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Liu L, Li Z, Zhou H, Duan W, Huo X, Xu W, Li S, Nie X, Liu H, Liu J, Sun D, Wei Y, Zhang G, Yuan W, Zheng L, Liu J, Wang D, Miao Z, Wang Y. Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update. Stroke Vasc Neurol 2023; 8:e3. [PMID: 38158224 PMCID: PMC10800268 DOI: 10.1136/svn-2023-002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND China is one of the countries with the highest burden of stroke. Implementing multidimensional management guidelines will help clinicians practise evidence-based care, improve patient outcomes and alleviate societal burdens. This update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular diseases. METHODS We conducted a comprehensive search on MEDLINE (via PubMed) up to 31 August 2023. The writing team established the recommendations through multiple rounds of online and offline discussions. Each recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association (CSA). The draft was reviewed and finalised by the CSA Stroke Guidelines Writing Committee. RESULTS This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care: emergency assessment and diagnosis of ischaemic cerebrovascular disease, acute-phase reperfusion therapy, evaluation of underlying mechanisms, antithrombotic therapy, prevention and treatment of complications, and risk factor management. CONCLUSIONS This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.
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Affiliation(s)
- Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanying Duan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaochuan Huo
- Neurological Disease Center, Cerebral Vascular Disease Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weihai Xu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Li
- Department of Neurology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huihui Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinjie Liu
- Department of General Medicine, Dalian Municipal Central Hospital Affiliated Dalian University of Technology, Dalian, China
| | - Dapeng Sun
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yufei Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Guitao Zhang
- Department of Neurology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weizhuang Yuan
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lina Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jingyi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zhongrong Miao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Xu L, Fu G. Acute Basilar Artery Occlusion Induced by Rapidly Progressive Thrombosis in Vertebrobasilar Dolichoectasia. Stroke 2023; 54:e494-e495. [PMID: 37795594 DOI: 10.1161/strokeaha.123.044834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Lingjia Xu
- Department of Neurology, Shaoxing Second Hospital, Zhejiang, China
| | - Guoping Fu
- Department of Neurology, Shaoxing Second Hospital, Zhejiang, China
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Cao X, Chen X, Qu B, Wang Z, Fan D, Li S. Endovascular Stent Implantation in the Treatment of Vertebrobasilar Dolichoectasia. J Craniofac Surg 2023; 34:e632-e636. [PMID: 37336470 DOI: 10.1097/scs.0000000000009437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/15/2023] [Indexed: 06/21/2023] Open
Abstract
Vertebrobasilar dolichoectasia (VBD) is a rare disease in clinic, with an incidence of 0.06% and 5.8%. It is a progressive vascular disease caused by the dilatation, tortuosity, and prolongation of vertebral and basilar arteries caused by a variety of factors. VBD can lead to hemodynamic changes, ischemic stroke, compression symptoms due to vasodilation, neurological dysfunction, hydrocephalus, subarachnoid hemorrhage, and other clinical manifestations. However, because the condition of VBD is complex and changeable, the treatment of VBD is not uniform. With the development of vascular intervention, especially the development of stent technology, it may become an effective method for the treatment of VBD. Two patients with VBD were treated with endovascular stent implantation.
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Affiliation(s)
- Xuemin Cao
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xiaoshuai Chen
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Bingkun Qu
- Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengwu Wang
- Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Danjie Fan
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Sen Li
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
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Aggarwal A, Kalra G, Caplan LR. Vertebrobasilar dolichoectasia and other arterial abnormalities leading to abducens nerve palsy. J Stroke Cerebrovasc Dis 2023; 32:107051. [PMID: 36871438 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107051] [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: 11/12/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Dolichoectatic vessels can cause cranial nerve dysfunction by either direct compression or ischemia. Abducens nerve palsy due to neurovascular compression by elongated, enlarged, tortuous or dilated arteries is an uncommon but important cause. AIM To highlight neurovascular compression as a cause of abducens nerve palsy and discuss various diagnostic techniques. METHODS Manuscripts were identified using the National Institutes of Health PubMed literature search system. Search terms included abducens nerve palsy, neurovascular compression, dolichoectasia and arterial compression. Inclusion criteria required that the articles were written in English. RESULTS The literature search identified 21 case reports where abducens nerve palsy was due to vascular compression. Out of these 18 patients were male and the mean age was 54 years. Eight patients had unilateral right abducens nerve involvement; eleven patients had unilateral left nerve involvement and two patients had bilateral involvement. The arteries causing the compression were basilar, vertebral and anterior inferior cerebellar arteries. A compressed abducens nerve is not usually clearly detected on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging). MRA (Magnetic Resonance Angiography), Heavy T2- WI (weighted imaging), CISS (constructive interference in steady state) and FIESTA (Fast Imaging Employing Steady-state Acquisition) are essential to demonstrate vascular compression of the abducens nerve. The various treatment options included controlling hypertension, glasses with prisms, muscle resection and microvascular decompression.
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Affiliation(s)
| | - Gagan Kalra
- Department of Ophthalmology, Cole Eye Institute- Cleveland Clinic, Cleveland, OH, United States
| | - Louis R Caplan
- Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, MA, United States
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Del Brutto VJ, Khasiyev F, Omran SS, Purohit M, Liu M, Wright C, Rundek T, Elkind MSV, Sacco RL, Gutierrez J. Association of Brain Arterial Elongation With Risk of Stroke and Death in Stroke-Free Individuals: Results From NOMAS. Arterioscler Thromb Vasc Biol 2023; 43:474-481. [PMID: 36727517 PMCID: PMC9974766 DOI: 10.1161/atvbaha.122.318819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brain arterial dilation and elongation characterize dolichoectasia, an arteriopathy associated with risk of stroke and death. We aim to determine whether brain arterial elongation increases the risk of stroke and death independent of brain arterial diameters. METHODS We analyzed 1210 stroke-free participants (mean age 71±9 years, 41% men, 65% Hispanic) with available time-of-flight magnetic resonance angiogram from the Northern Manhattan Study, a population-based cohort study across a multiethnic urban community. We obtained baseline middle cerebral artery M1-segment (MCA-M1) and basilar artery (BA) mean lengths and diameters using a semi-automated software. Cox proportional hazards models adjusted for brain arterial diameters and potential confounders yielded adjusted hazards ratios with 95% CIs for the primary outcomes of incident stroke and all-cause mortality, as well as secondary outcomes including noncardioembolic stroke, vascular death, and any vascular event. RESULTS Neither MCA-M1 nor BA lengths correlated with incident stroke or all-cause mortality. Both MCA-M1 and BA larger diameters correlated with all-cause mortality (MCA-M1 aHR, 1.52 [95% CI, 1.03-2.23], BA aHR, 1.28 [95% CI, 1.02-1.61]), as well as larger MCA-M1 diameters with vascular death (aHR, 1.84 [95% CI, 1.02-3.31]). Larger MCA-M1 and BA diameters did not correlate with incident stroke. However, larger BA diameters were associated with posterior circulation noncardioembolic stroke (aHR, 2.93 [95% CI, 1.07-8.04]). There were no statistical interactions between brain arterial lengths and diameters in relation to study outcomes. CONCLUSIONS In a multiethnic cohort of stroke-free adults, brain arterial elongation did not correlate with risk of stroke or death, nor influenced the significant association between brain arterial dilation and vascular risk.
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Affiliation(s)
- Victor J. Del Brutto
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Meghan Purohit
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Minghua Liu
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Clinton Wright
- National Institute of Neurologic Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Zheng T, Tang W, Shan Y, Guo R, Gao Y, Tian C, Liu L, Sun L, Liu W, Zhou Z, Jin Y, Duan S, Han B, Fan Y, Zhu X, Liu Z. Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high-resolution magnetic resonance imaging. Brain Pathol 2023; 33:e13135. [PMID: 36718993 PMCID: PMC10041158 DOI: 10.1111/bpa.13135] [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: 04/07/2022] [Accepted: 11/22/2022] [Indexed: 02/01/2023] Open
Abstract
The mechanisms underlying ischemic infarction in patients with vertebrobasilar dolichoectasia (VBD) remain unclear. In this study, we retrospectively analyzed the imaging characteristics of high-resolution magnetic resonance imaging (HR-MRI) in patients with VBD to explore the possible mechanisms of ischemic stroke (IS) in patients with VBD. Patients with VBD were recruited from the HR-MRI database between July 2017 and June 2021. HR-MRI was used to evaluate the diameter, bifurcation height, laterality, arterial dissection, and atherosclerotic plaques of the basilar artery (BA). Transcranial Doppler was used to measure the vertebrobasilar mean velocity (Vm), peak systolic velocity (Vs), end-diastolic velocity (Vd), and pulsatile index. Twenty-six patients with VBD were enrolled, of which 15 had IS and 11 did not. The incidence of classical vascular risk factors, including age, sex, hypertension, diabetes, and hypercholesterolemia, did not differ significantly between the two groups. The BA diameters of the stroke group were significantly higher than that of the nonstroke group (6.57 ± 1.00 mm vs. 5.06 ± 0.50 mm, p = 0.000). The height of the BA bifurcation in the stroke and nonstroke groups was statistically significant (p = 0.002). Compared with the nonstroke group, the Vm, Vs, and Vd of the BA in the stroke group were lower, but the difference was not significant. In the 16 patients with atherosclerotic stenosis, 30 atherosclerotic plaques were found in the BA, 18 (60%) in the greater curvature, and 12 (40%) in the lesser curvature. In addition, one artery dissection (on the lesser curvature) and two dissecting aneurysms (on the greater curvature) were found in the BA of three patients, respectively. The BA diameter and bifurcation height are factors related to IS in patients with VBD. The mechanism of stroke in patients with VBD may involve abnormal hemodynamics, artery dissection, and atherosclerosis. HR-MRI is a useful method for evaluating the risk and underlying mechanism of stroke in patients with VBD.
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Affiliation(s)
- Tao Zheng
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Wenxiong Tang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Yi Shan
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yang Gao
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Chaohui Tian
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Lili Sun
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Wei Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zhi Zhou
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Yi Jin
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Shaojie Duan
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Bingyu Han
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Yangyi Fan
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Xianjin Zhu
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zunjing Liu
- Department of Neurology, Peking University People's Hospital, Beijing, China
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Sari PM, Sani AF, Kurniawan D. Intravenous thrombolysis in patient with vertebrobasilar dolichoectasia and antiplatelet medication. Radiol Case Rep 2022; 17:3355-3359. [PMID: 35874870 PMCID: PMC9304876 DOI: 10.1016/j.radcr.2022.06.061] [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: 06/09/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: While the overall incidence of vertebrobasilar dolichoectasia (VBD) is less than 0.05%-0.06%, it is not uncommon in patients experiencing acute stroke. The influence of VBD on the outcome of intravenous (IV) thrombolysis therapy has not been widely studied. We present the following case of IV thrombolysis use in a patient experiencing acute stroke, who had an increased risk of bleeding due to prior antiplatelet use, and who had concomitant VBD. Case presentation: A 62-year-old man presented with weakness in the left extremities that had begun 1 hour prior to admission. The patient had a history of coronary artery disease and had been regularly taking antiplatelet medication. Upon arrival, the patient was in a decreased level of consciousness, with severe dysarthria, left central facial palsy, left lateralization, and a National Institute of Health Stroke Scale (NIHSS) score of 17. Computed tomography scan of the head showed no intracranial hemorrhage. The patient was administered IV thrombolysis at 2 hours and 45 minutes after symptom onset. Within the first 24 hours, the patient's NIHSS score decreased from 17 to 12, and the final NIHSS score prior to discharge was 7. The Head and neck angiography of this patient revealed VBD. Conclusion: This case demonstrated that IV thrombolysis is safe and effective for use in patients with acute ischemic stroke who have a history of antiplatelet usage and who experience concomitant VBD.
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Liu FX, Niu YG, Zhang DP, Zhang HL, Zhang ZQ, Sun RQ, Zhang YK. Modified Protocol for Establishment of Intracranial Arterial Dolichoectasia Model by Injection of Elastase Into Cerebellomedullary Cistern in Mice. Front Neurol 2022; 13:860541. [PMID: 35518204 PMCID: PMC9062172 DOI: 10.3389/fneur.2022.860541] [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: 01/23/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study aimed to construct an animal model of intracranial arterial dolichoectasia (IADE) applying the modified modeling protocol. Materials and Methods Twenty five milliunits elastase and inactivated elastase were, respectively, injected into the cerebellomedullary cistern of 60 C57/BL6 mice which were divided into experimental group (EG, n = 30) and control group (CG, n = 30) by using a computer-based random order generator. The modified modeling protocol clarified these aspects including brain three-dimensional parameters of mouse head fixation, angle of head inclination, fixed position of taper ear, needle holding technique, needle entry depth, prevention of liquid drug back flow, and storage conditions of elastase. And it was observed for the following parts such as mortality, inflammatory factors, craniocerebral arteries scanning, vascular tortuosity index, artery diameter, pathology of the cerebrovascular. Results Within differently surveyed stage, the total mortality of mice in EG was 20%. ELISA illustrated that the levels of matrix metalloproteinase-9 (MMP-9) and tumor necrosis factor α (TNF-α) in peripheral blood were increased significantly after modeling. Angiography indicated that 100% of IADE in EG were observed and the diameter and tortuosity index of the basilar artery were significantly increased (P < 0.01). EVG histological processing and staining showed the disrupted internal elastic lamina, the atrophied muscle layer, and the hyalinized connective tissue of the basilar artery with the vascular wall tunica media in EG. Micro-computed tomography reported that the craniocerebral arteries of the mice in EG were outstandingly elongated, tortuous, and dilated. Conclusion The modified modeling protocol can reduce the mortality, improve the success rate, and provide a stable animal model for IADE.
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Affiliation(s)
- Fei Xiang Liu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yu Ge Niu
- College of Traditional Chinese Medicine, Henan University of Traditional Chinese Medicine Academy, Zhengzhou, China
| | - Dao Pei Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Henan Vertigo Disease Diagnosis and Treatment Center, Zhengzhou, China.,Institute of Vertigo Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhen Qiang Zhang
- College of Traditional Chinese Medicine, Henan University of Traditional Chinese Medicine Academy, Zhengzhou, China
| | - Rui Qin Sun
- Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yun Ke Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
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Dolichoectasia: a brain arterial disease with an elusive treatment. Neurol Sci 2022; 43:4901-4908. [PMID: 35441277 DOI: 10.1007/s10072-022-06078-9] [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: 03/09/2022] [Accepted: 04/10/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Dolichoectasia is a form of brain large artery disease associated with a high risk of mortality and morbidity. Progressive enlargement of arterial size is a predictor of mortality, but there are no specific treatments for arresting or slowing down dilatation. Additionally, dilated brain arteries can cause flow stagnation, which can trigger thrombosis and cause stroke. Pathology and genetic studies indicate a possible role for increased matrix metalloproteinase activation in arterial dilatation and thus in the pathophysiology of dolichoectasia. Therefore, therapeutic interventions aimed at slowing down arterial dilatation and preventing thrombosis could hypothetically play a role in treating patients with dolichoectasia. METHODS We present four patients with dolichoectasia that exemplify therapeutic challenges worth discussing in the context of the current literature. Two patients were treated off-label with doxycycline (based on its antiMMP properties) and with apixaban, one patient was put on warfarin and later switched to aspirin, and the fourth patient underwent endovascular treatment. RESULTS We report four cases, all men 50 years or older. Of the two patients treated with doxycycline, we noted a slowdown of the basilar artery (BA) growth, but the BA continued to grow in the other patient. Of the two patients who received apixaban, none had a subsequent stroke in 5 and 4 years of follow-up, respectively. One patient was admitted with a fatal BA thrombosis and rupture, and pathological examination of the brain arteries demonstrated advanced arterial wall degeneration but no atherosclerosis. DISCUSSION These cases exemplify the challenges of treating people with dolichoectasia and highlight the need for better evidence regarding the best possible treatment for this population.
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Wang Y, Huang J, Qian G, Jiang S, Miao C. Study on the Correlation between different Levels of Patients with Vertebrobasilar Dolichoectasia and Posterior Circulation Blood Perfusion. J Stroke Cerebrovasc Dis 2022; 31:106378. [PMID: 35287024 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106378] [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: 11/29/2021] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE This study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated. METHODS A cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP. RESULTS Out of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05). CONCLUSION As VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.
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Affiliation(s)
- Yanshuang Wang
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, lianyungang, 222000, China.
| | - Jiarong Huang
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, lianyungang, 222000, China.
| | - Guizhen Qian
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, lianyungang, 222000, China.
| | - Shunbin Jiang
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, lianyungang, 222000, China.
| | - Chongchang Miao
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, lianyungang, 222000, China.
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Ng MA. Posterior Circulation Ischaemic Stroke. Am J Med Sci 2022; 363:388-398. [PMID: 35104439 DOI: 10.1016/j.amjms.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
Posterior circulation ischaemic stroke (PCIS) is a disease of high burden. They account for 20-25% of all ischaemic strokes. However, it is relatively under-researched and requires more clinical attention, since it carries worse functional outcomes. Vertigo, visual disturbances and sensory/motor disturbances are found in PCIS. Large artery atherosclerosis and embolism are main causes of PCIS, while there is growing evidence that vertebrobasilar dolichoectasia is a key association. Hypertension is the commonest risk factor, while diabetes mellitus is more specific to PCIS. PCIS is diagnosed through neuroimaging techniques, which examine structural brain abnormalities, vascular patency and perfusion. PCIS, in line with ischaemic stroke in general, requires medical treatment and lifestyle modifications. This includes smoking cessation, weight control, and dietary alterations. Aspirin use also significantly improves survival outcomes. While intravascular and intra-arterial thrombolysis improve clinical outcomes, this is not proven conclusively for stenting and angioplasty. Future research on PCIS can focus on multi-centre epidemiological studies, clinically significant anatomical variants, and collateralisation.
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Affiliation(s)
- Mr Alexander Ng
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Full Address: Block K, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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12
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Goroshchenko SA. [Diagnosis and treatment of non-saccular vertebrobasilar aneurysms]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:109-114. [PMID: 35758086 DOI: 10.17116/neiro202286031109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To systematize the data on diagnosis and treatment of non-saccular vertebrobasilar aneurysms. MATERIAL AND METHODS We have analyzed modern and fundamental studies in the PubMed database for the period 1969-2020. The following keywords were used: non-saccular aneurysm, dolichoectasia, vertebrobasilar pool. Fifty-nine studies including 1 meta-analysis, 9 case reports, 24 reviews and 25 original articles were selected. RESULTS Analysis of literature data indicates various unresolved problems associated with difficult diagnosis and choice of treatment that results high rates of disability and mortality. CONCLUSION Data on anatomical features of non-saccular aneurysms, such as presence or absence of perforating arteries within the affected arterial segment, analysis of electrophysiological changes following brainstem compression by aneurysm can serve as factors that will improve treatment outcomes in these patients.
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Affiliation(s)
- S A Goroshchenko
- Polenov Russian Research Neurosurgical Institute - Branch of the Almazov National Medical Research Center, St. Petersburg, Russia
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13
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Matrix metalloproteinase-2 and matrix metalloproteinase-9 serum levels in patients with vertebrobasilar dolichoectasia with and without stroke: case-control study. Neuroradiology 2021; 64:1187-1193. [PMID: 34845504 DOI: 10.1007/s00234-021-02869-7] [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: 08/08/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasilar dolichoectasia (VBD) with and without acute stroke. METHODS Case-control study. From an outpatient clinic, we recruited 14 controls and 19 patients with VBD. We also recruited 33 patients with stroke from two emergency departments, 14 without VBD (S/-VBD) and 19 with VBD (S/ + VBD). All the patients underwent serum MMP-2 and MMP-9 measurements and a non-contrast CT scan. Two investigators assessed the intracranial vertebral arteries (VA) and the basilar artery (BA) at the mid-pons. Diagnosis of VBD was made if the BA diameter was ≥ 4.5 mm. RESULTS The mean age of the 66 patients studied was 57.6 + 16.0 years, 41% female. In the 33 patients with stroke, the median NIHSS was 8 (range 15); there were no differences in the NIHSS scores between both groups with stroke. Median MMP-2 levels were lower in the S/-VBD when compared to controls. Median MMP-9 serum levels were higher in both groups with VBD when compared to controls and the S/-VDB group. Both groups with stroke exhibited higher MMP-9 serum levels than controls but were not statistically different from those found in patients with VBD. Serum levels of MMP-9 were significantly correlated with the diameters of the BA (r = 0.344, p = 0.01) and the left VA (r = 0.305, p = 0.05). CONCLUSION This study found that high serum levels of MMP-9 are associated with VBD independently of stroke and correlated with the degree of VBD.
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Vu HD, Huynh PT, Ryu J, Kang UR, Youn SW, Kim H, Ahn HJ, Park K, Hwang SK, Chang YC, Lee YJ, Lee HJ, Lee J. Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation. Int J Biol Sci 2021; 17:3818-3836. [PMID: 34671201 PMCID: PMC8495379 DOI: 10.7150/ijbs.60588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
Rationale: In intracranial arterial dolichoectasia (IADE) development, the feedback loop between inflammatory cytokines and macrophages involves TNF-α and NF-κB signaling pathways and leads to subsequent MMP-9 activation and extracellular matrix (ECM) degeneration. In this proof-of-concept study, melittin-loaded L-arginine-coated iron oxide nanoparticle (MeLioN) was proposed as the protective measure of IADE formation for this macrophage-mediated inflammation and ECM degeneration. Methods: IADE was created in 8-week-old C57BL/6J male mice by inducing hypertension and elastase injection into a basal cistern. Melittin was loaded on the surface of ION as a core-shell structure (hydrodynamic size, 202.4 nm; polydispersity index, 0.158). Treatment of MeLioN (2.5 mg/kg, five doses) started after the IADE induction, and the brain was harvested in the third week. In the healthy control, disease control, and MeLioN-treated group, the morphologic changes of the cerebral arterial wall were measured by diameter, thickness, and ECM composition. The expression level of MMP-9, CD68, MCP-1, TNF-α, and NF-κB was assessed from immunohistochemistry, polymerase chain reaction, and Western blot assay. Results: MeLioN prevented morphologic changes of cerebral arterial wall related to IADE formation by restoring ECM alterations and suppressing MMP-9 expression. MeLioN inhibited MCP-1 expression and reduced CD68-positive macrophage recruitments into cerebral arterial walls. MeLioN blocked TNF-α activation and NF-κB signaling pathway. In the Sylvian cistern, co-localization was found between the CD68-positive macrophage infiltrations and the MeLioN distributions detected on Prussian Blue and T2* gradient-echo MRI, suggesting the role of macrophage harboring MeLioN. Conclusions: The macrophage infiltration into the arterial wall plays a critical role in the MMP-9 secretion. MeLioN, designed for ION-mediated melittin delivery, effectively prevents IADE formation by suppressing macrophage-mediated inflammations and MMP activity. MeLioN can be a promising strategy preventing IADE development in high-risk populations.
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Affiliation(s)
- Huy Duc Vu
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Phuong Tu Huynh
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Junghwa Ryu
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sung Won Youn
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hongtae Kim
- Department of Anatomy, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Jin Ahn
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kwankyu Park
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Soon-Kyung Hwang
- Department of Molecular Biology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young-Chae Chang
- Department of Molecular Biology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yong Jig Lee
- Department of Plastic Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
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15
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1098] [Impact Index Per Article: 366.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Del Brutto VJ, Prabhakaran S, Liebeskind DS, Campo-Bustillo I, Cotsonis G, Nizam A, Romano JG. Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease: Results from the MYRIAD study. J Neuroimaging 2021; 31:931-939. [PMID: 33942908 DOI: 10.1111/jon.12872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. METHODS We analyzed 98 participants (mean age 63.8 ± 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. RESULTS IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. CONCLUSIONS IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
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Affiliation(s)
- Victor J Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | | | - Iszet Campo-Bustillo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Dobrocky T, Piechowiak EI, Goldberg J, Barvulsky Aleman E, Nicholson P, Lynch J, Bervini D, Kaesmacher J, Agid R, Krings T, Raabe A, Gralla J, Pereira VM, Mordasini P. Absence of pontine perforators in vertebrobasilar dolichoectasia on ultra-high resolution cone-beam computed tomography. J Neurointerv Surg 2020; 13:580-584. [PMID: 33087525 PMCID: PMC8142461 DOI: 10.1136/neurintsurg-2020-016818] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Abstract
Background Vertebrobasilar dolichoectasia (VBDE) is a rare type of non-saccular intracranial aneurysm, with poor natural history and limited effective treatment options. Visualizing neurovascular microanatomy in patients with VBDE has not been previously reported, but may yield insight into the pathology, and provide important information for treatment planning. Objective To carry out a retrospective analysis of ultra-high resolution cone-beam computed tomography (UHR-CBCT) in patients with fusiform basilar aneurysms, visualizing neurovascular microanatomy of the posterior circulation with a special focus on the pontine perforators. Methods UHR-CBCT was performed in seven patients (mean age 59 years; two female) with a VBDE, and in 14 control patients with unrelated conditions. Results The mean maximum diameter of the fusiform vessel segment was 28 mm (range 19–36 mm), and the mean length of the segment was 39 mm (range 15–50 mm). In all patients with VBDE, UHR-CBCT demonstrated an absence of perforating arteries in the fusiform arterial segment and a mean of 3.7 perforators arising from the unaffected vessel segment. The network of interconnected superficial circumferential pontine arteries (brainstem vasocorona) were draping around the aneurysm sac. In controls, a mean of 3.6, 2.5, and 1.2 perforators were demonstrated arising from the distal, mid-, and proximal basilar artery, respectively. Conclusions The absence of pontine perforators in the fusiform vessel segment of VBDE is counterbalanced by recruitment of collateral flow from pontine perforators arising from the unaffected segment of the basilar artery, as well as collaterals arising from the anterior inferior cerebellar artery/posterior inferior cerebellar artery and superior cerebellar artery. These alternative routes supply the superficial brainstem arteries (brainstem vasocorona) and sustain brainstem viability. Our findings might have implications for further treatment planning.
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Affiliation(s)
- Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Eike I Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Enrique Barvulsky Aleman
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick Nicholson
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Ronit Agid
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Vitor M Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
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18
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Chen Z, Li H, Wu M, Chang C, Fan X, Liu X, Xu G. Caliber of Intracranial Arteries as a Marker for Cerebral Small Vessel Disease. Front Neurol 2020; 11:558858. [PMID: 33071944 PMCID: PMC7542665 DOI: 10.3389/fneur.2020.558858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The dilation of intracranial large arteries caliber, may transfer more hemodynamic burden to the downstream brain capillaries, which, in the long run, results in cerebral small vessel disease (CSVD). This study aimed to investigate the relationship between intracranial artery calibers and small vessel disease. Methods: Patients with first-ever ischemic stroke of lacunar infarction subtype were enrolled via Nanjing Stroke Registry Program. An intracranial arterial Z-score, named the brain arterial remodeling (BAR) score, was calculated by averaging the calibers of the seven main intracranial arteries. Among the enrolled patients, those with a BAR score < −1 SD were deemed to have small intracranial artery calibers; those with a BAR score >1 SD were deemed to have large intracranial artery calibers and those with a between BAR score were deemed to have normal intracranial artery calibers. Imaging markers of CSVD, including lacuna, white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS) and cerebral microbleeds (CMBs) were rated and then summed to obtain a total CSVD score. Results: A total of 312 patients were involved in this study, patients with BAR score >1 SD were older (P = 0.039), and more prone to having a history of myocardial infarction (P = 0.033). The Spearman's rank correlation coefficient between the BAR score and total CSVD score is 0.320 (P < 0.001). Binary logistic regression found that BAR score >1 SD was correlated with lacuna (OR = 1.987; 95% CI, 1.037–3.807; P = 0.039); severe WMH (OR = 1.994; 95% CI, 1.003–3.964; P = 0.049); severe EPVS (OR = 2.544; 95% CI, 1.299–4.983; P = 0.006) and CSVD (OR = 2.997; 95% CI 1.182–7.599; P = 0.021). Ordinal logistic regression analysis found that age (OR = 1.028; 95% CI, 1.007–1.049; P = 0.009), hypertension (OR = 3.514; 95% CI, 2.114–5.769; P < 0.001) and BAR score >1 SD (OR = 2.418; 95% CI, 1.350–4.330; P = 0.003) were correlated with the total CSVD score. Conclusions: Patients with large intracranial arterial calibers may have heavier CSVD burden. The mechanisms of this association warrant further study.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Hui Li
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Chang
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
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