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Del Brutto VJ, Khasiyev F, Omran SS, Purohit M, Liu M, Wright C, Rundek T, Elkind MSV, Sacco RL, Gutierrez J. Association of Brain Arterial Elongation With Risk of Stroke and Death in Stroke-Free Individuals: Results From NOMAS. Arterioscler Thromb Vasc Biol 2023; 43:474-481. [PMID: 36727517 PMCID: PMC9974766 DOI: 10.1161/atvbaha.122.318819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brain arterial dilation and elongation characterize dolichoectasia, an arteriopathy associated with risk of stroke and death. We aim to determine whether brain arterial elongation increases the risk of stroke and death independent of brain arterial diameters. METHODS We analyzed 1210 stroke-free participants (mean age 71±9 years, 41% men, 65% Hispanic) with available time-of-flight magnetic resonance angiogram from the Northern Manhattan Study, a population-based cohort study across a multiethnic urban community. We obtained baseline middle cerebral artery M1-segment (MCA-M1) and basilar artery (BA) mean lengths and diameters using a semi-automated software. Cox proportional hazards models adjusted for brain arterial diameters and potential confounders yielded adjusted hazards ratios with 95% CIs for the primary outcomes of incident stroke and all-cause mortality, as well as secondary outcomes including noncardioembolic stroke, vascular death, and any vascular event. RESULTS Neither MCA-M1 nor BA lengths correlated with incident stroke or all-cause mortality. Both MCA-M1 and BA larger diameters correlated with all-cause mortality (MCA-M1 aHR, 1.52 [95% CI, 1.03-2.23], BA aHR, 1.28 [95% CI, 1.02-1.61]), as well as larger MCA-M1 diameters with vascular death (aHR, 1.84 [95% CI, 1.02-3.31]). Larger MCA-M1 and BA diameters did not correlate with incident stroke. However, larger BA diameters were associated with posterior circulation noncardioembolic stroke (aHR, 2.93 [95% CI, 1.07-8.04]). There were no statistical interactions between brain arterial lengths and diameters in relation to study outcomes. CONCLUSIONS In a multiethnic cohort of stroke-free adults, brain arterial elongation did not correlate with risk of stroke or death, nor influenced the significant association between brain arterial dilation and vascular risk.
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Affiliation(s)
- Victor J. Del Brutto
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meghan Purohit
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Minghua Liu
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Clinton Wright
- National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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du Fretay XH, Aubry P. [Imaging of coronary aneurysms in adults' coronary aneurysms]. Ann Cardiol Angeiol (Paris) 2022; 71:391-398. [PMID: 36241480 DOI: 10.1016/j.ancard.2022.09.011] [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: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Coronary aneurysms are rare and of various etiologies in adults. Natural history, modalities of management and clinical monitoring remain poorly known due to the lack of large studies and homogeneous diagnostic and follow-up criteria in the published data. Coronary angiography is, so far, the most common diagnostic tool but can overlook some partially thrombosed aneurysmal. Intracoronary imaging, particularly intravascular ultrasound, can differentiate aneurysms from pseudoaneurysms considered by some to be at greater risk of events, requiring a curative treatment. Intracoronary imaging can also help with etiological assessment and percutaneous treatment. With its growing use in the search for coronary atheromatous disease, coronary CT angiography has become a major diagnostic tool for coronary aneurysms. In addition, that it can incidentally detect coronary aneurysms, coronary CT angiography is particularly useful for giant aneurysms poorly visualized on coronary angiography or less well evaluated by intracoronary imaging. It specifies their relationship with adjacent anatomical structures. It is also a non-invasive modality of monitoring. These three imaging tools are currently the most relevant in current practice pending large studies evaluating the natural history of coronary aneurysms, with the identification of possible risk factors that could modify the management.
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Affiliation(s)
- Xavier Halna du Fretay
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Cardioreliance, 45770, Saran, France.
| | - Pierre Aubry
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Service de Cardiologie, Centre Hospitalier de Gonesse, 95500, Gonesse, France
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3
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Rezai Jahromi B, Niemelä M. “Dolichoectatic Vertebrobasilar Artery Aneurysms”. Neurosurg Clin N Am 2022; 33:419-429. [DOI: 10.1016/j.nec.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Ramana Reddy JV, Ha H, Sundar S. Modelling and simulation of fluid flow through stenosis and aneurysm blood vessel: a computational hemodynamic analysis. Comput Methods Biomech Biomed Engin 2022:1-23. [PMID: 35993592 DOI: 10.1080/10255842.2022.2112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this article, the hemodynamics of nanofluid flow through the modelled stenosis-aneurysm models in the presence of the catheter has been studied. The eight stenosis-aneurysm models are developed to mimic biological observations and thus make the model more realistic. The mathematical understanding helps in treating the stenosis in the blood vessel by targeting the unhealthy region to the drug, which is coated on nanoparticles. The catheter achieves the active drug release to the aimed organs by coating on the catheter surface, which adds additional benefits. In the present hemodynamic study, the blood is modeled as a couple stress fluid; as a result, the highly non-linear momentum, temperature, and concentration equations were obtained. The fluid flow equations' complexity is further increased by incorporating the variable viscosity effects that arose due to the suspension of nanoparticles. The resultant mathematical model is solved by using the homotopy perturbation method. The convergence of the perturbed solutions is studied and depicted the degree of deformation in the case of temperature and concentration. The effects of the porous nature of the stenosis, no-slip at the catheter surface, and the free slip at the blood vessel boundary in the non-stenotic region are also considered in the model. The essential physiological property like surface shear stress is computed, and various parameters' influence on shear stress is analyzed. The present analysis can be helpful in understanding the enhancement in mass dispersion and heat transfer in unhealthy blood vessels, which could be used for drug delivery in the treatment of stenotic conditions.
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Affiliation(s)
- J V Ramana Reddy
- Advanced Institute for Materials Research, Tohoku University, Sendai, Japan
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Korea
| | - S Sundar
- Department of Mathematics, Indian Institute of Technology Madras, Chennai, India
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5
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Bianchi A, Mazzoni LN, Busoni S, Pinna N, Albanesi M, Cavigli E, Cozzi D, Poggesi A, Miele V, Fainardi E, Gadda D. Assessment of cerebrovascular disease with computed tomography in COVID-19 patients: correlation of a novel specific visual score with increased mortality risk. LA RADIOLOGIA MEDICA 2021; 126:570-576. [PMID: 33247816 PMCID: PMC7695990 DOI: 10.1007/s11547-020-01313-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cerebrovascular disease (CVD) is considered a major risk factor for fatal outcome in COVID-19. We aimed to evaluate the possible association between computed tomography (CT) signs of chronic CVD and mortality in infected patients. MATERIALS AND METHODS We performed a double-blind retrospective evaluation of the cerebral CT scans of 83 COVID-19 patients looking for CT signs of chronic CVD. We developed a rapid visual score, named CVD-CT, which summarized the possible presence of parietal calcifications and dolichosis, with or without ectasia, of intracranial arteries, areas of chronic infarction and leukoaraiosis. Statistical analysis was carried out with weighted Cohen's K test for inter-reader agreement and logistic regression to evaluate the association of in-hospital mortality with CVD-CT, chest X-ray (CXR) severity score (Radiographic Assessment of Lung Edema-RALE) for radiological assessment of pulmonary disease, sex and age. RESULTS CVD-CT (odds ratio 1.6, 95% C.I. 1.2-2.1, p = 0.001) was associated with increased risk of mortality. RALE showed an almost significant association (odds ratio 1.05, 95% C.I. 1-1.1, p 0.06), whereas age and sex did not. CONCLUSION CVD-CT is associated with risk of mortality in COVID-19 patients. The presence of CT signs of chronic CVD may be correlated to a condition of fragility of the circulatory system, which constitutes a key risk factor for death in infected patients.
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Affiliation(s)
- Andrea Bianchi
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Nicola Mazzoni
- Medical Physics Department, Careggi University Hospital, Florence, Italy
- Medical Physics Unit, AUSL Toscana Centro, Prato, Pistoia, Italy
| | - Simone Busoni
- Medical Physics Department, Careggi University Hospital, Florence, Italy
| | - Nicola Pinna
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, Institute of Diagnostic Imaging 2, University of Sassari, Sassari, Italy
| | - Marco Albanesi
- Department of Clinical and Experimental Medicine, Institute of Diagnostic Imaging 2, University of Sassari, Sassari, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Careggi University Hospital, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Enrico Fainardi
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
- Department of "Scienze Biomediche, Sperimentali E Cliniche", Neuroradiology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Davide Gadda
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
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Yin K, Liang S, Tang X, Li M, Yuan J, Wu M, Li H, Chen Z. The relationship between intracranial arterial dolichoectasia and intracranial atherosclerosis. Clin Neurol Neurosurg 2020; 200:106408. [PMID: 33338822 DOI: 10.1016/j.clineuro.2020.106408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to investigate the relationship between intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS). METHODS Patients with acute ischemic stroke were screened via the Nanjing Stroke Registry Program. Patients were diagnosed with IADE (diameter, height of bifurcation, and laterality of basilar artery) based on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) results. Intracranial atherosclerosis was defined as a ≥50 % diameter reduction in internal carotid artery, middle cerebral artery, posterior cerebral artery, or anterior cerebral artery on MRA, computed tomography angiography, or digital subtraction angiography. We also evaluated the presence and degree of white matter changes and lacuna infarctions on MRI. RESULTS Of the 469 enrolled patients, 61 (13 %) had IADE. Patients with IADE were older (64.1 ± 9.9 vs. 59.6 ± 11.4 years, P = 0.004) and had a higher prevalence of hypertension (78.7 % vs. 61.0 %, P = 0.008) than patients without IADE. Patients with ICAS were older (62.6±10.5 vs 58.1±11.6 years, P < 0.001), had higher prevalence of hypertension (72.9 % vs. 55.0 %, P < 0.001) and a previous history of stroke (21.6 % vs. 9.2 %, P < 0.001), had higher levels of serum low-density lipoprotein cholesterol (2.57±0.82 vs. 2.31±0.86mmol/l P = 0.002), and had high counts of white blood cells (7.90±3.29 vs 7.10±2.44, P = 0.004). No association was detected between IADE and extracranial carotid atherosclerosis [odds ratio (OR)=0.618; 95 % confidence interval (CI), 0.280-1.367; P = 0.235]. After adjusting for age, sex, hypertension, and ischemic heart disease, patients with IADE had a lower ICAS rate than that in those without IADE (OR 0.417, 95 % CI, 0.213-0.816, P = 0.011). Unlike patients with ICAS, patients with IADE were more likely to have infratentorial stroke lesions (OR=2.952, 95 % CI, 1.207-7.223, P = 0.018), multi-lacuna (OR=2.142, 95 % CI, 1.158-3.964, P = 0.015), and white matter changes (OR = 2.782; 95 % CI, 1.522-5.085, P = 0.001). CONCLUSIONS IADE was associated with advanced age, hypertension, multi-lacuna, and white matter changes but was not associated with ICAS.
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Affiliation(s)
- Kailin Yin
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Sen Liang
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Xiaogang Tang
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Min Li
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jun Yuan
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Minghua Wu
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Hui Li
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
| | - Zhaoyao Chen
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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Chen Z, Li H, Wu M, Chang C, Fan X, Liu X, Xu G. Caliber of Intracranial Arteries as a Marker for Cerebral Small Vessel Disease. Front Neurol 2020; 11:558858. [PMID: 33071944 PMCID: PMC7542665 DOI: 10.3389/fneur.2020.558858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The dilation of intracranial large arteries caliber, may transfer more hemodynamic burden to the downstream brain capillaries, which, in the long run, results in cerebral small vessel disease (CSVD). This study aimed to investigate the relationship between intracranial artery calibers and small vessel disease. Methods: Patients with first-ever ischemic stroke of lacunar infarction subtype were enrolled via Nanjing Stroke Registry Program. An intracranial arterial Z-score, named the brain arterial remodeling (BAR) score, was calculated by averaging the calibers of the seven main intracranial arteries. Among the enrolled patients, those with a BAR score < −1 SD were deemed to have small intracranial artery calibers; those with a BAR score >1 SD were deemed to have large intracranial artery calibers and those with a between BAR score were deemed to have normal intracranial artery calibers. Imaging markers of CSVD, including lacuna, white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS) and cerebral microbleeds (CMBs) were rated and then summed to obtain a total CSVD score. Results: A total of 312 patients were involved in this study, patients with BAR score >1 SD were older (P = 0.039), and more prone to having a history of myocardial infarction (P = 0.033). The Spearman's rank correlation coefficient between the BAR score and total CSVD score is 0.320 (P < 0.001). Binary logistic regression found that BAR score >1 SD was correlated with lacuna (OR = 1.987; 95% CI, 1.037–3.807; P = 0.039); severe WMH (OR = 1.994; 95% CI, 1.003–3.964; P = 0.049); severe EPVS (OR = 2.544; 95% CI, 1.299–4.983; P = 0.006) and CSVD (OR = 2.997; 95% CI 1.182–7.599; P = 0.021). Ordinal logistic regression analysis found that age (OR = 1.028; 95% CI, 1.007–1.049; P = 0.009), hypertension (OR = 3.514; 95% CI, 2.114–5.769; P < 0.001) and BAR score >1 SD (OR = 2.418; 95% CI, 1.350–4.330; P = 0.003) were correlated with the total CSVD score. Conclusions: Patients with large intracranial arterial calibers may have heavier CSVD burden. The mechanisms of this association warrant further study.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Hui Li
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Chang
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
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Takeuchi M, Miwa K, Tanaka M, Zhou Y, Todo K, Sasaki T, Sakaguchi M, Kitagawa K, Mochizuki H. A 9-Year Longitudinal Study of Basilar Artery Diameter. J Am Heart Assoc 2020; 8:e011154. [PMID: 30798648 PMCID: PMC6474931 DOI: 10.1161/jaha.118.011154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Dilatation of the basilar artery ( BA ) has been recognized as a predictor of cardiovascular events ( CVE s). However, it is unclear if the longitudinal change in BA diameter (Δ BA ) is associated with CVE s. Methods and Results In a cohort of Japanese participants with vascular risk factors in an observational study, we evaluated the relationship of Δ BA to CVE s and the time course of the BA diameter. The short axis of the BA diameter was measured at the midpons level in T2-weighted images. Brain magnetic resonance imaging measurements included cerebral small-vessel disease, lacunars, and white matter hyperintensities. First, 493 patients were analyzed by the time-dependent Cox proportional hazards model to evaluate the association between Δ BA and CVE s, with adjustment for age, sex, vascular risk factors, and magnetic resonance imaging parameters. Second, we assessed the longitudinal Δ BA in 164 patients who underwent long-term follow-up magnetic resonance imaging, by linear regression analysis. In the mean follow-up of 8.7 years, 105 patients developed CVE s. A smaller Δ BA was independently associated with the high incidence of CVE s (hazard ratio, 0.36; 95% CI, 0.16-0.78; P=0.010; n=493). After a mean interval of 9.4 years, the average Δ BA was 0.41±0.46 mm (excluding patients with fetal-type circle of Willis). Progression of BA dilatation was associated with men but inversely associated with initial BA diameter and fetal-type circle of Willis (n=164). Conclusions BA diameter increased over time (excluding the patients with fetal-type circle of Willis), whereas Δ BA was inversely associated with the incidence of CVE s.
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Affiliation(s)
- Mariko Takeuchi
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Kaori Miwa
- 2 Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita, Osaka Japan
| | - Makiko Tanaka
- 3 Department of Stroke Medicine Hoshigaoka Medical Center Osaka Japan
| | - Yi Zhou
- 4 Laboratory of Pharmainformatics and Pharmacometrics Osaka University Graduate School of Pharmaceutical Sciences Suita, Osaka Japan
| | - Kenichi Todo
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Tsutomu Sasaki
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
| | - Manabu Sakaguchi
- 5 Department of Neurology Osaka General Medical Center Osaka Japan
| | - Kazuo Kitagawa
- 6 Department of Neurology Tokyo Women's Medical University Tokyo Japan
| | - Hideki Mochizuki
- 1 Department of Neurology and Stroke Center Osaka University Graduate School of Medicine Suita, Osaka Japan
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9
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Zhang DP, Yin S, Zhang HL, Li D, Song B, Liang JX. Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms. J Stroke 2020; 22:173-184. [PMID: 32635683 PMCID: PMC7341005 DOI: 10.5853/jos.2019.02985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/06/2020] [Indexed: 12/29/2022] Open
Abstract
Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IAD-Erelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry’s disease and late-onset Pompe’s disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (COL4A1/COL4A2) and forkhead box C1 (FOXC1) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.
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Affiliation(s)
- Dao Pei Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Suo Yin
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Dan Li
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jia Xu Liang
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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10
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Chen Z, Zhang S, Dai Z, Cheng X, Wu M, Dai Q, Liu X, Xu G. Recurrent risk of ischemic stroke due to Vertebrobasilar Dolichoectasia. BMC Neurol 2019; 19:163. [PMID: 31315603 PMCID: PMC6636033 DOI: 10.1186/s12883-019-1400-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023] Open
Abstract
Background Patients with vertebrobasilar dolichoectasia usually have persistent hemodynamic abnormalities, and therefore, may bear an increased risk of stroke. This study aimed to identify risk factors for stroke recurrence in patients with vertebrobasilar dolichoectasia. Methods Patients with acute ischemic stroke were screened and evaluated for eligibility. Enrolled patients were followed via scheduled clinical visits or telephone interviews. Ischemic stroke recurrence was proposed with clinical symptoms and confirmed with cranial Magnetic Resonance Imaging or Computerized Tomography scans. Baseline characteristics and vascular geometry were compared between patients with and without stroke recurrence. Significant parameters were introduced into COX proportional hazard model to detect possible predictors of stroke recurrence. Results A total of 115 stroke patients with vertebrobasilar dolichoectasia were enrolled, of which 22 (19.1%) had recurrence during 22 ± 6 months follow-up. Basilar artery diameter ≥ 5.3 mm (HR = 4.744; 95% CI, 1.718–13.097; P = 0.003), diffuse intracranial dolichoectasia (HR = 3.603; 95% CI, 1.367–9.496; P = 0.010) and ischemic heart disease history (HR = 4.095; 95% CI, 1.221–13.740; P = 0.022) had increased risk of recurrence. Conclusions Stroke patients with vertebrobasilar dolichoectasia may have a high risk of recurrence. Larger basilar artery diameter or diffuse intracranial dolichoectasia may increase the risk of recurrence.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Shuai Zhang
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 211400, Jiangsu, China
| | - Zhengze Dai
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Nanjing Pukou Hospital, Nanjing, 210002, Jiangsu, China
| | - Xi Cheng
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Geriatrics, the First Affiliation Hospital of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Minghua Wu
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China. .,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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11
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Fierini F, Poggesi A, Salvadori E, Acquafresca M, Fainardi E, Moretti M, Pantoni L. Cerebral small vessel disease and systemic arteriopathy in intracranial arterial dolichoectasia patients. Acta Neurol Scand 2019; 139:150-157. [PMID: 30338521 DOI: 10.1111/ane.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate clinical and demographic characteristics of patients with intracranial arterial dolichoectasia (IADE) and describe the possible coexistence of cerebral small vessel disease (SVD) and systemic arteriopathy. MATERIAL AND METHODS From January 2015 to March 2016, all the patients attending an outpatient service for chronic cerebrovascular diseases were screened for suspected IADE. Identified patients underwent a predefined protocol including: brain MR angiography for the diagnosis of IADE; brain MRI with visual rating of SVD features; whole-body CT angiography to assess signs of systemic arteriopathy; and neuropsychological examination. RESULTS Among the 251 patients screened, IADE was diagnosed in seven (mean age ± SD 68.8 ± 7.2 years, six males). Hypertension was the most frequent risk factor. All patients had basilar artery dolichoectasia, two also ectasia of a vessel of the anterior circulation. All patients had white matter hyperintensities that were moderate or severe in six, five had at least one lacune, and all had enlarged perivascular spaces. At least one microbleed was detected in six patients. A variable grade of global cortical atrophy was found in six patients. Systemic arterial ectasia was found in all but one patient. Neuropsychological examination showed a multidomain cognitive impairment in five patients. CONCLUSIONS Our study confirms the high prevalence of cerebral SVD in IADE. The involvement of the brain-supplying arteries is probably part of a systemic arteriopathy in IADE patients, thus suggesting the usefulness of assessing the whole arterial tree in clinical practice. Cognitive deterioration signs are frequent in these patients.
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Affiliation(s)
- Fabio Fierini
- Psychiatry Unit, Department of Health Sciences; University of Florence; Florence Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section; University of Florence; Florence Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section; University of Florence; Florence Italy
| | - Manlio Acquafresca
- Radiology Unit 4, Department of Diagnostic Imaging; Careggi University Hospital; Florence Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences; University of Florence; Florence Italy
| | - Marco Moretti
- Neuroradiology Unit, Department of Diagnostic Imaging; Careggi University Hospital; Florence Italy
| | - Leonardo Pantoni
- 'L. Sacco' Department of Biomedical and Clinical Sciences; University of Milan; Milan Italy
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12
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Zhai FF, Yan S, Li ML, Han F, Wang Q, Zhou LX, Ni J, Yao M, Zhang SY, Cui LY, Jin ZY, Zhu YC. Intracranial Arterial Dolichoectasia and Stenosis. Stroke 2018; 49:1135-1140. [PMID: 29581240 DOI: 10.1161/strokeaha.117.020130] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial arterial dolichoectasia (IADE) is a poorly understood arteriopathy compared with intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of IADE and ICAS and their relationship with neuroimaging markers of cerebral small vessel disease in a population-based study.
Methods—
This study comprised 1237 participants (aged 57.2±9.4 years, 37.6% men) who underwent brain magnetic resonance imaging and magnetic resonance angiography. IADE was assessed based on basilar artery dolichoectasia (diameter, height of bifurcation, and laterality of basilar artery) and dilation of basilar artery and internal carotid artery (intracranial volume-adjusted diameter ≥2 SD). ICAS was defined as any degree of stenosis in at least 1 intracranial artery. The neuroimaging markers of cerebral small vessel disease, including lacunes, white matter hyperintensities, microbleeds, dilated perivascular spaces, and brain atrophy, were evaluated.
Results—
Basilar arterial dolichoectasia was observed in 3.6% (45/1237); intracranial arterial dilation in 5.9% (67/1142); and ICAS in 15.7% (194/1237). Older age, higher systolic blood pressure, diabetes mellitus, higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) were associated with the presence of ICAS (all
P
<0.001), whereas only older age was associated with IADE. ICAS was associated with lacunes (odds ratio, 2.91; 95% confidence interval, 1.96–4.34;
P
<0.001), increased white matter hyperintensities volume (β±SE, 0.54±0.13;
P
<0.001), and brain atrophy (β±SE, −1.16±0.21;
P
<0.001), whereas basilar arterial dolichoectasia was mainly associated with dilated perivascular spaces in basal ganglia (odds ratio, 2.20; 95% confidence interval, 1.20–4.02;
P
=0.01) and, to a lesser extent, associated with lacunes and microbleeds.
Conclusions—
IADE and ICAS had different risk factor profiles and associated with different imaging phenotypes of cerebral small vessel disease, suggesting different underlying mechanisms.
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Affiliation(s)
- Fei-Fei Zhai
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shuang Yan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Fei Han
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Quan Wang
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Li-Xin Zhou
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Jun Ni
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Ming Yao
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.-Y.Z.)
| | - Li-Ying Cui
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (S.Y., M.-L.L., Z.-Y.J.)
| | - Yi-Cheng Zhu
- From the Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (F.-F.Z., F.H., Q.W., L.-X.Z., J.N., M.Y., L.-Y.C., Y.-C.Z.)
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13
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Abstract
Ectasias and coronary aneurysms are uncommon coronary artery diseases, can coexist and are poorly known. Their principal etiology in adults is coronary atherosclerosis. It has been suggested that these abnormalities would have poor prognosis and that slow flow could lead to in situ thrombosis and distal embolisation. However, ectasias and aneurysms are most often associated with coronary stenosis. We report a series of 47 cases of ectasias and coronary aneurysms with evaluation of the clinical and angiographic characteristics, the therapeutic choices and we review the literature concerning these lesions. In situ thrombosis does not seem to be the usual pathophysiological mechanism. We retain that this is a particular form of coronary atherosclerosis in this population and present technical problems in case of revascularization with an predominant indication of medical treatment (57.4 % of the cases), but rarely the introduction of anticoagulants (4.25 % of the cases), except in acute coronary syndromes where revascularization is most common (70.6 % of cases) as is usually expected in the general population. The complex angiographic presentation of these lesions is probably an explanation for the low numbers of revascularizations performed.
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Affiliation(s)
- M A Bouzid
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Hôpital européen de Paris-la-Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
| | - H Benamer
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Hôpital européen de Paris-la-Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Institut cardiovasculaire Paris-Sud, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France.
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