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Salih M, Taussky P, Ogilvy CS. Association between cervicocerebral artery dissection and tortuosity - a review on quantitative and qualitative assessment. Acta Neurochir (Wien) 2024; 166:285. [PMID: 38977512 DOI: 10.1007/s00701-024-06171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
Cervicocerebral artery dissection stands out as a significant contributor to ischemic stroke in young adults. Several studies have shown that arterial tortuosity is associated with dissection. We searched Pubmed and Embase to identify studies on the association between arterial tortuosity and cervicocerebral artery dissection, and to perform a review on the epidemiology of cervicocerebral artery tortuosity and dissection, pathophysiology, measurement of vessels tortuosity, strength of association between tortuosity and dissection, clinical manifestation and management strategies. The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation is used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervicocerebral artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with cervicocerebral artery dissection. Symptomatic patients with extracranial cervical artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Patients with recurrent ischemia, compromised cerebral blood flow or contraindications for antithrombotic agents are usually treated with open surgery or endovascular technique. Those with subarachnoid hemorrhage and intracranial artery dissection are often managed with surgical intervention due to high risk of re-hemorrhage.
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Affiliation(s)
- Mira Salih
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Philipp Taussky
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Christopher S Ogilvy
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States.
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Eun MY, Song HN, Choi JU, Cho HH, Kim HJ, Chung JW, Song TJ, Jung JM, Bang OY, Kim GM, Park H, Liebeskind DS, Seo WK. Global intracranial arterial tortuosity is associated with intracranial atherosclerotic burden. Sci Rep 2024; 14:11318. [PMID: 38760396 DOI: 10.1038/s41598-024-61527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
The effect of arterial tortuosity on intracranial atherosclerosis (ICAS) is not well understood. This study aimed to evaluate the effect of global intracranial arterial tortuosity on intracranial atherosclerotic burden in patients with ischemic stroke. We included patients with acute ischemic stroke who underwent magnetic resonance angiography (MRA) and classified them into three groups according to the ICAS burden. Global tortuosity index (GTI) was defined as the standardized mean curvature of the entire intracranial arteries, measured by in-house vessel analysis software. Of the 516 patients included, 274 patients had no ICAS, 140 patients had a low ICAS burden, and 102 patients had a high ICAS burden. GTI increased with higher ICAS burden. After adjustment for age, sex, vascular risk factors, and standardized mean arterial area, GTI was independently associated with ICAS burden (adjusted odds ratio [adjusted OR] 1.33; 95% confidence interval [CI] 1.09-1.62). The degree of association increased when the arterial tortuosity was analyzed limited to the basal arteries (adjusted OR 1.48; 95% CI 1.22-1.81). We demonstrated that GTI is associated with ICAS burden in patients with ischemic stroke, suggesting a role for global arterial tortuosity in ICAS.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Neurology, Graduate School, Korea University, Seoul, South Korea
| | - Ha-Na Song
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jong-Un Choi
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hwan-Ho Cho
- Department of Electronics Engineering, Incheon National University, Incheon, South Korea
| | - Hyung Jun Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jong-Won Chung
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Oh-Young Bang
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hyunjin Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, South Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea
| | - David S Liebeskind
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| | - Woo-Keun Seo
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Osteraas ND. Sex-based difference in selected stroke etiologies: cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, dissection, migraine, pregnancy/puerperium/OC use. J Stroke Cerebrovasc Dis 2024; 33:107753. [PMID: 38703878 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107753] [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: 01/03/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024] Open
Abstract
Females are at higher risk than males for a multitude of cerebrovascular conditions, both common and rare; partially resulting from a complex interplay between differing process involving genetics, hormonal influences, common cerebrovascular risk factors among others. Specific topics including cervical artery dissection, cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, migraine, along with these disorders in the setting of pregnancy, puerperium and oral contraceptive utilization. Epidemiology, pathophysiology, presentation, basics of management and outcomes are presented, with sex differences throughout.
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Affiliation(s)
- Nicholas Dykman Osteraas
- Department of Neuroscience at Saint Lukes Hospital, Advocate Aurora Health. 2900 W Oklahoma Ave, Milwaukee, WI 53215, United States.
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Stephens SB, Shalhub S, Dodd N, Li J, Huang M, Oda S, Kancherla K, Doan TT, Prakash SK, Weigand JD, Asch FM, Beecroft T, Cecchi A, Shittu T, Preiss L, LeMaire SA, Devereux RB, Pyeritz RE, Holmes KW, Roman MJ, Lacro RV, Shohet RV, Krishnamurthy R, Eagle K, Byers P, Milewicz DM, Morris SA. Vertebral Tortuosity Is Associated With Increased Rate of Cardiovascular Events in Vascular Ehlers-Danlos Syndrome. J Am Heart Assoc 2023; 12:e029518. [PMID: 37776192 PMCID: PMC10727246 DOI: 10.1161/jaha.123.029518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/26/2023] [Indexed: 10/02/2023]
Abstract
Background Arterial tortuosity is associated with adverse events in Marfan and Loeys-Dietz syndromes but remains understudied in Vascular Ehlers-Danlos syndrome. Methods and Results Subjects with a pathogenic COL3A1 variant diagnosed at age <50 years were included from 2 institutions and the GenTAC Registry (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions). Height-adjusted vertebral artery tortuosity index (VTI-h) using magnetic resonance or computed tomography angiography was calculated. Associations between VTI-h and outcomes of (1) cardiovascular events (arterial dissection/rupture, aneurysm requiring intervention, stroke), or (2) hollow organ collapse/rupture at age <50 years were evaluated using receiver operator curve analysis (using outcome by age 30 years) and mixed-effects Poisson regression for incidence rate ratios. Of 65 subjects (54% male), median VTI-h was 12 (interquartile range, 8-16). Variants were missense in 46%, splice site in 31%, and null/gene deletion in 14%. Thirty-two subjects (49%) had 59 events, including 28 dissections, 5 arterial ruptures, 4 aneurysms requiring intervention, 4 strokes, 11 hollow organ ruptures, and 7 pneumothoraces. Receiver operator curve analysis suggested optimal discrimination at VTI-h ≥15.5 for cardiovascular events (sensitivity 70%, specificity 76%) and no association with noncardiovascular events (area under the curve, 0.49 [95% CI, 0.22-0.78]). By multivariable analysis, older age was associated with increased cardiovascular event rate while VTI-h ≥15.5 was not (incidence rate ratios, 1.79 [95% CI, 0.76-4.24], P=0.185). However, VTI-h ≥15.5 was associated with events among those with high-risk variants <40 years (incidence rate ratios, 4.14 [95% CI, 1.13-15.10], P=0.032), suggesting effect modification by genotype and age. Conclusions Increased arterial tortuosity is associated with a higher incidence rate of cardiovascular events in Vascular Ehlers-Danlos syndrome. Vertebral tortuosity index may be a useful biomarker for prognosis when evaluated in conjunction with genotype and age.
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Affiliation(s)
- Sara B. Stephens
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of SurgeryOregon Health & Science UniversityPortlandORUSA
| | - Nicholas Dodd
- Memorial Health University Medical CenterSavannahGAUSA
| | - Jesse Li
- Division of Medical Genetics, Department of Internal MedicineThe University of Texas Health Science CenterHoustonTXUSA
| | - Michael Huang
- Division of Medical Genetics, Department of Internal MedicineThe University of Texas Health Science CenterHoustonTXUSA
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
- National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC)
| | - Kalyan Kancherla
- National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC)
- MedStar Heart and Vascular InstituteWashingtonDCUSA
- CHI St. VincentLittle RockARUSA
| | - Tam T. Doan
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
| | - Siddharth K. Prakash
- Division of Medical Genetics, Department of Internal MedicineThe University of Texas Health Science CenterHoustonTXUSA
| | - Justin D. Weigand
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
| | - Federico M. Asch
- National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC)
- MedStar Heart and Vascular InstituteWashingtonDCUSA
| | - Taylor Beecroft
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
| | - Alana Cecchi
- Division of Medical Genetics, Department of Internal MedicineThe University of Texas Health Science CenterHoustonTXUSA
| | - Teniola Shittu
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
| | | | - Scott A. LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTXUSA
| | | | - Reed E. Pyeritz
- Division of Translational Medicine and Human GeneticsPerelman School of Medicine at the University of PennsylvaniaPAUSA
| | - Kathryn W. Holmes
- Section of Cardiology, Department of PediatricsOregon Health & Science University and OHSU Doernbecher Children’s HospitalPortlandORUSA
| | - Mary J. Roman
- Department of MedicineWeill Cornell MedicineNew YorkNY
| | - Ronald V. Lacro
- Department of CardiologyBoston Children’s HospitalBostonMAUSA
| | | | | | - Kim Eagle
- National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC)
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, Department of Internal Medicine, Michigan MedicineUniversity of MichiganAnn ArborMIUSA
| | - Peter Byers
- Department of Laboratory Medicine and Pathology, Department of Medicine (Medical Genetics)University of WashingtonSeattleWAUSA
| | - Dianna M. Milewicz
- Division of Medical Genetics, Department of Internal MedicineThe University of Texas Health Science CenterHoustonTXUSA
| | - Shaine A. Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of MedicineTexas Children’s HospitalHoustonTXUSA
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Zhang X, Han J, Wang J, Yu S. A Comparative Study of the Etiology of Intracranial Vertebral Artery Dissection and Carotid Artery Dissection. Neurologist 2023; 28:281-286. [PMID: 36715669 PMCID: PMC10521784 DOI: 10.1097/nrl.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both extrinsic (trauma or violent movement) and intrinsic (structural abnormality, atherosclerosis, or hemodynamic instability) factors may result in arterial dissection. The role of these factors in the origin or progression of dissection remains unclear. This study aimed to characterize the clinical features, radiologic features, and outcomes of intracranial vertebral artery dissection compared with carotid artery dissection and to determine the major causative factors. METHODS Consecutive patients with craniocervical dissection (n=127) were retrospectively analyzed. Patients with intracranial vertebral artery dissection (n=77) and those with carotid artery dissection (n=35) were compared with respect to patient age, sex, cerebrovascular risk factors, laboratory indices, and radiologic features. RESULTS Intracranial vertebral artery dissection was the most common craniocervical arterial dissection in our cohort (n=77, 60.6%). Body mass index in the intracranial vertebral artery dissection group was significantly greater than that in carotid artery dissection group. Clinical manifestations of intracranial vertebral artery dissection included ischemic stroke (37.7%), dizziness or vertigo (39.0%), and headache or neck pain (44.2%). Two patients had a definite history of trauma. The frontal and lateral tortuosity ratios of the vertebral basilar artery were significantly greater while the vertex angle was smaller in the intracranial vertebral artery dissection group compared with carotid artery dissection group. A positive correlation between the tortuosity ratios and subarachnoid hemorrhage and a significant inverse correlation between the tortuosity ratios and lipid parameters (high-density lipoprotein; apolipoprotein A1) were identified. CONCLUSIONS Intrinsic causes may play a more important role in the development of intracranial vertebral artery dissection than carotid artery dissection.
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Affiliation(s)
- Xingwen Zhang
- Department of neurology, Chinese PLA General Hospital
| | - Jintao Han
- Department of Interventional vascular surgery, Peking University Third Hospital, Beijing, China
| | - Jun Wang
- Department of neurology, Chinese PLA General Hospital
| | - Shengyuan Yu
- Department of neurology, Chinese PLA General Hospital
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Li H, Xu S, Xu B, Zhang Y, Yin J, Yang Y. Unraveling the Links between Chronic Inflammation, Autoimmunity, and Spontaneous Cervicocranial Arterial Dissection. J Clin Med 2023; 12:5132. [PMID: 37568534 PMCID: PMC10419694 DOI: 10.3390/jcm12155132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Advances in imaging techniques have led to a rise in the diagnosis of spontaneous cervicocranial arterial dissection (SCCAD), which is now considered a common cause of stroke in young adults. However, our understanding of the pathophysiological mechanisms underlying SCCAD remains limited. Prior studies have proposed various factors contributing to arterial wall weakness or stress as potential causes for SCCAD. A combination of biopsies, case reports, and case-control studies suggests that inflammatory changes and autoimmunity may play roles in the cascade of events leading to SCCAD. In this review, we examine the close relationship between SCCAD, chronic inflammation, and autoimmune diseases, aiming to explore potential underlying pathophysiological mechanisms connecting these conditions. While some relevant hypotheses and studies exist, direct evidence on this topic is still relatively scarce. Further investigation of the underlying mechanisms in larger clinical cohorts is needed, and the exploration of animal models may provide novel insights.
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Affiliation(s)
- Hao Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Shiyao Xu
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Beibei Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Yutong Zhang
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Jun Yin
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
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Wang B, Zhao P, Zhang P, Hu J, Liu Y, Xie M, He Y. 3D-printed tortuous vessels with Photodissociable and morphology-controllable ink. J Biomater Appl 2023:8853282231183984. [PMID: 37485893 DOI: 10.1177/08853282231183984] [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: 07/25/2023]
Abstract
Acute ischemic stroke (AIS) is a high mortality cerebrovascular disease associated with vessel curvature. However, the relevant mechanism remains unclear due to a lack of appropriate tortuous vascular models to investigate and validate. This study explores the combination of projection-based 3D bioprinting (PBP) with photo-stimulus-responsive techniques to fabricate a sodium alginate (SA)/acrylamide (AAM) hydrogel vascular scaffold capable of bending deformation. The coordination of Fe3+ ions with carboxylate groups in the alginate chains of the vascular scaffold acts as a molecular switch, which can be dissociated through photoreduction to enable the deformation response. Fourier Transform Infrared (FTIR) and X-ray Photoelectron Spectroscopy (XPS) results verified the deformation principle. By subjecting the scaffold to UV light exposure, Fe3+ is reduced to Fe2+ in spatially selected regions, resulting in the release of strain and subsequent deformation. Furthermore, it also controlled the degree and direction of curvature of the vessels. The cell seeding experiment verified that the vascular scaffold showed excellent biocompatibility. Overall, our approach could be used to generate an in vitro model of curved vascular pathology to investigate the pathogenesis and provide new directions for the diagnosis and treatment of vascular diseases in the future.
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Affiliation(s)
- Biling Wang
- School of Mechatronics & Vehicle Engineering, East China Jiaotong University, Nanchang, China
- Engineering for Life Group (EFL), Suzhou, China
| | - Pengcheng Zhao
- School of Mechatronics & Vehicle Engineering, East China Jiaotong University, Nanchang, China
| | - Peng Zhang
- Engineering for Life Group (EFL), Suzhou, China
| | - Jun Hu
- School of Mechatronics & Vehicle Engineering, East China Jiaotong University, Nanchang, China
| | - Yande Liu
- School of Mechatronics & Vehicle Engineering, East China Jiaotong University, Nanchang, China
| | - Mingjun Xie
- Plastic and Reconstructive Surgery Center, Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yong He
- School of Mechatronics & Vehicle Engineering, East China Jiaotong University, Nanchang, China
- Engineering for Life Group (EFL), Suzhou, China
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
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Han J, Chen J, Tong X, Han M, Peng F, Niu H, Liu L, Liu F, Liu A. Association between smoking and intracranial artery dissection in patients aged less than 50 years: A propensity score-matched analysis. Tob Induc Dis 2023; 21:62. [PMID: 37215191 PMCID: PMC10193922 DOI: 10.18332/tid/162380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/07/2022] [Accepted: 03/19/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Smoking is a common risk factor for stroke in the young population. Intracranial artery dissection (ICAD) is a major cause of stroke in this population. However, the association between smoking and ICAD in young patients is not well characterized. We aimed to evaluate the association between smoking and ICAD in young individuals using propensity score-matched analysis. METHODS We conducted a retrospective study of consecutive patients aged <50 years with ICAD who were admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Patients with other non-atherosclerotic/non-aneurysmal cerebrovascular diseases were selected as controls. Propensity score matching was based on age and sex. Smoking and other vascular risk factors were compared between the two groups. RESULTS The ICAD and control group included 120 and 197 patients, respectively. Propensity score matching resulted in 70 matched pairs. Smoking was the only significant factor association with ICAD in the matched cohort (p=0.031). CONCLUSIONS In this propensity score-matched analysis, smoking showed a positive association with ICAD in young patients with common cerebrovascular diseases that were neither atherosclerotic nor aneurysmal. Further studies are required to investigate the predictive role of smoking for ICAD in the young population.
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Affiliation(s)
- Jiangli Han
- Department of Neurosurgery, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yatsen University, Zhuhai, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
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Oue H, Yamazaki Y, Qiao W, Yuanxin C, Ren Y, Kurti A, Shue F, Parsons TM, Perkerson RB, Kawatani K, Wang N, Starling SC, Roy B, Mosneag IE, Aikawa T, Holm ML, Liu CC, Inoue Y, Sullivan PM, Asmann YW, Kim BY, Bu G, Kanekiyo T. LRP1 in vascular mural cells modulates cerebrovascular integrity and function in the presence of APOE4. JCI Insight 2023; 8:e163822. [PMID: 37036005 PMCID: PMC10132158 DOI: 10.1172/jci.insight.163822] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023] Open
Abstract
Cerebrovasculature is critical in maintaining brain homeostasis; its dysregulation often leads to vascular cognitive impairment and dementia (VCID) during aging. VCID is the second most prevalent cause of dementia in the elderly, after Alzheimer's disease (AD), with frequent cooccurrence of VCID and AD. While multiple factors are involved in the pathogenesis of AD and VCID, APOE4 increases the risk for both diseases. A major apolipoprotein E (apoE) receptor, the low-density lipoprotein receptor-related protein 1 (LRP1), is abundantly expressed in vascular mural cells (pericytes and smooth muscle cells). Here, we investigated how deficiency of vascular mural cell LRP1 affects the cerebrovascular system and cognitive performance using vascular mural cell-specific Lrp1-KO mice (smLrp1-/-) in a human APOE3 or APOE4 background. We found that spatial memory was impaired in the 13- to 16-month-old APOE4 smLrp1-/- mice but not in the APOE3 smLrp1-/- mice, compared with their respective littermate control mice. These disruptions in the APOE4 smLrp1-/- mice were accompanied with excess paravascular glial activation and reduced cerebrovascular collagen IV. In addition, blood-brain barrier (BBB) integrity was disrupted in the APOE4 smLrp1-/- mice. Together, our results suggest that vascular mural cell LRP1 modulates cerebrovasculature integrity and function in an APOE genotype-dependent manner.
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Affiliation(s)
| | | | | | | | - Yingxue Ren
- Department of Quantitative Health Sciences, and
| | | | - Francis Shue
- Department of Neuroscience
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Tammee M. Parsons
- Department of Neuroscience
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ralph B. Perkerson
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | | | | | | | | | | | | | | | - Patrick M. Sullivan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Betty Y.S. Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Takahisa Kanekiyo
- Department of Neuroscience
- Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida, USA
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van Laarhoven CJHCM, Arnold M, Danilova M, Dreval M, Ferrari E, Simonetti BG, Gralla J, Heldner M, Kalashnikova L, Mancuso M, Metso TM, Steinsiepe VK, Strbian D, Tatlisumak T, de Kleijn DPV, de Borst GJ. Delayed Development of Aneurysmal Dilatations in Patients with Extracranial Carotid Artery Dissections. Eur J Vasc Endovasc Surg 2022; 64:595-601. [PMID: 35977695 DOI: 10.1016/j.ejvs.2022.08.010] [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: 06/21/2021] [Revised: 06/22/2022] [Accepted: 08/06/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Dissection of the carotid artery (CaAD) may result in aneurysm formation. The present study was undertaken to evaluate the time of onset of post-dissection extracranial carotid artery aneurysms (ECAA) following CaAD, and to analyse independent risk factors for the development of these aneurysms. METHODS From four European stroke centres, 360 patients with extracranial CaAD were included. The time between the estimated dissection onset and aneurysm formation was analysed, and the clinical risk factors increasing the probability of aneurysm were assessed. RESULTS The median duration of follow up was 5.2 months (range 0 - 24 months). A total of 75 post-dissection ECAAs were identified in 70 patients (19.4%, 95% confidence interval [CI] 15.7 - 23.8). In 52 of 70 (74%) patients, the ECAA was diagnosed at the initial clinical work up of CaAD diagnosis, with the median estimated time of dissection onset to ECAA diagnosis being six days (interquartile range [IQR] 0 - 25). In the remaining 18 (26%) patients who had normal carotid arteries at the initial imaging, the aneurysm diagnosis was made a median of 6.2 months (189 days) from the original imaging (IQR 128 - 198). A Cox proportional hazards model showed that both multiple artery dissections (hazard ratio [HR] 2.58, 95% CI 1.54 - 4.33) and arterial tortuosity (HR 1.79, 95% CI 1.08 - 2.95) were associated with presence of ipsilateral ECAA. CONCLUSION This post hoc cohort analysis showed substantially delayed development of ipsilateral ECAA in patients with CaAD, months after baseline. Multiple dissections and arterial tortuosity are associated with the presence of ECAA and can be used in future prediction models of ECAA development in patients with CaAD.
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Affiliation(s)
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Maria Danilova
- Research Centre of Neurology, University Hospital Moscow, University of Moscow, Moscow, Russia
| | - Marina Dreval
- Research Centre of Neurology, University Hospital Moscow, University of Moscow, Moscow, Russia
| | - Elena Ferrari
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Barbara G Simonetti
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neuropaediatrics, Institute of Paediatrics of Southern Switzerland EOC, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mirjam Heldner
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ludmila Kalashnikova
- Research Centre of Neurology, University Hospital Moscow, University of Moscow, Moscow, Russia
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Tiina M Metso
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Valentin K Steinsiepe
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
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11
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van Laarhoven CJHCM, Willemsen SI, Klaassen J, de Vries EE, van der Vliet QMJ, Hazenberg CEVB, Bots ML, de Borst GJ. Carotid tortuosity is associated with extracranial carotid artery aneurysms. Quant Imaging Med Surg 2022; 12:5018-5029. [PMID: 36330172 PMCID: PMC9622451 DOI: 10.21037/qims-22-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/19/2022] [Indexed: 09/03/2023]
Abstract
BACKGROUND Tortuous arteries may be associated with carotid dissection. The intima disruption caused by a carotid dissection is a possible cause of extracranial carotid artery aneurysms (ECAAs). The aim was to investigate if carotid tortuosity is also associated with ECAA in patients without presence or history of a carotid artery dissection. METHODS A retrospective case-control study was performed including 35 unilateral ECAA patients (cases) and 105 age- and sex-matched controls. Tortuosity was expressed as tortuosity-index (TI), curvature, and torsion measured on computed tomography angiography (CTA) data in 3Mensio Vascular and MATLAB by two independent investigators. Primary comparison was tortuosity in ipsi- versus contralateral carotid artery within the cohort of ECAA patients. Secondary comparison was tortuosity with ipsilateral carotid arteries in control patients. All observations were assessed on inter- and intra-operator reproducibility. RESULTS Carotid tortuosity was comparable within the cohort of ECAA patients (Spearman correlation 0.76, P<0.001), yet distinctively higher in comparison with unilateral controls. After adjustment for patient characteristics, presence of ECAA was associated with TI (β 0.146, 95% CI: 0.100-0.192). All tortuosity observations showed excellent inter- and intra-operator reproducibility. CONCLUSIONS Carotid tortuosity seems to be a risk factor for development of ECAA. Surveillance of individuals with increased carotid tortuosity therefore potentially ensures prompt diagnosis and treatment of ECAA. However, future research should investigate if persons with an increased tortuosity do indeed develop ECAA.
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Affiliation(s)
| | - Saskia I. Willemsen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Evelien E. de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Quirine M. J. van der Vliet
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carotid Aneurysm Registry (CAR) study groupBjörckMartinChiesaRobertoDavidovicLazarDósaEditJaaskelainenJuha ELindgrenAnttiMarkovicMiroslavMasciaDanieleNordanstigJoakimKumakuraHarue SantiagoSimão da SilvaErasmoSzeberinZoltán
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Leng X, Kou S, Lin Y, Hagemann AR, Hagemann IS, Thaker PH, Kuroki LM, McCourt CK, Mutch DG, Siegel C, Powell MA, Zhu Q. Quantification of ovarian lesion and fallopian tube vasculature using optical-resolution photoacoustic microscopy. Sci Rep 2022; 12:15850. [PMID: 36151126 PMCID: PMC9508221 DOI: 10.1038/s41598-022-19778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity in the pathological and clinical manifestations of ovarian cancer is a major hurdle impeding early and accurate diagnosis. A host of imaging modalities, including Doppler ultrasound, MRI, and CT, have been investigated to improve the assessment of ovarian lesions. We hypothesized that pathologic conditions might affect the ovarian vasculature and that these changes might be detectable by optical-resolution photoacoustic microscopy (OR-PAM). In our previous work, we developed a benchtop OR-PAM and demonstrated it on a limited set of ovarian and fallopian tube specimens. In this study, we collected data from over 50 patients, supporting a more robust statistical analysis. We then developed an efficient custom analysis pipeline for characterizing the vascular features of the samples, including the mean vessel diameter, vascular density, global vascular directionality, local vascular definition, and local vascular tortuosity/branchedness. Phantom studies using carbon fibers showed that our algorithm was accurate within an acceptable error range. Between normal ovaries and normal fallopian tubes, we observed significant differences in five of six extracted vascular features. Further, we showed that distinct subsets of vascular features could distinguish normal ovaries from cystic, fibrous, and malignant ovarian lesions. In addition, a statistically significant difference was found in the mean vascular tortuosity/branchedness values of normal and abnormal tubes. The findings support the proposition that OR-PAM can help distinguish the severity of tubal and ovarian pathologies.
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Affiliation(s)
- Xiandong Leng
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Sitai Kou
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Yixiao Lin
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Andrea R Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Ian S Hagemann
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Premal H Thaker
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lindsay M Kuroki
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Carolyn K McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David G Mutch
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew A Powell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Quing Zhu
- Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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13
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Keser Z, Chiang CC, Benson JC, Pezzini A, Lanzino G. Cervical Artery Dissections: Etiopathogenesis and Management. Vasc Health Risk Manag 2022; 18:685-700. [PMID: 36082197 PMCID: PMC9447449 DOI: 10.2147/vhrm.s362844] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65–95%), TIA/ischemic stroke (>50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3–9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Correspondence: Zafer Keser, Department of Neurology – Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Email
| | | | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
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14
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Song Y, Park SI, Budianto P, Kwon B, Suh DC. Clinical Manifestation and Radiologic Patterns of Spontaneous Cervicocephalic Dissection According to the Anatomic Location: A Single-Center Analysis in Korean Patients. Neurointervention 2022; 17:78-86. [PMID: 35692184 PMCID: PMC9256473 DOI: 10.5469/neuroint.2022.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Spontaneous cervicocephalic dissection (SCAD) is an important cause of stroke and shows various lesion locations and clinical features. The purpose of this study was to analyze the location of SCAD and its clinical and radiologic patterns in Korean patients. MATERIALS AND METHODS Patients with SCAD who were evaluated between 2013 and 2018 at a tertiary center in Korea were reviewed. We classified and compared the morphological (aneurysm or steno-occlusion) and presenting (hemorrhage or infarction) patterns according to the lesion locations (anterior circulation [AC] vs. posterior circulation [PC]; intradural [ID] vs. extradural [ED]). RESULTS A total of 166 patients were included in this study. The SCAD most commonly occurred in the PC-ID location (65.1%), followed by AC-ID (13.3%), AC-ED (13.3%), and PC-ED (8.4%). Aneurysm and steno-occlusion patterns were observed in 66.9% and 57.8% of the cases, respectively. The aneurysm pattern was significantly more common in the PC-ID location (78.7%) than in other locations. As for the presenting pattern, cerebral infarction was the most common pattern (39.8%), and intracranial hemorrhage was observed only in the ID location (7.2%). CONCLUSION In Korean patients, PC-ID, especially ID vertebral artery, was the most common location of SCAD, and most cases were accompanied by an aneurysm. It also suggested that these location trends differ by population or ethnicity.
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Affiliation(s)
- Yunsun Song
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ik Park
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pepi Budianto
- Department of Neurology, Universitas Sebelas Maret Hospital, Sukoharjo, Indonesia
| | - Boseong Kwon
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Neurointervention, GangNam St. Peter's Hospital, Seoul, Korea
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15
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Vertebral Artery Tortuosity and Morphometric Characteristics of Patients with Recurrent Cervical Artery Dissection. J Stroke Cerebrovasc Dis 2022; 31:106346. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
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16
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Arterial Tortuosity and Its Correlation with White Matter Hyperintensities in Acute Ischemic Stroke. Neural Plast 2022; 2022:4280410. [PMID: 35369646 PMCID: PMC8970938 DOI: 10.1155/2022/4280410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The association between arterial tortuosity and acute ischemic stroke (AIS) has been reported, but showing inconsistent results. We hypothesized that tortuosity of extra- and intracranial large arteries might be higher in AIS patients. Furthermore, we explored the correlation between artery tortuosity and white matter hyperintensity (WMH) severity in AIS patients. Methods 166 AIS patients identified as large artery atherosclerosis, and 83 control subjects were enrolled. All subjects received three-dimensional computed tomography angiography (CTA). Arterial tortuosity was evaluated using the tortuosity index. WMHs were evaluated using magnetic resonance imaging in all AIS patients. Results AIS patients showed significantly increased arterial tortuosity index relative to controls, including left carotid artery (CA) (p = 0.001), right CA (p < 0.001), left common carotid artery (CCA) (p < 0.001), right CCA (p < 0.001), left internal carotid artery (p = 0.001), right internal carotid artery (p = 0.01), left extracranial internal carotid artery (EICA) (p < 0.001), right EICA (p = 0.01), and vertebral artery dominance (VAD) (p = 0.001). The tortuosity of all above arteries was associated with the presence of AIS. AIS patients with moderate or severe WMHs had a higher tortuosity index in left CA (p = 0.005), left CCA (p = 0.003), left EICA (p = 0.07), and VAD (p = 0.001). In addition, the tortuosity of left EICA and VAD was associated with WMH severity in AIS patients. Conclusions Increased extra- and intracranial large arteries tortuosity is associated with AIS. The tortuosity of left carotid artery system and vertebral artery may be the independent risk factors for WMH severity in AIS patients. Clinical Trial Registration. This trial is registered with NCT03122002 (http://www.clinicaltrials.gov).
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17
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Pikus HJ. Letter: Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of Tertiary-Center 310 Patient Cohort. Oper Neurosurg (Hagerstown) 2022; 22:e186. [PMID: 35147586 DOI: 10.1227/ons.0000000000000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harold J Pikus
- Upper Valley Neurology Neurosurgery, Lebanon, New Hampshire, USA
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18
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Zhu J, Teolis S, Biassou N, Tabb A, Jabin PE, Lavi O. Tracking the Adaptation and Compensation Processes of Patients' Brain Arterial Network to an Evolving Glioblastoma. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2022; 44:488-501. [PMID: 32750811 DOI: 10.1109/tpami.2020.3008379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The brain's vascular network dynamically affects its development and core functions. It rapidly responds to abnormal conditions by adjusting properties of the network, aiding stabilization and regulation of brain activities. Tracking prominent arterial changes has clear clinical and surgical advantages. However, the arterial network functions as a system; thus, local changes may imply global compensatory effects that could impact the dynamic progression of a disease. We developed automated personalized system-level analysis methods of the compensatory arterial changes and mean blood flow behavior from a patient's clinical images. By applying our approach to data from a patient with aggressive brain cancer compared with healthy individuals, we found unique spatiotemporal patterns of the arterial network that could assist in predicting the evolution of glioblastoma over time. Our personalized approach provides a valuable analysis tool that could augment current clinical assessments of the progression of glioblastoma and other neurological disorders affecting the brain.
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19
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Mosteiro A, Pedrosa L, Torne R, Rodríguez-Hernández A, Amaro S, Reyes LA, Hoyos JA, San Roman L, de Riva N, Domínguez CJ, Enseñat J. Venous tortuosity as a novel biomarker of rupture risk in arteriovenous malformations: ARI score. J Neurointerv Surg 2021; 14:1220-1225. [PMID: 34880076 DOI: 10.1136/neurintsurg-2021-018181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Risk of rupture in arteriovenous malformations (AVMs) varies considerably among series. Hemodynamic factors, especially within the venous side of the circuit, seem to be responsible but are not yet well defined. We analyzed tortuosity in the draining vein as a potential new marker of rupture in AVMs, and propose a simple index to predict AVM bleeding. METHODS A retrospective analysis of the venous angioarchitecture of brain AVMs was carried out at our center from 2013 to 2021, with special attention to venous tortuosity. After univariate analysis, the features of interest were combined to construct several predictive models using multivariate logistic regression. The best model proposed was the new AVM rupture index (ARI), which was then validated in an independent cohort. RESULTS 68 AVMs were included in the first step and 32 in the validation cohort. Venous tortuosity, expressed as at least one curve >180°, was a significant predictor of rupture (p=0.023). The proposed bleeding index consisted of: venous tortuosity (any curve of >180°), single draining vein, and paraventricular/infratentorial location. It seems to be a robust evaluation tool, with an area under the receiver operating characteristic (AUROC) curve of 0.806 (95% CI 0.714 to 0.899), consistently replicated in the independent sample (AUROC 0.759 (95% CI 0.607 to 0.911)), and with an inter-rater kappa coefficient of 0.81 . CONCLUSIONS Venous tortuosity may serve as a predictor of bleeding in AVMs that warrants further investigation. This likely new marker was one of the three elements of the proposed ARI. ARI outperformed the predictive accuracy of previous scores, and remained consistent in an independent cohort.
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Affiliation(s)
- Alejandra Mosteiro
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Leire Pedrosa
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS Biomedical Research Institute, Barcelona, Spain
| | - Ramón Torne
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain .,IDIBAPS Biomedical Research Institute, Barcelona, Spain.,Comprehensive Stroke Unit, Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Sergi Amaro
- Comprehensive Stroke Unit, Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luis A Reyes
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jhon A Hoyos
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Luis San Roman
- Radiology Department, Angioradiology Section, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nicolás de Riva
- Department of Anesthesiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carlos J Domínguez
- Department of Neurosurgery, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,IDIBAPS Biomedical Research Institute, Barcelona, Spain
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20
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Venturini G, Vuolo L, Pracucci G, Picchioni A, Failli Y, Benvenuti F, Sarti C. Association between carotid artery dissection and vascular tortuosity: a case-control study. Neuroradiology 2021; 64:1127-1134. [PMID: 34766191 DOI: 10.1007/s00234-021-02848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to verify if vascular tortuosity (VT) may represent a risk factor for spontaneous epiaortic vessel dissection (sEVD) in young adult patients. METHODS We identified 304 patients aged under 55 years consecutively admitted for acute cerebrovascular events to our Stroke Unit. After checking the possibility to perform a 3D reconstruction of epiaortic vessels on CT-angiography images, we selected and compared fifty patients with sEVD (cases) with fifty-one patients without dissection (controls). VT of carotid and vertebral arteries was measured on reconstructions evaluating the vascular tortuosity index (VTI), calculated according to a specific algorithm, and the presence of kinking and coiling. Differences between groups were analyzed by Student-t test for numeric variables and chi-square test for categoric ones. A ROC curve analysis was used to look for a VTI threshold value beyond which the risk of dissection was significantly increased. RESULTS VTI was significantly higher in cases than in controls only considering carotid arteries (p = 0.029); cases did not have a significantly higher rate of kinking and coiling than controls (p = 0.059 and 0.077, respectively). We have found a significant VTI threshold value of 27.9% (under curve area = 61.6%, p = 0.04) only for carotid artery dissection. CONCLUSION VT appears to be associated with an increased risk of dissection for the carotid district but not for the vertebral one. The different structure, embryogenesis, and pathophysiology of dissection between the two districts could explain this finding. VTI threshold as carotid artery dissection predictor deserves confirmation in larger studies.
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Affiliation(s)
- Gabriele Venturini
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Luisa Vuolo
- Neuroradiology Unit, Careggi University Hospital, Largo Piero Palagi, 1, 50139, Florence, Italy
| | - Giovanni Pracucci
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Antonella Picchioni
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Ylenia Failli
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Federica Benvenuti
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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21
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Tong X, Dong J, Zhou G, Zhang X, Wang A, Ji Z, Jiao L, Mei Y, Chen D. Hemodynamic effects of size and location of basilar artery fenestrations associated to pathological implications. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3507. [PMID: 34184422 DOI: 10.1002/cnm.3507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/07/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Fenestration is a rare congenital abnormality that refers to a segmental duplication of arteries. It is still not clear about the role of fenestrations in the etiology and pathological evolution of vascular diseases. This study aims to investigate the hemodynamic influence brought by various sizes and locations of fenestration in basilar artery models. A series presumptive fenestration models were established based on a normal basilar artery model with various sizes and locations. Identical boundary conditions were utilized in the computational fluid dynamics simulations and different flow patterns in the fenestration and bifurcation regions were comprehensively analyzed. Wall shear stress (WSS)-related parameters such as oscillatory shear index (OSI) and aneurysm formation index (AFI) were computed and compared. The value of WSS on fenestration increased by the fenestration's tortuosity, and nearly-circular fenestration suffered higher WSS than narrow-strips one. Also, high OSI and low AFI value mainly occurred in the bifurcation region, indicating a high level of turbulence and high risk of aneurysm formation. The location of fenestration mainly changed the impact force of blood flow on the bifurcation and the disorder characteristics of blood flow, while the size of fenestration changed the WSS distribution on the proximal inner wall and bifurcation region of fenestration. In summary, the nearly-circular fenestration should be stratified carefully which may results in a high risk inducing unfavorable vascular wall remodeling.
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Affiliation(s)
- Xinyu Tong
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jia Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ancong Wang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Zhi Ji
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Heilongjiang Key Laboratory of Anti-fibrosis Biotherapy, Mudanjiang Medical University, Mudanjiang, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
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22
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Pei Y, Xu Z, Liang G, Jin H, Duan Y, Yang B, Qiao X, You H, Xing D. Risk Factors of Anterior Circulation Intracranial Aneurysm Rupture: Extracranial Carotid Artery Tortuosity and Aneurysm Morphologic Parameters. Front Neurol 2021; 12:693549. [PMID: 34322085 PMCID: PMC8313111 DOI: 10.3389/fneur.2021.693549] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study was conducted to explore the risk factors of anterior circulation intracranial aneurysm rupture based on extracranial carotid artery (ECA) tortuosity. Methods: This retrospective study, conducted from January 1, 2017, to March 1, 2021, collected and reviewed the clinical and imaging data of 308 patients with anterior circulation intracranial aneurysm [133 (43.2%) patients in the ruptured aneurysm group; 175 (56.8%) patients in the unruptured aneurysm group]. Computed tomography angiography (CTA) of the head and neck was used to determine the ECA tortuosity (normal, simple tortuosity, kink, coil) and the morphologic parameters of the aneurysms. The relationship of aneurysm rupture to ECA tortuosity and the morphologic parameters were analyzed. Results: After univariate analysis, kink, angle of flow inflow (FA), aspect ratio (AR), aneurysm length (L), the distance from the tortuosity to the aneurysm (distance), and size ratio (SR) were significantly correlated with anterior circulation intracranial aneurysm rupture (p < 0.05). Spearman correlation analysis showed that ECA tortuosity was correlated with FA and SR (p < 0.05). Multiple logistic analyses showed that FA [odds ratio (OR), 1.013; 95% CI, 1.002–1.025], SR (OR, 1.521; 95% CI, 1.054–2.195), and kink (OR, 1.823; 95% CI, 1.074–3.096) were independently associated with aneurysm rupture. Conclusion: Study results suggest that FA, SR, and ECA kink were independent risk factors associated with anterior circulation intracranial aneurysm rupture.
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Affiliation(s)
- Yusong Pei
- Jinzhou Medical University General Hospital of Northern Theater Command Postgraduate Training Base, Shenyang, China
| | - Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Hai Jin
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yang Duan
- Center for Neuroimaging, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xinxin Qiao
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongrui You
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Dengxiang Xing
- Center for Medical Data, General Hospital of Northern Theater Command, Shenyang, China
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23
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Pikus HJ, Harbaugh RE. Commentary on: Chiropractic associated vertebral artery dissection: An analysis of 34 patients amongst a cohort of 310. Clin Neurol Neurosurg 2021; 207:106790. [PMID: 34245988 DOI: 10.1016/j.clineuro.2021.106790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Harold J Pikus
- Upper Valley Neurology Neurosurgery, 106 Hanover Street, Lebanon, NH 03766, USA.
| | - Robert E Harbaugh
- Distinguished Department of Neurosurgery, Department of Engineering Science & Mechanics Penn State University, Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, PA 17033, USA.
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24
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Trager RJ, Perle SM. Letter to the Editor regarding "Chiropractic associated vertebral artery dissection: An analysis of 34 patients amongst a cohort of 310". Clin Neurol Neurosurg 2021; 206:106706. [PMID: 34053803 DOI: 10.1016/j.clineuro.2021.106706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Robert J Trager
- Connor Integrative Health Network, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Stephen M Perle
- University of Bridgeport, School of Chiropractic, 225 Myrtle Ave, Bridgeport, CT 06604, USA
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25
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Saba L, Sanfilippo R, Suri JS, Cademartiri F, Corrias G, Mannelli L, Zucca S, Senis I, Montisci R, Wintermark M. Does Carotid Artery Tortuosity Play a Role in Stroke? Can Assoc Radiol J 2021; 72:789-796. [PMID: 33656944 DOI: 10.1177/0846537121991057] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To explore the association between carotid artery length and tortuosity, and the occurrence of stroke. MATERIAL AND METHODS In this retrospective study, IRB approved, 411 consecutive patients (males: 245; median age: 56 ± 12 years, age range: 21-93 years) with anterior circulation ischemic stroke were included. Only patients that underwent CTA within 7 days were considered and stroke caused by cardiac embolism and thoracic aorta embolism were excluded. For each patient, both carotid arteries were considered, and the ICA, CCA-ICA length and tortuosity were calculated. Inter-observer analysis was quantified with the Bland-Altman test. Mann-Whitney test and logistic regression analysis were also calculated to test the association between length and tortuosity with the occurrence of stroke. RESULTS In the final analysis, 166 patients (males: 72; median age: 54 ± 12 years, age range: 24-89 years) with anterior circulation ischemic stroke that were admitted to our hospital between February 2008 and December 2013 were included. The results showed a good concordance for the length of the vessels with a mean variation of 0.7% and 0.5% for CCA-ICA and ICA length respectively an for the tortuosity with a mean variation of 0.2% and -0.4% for CCA-ICA and ICA respectively. The analysis shows a statistically significant association between the tortuosity index of the ICA and CCA-ICA sides with stroke (P value = 0.0001 in both cases) and these findings were confirmed also with the logistic regression analysis. CONCLUSION Results of this study suggest that tortuosity index is associated with the presence of stroke whereas the length of the carotid arteries does not play a significant role.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | | | - Giuseppe Corrias
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | | | - Serena Zucca
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Ignazio Senis
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Max Wintermark
- Department of Radiology, 6429University of Stanford, CA, USA
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26
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Adham S, Billon C, Legrand A, Domigo V, Denarié N, Charpentier E, Jeunemaitre X, Frank M. Spontaneous Cervical Artery Dissection in Vascular Ehlers-Danlos Syndrome: A Cohort Study. Stroke 2021; 52:1628-1635. [PMID: 33641388 DOI: 10.1161/strokeaha.120.032106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vascular Ehlers-Danlos syndrome is a rare inherited connective tissue disorder because of pathogenic variants in the COL3A1 gene. Arterial complications can affect all anatomic areas and about 25% involve supra-aortic trunks (SATs) but no systematic assessment of cervical artery lesions has been made. The primary objective was to determine an accurate prevalence of spontaneous SAT lesions in a large series of patients with vascular Ehlers-Danlos syndrome at diagnosis and during follow-up. Secondary objectives were to study their neurological consequences (transient ischemic attack or stroke) and the possible relationships with sex, genotype, ascertainment status. METHODS A retrospective review of a monocentric cohort of patients with molecularly proven vascular Ehlers-Danlos syndrome followed in a tertiary referral center from 2000 to 2017. RESULTS One hundred forty-four patients were analyzed, 56.9% (n=82) had SAT lesions: 64.6% females, 74.4% index-case patients. Most lesions were identified in early arterial assessment (48% at first work-up, mean age of 35.7±13.0 years). Cumulative incidence of a first identification of a SAT lesion was 41.7% at 40 years old. On the complete period of survey, 183 SAT lesions (with 132 dissections and 33 aneurysms) were identified, mainly in internal carotid arteries (56.3%) and vertebral arteries (28.9%), more rarely in patients with COL3A1 null mutations (P=0.008). Transient ischemic attack or stroke were reported in n=16 (19.5%) of the 82 patients with SAT lesions without relation with age, sex, treatment, or hypertension. CONCLUSIONS Cervical artery lesions are frequent and mostly asymptomatic in patients with vascular Ehlers-Danlos syndrome. Local dissections and aneurysms are the most frequent type of lesions, but transient ischemic attack or stroke seem rare.
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Affiliation(s)
- Salma Adham
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.).,Université de Paris, INSERM, U970 PARCC, Paris, France (S.A., C.B., A.L., X.J., M.F.)
| | - Clarisse Billon
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.).,Université de Paris, INSERM, U970 PARCC, Paris, France (S.A., C.B., A.L., X.J., M.F.)
| | - Anne Legrand
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.).,Université de Paris, INSERM, U970 PARCC, Paris, France (S.A., C.B., A.L., X.J., M.F.)
| | - Valérie Domigo
- GH Sainte-Anne, Service d'imagerie morphologique et fonctionnelle, Paris, France (V.D.).,INSERM, U894, IMA-BRAIN, DHU NeuroVasc, Paris, France (V.D.)
| | - Nicolas Denarié
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.)
| | - Etienne Charpentier
- AP-HP, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France (E.C.)
| | - Xavier Jeunemaitre
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.).,Université de Paris, INSERM, U970 PARCC, Paris, France (S.A., C.B., A.L., X.J., M.F.)
| | - Michael Frank
- AP-HP, Hôpital Européen Georges Pompidou, Département de Génétique, Centre de Référence des Maladies Vasculaires Rares, Paris, France (S.A., C.B., A.L., N.D., X.J., M.F.).,Université de Paris, INSERM, U970 PARCC, Paris, France (S.A., C.B., A.L., X.J., M.F.)
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27
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Akamatsu Y, Gomez-Paz S, Moore JM, Ogilvy CS, Thomas AJ. Utility of Pipeline embolization device for emergency recanalization of a dissecting carotid tonsillar loop: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2064. [PMID: 36131585 PMCID: PMC9628100 DOI: 10.3171/case2064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cervical arterial tortuosity is not uncommon in patients with spontaneous carotid artery dissections (CADs), but the tortuosity often precludes endovascular stent reconstruction. The authors report 2 cases of emergency recanalization of a carotid tonsillar loop dissection using a Pipeline embolization device (PED). OBSERVATIONS Two patients presented with symptomatic CAD involving tonsillar looping of the cervical internal carotid artery (ICA). Although the tonsillar loop prevented navigation of the carotid and peripheral stent delivery system, a PED was easily navigated and successfully deployed, resulting in successful recanalization of a looped ICA. LESSONS Emergency recanalization of a cervical CAD using a PED is a feasible alternative for treating a cervical CAD associated with tonsillar loops.
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Affiliation(s)
- Yosuke Akamatsu
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Santiago Gomez-Paz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Justin M. Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Ajith J. Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
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28
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Pérez-Sánchez S, Domínguez-Mayoral A, De Torres-Chacón R, Gamero-García MA, Barragán-Prieto A, Escudero-Martínez I, Ocete RF, Herrero-Lara J, Algaba P, Moniche F, González A, Cueto L, Montaner J. Cervical dissection diagnoses increase following endovascular treatments. J Int Med Res 2021; 48:300060520906740. [PMID: 32223660 PMCID: PMC7133397 DOI: 10.1177/0300060520906740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives The detection of cervical arterial dissection (CAD) has been rising in recent years owing to advanced imaging techniques. The aim of this study was to explore whether wide implementation of endovascular treatment for ischemic stroke has an impact on the diagnosis of CAD. Methods We included all patients with CAD diagnosed at two university hospitals in Seville, Spain from January 2015 to December 2017. We collected clinical variables and information on imaging techniques used for the diagnosis. Implementation of 24 hour/365 day mechanical thrombectomy began in Seville on 15 August 2016. We compared diagnosis rates of CAD performed before and after this date. Results We identified 41 patients with CAD. We found 13 patients diagnosed before (1.1% of all ischemic strokes) and 28 (2.2%) after implementation of neurointerventional therapy. In 17 patients, diagnosis was made in the acute phase. Dissection was not suspected according to computed tomography angiography in 11 patients owing to small dissections (n = 2) or total occlusion (n = 9). Conclusions CAD diagnoses have been rising in recent years, essentially owing to continuous improvement in imaging techniques. Rapid access to arteriography for thrombectomy is increasing the diagnoses of CAD, even in patients with a low suspicion of dissection.
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Affiliation(s)
- Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Ana Domínguez-Mayoral
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Reyes De Torres-Chacón
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Miguel A Gamero-García
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Irene Escudero-Martínez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Rafael F Ocete
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juan Herrero-Lara
- Department of Radiology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Luis Cueto
- Department of Radiology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
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29
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Zhang L, Liu X, Gong B, Li Q, Luo T, Lv F, Zheng Y, Zheng W, Guo H. Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection. Eur J Vasc Endovasc Surg 2021; 61:542-549. [PMID: 33402322 DOI: 10.1016/j.ejvs.2020.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Spontaneous cervicocerebral artery dissection (sCCD) is an important cause of ischaemic stroke that often occurs in young and middle aged patients. The purpose of this study was to investigate the correlation between tortuosity of the carotid artery and sCCD. METHODS Patients with confirmed sCCD who underwent computed tomography angiography (CTA) were reviewed retrospectively. Age and sex matched patients having CTA were used as controls. The tortuosity indices of the cervical arteries were measured from the CTA images. The carotid siphon and the extracranial internal carotid artery (ICA) were evaluated according to morphological classification. The carotid siphons were classified into five types. The extracranial ICA was categorised as simple tortuosity, coiling or kinking. Independent risk factors for sCCD were investigated using multivariable analysis. RESULTS The study included sixty-six patients with sCCD and 66 controls. There were no differences in vascular risk factors between the two groups. The internal carotid tortuosity index (ICTI) (25.24 ± 12.37 vs. 15.90 ± 8.55, respectively; p < .001) and vertebral tortuosity index (VTI) (median 11.28; interquartile range [IQR] 6.88, 18.80 vs. median 8.38; IQR 6.02, 12.20, respectively; p = .008) were higher in the patients with sCCD than in the controls. Type III and Type IV carotid siphons were more common in the patients with sCCD (p = .001 and p < .001, respectively). The prevalence of any vessel tortuosity, coiling and kinking of the extracranial ICA was higher in the patients with sCCD (p < .001, p = .018 and p = .006, respectively). ICTI (odds ratio [OR] 2.964; p = .026), VTI (OR 5.141; p = .009), and Type III carotid siphons (OR 4.654; p = .003) were independently associated with the risk of sCCD. CONCLUSION Arterial tortuosity is associated with sCCD, and greater tortuosity of the cervical artery may indicate an increased risk of arterial dissection.
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Affiliation(s)
- Lijuan Zhang
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoshuang Liu
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Beibei Gong
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- The Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - FaJin Lv
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yineng Zheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanlin Zheng
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haoming Guo
- The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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30
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Khasiyev F, Gutierrez J. Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk. J Neuroimaging 2020; 31:251-260. [PMID: 33244825 DOI: 10.1111/jon.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Abstract
Cervical carotid artery (cCA) dolichoectasia (DE) is characterized by elongation, tortuosity, and/or dilatation. The prevalence of cCA DE has been reported 13-31% in population-based and 14-58% in hospital-based studies. The exact mechanisms of this aberrant arterial remodeling are unknown. Although atherosclerosis has often been implicated, the evidence has conflicting results that would support atherosclerosis as the underlying pathology. Actually, other nonatherosclerotic mechanisms related to connective tissue remodeling may play a role. Such mechanism is supported by epidemiological evidence that cCA DE is associated with carotid dissections. Similarly, cCA DE has been associated with vascular risk factors, but inconsistently. Fewer studies have evaluated the risk of vascular events in people with cCA DE. Cross-sectionally, cCA DE is associated with cerebrovascular disease, including white matter hyperintensities, lacunar stroke, and stroke overall. The often-conflicting results may in part be due to the heterogeneity of the population studies and variable definitions used. Preferential use of objective measure of cCA DE, such as carotid length, is advisable, and may help comparing result among different studies. Prospectively, people with cCA DE have a higher risk of vascular events, although it is uncertain if the risk of stroke is also higher in this population. In the absence of alternative stroke etiologies, stroke patients with cCA DE should be considered to have had a cryptogenic stroke and treated with daily antiplatelet therapy. Further population-based studies are needed to clarify whether specific therapies may be implement to reduce the risk of events among people with cCA DE.
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Affiliation(s)
- Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO
| | - Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
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31
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Gołębiowski T, Poznański P, Kusztal M, Miś M, Szczurowska A, Letachowicz K, Konieczny A, Majchrzak K, Janczak D, Krajewska M. Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis. Artif Organs 2020; 45:303-308. [PMID: 32920839 DOI: 10.1111/aor.13817] [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: 06/14/2020] [Revised: 07/29/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
Tortuosity of the carotid artery is usually an asymptomatic vascular abnormality and is discovered accidentally during cerebral angiography. These vascular changes may aggravate surgical procedures in the neck region. We described a technique of permanent catheter insertion in patients with renal graft failure in whom renal replacement therapy was necessary. Severe tortuosity of cervical arteries may make this procedure more difficult, necessitating a special technique, that is, full image monitoring.
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Affiliation(s)
- Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Miś
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Agata Szczurowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Konrad Majchrzak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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Parlapiano G, Di Lorenzo F, Salehi LB, Ruvolo G, Novelli G, Sangiuolo F. Neurovascular manifestations in connective tissue diseases: The case of Marfan Syndrome. Mech Ageing Dev 2020; 191:111346. [DOI: 10.1016/j.mad.2020.111346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
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Hori S, Hori E, Umemura K, Shibata T, Okamoto S, Kubo M, Horie Y, Kuroda S. Anatomical Variations of Vertebrobasilar Artery are Closely Related to the Occurrence of Vertebral Artery Dissection-An MR Angiography Study. J Stroke Cerebrovasc Dis 2020; 29:104636. [PMID: 32008922 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 01/22/2023] Open
Abstract
GOAL Intracranial arterial dissection is a major cause of ischemic stroke and subarachnoid hemorrhage in relatively young patients. We assessed the hypothesis that the tortuosity of the vertebrobasilar artery is associated with the occurrence of vertebral artery (VA) dissection, using MR angiography (MRA). MATERIALS AND METHODS This study enrolled 43 patients with VA dissection, and 63 age- and sex-matched healthy subjects were used as the controls. MRA was employed to evaluate the presence of dominant VA and the lateral shift of vertebrobasilar junction in both groups. The VA diameters were considered different when the difference was greater than .3 mm. These anatomical variations were divided into 3 types: Type 1 (vertebrobasilar junction within 2 mm from the midline), Type 2 (>2 mm-lateral shift of vertebrobasilar junction to the ipsilateral side of the dominant VA), and Type 3 (>2 mm-lateral shift of vertebrobasilar junction to the contralateral side of the dominant VA). FINDINGS The presence of dominant VA and the lateral shift of vertebrobasilar junction were more prevalent in patients with VA dissection than in the controls (OR: 3.46, P = .013, and OR: 4.51, P = .001, respectively). The lateral shift of vertebrobasilar junction was classified into Type 1 (n = 6), Type 2 (n = 13), and Type 3 (n = 17) among patients with VA dissection, while into Type 1 (n = 20), Type 2 (n = 8), and Type 3 (n = 7) among the controls. Type 3 predominance was observed in patients with VA dissection (P = .02). CONCLUSIONS Anatomical variations of the vertebrobasilar artery may play an important role in the occurrence of VA dissection.
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Affiliation(s)
- Satoshi Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan.
| | - Emiko Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Kimiko Umemura
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Takashi Shibata
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Soushi Okamoto
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Michiya Kubo
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Yukio Horie
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
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Adam G, Darcourt J, Roques M, Ferrier M, Gramada R, Meluchova Z, Patsoura S, Viguier A, Cognard C, Larrue V, Bonneville F. Standard Diffusion-Weighted Imaging in the Brain Can Detect Cervical Internal Carotid Artery Dissections. AJNR Am J Neuroradiol 2020; 41:318-322. [PMID: 31948949 DOI: 10.3174/ajnr.a6383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The ICA is the most common site of cervical artery dissection. Prompt and reliable identification of the mural hematoma is warranted when a dissection is clinically suspected. The purpose of this study was to assess to capacity of a standard DWI sequence acquired routinely on the brain to detect dissecting hematoma related to cervical ICA dissections. MATERIALS AND METHODS This was a retrospective study of a cohort of 110 patients younger than 55 years of age (40 women; mean age, 46.79 years) admitted at the acute phase of a neurologic deficit, headache, or neck pain and investigated by at least a standard 3T diffusion-weighted sequence of the brain. Among them were 50 patients (14 women; mean age, 46.72 years) with subsequently confirmed ICA dissection. In the whole anonymized cohort, both a senior and junior radiologist separately assessed, on the DWI sequences only, the presence of a crescent-shaped or circular hypersignal projecting on the subpetrosal segment of the ICA arteries, assuming that it would correspond to a mural hematoma related to an ICA dissection. RESULTS The senior radiologist found 46 subpetrosal hyperintensities in 43/50 patients with ICA dissection and none in patients without dissection (sensitivity, 86%; specificity, 100%). The junior radiologist found 48 subpetrosal hyperintensities in 45/50 patients with dissection and none in patients without dissection (sensitivity, 90%; specificity, 100%). CONCLUSIONS In our cohort, a standard DWI sequence performed on the brain at the acute phase of a stroke or for a clinical suspicion of dissection detected nearly 90% of cervical ICA dissections.
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Affiliation(s)
- G Adam
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - J Darcourt
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - M Roques
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - M Ferrier
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - R Gramada
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - Z Meluchova
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - S Patsoura
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - A Viguier
- Neurology (A.V., V.L.), Centre Hospitalier Universitaire Toulouse, Pierre-Paul Riquet Hospital, Toulouse, France
| | - C Cognard
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
| | - V Larrue
- Neurology (A.V., V.L.), Centre Hospitalier Universitaire Toulouse, Pierre-Paul Riquet Hospital, Toulouse, France
| | - F Bonneville
- From the Departments of Diagnostic and Therapeutic Neuroradiology (G.A., J.D., M.R., M.F., R.G., Z.M., S.P., C.C., F.B.)
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Jin G, Li Q, Zheng P, Cao D, Zhu D, Zou D, Lv F, Shen Y, Zhan Q, Xie P. Association between Extracranial Carotid Artery Tortuosity and Clinical Outcomes in Anterior Circulation Acute Ischemic Stroke without Undergoing Endovascular Treatment. J Stroke Cerebrovasc Dis 2019; 29:104512. [PMID: 31786044 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104512] [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: 07/31/2019] [Revised: 10/20/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Extracranial carotid artery (ECA) tortuosity may influences successful recanalization rates of mechanical thrombectomy in acute ischemic stroke (AIS), yet the relationship between ECA tortuosity and the prognosis of patients with anterior circulation AIS who cannot undergo endovascular treatment remains uncertain. We hypothesized that increased tortuosity of the ECA leads to unfavorable outcomes in such patients. METHODS Patients with anterior circulation AIS who underwent computed tomography angiography of the head and neck in our hospital between March 2018 and November 2018 were retrospectively analyzed. The tortuosity of the bilateral ECA was measured, and functional outcomes were evaluated by a modified Rankin Scale (mRS) at 90 days. Multivariate logistic regression models were used to determine the association between ECA tortuosity and outcomes of patients. RESULTS A total of 203 patients were enrolled in our study, including 140 patients (68.97%) with favorable outcomes (mRS, 0-2) and 63 patients (31.03%) with unfavorable outcomes (mRS, 3-6). After adjusting for age, atrial fibrillation, stroke territory, and posthospital antithrombotics/statins therapy in multivariate logistic regression model I, ECA tortuosity (odds ratio, 1.052; 95% confidence interval, 1.010-1.096; P = .015) was an independent risk of unfavorable outcomes in enrolled patients. In the other 2 models (II and III) which adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, and with or without posthospital medication, ECA tortuosity was also showed independent relationship to unfavorable outcomes. The optimal cutoff was 12.5 to predict the unfavorable outcomes in a receiver operating characteristic curve. CONCLUSIONS Our study demonstrated that the ECA tortuosity is an independent predictor of unfavorable outcomes for anterior circulation AIS patients who without undergoing endovascular treatment after hospital admission. ECA tortuosity values greater than 12.5 may indicate an unfavorable outcome.
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Affiliation(s)
- Ge Jin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Peng Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Du Cao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Zhu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dezhi Zou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiqing Shen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qunling Zhan
- Department of Neurology, Chongqing Renji Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Non-traumatic cervical artery dissection and ischemic stroke: A narrative review of recent research. Clin Neurol Neurosurg 2019; 187:105561. [DOI: 10.1016/j.clineuro.2019.105561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 12/19/2022]
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Welby JP, Kim ST, Carr CM, Lehman VT, Rydberg CH, Wald JT, Luetmer PH, Nasr DM, Brinjikji W. Carotid Artery Tortuosity Is Associated with Connective Tissue Diseases. AJNR Am J Neuroradiol 2019; 40:1738-1743. [PMID: 31558499 DOI: 10.3174/ajnr.a6218] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/31/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE There is a general assumption in the cerebrovascular literature that there is an association between carotid artery tortuosity and connective tissues disease; however, this has not been firmly established. The purpose of this study was to determine the prevalence of carotid artery tortuosity in patients with connective tissue diseases relative to matched controls. MATERIALS AND METHODS Patients with previous CTA or MRA and a diagnosis of connective tissue diseases were identified and compared with a cohort of age-matched controls. Radiologists blinded to the diagnosis reviewed the images and evaluated the presence of carotid artery tortuosity (including loops, kinks, or coils). Continuous variables were compared using the Student t test, and categoric variables with χ2 tests. RESULTS One hundred forty-three patients with connective tissue disease and 143 controls were included in this study. Specific diagnoses included Marfan (n = 33), nonvascular Ehlers-Danlos (n = 36), Ehlers-Danlos vascular-type (n = 32), neurofibromatosis type 1 (n = 26), and Loeys-Dietz (n = 16) syndromes. The presence of carotid tortuosity was 44% in connective tissue disease and 16% in controls (P < .001). Of tortuosity manifestations, coils were most prevalent (23% versus 3%; P < .001). Among the various connective tissue diseases, the rates of any carotid tortuosity were 88% for Marfan syndrome, 63% for Loeys-Dietz syndrome, 42% for neurofibromatosis type 1, and 19% for both vascular- and nonvascular-type Ehlers-Danlos syndrome. The positive predictive value of the combination of aortic aneurysm and carotid tortuosity being associated with connective tissue disease was 95.4%. The specificity was 98.6%. CONCLUSIONS Carotid artery tortuosity is highly associated with connective tissue diseases, particularly Marfan syndrome, Loeys-Dietz syndrome, and neurofibromatosis type 1. Such findings are relevant in risk assessment for vascular complications in connective tissue disease, endovascular treatment planning, and in understanding the pathomechanisms of vascular tortuosity in general.
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Affiliation(s)
- J P Welby
- From the Mayo Clinic Alix School of Medicine (J.P.W.)
| | - S T Kim
- Department of Radiology (S.T.K.), University of California, San Francisco, San Francisco, California
| | - C M Carr
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
| | - V T Lehman
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
| | - C H Rydberg
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
| | - J T Wald
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
| | - P H Luetmer
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
| | | | - W Brinjikji
- Departments of Radiology (C.M.C., V.T.L., C.H.R., J.T.W., P.H.L., W.B.)
- Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
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Anatomical relationship between carotid artery and styloid and hyoid bones in patients showing unintended head rotation on CTA. Acta Neurol Belg 2018; 118:597-602. [PMID: 30143996 DOI: 10.1007/s13760-018-1008-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
Styloid process length and styloid/hyoid bone proximity to the internal carotid artery (ICA) have been implicated in certain carotid pathologies (e.g. carotid artery dissection). Neck movement or trauma may contribute to some of these carotid pathologies. Styloid/hyoid bone to ICA distances have never been systematically analyzed in regard to head rotation and head flexion-extension. We studied axial slices on computed tomography angiograms of 103 nondissection patients showing > 1° head rotation. We measured the distance between ICA and the hyoid bone (HICA) and the closest point and the tip of the styloid bone (SCICA and STICA, respectively), the length of the styloid, and the angle of head rotation and head flexion-extension. STICA distances were significantly smaller on the right as compared to the left side in both the right and the left rotating patient groups (right STICA, 4.4 mm for the right rotating group and 6.4 mm for the left rotating group, p = 0.0091; left STICA, 5.1 mm for the right rotating group and 6.9 for the left rotating group, p = 0.034). No significant differences were observed for SCICA and HICA distances between right and left rotating groups, and head flexion-extension did not altered significantly SCICA, STICA, or HICA distances. Both right- and left-sided head rotation seems to be associated with decreased right-sided and increased the left-sided styloid tip to internal carotid artery distances. This has to be studied and confirmed in single patient analyses using more severe head rotation and flexion-extension angles.
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de Vries EE, Pourier VEC, van Laarhoven CJHCM, Vonken EJ, van Herwaarden JA, de Borst GJ. Comparability of semiautomatic tortuosity measurements in the carotid artery. Neuroradiology 2018; 61:147-153. [PMID: 30338348 PMCID: PMC6348067 DOI: 10.1007/s00234-018-2112-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
Purpose Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients. Methods CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline’s true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages. Results Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96–1.0), 0.90 (0.69–0.97), 0.84 (0.53–0.95), and 0.72 (0.28–0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98–1.0) for 3mensio vs. OsiriX, to 0.95 (0.82–0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013). Conclusions Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
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Affiliation(s)
- Evelien E de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Vanessa E C Pourier
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Constance J H C M van Laarhoven
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Evert J Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
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Carotid Artery Tortuosity Index Is Associated With the Need for Early Aortic Root Replacement in Patients With Loeys-Dietz Syndrome. J Comput Assist Tomogr 2018; 42:747-753. [PMID: 29901510 DOI: 10.1097/rct.0000000000000764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to determine if carotid arterial tortuosity represents a marker of disease severity in Loeys-Dietz syndrome (LDS). METHODS Fifty-four 54 LDS patients (mean age, 17.0 years) who underwent computed tomogram angiography from January 2004 to December 2013 were retrospectively identified. Carotid artery tortuosity index (CATI) was calculated from computed tomogram angiography. Clinical variables were obtained from the medical records. Relationship between CATI and need for aortic root replacement was evaluated with Cox proportional hazard model and Kaplan-Meier analysis. RESULTS Higher CATI was associated with the need for aortic root replacement (P < 0.001) in the univariate Cox proportional hazard model. Patients were stratified based on both CATI and aortic root size in Kaplan-Meier analysis, and patients with higher CATI were more likely to require aortic root replacement (P < 0.001) in both aortic root size strata. CONCLUSION Increased carotid artery tortuosity is associated with the need for early aortic root replacement in patients with LDS.
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Ryu J, Kim BJ, Lee KM, Kim HG, Choi SK, Kim EJ, Lee SH, Chang DI, Kwun BD. Intracranial Arterial Tortuosity According to the Characteristics of Intracranial Aneurysms. World Neurosurg 2018; 120:e1185-e1192. [PMID: 30236811 DOI: 10.1016/j.wneu.2018.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/25/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Intracranial aneurysm (IA) is the leading cause of subarachnoid hemorrhage. The pathomechanisms of IA are poorly understood but can be related to arterial tortuosity resulting from underlying systemic factors leading to arterial wall weakening. We aimed to analyze the tortuosity of the intracranial artery in a cohort with IA, hypothesizing that the tortuosity of intracranial arteries differs depending on the characteristics of the IA. METHODS Patients with saccular IA were consecutively enrolled. Clinical factors and vascular tortuosity of the right and left middle cerebral arteries and basilar artery (BA) of all patients with IA were compared according to the characteristics of the IA: 1) ruptured versus unruptured, 2) multiple versus single, and 3) large (>5 cm) versus small (≤5 cm). Unruptured IAs were comparatively analyzed according to aneurysm size and aspect ratio, whereas ruptured IAs were analyzed according to aneurysm size. RESULTS Two hundred eighty-five patients were enrolled (mean age, 59 years; 71.2% women). The tortuosity of the BA was higher in the large IA group (5.63 ± 6.26; n = 133; P = 0.009), large unruptured IA group (6.64 ± 6.32; n = 53; P = 0.039), and large ruptured IA group (5.50 ± 6.52; n = 80; P = 0.033) compared with the small IA, small unruptured IA, and small ruptured IA group. In multivariate analysis, increased BA tortuosity was significantly associated with large IAs (β = 1.066; P = 0.008), unruptured large IAs (β = 1.077; P = 0.033), and ruptured large IAs (β = 1.086; P = 0.025). CONCLUSIONS The BA tortuosity was higher in patients with large IAs, which may represent an imaging biomarker of aneurysm growth.
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Affiliation(s)
- Jiwook Ryu
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
| | - Dae-Il Chang
- Department of Neurology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
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Li CH, Gao BL, Wang JW, Liu JF, Li H, Yang ST, Ren CF. RETRACTED: Endovascular Stent Deployment in the Management of Lesions Related to Internal Carotid Artery Redundancy. World Neurosurg 2018; 116:e903-e912. [DOI: 10.1016/j.wneu.2018.05.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 12/27/2022]
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Kaneko N, Komuro Y, Yokota H, Tateshima S. Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels. J Neurointerv Surg 2018; 11:119-122. [PMID: 30045949 DOI: 10.1136/neurintsurg-2018-014061] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Tortuous vascular anatomy is one of the greatest challenges in mechanical thrombectomy. This study examines the impact of vascular tortuosity on the performance of stent retrievers and evaluates the efficacy of the newer generation stent retrievers with segmented design. MATERIALS AND METHODS Models with mild, moderate, and severe tortuosity with an internal carotid artery (ICA) and a middle cerebral artery (MCA) were created. An elastic and cohesive clot was placed in the MCA lying from distal M1 and proximal M2. We assessed the revascularization rates of two commonly used stent retrievers (Trevo XP and Solitaire FR) and two newer stent retrievers with segmented design (Embotrap and Versi) in each vascular model. RESULTS Both the type of stent retriever and the severity of vessel tortuosity significantly affected the successful recanalization rate. Post-hoc tests showed that the rate of revascularization was significantly less in severe tortuosity than in mild or moderate tortuosity (P<0.001). The Versi resulted in higher success rates than the Solitaire (P<0.01) and the Trevo (P<0.05). The success rates of the Embotrap were higher than the Solitaire and Trevo stent retrievers, although the difference was not statistically significant. CONCLUSIONS Severe tortuosity reduces the performance of mechanical thrombectomy. The segmented design in stent retrievers could improve the efficacy of mechanical thrombectomy in tortuous vessels. TRIAL REGISTRATION ESCAPE NCT01778335;SWIFT PRIME >NCT01657461; REVASCAT >NCT01692379; All post-results.
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Affiliation(s)
- Naoki Kaneko
- Division of Interventional Neuroradiology, Department of Radiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Yutaro Komuro
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiology, University of California, Los Angeles, Los Angeles, California, USA
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Koge J, Iwata T, Mizuta S, Nakamura Y, Matsumoto SI, Yamada T. Successful carotid artery stenting of a dissected, highly tortuous internal carotid artery after straightening with a peripheral microguidewire. J Clin Neurosci 2018; 53:265-268. [DOI: 10.1016/j.jocn.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/12/2018] [Accepted: 04/08/2018] [Indexed: 12/28/2022]
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Chung SE, Yoon TH, Lee KM, Kim HG, Kim BJ. A case report of multiple cervical artery dissection after peripheral type facial palsy and use of steroids. BMC Neurol 2018; 18:74. [PMID: 29807531 PMCID: PMC5971422 DOI: 10.1186/s12883-018-1080-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/22/2018] [Indexed: 11/15/2022] Open
Abstract
Background Cervical artery dissection is one of the most important causes of ischemic stroke in young age patients. However, multiple cervical artery dissection simultaneously involving the anterior and posterior circulation is uncommon. Here, we would like to report a case of a patient with bilateral vertebral artery (VA) and internal carotid artery dissection (ICA) after a use of systemic steroid due to peripheral facial palsy. Case presentation A 44-year-old man with hypertension visited emergency department due to recurrent vertigo. He was receiving methyl prednisolone for two weeks for the treatment of right peripheral type facial palsy which occurred after retro-orbital headache. Neurologic examination revealed severe ataxia at left side. Sensory for pain and temperature was declined in the right arm and leg. Diffusion-weighted image showed an acute ischemic lesion at the whole territory of posterior-inferior cerebellar artery. Severe stenosis was observed from bilateral VAs and ICAs on conventional magnetic resonance angiography. Intramural hematoma and intimal flap was observed from the high-resolution MRI. Conclusions Peripheral type facial palsy is an unusual presentation of carotid dissection. Steroids aggravate arterial dissection by increasing blood pressure and blood vessel fragility by its negative effect on connective tissue strength. Use of steroid in patients with peripheral type facial palsy with severe headache may need caution.
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Affiliation(s)
- Sung Eun Chung
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Tae Hwan Yoon
- Department of Neurology, Kyung Hee University Hospital College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 190, Republic of Korea
| | - Kyung Mi Lee
- Department Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Hyug-Gi Kim
- Department of Neurology, Kyung Hee University Hospital College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 190, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital College of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 190, Republic of Korea.
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Shi H, Hou J, Shi W, Gu J. Acute ischemic dissection of an "S"-shaped carotid artery: The "one-stop" value of using a detachable Solitaire AB stent. J Clin Neurosci 2018; 53:177-182. [PMID: 29753622 DOI: 10.1016/j.jocn.2018.04.075] [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: 11/08/2017] [Revised: 04/06/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
This study aimed to evaluate the efficacy and safety of endovascular repair using detachable Solitaire AB stents for acute ischemic dissection of "S"-shaped carotid arteries. From May 2015 to December 2016, a total of 127 patients with acute ischemic stroke (AIS) underwent endovascular treatment in our center. Among them, five AISs were due to acute dissection of an "S"-shaped carotid artery. Coexisting carotid embolism was identified in all five patients, who first underwent successful Solitaire AB stent-based retrieval of the embolism. All patients then underwent Solitaire AB stenting to reopen the occluded carotid arteries, all of which were successfully recanalized. There were no procedure-related complications, except for minor hemorrhage transformation in one patient. The mean NIHSS scores were 12 ± 3.7 and 3.8 ± 3.4 at admission and 90 days after stenting, respectively (P = 0.018). The median modified Rankin Scale score at 90 days was 2.0 ± 1.4. Follow-up computed tomography angiography demonstrated in-stent patency in four of the five patients. Dissection of an "S"-shaped carotid artery infrequently leads to AIS. Such dissected arteries can be safely and reliably repaired by this stenting, ensuring successful reconstruction of the carotid arterial circulation.
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Affiliation(s)
- Hongchao Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Jiankang Hou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Wanyin Shi
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China.
| | - Jianping Gu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China.
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Kim BJ, Lee SH, Kwun BD, Kang HG, Hong KS, Kang DW, Kim JS, Kwon SU. Intracranial Aneurysm Is Associated with High Intracranial Artery Tortuosity. World Neurosurg 2018; 112:e876-e880. [PMID: 29425982 DOI: 10.1016/j.wneu.2018.01.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although intracranial aneurysms (IAs) are focal bulges of arterial walls, an uncharacterized predisposing factor that affects cerebral arteries may increase tortuosity of intracranial arteries in patients with IAs. METHODS Subjects who underwent routine health examinations and magnetic resonance angiography at a university hospital health promotion center were enrolled. Age- and sex-matched control subjects were selected from among individuals who did not have IAs. Tortuosity of right and left middle cerebral arteries and basilar artery (BA) was measured. Distant factor [(arc/chord ratio × 100) - 100] was used to estimate tortuosity. Vascular risk factors and intracranial arterial tortuosities were compared between subjects with IAs and control subjects. Independent factors associated with intracranial artery tortuosity were also investigated. RESULTS Of 18,954 (1.9%) subjects, 367 exhibited IAs. The prevalence of hypertension (P = 0.01) and current smoking (P = 0.01) were higher in subjects with IAs than in control subjects. The BA tortuosity was greater in subjects with IAs compared with control subjects (9.0 ± 8.1 vs. 5.5 ± 7.2; P < 0.001). In addition to hypertension, smoking, and absence of coronary artery disease, BA tortuosity (P < 0.001) was independently associated with presence of IAs. The presence of IA (P < 0.001) and absence of coronary artery disease (P = 0.002) were independently associated with high BA tortuosity. CONCLUSIONS Patients with IAs exhibit a more tortuous BA. A predisposing factor weakening the cerebrovasculature in patients with IAs may exist and may manifest as high tortuosity of intracranial arteries.
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Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Hyun Goo Kang
- Department of Neurology, Chosun University, Gwang-ju, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Ilsan, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea.
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Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Cervicocephalic Dolichoarteriopathy. J Stroke Cerebrovasc Dis 2017; 26:2579-2586. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/23/2017] [Accepted: 06/01/2017] [Indexed: 11/20/2022] Open
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50
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Schlemm L, Nolte CH, Engelter ST, Endres M, Ebinger M. Cervical artery dissection after sports - An analytical evaluation of 190 published cases. Eur Stroke J 2017; 2:335-345. [PMID: 31008325 DOI: 10.1177/2396987317720544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/19/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Cervical artery dissections may be preceded by mechanical trigger events, often related to sports. Methods Using the MEDLINE database, we identified case reports and case series of sports-related cervical artery dissections. Information of the type of sport, age and gender of the patient, affected vessels, associated infarction, time delay, and neurological sequelae were extracted. Demographic and clinical characteristics were compared between sport groups using analysis of variance and Chi square tests. Differences were further assessed with adjusted post hoc tests and homogenous subsets. Results A total of 115 reports describing 190 patients with cervical artery dissections related to 45 different sports were identified. The mean age of all patients was 35 years; 26% of all patients were women. Anterior and posterior circulation, as well as left and right side were affected with similar frequency. Patients belonging to different sport categories differed significantly with regard to age (p < 0.001), gender (p < 0.001), and affected circulation (anterior vs. posterior, p = 0.02). The posterior circulation was most often affected in golf players (88%) and least often in individuals engaging in exercise (23%) and scuba divers (29%). Laterality (left vs. right) and mortality were similar between sport groups. Discussion We performed a comprehensive review and analytical evaluation of case reports describing patients with cervical artery dissections after sport. Confirmation of our findings in prospective studies is needed. Conclusion Cervical artery dissection has been described in relation to a wide variety of sports. The risk of injury to particular neurovascular structures may depend on the type sport involved. Discipline-specific incidence rates are not known.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,London School of Economics and Political Science, London, UK
| | - Christian H Nolte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site, Berlin, Germany
| | - Martin Ebinger
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, MEDICAL PARK Berlin Humboldtmühle, Berlin, Germany
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