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Luo J, Yang R, Wang T, Chen J, Lu X, Yang B, Gao P, Wang Y, Chen Y, Dmytriw AA, Zheng J, Regenhardt RW, Li Z, Xu H, Ma Y, Zhao J, Jiao L. First-in-human experience of sirolimus coated balloon for symptomatic intracranial artery stenosis. J Neurointerv Surg 2024:jnis-2023-021177. [PMID: 38378241 DOI: 10.1136/jnis-2023-021177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The drug coated balloon is a promising endovascular therapy for intracranial atherosclerosis (ICAS), potentially combining the advantages of primary angioplasty and antiproliferative drugs. Previous studies have focused on the paclitaxel coated balloon, revealing promising outcomes in the treatment of ICAS, while concerns about the neurotoxicity of paclitaxel were reported. Sirolimus was shown to have less neurotoxicity in the canine cerebral vasculature. The feasibility and safety of a sirolimus coated balloon (SCB) for ICAS have never been evaluated in humans. We assessed the first-in-human feasibility and safety of SCBs for treating symptomatic patients with severe ICAS. METHODS This prospective, open label, single arm cohort study was designed to enroll patients with transient ischemic attacks or non-disabling, non-perforator territory ischemic stroke caused by severe ICAS (70-99%) and following at least 3 weeks after the onset of ischemic symptoms. The primary outcome was stroke or death within 30 days. All patients were followed up to detect restenosis at 6 months. RESULTS A total of 60 eligible patients were enrolled with an average age of 59.4±10.8 years. The technical success rate of SCBs for ICAS was 100%. Seven patients (11.7%) required stenting because of flow limited dissections or elastic retraction. Three patients (5.0%) had 30 day strokes, including two ischemic strokes and one hemorrhagic stroke. An additional three patients had recurrent stroke or death during follow-up. Ten patients had restenosis but only two had symptoms. CONCLUSIONS SCBs may be feasible and safe in selected patients with symptomatic ICAS, with high grade stenosis (70-99%). Further studies are warranted.
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Affiliation(s)
- Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Adam A Dmytriw
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiamin Zheng
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zheng Li
- Zylox-Tonbridge Medical Technology, HangZhou, ZheJiang, China
| | - Han Xu
- R&D Center, Zylox-Tonbridge Medical Technology, Hangzhou, Zhejiang, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jonathon Zhao
- Zylox-Tonbridge Medical Technology, HangZhou, ZheJiang, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
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Gomyo M, Tsuchiya K, Yokoyama K. Vessel Wall Imaging of Intracranial Arteries: Fundamentals and Clinical Applications. Magn Reson Med Sci 2023; 22:447-458. [PMID: 36328569 PMCID: PMC10552670 DOI: 10.2463/mrms.rev.2021-0140] [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: 10/20/2021] [Accepted: 08/11/2022] [Indexed: 10/03/2023] Open
Abstract
With the increasing use of 3-tesla MRI scanners and the development of applicable sequences, it has become possible to achieve high-resolution, good contrast imaging, which has enabled the imaging of the walls of small-diameter intracranial arteries. In recent years, the usefulness of vessel wall imaging has been reported for numerous intracranial arterial diseases, such as for the detection of vulnerable plaque in atherosclerosis, diagnosis of cerebral arterial dissection, prediction of the rupture of cerebral aneurysms, and status of moyamoya disease and cerebral vasculitis. In this review, we introduce the histological characteristics of the intracranial artery, discuss intracranial vessel wall imaging methods, and review the findings of vessel wall imaging for various major intracranial arterial diseases.
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Affiliation(s)
- Miho Gomyo
- Department of Radiology, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, Japan
| | | | - Kenichi Yokoyama
- Department of Radiology, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, Japan
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3
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The MRI enhancement ratio and plaque steepness may be more accurate for predicting recurrent ischemic cerebrovascular events in patients with intracranial atherosclerosis. Eur Radiol 2022; 32:7004-7013. [PMID: 35771249 DOI: 10.1007/s00330-022-08893-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the complementary value of high-resolution multi-contrast MRI (hrMRI) in identifying symptomatic patients with intracranial atherosclerosis (ICAS) who are likely to experience recurrent ischemic cerebrovascular events. METHODS In this retrospective cohort study, eighty patients with acute ischemic events attributed to ICAS who underwent hrMRI examination between January 2015 and January 2019 were included. Median follow-up for all patients was 30 months (range: 1 to 52 months) and recurrent ischemic cerebrovascular events were recorded. Cox regression analysis and time-dependent ROC were performed to quantify the association between the plaque characteristics and recurrent events. RESULTS During the follow-up, 14 patients experienced recurrent ischemic cerebrovascular events. Young males and those with diabetes and poor medication persistence were more likely to experience recurrent events. ICAS in patients with recurrence had significantly higher enhancement ratio and steepness which is defined as the ratio between the plaque height and length than those without (p < 0.001 and p = 0.015, respectively). After adjustment of clinical factors, enhancement ratio (HR, 13.13 [95% CI, 3.58-48.20], p < 0.001) and plaque steepness (HR, 110.27 [95% CI, 4.75-2560.91], p = 0.003) were independent imaging biomarkers associated with recurrent events. Time-dependent ROC indicated that integrated high enhancement ratio and steepness into clinical risk factors improved discrimination power with the ROC increased from 0.79 to 0.94 (p = 0.008). CONCLUSIONS The enhancement ratio and plaque steepness improved the accuracy over traditional clinical risk factors in predicting recurrent ischemic cerebrovascular events for patients with ICAS. KEY POINTS • High-resolution magnetic resonance imaging helps clinicians to evaluate high-risk Intracranial plaque. • The higher enhancement ratio and plaque steepness (= height/length) were the primary biomarkers associated with future ischemic cerebrovascular events. • High-resolution magnetic resonance imaging combined with clinical characteristics showed a higher accuracy for the prediction of recurrent events in patients with intracranial atherosclerosis.
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Du H, Li J, Yang W, Bos D, Zheng L, Wong LKS, Leung TW, Chen X. Intracranial Arterial Calcification and Intracranial Atherosclerosis: Close but Different. Front Neurol 2022; 13:799429. [PMID: 35211084 PMCID: PMC8861312 DOI: 10.3389/fneur.2022.799429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Intracranial arterial calcification (IAC) may be present in the intimal or medial arterial layer. This study aimed to elucidate the link between the calcification and atherosclerotic disease in the intracranial vasculature. Methods Consecutive patients with acute ischemic stroke were included. Bilateral intracranial segment of the internal carotid artery, M1 segment of the middle cerebral artery, intracranial segment of the vertebral artery, and the basilar artery were visualized by the multi-detector computed tomography (CT) and vessel-wall magnetic resonance imaging (vwMRI) within 14 days after stroke onset. IAC was into the intimal or medial pattern. Subsequently, on the vwMRI, we assessed the luminal stenosis, eccentricity, plaque burden, and intraplaque hemorrhage (IPH) as markers of atherosclerosis at each IAC site. Results Among 69 patients with stroke, IAC was identified in 35% of (161/483) artery segments, of which 61.5% were predominantly intimal calcification and 38.5% were predominantly medial calcification. About 79.8% of intimal calcifications and 64.5% of medial calcifications co-existed with atherosclerotic plaques. Intimal calcification was associated with luminal stenosis (p = 0.003) caused by atherosclerotic lesions. Compared with the medial IAC, intimal IAC was more often accompanied by eccentric plaques (p = 0.02), larger plaque burden (p = 0.001), and IPH (p = 0.001). Conclusion Our multimodal imaging-based comparison study on intracranial arteriosclerosis demonstrated that intimal IAC, compared with medial IAC, was more often accompanied by the luminal stenosis, larger plaque burden, eccentricity, and IPH, providing strong evidence for clinical evaluation on the mechanism, risk, and prognosis of ischemic stroke.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jia Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Clinical Epidemiology, Harvard TH Chan School of Public Health Boston, Cambridge, MA, United States
| | - Lu Zheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Munio M, Darcourt J, Gollion C, Barbieux-Guillot M, Bonneville F, Larrue V. Large artery intracranial stenosis in young adults with ischaemic stroke. Rev Neurol (Paris) 2021; 178:206-212. [PMID: 34920893 DOI: 10.1016/j.neurol.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/25/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Large artery intracranial stenosis (ICS) is a common finding in stroke patients, but is much less prevalent in Western countries than in Asia and in young adults than in the elderly. We investigated the prevalence and causes of ICS among French young adults with ischaemic stroke. Clinical and radiological data of patients aged 18-54 years treated consecutively for acute ischaemic stroke in the anterior circulation at a tertiary stroke centre were analysed retrospectively. Patients with>50% ICS were identified. ICS was evaluated using TOF-MRA, vessel wall-MRI, digital subtraction angiography and CT-angiography. A total of 316 patients were included. ICS was diagnosed in 29 patients, resulting in a prevalence of 9.2% (95% CI, 6.2 to 13.3). The leading cause of ICS was atherosclerosis (n=13), ahead of moyamoya disease (n=4), dissection (n=2), vasculitis (n=2), and reversible cerebral vasoconstriction syndrome (n=1). The cause of ICAS could not be determined in 7 patients. ICS was found in nearly one in 10 ischaemic strokes among French young adults. Atherosclerosis was the leading cause of ICS. The cause of ICS could not be determined in almost a quarter of the patients.
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Affiliation(s)
- M Munio
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - J Darcourt
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Pierre Paul Riquet, université de Toulouse, Toulouse, France
| | - C Gollion
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - M Barbieux-Guillot
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France
| | - F Bonneville
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Pierre Paul Riquet, université de Toulouse, Toulouse, France
| | - V Larrue
- Département de neurologie, hôpital Pierre Paul Riquet, université de Toulouse, place du Docteur Baylac, TSA 40031, 31059 Toulouse cedex 09, France.
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Mattay RR, Saucedo JF, Lehman VT, Xiao J, Obusez EC, Raymond SB, Fan Z, Song JW. Current Clinical Applications of Intracranial Vessel Wall MR Imaging. Semin Ultrasound CT MR 2021; 42:463-473. [PMID: 34537115 DOI: 10.1053/j.sult.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intracranial vessel wall MR imaging (VWI) is increasingly being used as a valuable adjunct to conventional angiographic imaging techniques. This article will provide an updated review on intracranial VWI protocols and image interpretation. We review VWI technical considerations, describe common VWI imaging features of different intracranial vasculopathies and show illustrative cases. We review the role of VWI for differentiating among steno-occlusive vasculopathies, such as intracranial atherosclerotic plaque, dissections and Moyamoya disease. We also highlight how VWI may be used for the diagnostic work-up and surveillance of patients with vasculitis of the central nervous system and cerebral aneurysms.
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Affiliation(s)
- Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jose F Saucedo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Jiayu Xiao
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Scott B Raymond
- Department of Radiology, University of Vermont Medical Center, Burlington, VT
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
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7
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Song JW, Wasserman BA. Vessel wall MR imaging of intracranial atherosclerosis. Cardiovasc Diagn Ther 2020; 10:982-993. [PMID: 32968655 DOI: 10.21037/cdt-20-470] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.
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Affiliation(s)
- Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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8
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Xu Z, Li M, Lyu J, Hou Z, He J, Mo D, Gao F, Liu X, Sui B, Shen M, Pan Y, Wang Y, Lou X, Miao Z, Luo B, Ma N. Different risk factors in identical features of intracranial atherosclerosis plaques in the posterior and anterior circulation in high-resolution MRI. Ther Adv Neurol Disord 2020; 13:1756286420909991. [PMID: 32206091 PMCID: PMC7074472 DOI: 10.1177/1756286420909991] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/15/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We constructed a high-volume registry to identify whether risk factors of intracranial atherosclerotic plaque (ICAP) features differ in the posterior and anterior circulation in patients with symptomatic intracranial atherosclerotic stenosis (ICAS) investigated by high-resolution magnetic resonance imaging (HRMRI). METHODS The registry was constructed for patients with symptomatic ICAS who underwent HRMRI for culprit plaques. ICAP-vulnerable features included positive remodelling, diffuse distribution, intraplaque haemorrhage and strong enhancement. RESULTS We analysed risk factors for the same ICAP features between the posterior and anterior circulation in data of 97 patients in the posterior circulation and 105 patients in the anterior circulation ICAPs. In patients with diffuse distribution, the probability of being female were lower [odds ratio (OR):0.08; 95% confidence interval (CI):0.02-0.34; p = 0.001] and having diabetes mellitus was higher (OR: 7.75; 95% CI:1.75-34.39; p = 0.007) in posterior circulation patients. In patients with strong enhancement, the probability of having diabetes was higher in posterior circulation patients (OR:6.71; 95% CI:1.37-32.81; p = 0.019). CONCLUSIONS Our results demonstrate more risk factors in the posterior than in the anterior circulation in patients with the same ICAP-vulnerable features, highlighting the need for stratification of risk factors in symptomatic ICAPs. TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02705599.
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Affiliation(s)
- Ziqi Xu
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Mingyao Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Zhikai Hou
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jianfeng He
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Benyan Luo
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No.119 Nansihuanxilu, Fengtai District, Beijing 100070, China
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Dai W, Li D, Cai Y, Qiu E, Xu J, Li J, Wang Y, Guo Y, Li Y, Jiang B, Zhang Y, Ge J, Yao C, Zhang R, Liu G, Yao G, Cai J, Zhao X. Association between homocysteine and multivascular atherosclerosis in stroke-related vascular beds determined by three-dimensional magnetic resonance vessel wall imaging. J Clin Neurosci 2019; 70:72-78. [PMID: 31447358 DOI: 10.1016/j.jocn.2019.08.076] [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: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atherosclerosis in stroke-related vascular beds is the major cause of stroke. Studies demonstrated that multivascular atherosclerosis is prevalent in stroke patients and those with multivascular plaques had higher risk of recurrent stroke. OBJECTIVES This study investigated the relationship between homocysteine and multivascular atherosclerosis in stroke-related vascular beds using magnetic resonance imaging. METHODS Patients with recent ischemic cerebrovascular symptoms were enrolled and underwent three-dimensional magnetic resonance vessel wall imaging for intracranial arteries, extracranial carotid arteries and aortic arch. Traditional risk factors and homocysteine were measured. Presence of multivascular plaques defined as plaques in at least two stroke-related vascular beds on magnetic resonance imaging was determined. The relationship between homocysteine and characteristics of multivascular plaques was determined. RESULTS Of 49 enrolled patients (mean age: 56.3 ± 13.8 years; 35 males), 23 had multivascular plaques. Homocysteine (odds ratio, 1.17; 95% confidence interval, 1.02-1.34; p = 0.022) and age (odds ratio, 1.71; 95% confidence interval, 1.22-2.41; p = 0.002) were significantly associated with presence of multivascular plaques. The adjusted associations remained significant (both p < 0.05). In discriminating presence of multivascular plaques, the area-under-the-curve of age, homocysteine and combination of them was 0.79, 0.70 and 0.87 respectively. CONCLUSIONS Homocysteine is independently associated with stroke-related multivascular plaques and combination of age and homocysteine has stronger predictive value.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China; Department of Neurology, Chinese PLA General Hospital & Medical School of Chinese PLA, Beijing 100853, China
| | - Dongye Li
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing 100069, China
| | - Ying Cai
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, China
| | - Enchao Qiu
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Jingwei Xu
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Jing Li
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yunxia Wang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yueqi Guo
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yifan Li
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Bo Jiang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yunyan Zhang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Junling Ge
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Cunshan Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Guoen Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.
| | - Jianming Cai
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.
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Liu S, Luo Y, Wang C, Tang R, Sheng Z, Xie W, Chai S, Guo Y, Chai C, Yang Q, Fan Z, Chang B, Xia S. Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis. J Magn Reson Imaging 2019; 51:195-204. [PMID: 31069889 DOI: 10.1002/jmri.26778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Song Liu
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Luo
- Radiology DepartmentTranslational Research Institute of Brain and Brain‐Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine Shanghai China
| | - Chen Wang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Ruowei Tang
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Zhiguo Sheng
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Weiwei Xie
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Shengting Chai
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Guo
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Chao Chai
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Qi Yang
- Radiology DepartmentXuanwu Hospital, Capital Medical University Beijing China
| | - Zhaoyang Fan
- Biomedical Imaging Research InstituteCedars‐Sinai Medical Center California Los Angeles USA
| | - Binge Chang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Shuang Xia
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
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11
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Quantitative score of the vessel morphology in middle cerebral artery atherosclerosis. J Neurol Sci 2019; 399:111-117. [PMID: 30798108 DOI: 10.1016/j.jns.2019.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We aimed to quantitatively assess the vessel morphology of middle cerebral artery (MCA) atherosclerosis and explore its value in discriminating plaque types. METHODS Patients were selected from a high-resolution magnetic resonance imaging (HRMRI) study from January 2007 to December 2015. One hundred and three patients with acute cerebral infarcts due to MCA stenosis (>50%) and eighty-nine patients with asymptomatic MCA stenosis (>50%) were included. Quantitative measurements of MCA morphology, including lumen area, outer-wall and wall area at stenotic site and reference site, stenotic degree, plaque length, remodeling index and plaque eccentricity, were performed on HRMRI with observers blinded to clinical presentations. Firth's penalized logistic regression analysis was used to construct a symptomatic plaque score (SPS) model. Then, the HRMRI data of 39 patients prospectively enrolled from January 2016 to January 2017 were used to validate the SPS model. RESULTS The HRMRI data of 103 patients with symptomatic MCA stenosis and 89 patients with asymptomatic MCA stenosis in the construction cohort were analyzed. Four main factors were found to be associated with symptomatic plaques: stenotic lumen area ≥ 2.28 mm2, stenotic wall area ≥ 8.88 mm2, plaque length and presence of an eccentric plaque. Summation of each logistic regression coefficient multiplying the corresponding score produced the SPS with an area under curve (AUC) of 0.890 on receiver operating characteristics analysis. Validation of the score of 39 plaques (19 symptomatic and 20 asymptomatic) revealed an AUC of 0.862, confirming the continued diagnostic ability. When the data were pooled in all 235 plaques, the optimal cutoff score of discriminating symptomatic and asymptomatic plaques was 2.79 (SPS ≥ 2.79 indicating a symptomatic plaque) with AUC = 0.886, sensitivity 81.1% and specificity 80.5%. CONCLUSIONS The quantitative analysis of MCA morphology can independently and accurately discriminate plaque types, suggesting its close association with the underlying pathophysiology. Further prospective studies are required to verify whether the SPS model is clinically valuable in monitoring plaque progression and assessing the vulnerability.
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12
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Zheng L, Yang WJ, Niu CB, Zhao HL, Wong KS, Leung TWH, Chen XY. Correlation of Adventitial Vasa Vasorum with Intracranial Atherosclerosis: A Postmortem Study. J Stroke 2018; 20:342-349. [PMID: 30309229 PMCID: PMC6186920 DOI: 10.5853/jos.2018.01263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/07/2018] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose Vasa vasorum (VV) have been believed to be rare or non-existent in small-caliber intracranial arteries. In a series of human cerebral artery specimens, we identified and examined the distribution of VV in association with co-existing intracranial atherosclerosis.
Methods We obtained cerebral artery specimens from 32 consecutive autopsies of subjects aged 45 years or above. We scrutinized middle cerebral artery (MCA), vertebral artery (VA), and basilar artery (BA) for the presence of adventitial VV. We described the distribution of VV, and the characteristics of co-existing atherosclerotic lesions.
Results Among 157 intracranial arteries, adventitial VV were present in 74 of the 157 specimens (47%), involving MCA (n=13, 18%), BA (n=14, 19%), and VA (n=47, 64%). Although qualitatively these 74 adventitial VV distributed similarly in arteries with or without atherosclerotic lesions (disease-free arteries n=4/8; arteries of pre-atherosclerosis n=17/42; and arteries of progressive atherosclerosis n=53/107), the presence of adventitial VV in intracranial VA was associated with a heavier plaque load (1.72±1.66 mm2 vs. 0.40±0.32 mm2, P<0.001), severer luminal stenosis (25%±21% vs. 12%±9%, P=0.002), higher rate of concentric lesions (79% vs. 36%, P=0.002), and denser intraplaque calcification (44% vs. 0%, P=0.003). Histologically, intracranial VA with VV had a larger diameter (3.40±0.79 mm vs. 2.34±0.58 mm, P<0.001), thicker arterial wall (0.31±0.13 mm vs. 0.23±0.06 mm, P=0.002), and a larger intima-media (0.19±0.09 mm vs. 0.13± 0.04 mm, P=0.003) than VA without VV.
Conclusions Our study demonstrated the distribution of adventitial VV within brain vasculature and association between vertebral VV and progressive atherosclerotic lesions with a heavier plaque load and denser intraplaque calcification.
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Affiliation(s)
- Lu Zheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wen Jie Yang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chun Bo Niu
- Department of Pathology, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Hai Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Thomas Wai Hong Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Xiang Yan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
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13
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Yang WJ, Fisher M, Zheng L, Niu CB, Paganini-Hill A, Zhao HL, Xu Y, Wong KS, Ng HK, Chen XY. Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study. Front Neurol 2017; 8:488. [PMID: 28993752 PMCID: PMC5622314 DOI: 10.3389/fneur.2017.00488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background Anterior and posterior circulation atherosclerosis differ in vascular risk factors and stroke mechanisms. However, few studies have compared the pathological features between these lesions. Using a series of intracranial artery specimens, we characterized the intracranial atherosclerotic lesions and compared pathological features among different arteries of the intracranial vasculature. Methods Intracranial large arteries of 32 consecutively recruited autopsy cases of Chinese adults aged 45 years or older were examined pathologically using routine histology and immunostaining, to characterize the pathological features of the atherosclerotic lesions. We analyzed middle cerebral arteries (MCAs) (both left and right), vertebral arteries (VAs) (side more affected), and basilar arteries (BAs). Results Progressive atherosclerotic lesions were present in 91(71%) of the 128 arteries examined. Features of complicated plaques were infrequently detected: plaque hemorrhage was encountered in 12%, neovasculature in 12%, lumen thrombi in 13%, macrophage infiltration in 20%, and calcification in 25% of arteries. Luminal narrowing of MCA was the most severe, followed by VA; the BA least stenotic (37 ± 25 vs. 30 ± 24 vs. 20 ± 20%, all p < 0.05). MCA had more eccentric (vs. concentric) plaques than VA (69 vs. 25%, p = 0.003) and BA (69 vs. 38%; p = 0.03). Lumen thrombi were more frequent in BA, and calcification most commonly occurred in VA atherosclerotic lesions. Conclusion Intracranial atherosclerotic plaques were commonly present in this sample, but the lesions generally lacked features of complicated plaques. MCA lesions had demonstrable differences compared with VA and BA lesions. Further studies are needed to determine whether these characteristics indicate a distinctive atherosclerotic phenotype for the intracranial vasculature.
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Affiliation(s)
- Wen Jie Yang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mark Fisher
- Department of Neurology, University of California Irvine, Irvine, CA, United States.,Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, CA, United States
| | - Lu Zheng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Bo Niu
- Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China
| | - Annlia Paganini-Hill
- Department of Neurology, University of California Irvine, Irvine, CA, United States
| | - Hai Lu Zhao
- Center for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
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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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15
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Lee DH, Park JH. Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
| | - Jong-Ho Park
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
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16
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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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17
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Chen XY, Dieleman N, Chu WCW. Response by Chen et al to Letter Regarding Article, "Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis". Stroke 2016; 47:e255. [PMID: 27650067 DOI: 10.1161/strokeaha.116.014878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xiang Yan Chen
- Department of Medicine and Therapeutics Chinese University of Hong Kong Shatin, Hong Kong SAR, China
| | - Nikki Dieleman
- Department of Radiology University Medical Center Utrecht The Netherlands
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology Chinese University of Hong Kong Shatin, Hong Kong SAR, China
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18
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Yang WJ, Chen XY, Zhao HL, Niu CB, Zhang B, Xu Y, Wong KS, Ng HK. Postmortem Study of Validation of Low Signal on Fat-Suppressed T1-Weighted Magnetic Resonance Imaging as Marker of Lipid Core in Middle Cerebral Artery Atherosclerosis. Stroke 2016; 47:2299-304. [PMID: 27462119 PMCID: PMC4991347 DOI: 10.1161/strokeaha.116.013398] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022]
Abstract
Background and Purpose— High signal on T1-weighted fat-suppressed images in middle cerebral artery plaques on ex vivo magnetic resonance imaging was verified to be intraplaque hemorrhage histologically. However, the underlying plaque component of low signal on T1-weighted fat-suppressed images (LST1) has never been explored. Based on our experience, we hypothesized that LST1 might indicate the presence of lipid core within intracranial plaques. Methods— 1.5 T magnetic resonance imaging was performed in the postmortem brains to scan the cross sections of bilateral middle cerebral arteries. Then middle cerebral artery specimens were removed for histology processing. LST1 presence was identified on magnetic resonance images, and lipid core areas were measured on the corresponding histology sections. Results— Total 76 middle cerebral artery locations were included for analysis. LST1 showed a high specificity (96.9%; 95% confidence interval, 82.0%–99.8%) but a low sensitivity (38.6%; 95% confidence interval, 24.7%–54.5%) for detecting lipid core of all areas. However, the sensitivity increased markedly (81.2%; 95% confidence interval, 53.7%–95.0%) when only lipid cores of area ≥0.80 mm2 were included. Mean lipid core area was 5× larger in those with presence of LST1 than in those without (1.63±1.18 mm2 versus 0.32±0.31 mm2; P=0.003). Conclusions— LST1 is a promising imaging biomarker of identifying intraplaque lipid core, which may be useful to distinguish intracranial atherosclerotic disease from other intracranial vasculopathies and to assess plaque vulnerability for risk stratification of patients with intracranial atherosclerotic disease. In vivo clinical studies are required to explore the correlation between LST1 and clinical outcomes of patients with intracranial atherosclerotic disease.
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Affiliation(s)
- Wen-Jie Yang
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Xiang-Yan Chen
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China.
| | - Hai-Lu Zhao
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Chun-Bo Niu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Bing Zhang
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Yun Xu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Ka-Sing Wong
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | - Ho-Keung Ng
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Centre for Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, China (C.-B.N.); and Department of Radiology (B.Z.) and Department of Neurology (Y.X.), Affiliated Drum Tower Hospital of Nanjing University Medical School, China
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