1
|
Qu Y, Zhang H, Li H, Yu L, Sun Y, Chen Y. Aldehyde Dehydrogenase 2 (ALDH2) Glu504Lys Polymorphism Affects Collateral Circulation and Short-Term Prognosis of Acute Cerebral Infarction Patients. Med Sci Monit 2017; 23:4559-4566. [PMID: 28939800 PMCID: PMC5629992 DOI: 10.12659/msm.905206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Acute cerebral infarction is a major clinical subtype of ischemic stroke that has become a leading cause of death and disability worldwide. Aldehyde dehydrogenase 2 (ALDH2) is an important oxidative enzyme in alcohol metabolism. The polymorphism of ALDH2 Glu504Lys polymorphism modifies the activity of this enzyme. However, the potential association between the allelic variation of ALDH2 Glu504Lys with collateral circulation and short-term prognosis of acute cerebral infarction remains unclear. Material/Methods A total of 394 patients with acute cerebral infarction were recruited for ALDH2 genotyping using direct sequencing. Cerebrovascular stenosis and collateral circulation were evaluated by digital subtraction angiography (DSA). Short-term prognosis was assessed in accordance with the modified Ranking Scale (mRS). Results We identified 297 as EAS and 394 as IAS. There were more patients with occluded blood vessel in the opened group and far fewer in the unopened group. ALDH2 polymorphism was significantly different among the primary, secondary, and tertiary opened groups. ALDH2 gene Glu504Lys was significantly associated with short-term prognosis. The genotype GA+AA of ALDH2 gene Glu504Lys locus was an independent risk factor of poor 90-day prognosis. Conclusions ALDH2 Glu504Lys could be a risk factor for collateral circulation and a negative predictor for short-term prognosis in acute cerebral infarction in Han Chinese. ALDH2 Glu504Lys could be a new therapeutic target for patients with acute cerebral infarction.
Collapse
Affiliation(s)
- Yun Qu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China (mainland).,The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Huilong Zhang
- Department of Emergency, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Haiyong Li
- Department of Emergency, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Limei Yu
- Department of Emergency, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Ying Sun
- Department of Emergency, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China (mainland)
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China (mainland)
| |
Collapse
|
2
|
Rimmele DL, Larena-Avellaneda A, Alegiani AC, Rosenkranz M, Schmidt NO, Regelsberger J, Hummel FC, Magnus T, Debus ES, Fiehler J, Gerloff C, Thomalla G. Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board. Neurology 2017; 89:399-407. [PMID: 28659428 DOI: 10.1212/wnl.0000000000004151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/28/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option. METHODS We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions. Over a time period of 53 months, 614 cases with ICA stenosis were discussed, with 285 (46%) symptomatic and 279 (45%) asymptomatic cases. RESULTS Recommendation for symptomatic ICA stenosis was revascularization in 76%, medical management alone in 8%, and further diagnostics in 16%. For asymptomatic ICA stenosis, recommendation was randomization in a clinical trial in 29%, revascularization in 27%, medical management alone in 23%, and further diagnostics in 22%. Treatment recommendations were followed in 94% of symptomatic ICA stenosis and 69% of asymptomatic ICA stenosis. Patients in whom carotid artery stenting was recommended for revascularization were younger and showed a higher rate of severe (≥70%) ICA stenosis. CONCLUSIONS Interdisciplinary board decisions are a helpful and transparent tool to assure adherence to guideline recommendations, and to provide consensus-based individualized treatment strategies in clinical practice in the absence of unequivocal evidence.
Collapse
Affiliation(s)
- David Leander Rimmele
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Axel Larena-Avellaneda
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Anna C Alegiani
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Michael Rosenkranz
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Nils Ole Schmidt
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Jan Regelsberger
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Friedhelm C Hummel
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Tim Magnus
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Eike Sebastian Debus
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Jens Fiehler
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Christian Gerloff
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland
| | - Götz Thomalla
- From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland.
| |
Collapse
|