF213 p.R4810K Genotype. J Stroke Cerebrovasc Dis 2022; 31:106481. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
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Li L, Tang M, Yan X, Gao J, Ma N, Shi X, Niu Y, Wen Y, Ai K, Lei X, Zhang X. Plaque Characteristics in Young Adults With Symptomatic Intracranial Atherosclerotic Stenosis: A Preliminary Study. Front Neurol 2022; 13:825503. [PMID: 35222253 PMCID: PMC8868124 DOI: 10.3389/fneur.2022.825503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To determine how intracranial vascular wall and atherosclerosis plaque characteristics differ between young and old adults with sICAS. Methods Eighty-four consecutive patients with sICAS who underwent high-resolution magnetic resonance imaging (HRMRI) from December 2017 to July 2020 were retrospectively collected. These participants were divided into young adult group (18–50 years, n = 28) and old adult group (>50 years, n = 56). Reviewers were blinded to any clinical information and HRMRI scans were analyzed for qualitative and quantitative indicators of vascular walls and plaque at the maximal lumen narrowing site using the independent-sample t-test, Mann–Whitney U-test, chi-square test or Fisher exact test, and logistic regression analysis. Results Young patients with sICAS had significantly smaller maximum wall thickness (1.45 ± 0.38 vs.1.75 ± 0.51 mm2, P = 0.003), higher prevalence of positive remodeling (53.57 vs. 21.43%, P = 0.003), and lower prevalence of diabetes mellitus (14.29 vs. 35.71%, P = 0.04) than old patients. Plaque burden and other plaque features were comparable between young and old patients. Conclusion Young patients with sICAS have smaller maximum wall thickness and greater ability to reconstruct, and are more likely to show positive remodeling, which may lead to some atherosclerotic lesions being missed. Young patients with evidence of vessel narrowing should be carefully examined for presence of high-risk atherosclerotic plaque.
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Affiliation(s)
- Ling Li
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Min Tang
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xuejiao Yan
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jie Gao
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Niane Ma
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaorui Shi
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yaxin Niu
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Wen
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Kai Ai
- Philips Healthcare, Xi'an, China
| | - Xiaoyan Lei
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Xiaoyan Lei
| | - Xiaoling Zhang
- Department of Magnetic Resonance Imaging, Shaanxi Provincial People's Hospital, Xi'an, China
- Xiaoling Zhang
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12
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High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease. Neuroradiology 2022; 64:1569-1577. [PMID: 35112218 DOI: 10.1007/s00234-021-02891-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE High-resolution MR vessel wall imaging (HRVWI) can characterise vessel wall pathology affecting intracranial circulation and helps in differentiating intracranial vasculopathies. The aim was to differentiate intracranial pathologies involving middle cerebral artery (MCA) in patients with ischemic stroke and characterise the high-risk plaques in intracranial atherosclerotic disease (ICAD) using HRVWI. METHODS Patients with ischemic stroke with isolated MCA disease with ≥ 50% luminal narrowing by vascular imaging were enrolled within 2 weeks of onset and underwent high-resolution (3 T) intracranial vessel wall imaging (VWI). The pattern of vessel wall thickening, high signal on T1-weighted images, juxtaluminal hyperintensity, pattern and grade of enhancement were studied. The TOAST classification before and after HRVWI and the correlation of the recurrence of ischemic events at 3 months with imaging characteristics were analysed. RESULTS Of the 36 patients, the mean age was 49.53 ± 15.61 years. After luminal imaging, by TOAST classification, 12 of 36 patients had stroke of undetermined aetiology. After vessel wall imaging, lesions in MCA were analysed. Of them, 23 patients had ICAD, 8 had vasculitis, and 2 had partially occlusive thrombus in MCA. The ability of HRVWI to bring a change in diagnosis was significant (p = 0.031). Of the 23 patients with ICAD, 12 patients had recurrent strokes within 3 months. The presence of grade 2 contrast enhancement (p = 0.02) and type 2 wall thickening (p = 0.03) showed a statistically significant association with recurrent ischemic events. CONCLUSION High-resolution MRVWI can help in identifying the aetiology of stroke. The HRVWI characteristics in ICAD can help in risk stratification.
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Im SH, Jang DK, Kim H, Park SK, Han KD. Long-term mortality in patients with moyamoya angiopathy according to stroke presentation type in South Korea. Acta Neurochir (Wien) 2021; 163:3473-3481. [PMID: 34427768 DOI: 10.1007/s00701-021-04959-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Incidence, prevalence, and long-term survival outcomes in patients with moyamoya angiopathy (MMA) according to stroke presentation type and age group have not been clearly elucidated. METHODS We investigated mortality in patients with MMA (moyamoya disease, probable moyamoya disease, moyamoya syndrome) of whose International Classification Disease 10 code was I67.5 from 2006 to 2015 using the Korean National Health Insurance database. MMA at diagnosis was classified into 3 types (ischemic, hemorrhagic, and asymptomatic or else) according to stroke presentation. Survival analysis was performed according to stroke presentation type and age group (< 15 years and ≥ 15 years) using the Kaplan-Meier method. RESULTS There were 12,146 newly diagnosed moyamoya cases, with a female-to-male ratio of 1.81; the ischemic type was identified in 3671 (30.2%) patients, the hemorrhagic type in 2449 (20.2%) patients, and the asymptomatic or else type in 6026 (49.6%) patients. The mean age at diagnosis according to stroke presentation was 33.1 (± 14.8) years in asymptomatic or else type, 41.2 (± 17.3) years in ischemic type, and 45.4 (± 14.3) years in hemorrhagic type (P < 0.001). The 10-year survival rates in ischemic-, hemorrhagic-, and asymptomatic or else-type patients were 88.9%, 76.3%, and 94.3%, respectively (log-rank test; P < 0.001). Pediatric MMA (< 15 years) and adult MMA (≥ 15 years) showed different survival curves according to stroke presentation type (log-rank test; P = 0.017, P < 0.001, respectively). CONCLUSIONS Our study showed that moyamoya patients had different diagnosis ages and distinct survival courses according to stroke presentation type. Adult moyamoya patients with hemorrhagic presentation had the worst survival outcomes.
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Affiliation(s)
- Sang-Hyuk Im
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Kyu Jang
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
| | - Hoon Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Kang H, Liang J, Zhang Y, Li Z, Yang X, Sui B. Imaging Features of Symptomatic MCA Stenosis in Patients of Different Ages: A Vessel Wall MR Imaging Study. AJNR Am J Neuroradiol 2021; 42:1934-1941. [PMID: 34475196 DOI: 10.3174/ajnr.a7268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The prevalence of intracranial artery stenosis is high in Asian people. This study aimed to investigate whether there are differences in the imaging features of symptomatic MCA stenosis in patients of different ages using vessel wall MR imaging. MATERIALS AND METHODS We retrospectively reviewed the data of consecutive patients with unilateral MCA stenosis based on a prospectively established vessel wall MR imaging data base between January 2017 and December 2018. According to age, the patients were divided into the young group (18-45 years of age) and the middle-aged and elderly group (older than 45 years of age). RESULTS Overall, 131 patients with unilateral MCA stenosis were included (45.8% in the young group and 54.2% in the middle-aged and elderly group). Middle-aged and elderly patients had a higher prevalence of hypertension (P = .01) and diabetes (P = .05). The lesion length (P < .0001), proportion of circular involvement (P = .006), and proportion of circular enhancement (P = .03) were higher in the young group than in the middle-aged and elderly group. The analysis of the atherosclerotic subgroup showed that compared with middle-aged and elderly patients, young patients had longer lesions (P = .002). The atherosclerotic-versus-nonatherosclerotic subgroup analysis showed that the maximal wall thickness in the patients with atherosclerosis was larger than that of patients without it (P = .002). CONCLUSIONS Compared with the middle-aged and elderly group, young patients with MCA stenosis tended to have longer lesions and more circular wall involvement and circular enhancement, which may indicate the differences in underlying vascular pathophysiologic and developmental mechanisms in symptomatic MCA stenosis.
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Affiliation(s)
- H Kang
- From the Beijing Neurosurgical Institute (H.K., Y.Z., X.Y.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J Liang
- Shijingshan Teaching Hospital of Capital Medical University (J.L.), Beijing Shijingshan Hospital, Beijing, China
| | - Y Zhang
- From the Beijing Neurosurgical Institute (H.K., Y.Z., X.Y.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Z Li
- Tiantan Neuroimaging Center for Excellence (Z.L., B.S.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - X Yang
- From the Beijing Neurosurgical Institute (H.K., Y.Z., X.Y.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - B Sui
- Tiantan Neuroimaging Center for Excellence (Z.L., B.S.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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15
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Kim JS. Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines. J Stroke 2021; 23:149-161. [PMID: 34102752 PMCID: PMC8189863 DOI: 10.5853/jos.2021.01249] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of "high-intensity statins" and "low LDL-C target" strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Xu W, Zhang X, Chen H, Zhao Z, Zhu M. Prevalence and outcome of young stroke patients with middle cerebral artery stenosis. BMC Neurol 2021; 21:99. [PMID: 33663425 PMCID: PMC7931598 DOI: 10.1186/s12883-021-02125-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/18/2021] [Indexed: 12/31/2022] Open
Abstract
Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.
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Affiliation(s)
- Wenjuan Xu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, China
| | - Xiaoyu Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, 250014, China
| | - Huan Chen
- Department of Neurology, First People's Hospital of Jinan, Jinan, 250013, China
| | - Zhangning Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, 250014, China
| | - Meijia Zhu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, 250014, China.
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17
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Lehman VT, Cogswell PM, Rinaldo L, Brinjikji W, Huston J, Klaas JP, Lanzino G. Contemporary and emerging magnetic resonance imaging methods for evaluation of moyamoya disease. Neurosurg Focus 2020; 47:E6. [PMID: 31786551 DOI: 10.3171/2019.9.focus19616] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/06/2019] [Indexed: 11/06/2022]
Abstract
Numerous recent technological advances offer the potential to substantially enhance the MRI evaluation of moyamoya disease (MMD). These include high-resolution volumetric imaging, high-resolution vessel wall characterization, improved cerebral angiographic and perfusion techniques, high-field imaging, fast scanning methods, and artificial intelligence. This review discusses the current state-of-the-art MRI applications in these realms, emphasizing key imaging findings, clinical utility, and areas that will benefit from further investigation. Although these techniques may apply to imaging of a wide array of neurovascular or other neurological conditions, consideration of their application to MMD is useful given the comprehensive multidimensional MRI assessment used to evaluate MMD. These MRI techniques span from basic cross-sectional to advanced functional sequences, both qualitative and quantitative.The aim of this review was to provide a comprehensive summary and analysis of current key relevant literature of advanced MRI techniques for the evaluation of MMD with image-rich case examples. These imaging methods can aid clinical characterization, help direct treatment, assist in the evaluation of treatment response, and potentially improve the understanding of the pathophysiology of MMD.
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Affiliation(s)
| | | | | | | | | | - James P Klaas
- 3Neurology, Mayo Clinic College of Graduate Medical Education, Rochester, Minnesota
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18
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Song JW, Moon BF, Burke MP, Kamesh Iyer S, Elliott MA, Shou H, Messé SR, Kasner SE, Loevner LA, Schnall MD, Kirsch JE, Witschey WR, Fan Z. MR Intracranial Vessel Wall Imaging: A Systematic Review. J Neuroimaging 2020; 30:428-442. [PMID: 32391979 DOI: 10.1111/jon.12719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of this systematic review is to identify trends and extent of variability in intracranial vessel wall MR imaging (VWI) techniques and protocols. Although variability in selection of protocol design and pulse sequence type is known, data on what and how protocols vary are unknown. Three databases were searched to identify publications using intracranial VWI. Publications were screened by predetermined inclusion/exclusion criteria. Technical development publications were scored for completeness of reporting using a modified Nature Reporting Summary Guideline to assess reproducibility. From 2,431 articles, 122 met the inclusion criteria. Trends over the last 23 years (1995-2018) show increased use of 3-Tesla MR (P < .001) and 3D volumetric T1-weighted acquisitions (P < .001). Most (65%) clinical VWI publications report achieving a noninterpolated in-plane spatial resolution of ≤.55 mm. In the last decade, an increasing number of technical development (n = 20) and 7 Tesla (n = 12) publications have been published, focused on pulse sequence development, improving cerebrospinal fluid suppression, scan efficiency, and imaging ex vivo specimen for histologic validation. Mean Reporting Summary Score for the technical development publications was high (.87, range: .63-1.0) indicating strong scientific technical reproducibility. Innovative work continues to emerge to address implementation challenges. Gradual adoption into the research and scientific community was suggested by a shift in the name in the literature from "high-resolution MR" to "vessel wall imaging," specifying diagnostic intent. Insight into current practices and identifying the extent of technical variability in the literature will help to direct future clinical and technical efforts to address needs for implementation.
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Affiliation(s)
- Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Morgan P Burke
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Mark A Elliott
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven R Messé
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Scott E Kasner
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA.,Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Laurie A Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA.,Department of Otolaryngology, Hospital of University of Pennsylvania, Philadelphia, PA
| | | | - John E Kirsch
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Walter R Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Zhaoyang Fan
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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19
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Xiao L, Chu W, Wang H. Color-coded duplex sonography vs. 3.0 Tesla magnetic resonance angiography for detection of intracranial stenosis of the internal carotid artery: A prospective cohort study. Exp Ther Med 2019; 19:473-480. [PMID: 31885696 PMCID: PMC6913323 DOI: 10.3892/etm.2019.8255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022] Open
Abstract
Hemodynamic changes may provide important information for clinical decision-making in internal carotid artery (ICA) stenosis. The degree of stenosis is responsible for the hemodynamic changes. For detection of intracranial stenosis, each diagnostic method has its own advantages and disadvantages. The goal of the present study was to compare the sensitivity and accuracy of color-coded duplex sonography with that of magnetic resonance angiography (MRA) for the detection of intracranial stenosis. Patients with 3 vessels and/or left stem coronary artery disease were subjected to transcranial and extracranial color-coded duplex sonography (n=998), MRA (n=998) and invasive catheter angiography (n=939). The degree of stenosis was defined according to the Warfarin-Aspirin Symptomatic Intracranial Disease methodology. A ≥50% reduction in artery diameter was considered as a positive obstructive lesion. The benefits of each imaging method were assessed by clinical decision-making analysis. Color-coded duplex sonography and MRA, had sensitivities of 0.935 and 0.957 and accuracies of 0.92 and 0.974, respectively, when using invasive catheter angiography as a gold standard. The number of false-positive obstructive lesions detected by MRA was significantly higher than that for color-coded duplex sonography (53 vs. 13, P<0.0001). Color-coded duplex sonography was able to detect an obstructive lesion in one single image for ICAs with ≥57% stenosis, while MRA was only capable of detecting an obstructive lesion in one single image for ICAs with ≥80% stenosis. In conclusion, color-coded duplex sonography is a reliable method for the detection of intracranial stenosis in patients with coronary artery disease.
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Affiliation(s)
- Lu Xiao
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
| | - Wen Chu
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
| | - Hua Wang
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan 471000, P.R. China
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Song JW, Guiry SC, Shou H, Wang S, Witschey WR, Messé SR, Kasner SE, Loevner LA. Qualitative Assessment and Reporting Quality of Intracranial Vessel Wall MR Imaging Studies: A Systematic Review. AJNR Am J Neuroradiol 2019; 40:2025-2032. [PMID: 31727743 DOI: 10.3174/ajnr.a6317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last quarter-century, the number of publications using vessel wall MR imaging has increased. Although many narrative reviews offer insight into technique and diagnostic applications, a systematic review of publication trends and reporting quality has not been conducted to identify unmet needs and future directions. PURPOSE We aimed to identify which intracranial vasculopathies need more data and to highlight areas of strengths and weaknesses in reporting. DATA SOURCES PubMed, EMBASE, and MEDLINE databases were searched up to September 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA ANALYSIS Two independent reviewers screened and extracted data from 128 articles. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to assess the reporting quality of analytic observational studies. DATA SYNTHESIS There has been an exponentially increasing trend in the number of vessel wall MR imaging publications during the past 24 years (P < .0001). Intracranial atherosclerosis is the most commonly studied intracranial vasculopathy (49%), followed by dissections (13%), aneurysms (8%), and vasculitis (5%). Analytic observational study designs composed 48% of the studies. Transcontinental collaborations showed nonsignificantly higher reporting quality compared with work originating from single continents (P = .20). LIMITATIONS A limitation is the heterogeneity in study designs. CONCLUSIONS Investigations on the diagnostic utility of vessel wall MR imaging in less commonly studied intracranial vasculopathies such as dissections, aneurysms, and vasculitis are warranted. More consistent adherence to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines should improve transparency and maximize effective synthesis for clinical translation. Diverse collaborative teams are encouraged to advance the understanding of intracranial vasculopathies using vessel wall MR imaging.
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Affiliation(s)
- J W Song
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - S C Guiry
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - H Shou
- Department of Biostatistics, Epidemiology and Informatics (H.S.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Wang
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - W R Witschey
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | | | | | - L A Loevner
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
- Otolaryngology (L.A.L.)
- Neurosurgery (L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Xu W. High-resolution MRI of intracranial large artery diseases: how to use it in clinical practice? Stroke Vasc Neurol 2019; 4:102-104. [PMID: 31338221 PMCID: PMC6613940 DOI: 10.1136/svn-2018-000210] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
High-resolution MRI (HRMRI) has emerged as a useful tool for clinical research in recent years. Compared with traditional cranial and vessel imaging, HRMRI provides more additional valuable pathophysiology information that is helpful for the differential diagnosis of intracranial atherosclerosis, dissection and vasculitis. However, there are some points that a neurologist should keep in mind. First, although enhanced vessel wall imaging is widely applied for research purposes, it is not appropriate for routine clinical use. Any injury or inflammation within vessel wall can result in enhancement, which is unspecific for a diagnosis. Second, although plaque components identified on HRMRI arouse researchers' interest, they may have limited positive predictive value for future stroke. Ruptured plaques may have higher prevalence in asymptomatic patients than expected. More prospective observational studies are required. Third, the vessel wall morphology features remain the useful and reliable clue for a diagnosis. It is true that eccentric vessel wall lesions most likely represent atherosclerosis if vessel dissection is easily excluded. For concentric wall lesions, however, the underlying pathophysiology is complicated, either atherosclerotic or non-atherosclerotic. Fourth, HRMRI can show luminal thrombus directly and provide valuable details. All in all, when HRMRI is used by a neurologist, it should not be viewed as the only key for a diagnosis. The diagnosis should be made based on patient history, lab works, other imaging technique and even genetic examinations.
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Affiliation(s)
- Weihai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Bang OY, Kim BM, Seo WK, Jeon P. Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin-Neuroimaging Perspectives. Front Neurol 2019; 10:269. [PMID: 30949124 PMCID: PMC6435574 DOI: 10.3389/fneur.2019.00269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70-80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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The Clinical and Vascular Characteristics of RNF213 c.14576G>A Variant-Related Intracranial Major Artery Disease in China. Behav Neurol 2019; 2019:7908392. [PMID: 30992731 PMCID: PMC6434291 DOI: 10.1155/2019/7908392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Recently, several studies indicated the c.14576G>A variant on the ring finger protein 213 (RNF213), a founder variant of moyamoya diseases (MMD), was associated with non-MMD intracranial major artery stenosis/occlusion (non-MMD ICASO). We proposed that RNF213 variant-related ICASO including MMD might be a special entity with its own characteristics based on a genetic background. The aim of the study was to learn the clinical and vascular features of RNF213 variant-related ICASO. Moreover, we tried to explore the clinical significance of a testing variant in ICASO patients in China. Methods Clinical material and routine image data were collected in 160 Chinese patients with ICASO, including 41 verified MMD and 119 non-MMD. DNA samples were extracted, and the c.14576G>A variant on RNF213 was genotyped. Then, the clinical and vascular features were compared between the patients with and without a relevant variant. Furthermore, the patients with RNF213 mutation were performed with high resolution magnetic resonance imaging (HR-MRI) examination to conclude features of the artery wall. Results There were 16 (10%) patients (including 9 MMD and 7 non-MMD ICASO) presenting a heterozygous c.14576G>A variant while none of homozygote was found. Compared to the patients without the c.14576G>A variant, the variant group had more female, less symptomatic patients, and more possibility of having collateral vessels in vascular imaging. In the symptomatic subgroup, there is no significant difference in clinical presentation (p > 0.05) between two groups. However, RNF213 variant-related ICASO had lower scores in NIHSS (1.0 ± 3.0 vs. 3.9 ± 5.0, p < 0.05) but not in mRS. In the symptomatic subgroup, in addition, most of the HR-MRI images of variant ICASO (77.8%, 7 of 9) were characterized by a shrunken outer diameter, concentric thickening vessel wall, and collateral vessel structures on the stenotic portion, which was prone to be diagnosed as HR-MMD (a MMD diagnosis diagnosed by HR-MRI). The rest of the two variants showed a relatively eccentric luminal narrow, normal outer diameter without collateral vessel findings, identified as HR-ICAD (intracranial atherosclerotic disease diagnosed by HR-MRI). Conclusions Our study demonstrated that the c.14576G>A variant on RNF213 may be a biomarker to good outcome of ICASO in Chinese. The variant-related ICASO was characterized by both features of MMD and ICAD diagnosed by HR-MRI.
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Song Y, Lee D, Suh DC, Kim JG, Kim JK, Han M, Liu H, Zhao L, Kim EH, Jung SC, Lee DG, Koo HJ, Kim MJ, Baek S, Hwang SM, Kim BJ, Kim YJ, Cho HJ, Kim SJ, Jeon SB, Kim JS. Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis. Neurointervention 2019; 14:43-52. [PMID: 30827064 PMCID: PMC6433193 DOI: 10.5469/neuroint.2018.01123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. Materials and Methods All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. Results Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. Conclusion In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joong-Goo Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hairi Liu
- Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, China
| | - Lingbo Zhao
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Eun Hye Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung Chul Jung
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dong-Geun Lee
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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The ability of magnetic resonance black blood vessel wall imaging to evaluate blunt cerebrovascular injury following acute trauma. J Neuroradiol 2019; 47:210-215. [PMID: 30677426 DOI: 10.1016/j.neurad.2019.01.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Blunt cerebrovascular injury (BCVI) is associated with a significant risk of ischemic stroke when left untreated. Cross-sectional imaging is vital to early BCVI diagnosis and treatment; however, conventional luminal vessel imaging is limited in its ability to evaluate for vessel wall pathology. The purpose of this study is to evaluate the ability of vessel wall magnetic resonance imaging (VWI) to detect and evaluate BCVI in acutely injured trauma patients relative to neck computed tomographic angiography (CTA). MATERIALS AND METHODS Trauma patients with suspected BCVI on initial neck CTA were prospectively recruited for VWI evaluation. Two neuroradiologists blinded to patient clinical history and CTA findings evaluated each artery independently on VWI and noted the presence and grade of BCVI. These results were subsequently compared to neck CTA findings relative to expert clinical consensus review. Interrater reliability of VWI for detecting BCVI was evaluated using a weighted Cohen κ-statistic. RESULTS Ten trauma patients (40 cervical arteries) were prospectively evaluated using both CTA and VWI. Out of 18 vascular lesions identified as suspicious for BCVI on CTA, six lesions were determined to represent true BCVI by expert consensus review. There was almost perfect agreement between VWI and expert consensus regarding the presence and grade of BCVI (κ=0.82). This agreement increased when considering only low grade BCVI. There was only fair agreement between CTA and expert clinical consensus (κ=0.36). This agreement decreased when considering only low grade BCVI. CONCLUSIONS VWI can potentially accurately identify and evaluate BCVI in acutely injured trauma patients with excellent inter-rater reliability.
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Han Y, Qiao H, Chen S, Jing J, Pan Y, Li D, Liu Y, Meng X, Wang Y, Zhao X. Intracranial artery stenosis magnetic resonance imaging aetiology and progression study: Rationale and design. Brain Behav 2018; 8:e01154. [PMID: 30456898 PMCID: PMC6305940 DOI: 10.1002/brb3.1154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been shown that intracranial artery stenosis (ICAS) plays a key role in Chinese ischemic stroke or transient ischemic attack (TIA) patients. Many vascular diseases can lead to ICAS, such as atherosclerosis, dissection, vasculitis, moyamoya disease, and reversible cerebral vasoconstriction syndrome (RCVS). In addition, progression of intracranial atherosclerotic disease (ICAD) will increase the risk of ischemic cerebrovascular events. The ICASMAP study primarily aims to determine the etiology and disease distribution of ICAS using noninvasive magnetic resonance (MR) imaging and evaluate the rate for progression of ICAD in symptomatic population. METHODS The ICASMAP study is a prospective, observational, and multicenter study by recruiting 300 subjects (18-80 years old) with recent stroke or TIA (within 2 weeks after onset of symptoms) in China. All the subjects will undergo MR imaging examination including brain and intracranial artery MR imaging at baseline. In addition, the clinical risk factors will be collected and blood biomarkers will be tested. A subgroup of more than 200 subjects who were diagnosed with ICAD according to baseline MR imaging will be followed up for 2 years. During the follow-up study, MR imaging examination will be performed at 12 and 24 months. The primary end point is presence of progression of intracranial artery atherosclerotic plaques. CONCLUSIONS The ICASMAP study investigates the etiology of ICAS and progression of ICAD in Chinese stroke patients and may help to improve the precise diagnosis and intervention of ICAS and stroke prevention.
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Affiliation(s)
- Yongjun Han
- Center for Brain Disorders Research, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Huiyu Qiao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Shuo Chen
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Dongye Li
- Center for Brain Disorders Research, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Yang Liu
- Department of Radiology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Shin J, Chung JW, Park MS, Lee H, Cha J, Seo WK, Kim GM, Bang OY. Outcomes after ischemic stroke caused by intracranial atherosclerosis vs dissection. Neurology 2018; 91:e1751-e1759. [PMID: 30291187 DOI: 10.1212/wnl.0000000000006459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/28/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To compare the outcomes between patients with nontraumatic intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) using high-resolution MRI (HR-MRI). METHODS We conducted a prospective study using HR-MRI in patients with acute symptomatic cerebrovascular disease due to intracranial occlusive disease and no dissection on luminal images. Patients were followed-up for 27.9 ± 19.3 months. We compared the functional outcome, recurrence, and changes in vascular status between patients with ICAD (dissection and no plaque on HR-MRI) and ICAS (atherosclerosis plaque on HR-MRI). RESULTS We included 312 patients (mean age, 59.0 ± 14.2 years; men, 58.3%), of whom 113 had ICAD and 199 had ICAS. The functional outcome (as measured by modified Rankin Scale score) on the 90th day after symptom onset was not different between the groups, after adjusted for other factors (p = 0.095). However, recurrent ischemic cerebrovascular disease on the relevant vascular territory was lower in the ICAD group (7 patients, 6.2%) than in the ICAS group (37 patients, 18.6%). ICAD was a significant independent determinant of disease recurrence (hazard ratio, 0.43; 95% confidence interval, 0.19-0.98). Improvement in vascular stenosis on follow-up vascular studies was more frequently observed in ICAD (50.7%) than in ICAS (11.6%). ICAD was an independent determinant of vascular improvement (odds ratio, 7.94; 95% confidence interval, 3.32-19.01). CONCLUSION Considering the high prevalence of ICAD in the patients with presumed ICAS and the differential outcomes between ICAD and ICAS, HR-MRI may be a useful diagnostic tool in this population.
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Affiliation(s)
- Jaewon Shin
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Jong-Won Chung
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Moo Seok Park
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Hanul Lee
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Jihoon Cha
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Keun Seo
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea
| | - Oh Young Bang
- From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea.
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28
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Liang M, Wang P, Ma Y, Zhang X, Gao J, Ma M, Dai Z, Liu D, Liu X. New vessels formation in young strokes with isolated steno-occlusive MCA. Brain Behav 2018; 8:e01088. [PMID: 30260098 PMCID: PMC6192400 DOI: 10.1002/brb3.1088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE New vessels formation (NVF) along the steno-occlusive middle cerebral artery (MCA) is often observed in digital subtraction angiography (DSA) imaging. In the study, we aim to explore the clinical relevance of NVF in young ischemic stroke patients with isolated middle cerebral artery (MCA) stenosis. METHODS We retrospectively reviewed the digital subtraction angiography (DSA) images of 93 young ischemic stroke patients (age ≤ 45 years old) in our center from January 2006 to June 2016. All the patients were diagnosed with isolated steno-occlusive middle cerebral artery (MCA) disease.NVF was defined as new vessels formation along the stenotic MCA on anteroposterior DSA projection. The association between NVF and functional outcome was analyzed. RESULTS The prevalence of NVF was 0 in moderate stenosis, 15.8% in severe stenosis, and 53.7% in MCA occlusions. The presence of NVF had a strong correlation with the severity of MCA stenosis (r = 0.467, p < 0.001). Compared to patients without NVF, patients with NVF were more likely to suffer an unfavorable functional outcome (6.2% vs. 21.4%, p = 0.061) at 3 months. Univariate logistic regression analysis showed that NVF was associated with unfavorable outcome [Odds Ratio (OR) = 4.159, 95% confidence intervals (CI) = (1.072, 16.137), p = 0.039]. CONCLUSIONS This study demonstrated that NVF were associated with poor clinical outcome in young ischemic stroke patients who were diagnosed with isolated steno-occlusive MCA.
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Affiliation(s)
- Meng Liang
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Peng Wang
- Department of Medical Imaging, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Yan Ma
- Department of Medical Imaging, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Xiaohao Zhang
- Department of Neurology, Second Afliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Minmin Ma
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
| | - Zhengze Dai
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu, China
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Bang OY, Toyoda K, Arenillas JF, Liu L, Kim JS. Intracranial Large Artery Disease of Non-Atherosclerotic Origin: Recent Progress and Clinical Implications. J Stroke 2018; 20:208-217. [PMID: 29886713 PMCID: PMC6007295 DOI: 10.5853/jos.2018.00150] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 12/18/2022] Open
Abstract
Intracranial large artery disease (ILAD) is the major cause of stroke worldwide. With the application of recently introduced diagnostic techniques, the prevalence of non-atherosclerotic ILAD is expected to increase. Herein, we reviewed recent reports and summarized progress in the diagnosis and clinical impact of differentiation between ILAD of atherosclerotic and non-atherosclerotic origin. Our review of the literature suggests that more careful consideration of non-atherosclerotic causes and the application of appropriate diagnostic techniques in patients with ILAD may not only provide better results in the treatment of patients, but it may also lead to more successful clinical trials for the treatment of intracranial atherosclerosis.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Juan F Arenillas
- Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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30
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High-resolution magnetic resonance vessel wall imaging of chronic intracranial internal carotid artery occlusion. J Neuroradiol 2018; 45:336-337. [PMID: 29752977 DOI: 10.1016/j.neurad.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/25/2017] [Accepted: 04/21/2018] [Indexed: 11/21/2022]
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31
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Xue S, Cheng W, Wang W, Song X, Wu J, Song H. The association between the ring finger protein 213 gene R4810K variant and intracranial major artery stenosis/occlusion in the Han Chinese population and high-resolution magnetic resonance imaging findings. Brain Circ 2018; 4:33-39. [PMID: 30276334 PMCID: PMC6057703 DOI: 10.4103/bc.bc_9_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE: The ring finger protein 213 (RNF213) gene R4810K variant, a susceptibility locus for moyamoya disease (MMD), has recently been identified to be associated with intracranial major artery stenosis/occlusion (ICASO) without satisfying the diagnostic criteria of MMD in the Japanese population. However, further studies are needed to determine whether this variant is associated with ICASO in other populations and whether R4810K variant-related ICASO could be categorized as MMD. The aim of this study is to elucidate whether the R4810K variant was associated with ICASO among the Han Chinese population and potential histopathology of R4810K variant-related ICASO. MATERIALS AND METHODS: We conducted a case–control study to evaluate association and performed high-resolution (HR) magnetic resonance imaging (MRI) to investigate arterial wall feature of ICASO. The R4810K variant was genotyped in 114 ICASO patients and 268 controls. Then, patients with R4810K variant-related ICASO were subjected to HR MRI examination and presumptively diagnosed based on the characteristics thus observed. STATISTICAL ANALYSIS: The relationship between R4810K variant and ICASO was evaluated by Fisher's exact test with odds ratios (OR) and 95% confidence interval (CI). RESULTS: The R4810K variant was associated with ICASO and increased the risk for ICASO (P < 0.01; OR: 20.2; 95% CI: 2.5–163.11). Presumptive MMD was diagnosed in all female patients with R4810K variant. However, presumptive intracranial atherosclerotic stenosis was diagnosed in one of three males harboring this variant. CONCLUSIONS: The R4810K variant is a genetic risk factor for ICASO among the Han Chinese population and that R4810K variant-related ICASO should be identified as MMD in female but not uncertain in male patients.
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Affiliation(s)
- Sufang Xue
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Weiyang Cheng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wanqian Wang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
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32
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Kim JS. Intracranial Atherosclerosis: Where Are We Now? J Stroke 2017; 19:247-248. [PMID: 29037016 PMCID: PMC5647637 DOI: 10.5853/jos.2017.02180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
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33
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Arterial Dissection as a Cause of Intracranial Stenosis in East Asians. J Am Coll Cardiol 2017; 70:2205-2206. [DOI: 10.1016/j.jacc.2017.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/12/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
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Kim JS, Bang OY. Medical Treatment of Intracranial Atherosclerosis: An Update. J Stroke 2017; 19:261-270. [PMID: 29037012 PMCID: PMC5647642 DOI: 10.5853/jos.2017.01830] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022] Open
Abstract
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Lang M, Moore NZ, Witek AM, Kshettry VR, Bain MD. Microsurgical Repair of Ruptured Aneurysms Associated with Moyamoya-Pattern Collateral Vessels of the Middle Cerebral Artery: A Report of Two Cases. World Neurosurg 2017; 105:1042.e5-1042.e10. [DOI: 10.1016/j.wneu.2017.06.166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/25/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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36
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Xu YY, Li ML, Gao S, Jin ZY, Sun ZY, Chen J, Hou B, Zhou HL, Feng F, Xu WH. Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:319. [PMID: 28861416 DOI: 10.21037/atm.2017.06.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Using high-resolution magnetic resonance imaging (HRMRI), we sought to investigate the underlying etiology of intracranial stenosis in young patients. METHODS We retrospectively studied 122 Chinese young adult patients (from 18 to 45 years old, mean age 36.2±7.5 years) with unilateral middle cerebral artery (MCA) stenosis based on a prospectively established HRMRI database. The eccentricity, degree of stenosis, and remodeling types of MCA lesions were analyzed. The MCA lesions were classified as eccentric (presumed atherosclerosis) or concentric stenosis (presumed non-atherosclerosis). The clinical data and vessel wall properties were compared between the patients >35 years old and the patients ≤35 years old. RESULTS Eccentric stenosis was observed in 98 (80.3%) patients and concentric stenosis in 24 (19.7%) patients. The patients with eccentric stenosis were older (37.5±6.8 vs. 31.4±8.4 years old, P<0.001) and more likely had atherosclerosis risk factors (56.1% vs. 25.0%, P=0.006). The patients >35 years old had higher prevalence (90.1% vs. 66.7%, P=0.001) of eccentric stenosis and atherosclerosis factors (60.6% vs. 35.3%, P=0.006) than the patients ≤35 years old. Most of the patients with concentric stenosis were ≤35 years old (17/24, 70.8%) and were female (16/24, 66.7%). Binary Logistic analysis suggested smoking (OR =3.171; 95% CI, 1.210-8.314) and remodeling ratio (OR =1.625; 95% CI, 1.001-2.636) were independent predictive factors for symptomatic stenosis. CONCLUSIONS Atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients. Non-atherosclerosis disease is an important etiology in young female, especially in the patients aged 35 years old or younger.
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Affiliation(s)
- Yu-Yuan Xu
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming-Li Li
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shan Gao
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zheng-Yu Jin
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhao-Yong Sun
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jie Chen
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bo Hou
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hai-Long Zhou
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Feng Feng
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei-Hai Xu
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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37
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Hongo H, Miyawaki S, Imai H, Shinya Y, Ono H, Mori H, Nakatomi H, Kunimatsu A, Saito N. Smaller outer diameter of atherosclerotic middle cerebral artery associated with RNF213 c.14576G>A Variant (rs112735431). Surg Neurol Int 2017; 8:104. [PMID: 28695051 PMCID: PMC5473080 DOI: 10.4103/sni.sni_59_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Intracranial atherosclerosis (ICAS) involves diverse histologies and several remodeling patterns. Ring finger protein 213 (RNF213) c.14576G>A variant (rs112735431), recently reported to be associated with ICAS, may be linked with negative remodeling (outer diameter – reducing morphological alteration) of intracranial arteries. This study investigated the outer diameter of atherosclerotic middle cerebral artery (MCA). Methods: Patients with unilateral atherosclerotic MCA stenosis/occlusion were enrolled in this single-hospital-based case-control study at The University of Tokyo Hospital. The patients were divided into two groups by the presence of RNF213 c.14576G>A (variant group and wild-type group) and the outer diameter of the MCA was measured with high-resolution magnetic resonance imaging. Results: Twenty-eight patients with the wild type and 19 patients with the variant type were included. The outer diameter of the stenotic side MCA was smaller in the variant group than in the wild-type group (P = 8.3 × 10-6). The outer diameter of the normal side MCA was also smaller in the variant group than in the wild-type group (P = 5.2 × 10-3). The ratio of stenotic side to normal side was also smaller in the variant group than in the wild-type group (P = 1.5 × 10-5). Conclusions: This study indicates that RNF213 c.14576G>A is associated with negative remodeling of ICAS.
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Affiliation(s)
- Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Shinya
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Harushi Mori
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Kunimatsu
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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38
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Radu RA, Terecoasă EO, Băjenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand? Clin Neurol Neurosurg 2017; 159:93-106. [PMID: 28609703 DOI: 10.1016/j.clineuro.2017.05.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/06/2017] [Accepted: 05/18/2017] [Indexed: 12/25/2022]
Abstract
Despite major technological advances in ischemic stroke diagnostic techniques, our current understanding of stroke mechanisms and etiology continues to remain unclear in a significant percent of patients. As a result, several etiological ischemic stroke classifications have emerged during the last two decades but their reliability and validity is far from perfect and further world-wide research is needed in order to achieve the so much needed "standard reference language". An ideal ischemic stroke classification should both comprise all underlying pathologies that could potentially concur to an index event and emphasize the most likely etiological and pathophysiological mechanism. Currently available approaches to ischemic stroke classification are either phenotypic or causative in nature, a multitude of criteria being published by different authors. Phenotypic classifications are targeted towards describing the concurring underlying pathologies, without highlighting the most probable ischemic stroke etiology, while causative classifications focus on establishing the most likely cause, neglecting other associated diseases. A judicious use of this two different concepts might improve clinical research as well as daily clinical practice.
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Affiliation(s)
- Răzvan Alexandru Radu
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania
| | - Elena Oana Terecoasă
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Ovidiu Alexandru Băjenaru
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Tiu
- Stroke Unit, Department of Neurology, University Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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39
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RNF213 p.R4810K Variant and Intracranial Arterial Stenosis or Occlusion in Relatives of Patients with Moyamoya Disease. J Stroke Cerebrovasc Dis 2017; 26:1841-1847. [PMID: 28506590 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to determine the effectiveness of genetic testing for the p.R4810K variant (rs112735431) of the Mysterin/RNF213 gene, which is associated with moyamoya disease and other intracranial vascular diseases, in the family members of patients with moyamoya disease. METHODS We performed genotyping of the RNF213 p.R4810K polymorphism and magnetic resonance angiography on 59 relatives of 18 index patients with moyamoya disease. Nineteen individuals had follow-up magnetic resonance angiography with a mean follow-up period of 7.2 years. RESULTS Six of the 34 individuals with the GA genotype (heterozygotes for p.R4810K) showed intracranial steno-occlusive lesions in the magnetic resonance angiography, whereas none of the 25 individuals with the GG genotype (wild type) showed any abnormalities. Follow-up magnetic resonance angiography revealed de novo lesions in 2 and disease progression in 1 of the 11 individuals with the GA genotype, despite none of the 8 individuals with the GG genotype showing any changes. Accordingly, 8 individuals had steno-occlusive lesions at the last follow-up, and all had the p.R4810K risk variant. The prevalence of steno-occlusive intracranial arterial diseases in family members with the p.R4810K variant was 23.5% (95% confidence interval: 9.27%-37.78%), which was significantly higher than in those without the variant (0%, P = .0160). CONCLUSIONS Genotyping of the p.R4810K missense variant is useful for identifying individuals with an elevated risk for steno-occlusive intracranial arterial diseases in the family members of patients with moyamoya disease.
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40
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Zhu XJ, Wang W, Liu ZJ. High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis. Chin Med J (Engl) 2017; 129:1363-70. [PMID: 27231176 PMCID: PMC4894049 DOI: 10.4103/0366-6999.182826] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis. DATE SOURCES We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging (VWI), high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. STUDY SELECTION We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. RESULTS VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. CONCLUSIONS This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.
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Affiliation(s)
- Xian-Jin Zhu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zun-Jing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
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41
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Yu LB, Zhang Q, Shi ZY, Wang MQ, Zhang D. High-resolution Magnetic Resonance Imaging of Moyamoya Disease. Chin Med J (Engl) 2016; 128:3231-7. [PMID: 26612300 PMCID: PMC4794888 DOI: 10.4103/0366-6999.170257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To introduce the imaging characteristics of moyamoya disease (MMD) using high-resolution magnetic resonance imaging (HR-MRI) and to discuss the role of HR-MRI in differentiating MMD from other intracranial artery diseases, especially intracranial atherosclerotic disease (ICAD). Data Sources: This review was based on the data in articles published between 2005 and 2015, which were obtained from PubMed. The keywords included HR-MRI, MMD, ICAD, and intracranial artery diseases. Study Selection: Articles related to HR-MRI for MMD or other intracranial artery diseases were selected for review. Results: There are differences between the characteristic patterns of HR-MRI in MMD and ICAD. MMD is associated with inward remodeling, smaller outer diameters, concentric occlusive lesions and homogeneous signal intensity, while ICAD is more likely to be associated with outward remodeling, normal outer diameters, eccentric occlusive lesions, and heterogeneous signal intensity. Other intracranial artery diseases, such as dissection and vasculitis, also have distinctive characteristics in HR-MRI. HR-MRI may become a useful tool for the differential diagnosis of MMD in the future. Conclusions: HR-MRI of MMD provides a more in-depth understanding of MMD, and it is helpful in evaluating pathological changes in the vessel wall and in differentiating MMD from other intracranial artery steno-occlusive diseases, particularly ICAD.
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Affiliation(s)
| | | | | | | | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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42
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Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging. Sci Rep 2016; 6:38534. [PMID: 27917937 PMCID: PMC5137109 DOI: 10.1038/srep38534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/10/2016] [Indexed: 12/12/2022] Open
Abstract
A recent study showed that posterior circulation plaques have a greater capacity for positive remodeling in a non-Asian population. We aimed to investigate if the features of plaques in the middle cerebral artery (MCA) were different from those in the basilar artery (BA) in a northern Chinese population. We retrospectively analysed the records of 71 consecutive patients with acute ischemic stroke. All patients had at least one MCA or BA plaque with early or mild (<50% stenosis) atherosclerosis identified using vessel wall magnetic resonance imaging. The remodeling ratio, eccentricity index, and plaque range were compared between MCA and BA plaques using multilevel analysis. A total of 101 plaques were included. There were 70 plaques located in the MCA and 31 plaques located in the BA. The features of non-advanced atherosclerotic plaques did not differ between the MCA and BA when accounting for the degree of stenosis or plaque burden in a northern Chinese population. Symptomatic plaques were associated with a higher eccentricity index and smaller plaque range than asymptomatic plaques under the same plaque burden. Further studies are warranted to investigate the progression of atherosclerosis in different intracranial arteries.
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43
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Lehman VT, Brinjikji W, Kallmes DF, Huston J, Lanzino G, Rabinstein AA, Makol A, Mossa-Bosha M. Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol 2016; 89:20160496. [PMID: 27585640 DOI: 10.1259/bjr.20160496] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intracranial arterial pathology has traditionally been evaluated with luminal imaging. Recently, high-resolution vessel wall imaging (HR-VWI) with MRI has facilitated submillimetre evaluation of the arterial walls. This technique can help differentiate various causes of intracranial steno-occlusive disease, identify culprit atherosclerotic plaques with a recent cerebral infarct, locate vessel wall pathology in areas with minimal or no narrowing on luminal imaging, predict aneurysm stability and identify a ruptured aneurysm when multiple aneurysms are present. Interpretation of HR-VWI examinations requires a solid understanding of the pathophysiology, clinical features, serum and cerebrospinal fluid laboratory findings, treatment administered and fundamental patterns of VWI abnormalities that may be encountered with the intracranial vasculopathies. This pictorial essay aimed to illustrate the essential findings of common conditions encountered with HR-VWI including intracranial atherosclerosis, moyamoya disease, intracranial vasculitis, varicella zoster vasculopathy, reversible cerebral vasoconstriction syndrome and aneurysms.
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Affiliation(s)
- Vance T Lehman
- 1 Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - Waleed Brinjikji
- 1 Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - David F Kallmes
- 1 Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - John Huston
- 1 Department of Radiology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - Giuseppe Lanzino
- 2 Department of Neurosurgery, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - Alejandro A Rabinstein
- 3 Department of Neurology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - Ashima Makol
- 4 Department of Rheumatology, Mayo Clinic College of Graduate Medical Education, Rochester, MN, USA
| | - Mahmud Mossa-Bosha
- 5 Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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44
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Kim YJ, Lee JK, Ahn SH, Kim BJ, Kang DW, Kim JS, Kwon SU. Nonatheroscleotic Isolated Middle Cerebral Artery Disease May Be Early Manifestation of Moyamoya Disease. Stroke 2016; 47:2229-35. [DOI: 10.1161/strokeaha.116.012751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/01/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Middle cerebral artery steno-occlusive disease (MCAD) is not an uncommon cause of ischemic stroke in young Asians. Aside from atherosclerosis, the pathogenesis of MCAD include various nonatherosclerotic vasculopathies, most of which are yet to be defined. This study investigated the pathogenesis of symptomatic isolated MCAD in young Asian patients using high-resolution magnetic resonance imaging (HR-MRI) and mutation analysis of
RNF213
.
Methods—
Patients aged <60 years with stroke or transient ischemic attack caused by MCAD were prospectively enrolled. Patients with a confirmed diagnosis of moyamoya disease, dissection, and vasculitis; with significant steno-occlusion in cerebral arteries other than the MCA; or with high-risk cardioembolic source were excluded. Using high-resolution MRI, patients were classified into an atherosclerosis group and a nonatherosclerosis group.
Results—
Eighty-one patients were enrolled, 45 (56.6%) in the atherosclerosis and 36 (44.4%) in the nonatherosclerosis group. The nonatherosclerosis group was significantly younger (
P
=0.013), had a smaller number of vascular risk factors (
P
=0.001), showed a lower homocysteine level (
P
<0.001), thinner intima-media thickness (
P
=0.006), and had more frequent heterozygotes at
RNF213
(
P
=0.045) than the atherosclerosis group. Diffusion-weighted image lesion pattern showed no significant differences in assumed stroke mechanisms between the 2 groups.
Conclusions—
Nonatherosclerotic pathogenesis are common in young Asians with symptomatic isolated MCAD. Clinical findings, high-resolution MRI features, and results of
RNF213
mutation analysis suggest that moyamoya disease is responsible etiologically for a significant portion of nonatherosclerotic lesions. Symptomatic isolated MCAD may be an early manifestation of moyamoya disease in young Asian adults.
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Affiliation(s)
- Yeon-Jung Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Joo Kyung Lee
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Sung-Ho Ahn
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Bum Joon Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Dong-Wha Kang
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Jong S. Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Sun U. Kwon
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
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Yu LB, He H, Zhao JZ, Wang R, Zhang Q, Shi ZY, Shao JS, Zhang D. More Precise Imaging Analysis and Diagnosis of Moyamoya Disease and Moyamoya Syndrome Using High-Resolution Magnetic Resonance Imaging. World Neurosurg 2016; 96:252-260. [PMID: 27576769 DOI: 10.1016/j.wneu.2016.08.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The diagnosis of moyamoya disease (MMD) is often uncertain. Moyamoya syndrome (MMS) is often misdiagnosed as MMD. High-resolution magnetic resonance imaging (HR-MRI) enables vessel wall assessment to obtain more precise diagnoses. The aim of this study was to determine the true etiologies of arterial steno-occlusion in patients with an angiographic diagnosis of MMD or MMS using HR-MRI. METHODS HR-MRI was performed in 21 adult patients with angiographically proven MMD or MMS. A definite diagnosis was based on the HR-MRI findings. The diagnoses made via the 2 different imaging technologies were compared, and significant findings were analyzed. RESULTS A total of 21 patients were enrolled, including 7 patients with angiographically proven MMD and 14 patients with angiographically proven MMS. Among the 7 patients with MMD, HR-MRI confirmed the diagnosis of MMD in 6; the remaining patient was considered to have atherosclerosis in the bilateral distal internal carotid arteries (ICAs) and the left middle cerebral artery. Among the 14 patients with MMS, HR-MRI confirmed MMD in 6 patients (including 2 patients with unilateral MMD), atherosclerosis in 5 patients (including 3 patients with bilateral atherosclerosis and 2 with unilateral atherosclerosis), arterial dissection of the left ICA in 1 patient, and MMD in the left cerebral hemisphere with atherosclerosis in the right hemisphere in 2 patients. CONCLUSIONS Differentiating MMD from MMS is difficult in certain situations, and HR-MRI may help provide a more in-depth understanding of MMD and MMS, thereby achieving a more reliable diagnosis.
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Affiliation(s)
- Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huan He
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ji-Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhi-Yong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun-Shi Shao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China.
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46
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Uemura M, Terajima K, Suzuki Y, Watanabe M, Akaiwa Y, Katada S, Okamoto K, Nishizawa M, Igarashi H, Nakada T. Visualization of the Intimal Flap in Intracranial Arterial Dissection Using High-Resolution 3T MRI. J Neuroimaging 2016; 27:29-32. [PMID: 27510458 DOI: 10.1111/jon.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Presence of an intimal flap is a critical imaging finding in diagnosing intracranial artery dissection (ICAD). Recent reports showed that high-resolution magnetic resonance imaging (MRI) was better at identifying intimal flaps as compared with routine MRI techniques used in clinical settings. However, no current standardized sequence for high-resolution MRI without gadolinium enhancement produces images of satisfactory quality with clinically tolerable scanning times. This study evaluated a nonenhanced high-resolution fast spin echo (HR-FSE) MRI sequence for visualizing intimal flaps in patients with ICAD. SUBJECTS AND METHODS Three patients with ICAD underwent plain MRI examination using a 2-dimensional T2-weighted FSE imaging sequence optimized for our 3T system (in-plane pixel size, .23 mm × .23 mm; slice thickness 3 mm with no interslice gap), as well as scanning with conventional modalities, including CT angiography, magnetic resonance angiography, and digital subtraction angiography. We assessed whether these imaging methods could visualize an intimal flap and/or double lumen sign in the participants and compared the results between HR-FSE and the other modalities. RESULTS HR-FSE images clearly showed intimal flaps and double lumen signs in all 3 patients, whereas the conventional modalities identified a double lumen sign in only 2 of the 3 patients. CONCLUSIONS The present method of optimized HR-FSE imaging with a 3T system improved visualization of intimal flaps and should thus be considered for assessing patients with suspected ICAD that cannot be definitively diagnosed by conventional imaging modalities.
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Affiliation(s)
- Masahiro Uemura
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kenshi Terajima
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.,Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata, Japan.,Department of Medical Informatics, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata University, Niigata, Japan
| | - Yuji Suzuki
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masaki Watanabe
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yasuhisa Akaiwa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Shinichi Katada
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hironaka Igarashi
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata, Japan
| | - Tsutomu Nakada
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, Niigata, Japan
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47
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de Havenon A, Chung L, Park M, Mossa-Basha M. Intracranial vessel wall MRI: a review of current indications and future applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0021-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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48
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Chung JW, Bang OY, Lee MJ, Hwang J, Cha J, Choi JH, Choe YH. Echoing Plaque Activity of the Coronary and Intracranial Arteries in Patients With Stroke. Stroke 2016; 47:1527-33. [DOI: 10.1161/strokeaha.116.013122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Jong-Won Chung
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Oh Young Bang
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Mi Ji Lee
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jaechun Hwang
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jihoon Cha
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Jin-Ho Choi
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
| | - Yeon Hyeon Choe
- From the Departments of Neurology (J.-W.C., O.Y.B., M.J.L., J.H.) and Radiology (J.C., Y.H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; and Department of Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.-H.C.)
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49
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Zhou L, Xing P, Zou L, Shen J, Tian Y, Lu X. Middle cerebral artery stenosis in patients with nasopharyngeal carcinoma after radiotherapy: the incidence of stenosis and the risk factors. Br J Radiol 2016; 89:20150815. [PMID: 26934603 DOI: 10.1259/bjr.20150815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to investigate the incidence of middle cerebral artery (MCA) stenosis by contrast-enhanced MR angiography (CE-MRA), and to evaluate the risk factors for significant (>50%) MCA stenosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS 116 patients with NPC after radiotherapy were recruited into the irradiation group to investigate the incidence and degree of MCA stenosis by CE-MRA. The results were compared with those of the control group, which comprised 57 newly diagnosed patients with NPC who did not receive radiotherapy. Furthermore, the risk factors for significant MCA stenosis were evaluated. RESULTS There was a higher incidence of MCA stenosis in the irradiation group than in the control group in terms of patient number (p = 0.000) and vessel involvement (p = 0.000), respectively. The incidence of significant MCA stenosis in the irradiation group was 8.6% (10/116 patients) and 5.2% (12/232 patients) in terms of patient number and vessel involvement, respectively. However, no significant MCA stenosis was found in the control group. Univariate analysis showed that hypercholesterolaemia, T(3-4) stage and longer time interval from radiotherapy were the risk factors related to significant MCA stenosis. Multivariate analysis demonstrated that only T stage was the independent risk factor for significant MCA stenosis development. CONCLUSION The results showed that radiation can cause MCA stenosis in patients with NPC after radiotherapy, especially in those with T(3-4) stage, and further study is needed. ADVANCES IN KNOWLEDGE Radiation-induced MCA stenosis exists in patients with NPC after radiotherapy, and its prevalence is more common in patients with clinical T(3-4) stage.
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Affiliation(s)
- Lijuan Zhou
- 1 Department of Radiology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengfei Xing
- 2 Department of Oncology & Radiotherapy, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Zou
- 2 Department of Oncology & Radiotherapy, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Junkang Shen
- 1 Department of Radiology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ye Tian
- 2 Department of Oncology & Radiotherapy, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueguan Lu
- 2 Department of Oncology & Radiotherapy, the Second Affiliated Hospital of Soochow University, Suzhou, China
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50
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Bang OY. Considerations When Subtyping Ischemic Stroke in Asian Patients. J Clin Neurol 2016; 12:129-36. [PMID: 26833987 PMCID: PMC4828557 DOI: 10.3988/jcn.2016.12.2.129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 12/22/2022] Open
Abstract
Both the incidence and prevalence of stroke in Asia are steadily increasing, and the burden of stroke is particularly high in Asian countries. Although strokes in Asians and Caucasians share many common features, there are some differences that are probably due to differences in lifestyle and genetic background. While there have been advances in the stroke classification system, the assignment of Asian stroke patients to etiological categories has received little attention. The current classification system may not be well suited to Asian patients with ischemic stroke because the proportions and relative importance of stroke subtypes may differ with race and ethnicity. This review addresses concerns about the use of the current stroke classification system in Asian patients with ischemic stroke, and proposes a classification system that is more specific to the Asian population, in conjunction with discussing advances in diagnostic techniques.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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