1
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Rada I, Calderón JF, Martínez G, Muñoz Venturelli P. Genetics of spontaneous cervical and coronary artery dissections. Front Glob Womens Health 2023; 4:1007795. [PMID: 37214559 PMCID: PMC10196206 DOI: 10.3389/fgwh.2023.1007795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives Spontaneous cervical artery dissections (SCeAD) and coronary artery dissections (SCoAD) are major causes of neurovascular and cardiovascular morbidity in young adults. Although multiple aspects of their etiology are still unknown, most consensuses are focused on the presence of constitutional genetic aspects and environmental triggers. Since recent evidence of genetic contribution points to a possible overlap between these conditions, we aimed to describe current information on SCeAD and SCoAD genetics and their potential shared pathological aspects. Materials and methods A narrative review is presented. Publications in English and Spanish were queried using database search. The articles were evaluated by one team member in terms of inclusion criteria. After collecting, the articles were categorized based on scientific content. Results Given that patients with SCeAD and SCoAD rarely present connective tissue disorders, other genetic loci are probably responsible for the increased susceptibility in some individuals. The common variant rs9349379 at PHACTR1 gene is associated with predisposition to pathologies of the arterial wall, likely mediated by variations in Endothelin-1 (ET-1) levels. The risk of arterial dissection may be increased for those who carry the rs9349379(A) allele, associated with lower expression levels of ET-1; however, the local effect of this vasomotor imbalance remains unclear. Sex differences seen in SCeAD and SCoAD support a role for sex hormones that could modulate risk, tilting the delicate balance and forcing vasodilator actions to prevail over vasoconstriction due to a reduction in ET-1 expression. Conclusions New evidence points to a common gene variation that could explain dissection in both the cervical and coronary vasculatures. To further confirm the risk conferred by the rs9349379 variant, genome wide association studies are warranted, hopefully in larger and ethnically diverse populations.
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Affiliation(s)
- Isabel Rada
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Juan Francisco Calderón
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Gonzalo Martínez
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Muñoz Venturelli
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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2
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Bax M, Romanov V, Junday K, Giannoulatou E, Martinac B, Kovacic JC, Liu R, Iismaa SE, Graham RM. Arterial dissections: Common features and new perspectives. Front Cardiovasc Med 2022; 9:1055862. [PMID: 36561772 PMCID: PMC9763901 DOI: 10.3389/fcvm.2022.1055862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations - such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Valentin Romanov
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Boris Martinac
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY, United States
| | - Renjing Liu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
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3
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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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4
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Arnaud C, Boulanger M, Lorthioir A, Amar L, Azarine A, Boyer L, Chatellier G, Di Monaco S, Jeunemaitre X, Kastler A, Mousseaux E, Oppenheim C, Thony F, Persu A, Olin JW, Azizi M, Touzé E. Male Sex Is Associated With Cervical Artery Dissection in Patients With Fibromuscular Dysplasia. J Am Heart Assoc 2021; 10:e018311. [PMID: 33998257 PMCID: PMC8483547 DOI: 10.1161/jaha.120.018311] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Cervical artery dissection (CeAD) is a frequent manifestation of fibromuscular dysplasia (FMD). However, risk factors for CeAD are unknown. We investigated factors associated with CeAD in the ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry. Methods and Results The ARCADIA registry includes women or men aged ≥18 years, with a diagnosis of renal, cervical, or intracranial artery FMD, who were prospectively recruited at 16 university hospitals in France and Belgium. Diagnosis of acute or past CeAD at inclusion was established on imaging according to standard diagnostic criteria. Associations between potential determinants and CeAD were assessed by logistic regression analyses. Among 469 patients (75 men) with FMD, 65 (13.9%) had CeAD. Patients with CeAD were younger, more likely to be men, have a history of migraine, and less likely to have a history of hypertension than patients without CeAD. In the multivariable analysis, male sex (odds ratio [OR], 2.66; 95% CI, 1.34-5.25), history of migraine (OR, 1.90; 95% CI, 1.06-3.39), age ≥50 years (OR, 0.41; 95% CI, 0.23-0.73), history of hypertension (OR, 0.35; 95% CI, 0.20-0.64), and involvement of ≥3 vascular beds (OR, 2.49; 95% CI, 1.15-5.40) were significantly associated with CeAD. To validate the association between CeAD and sex, we performed a systematic review. We collected additional data on sex from 2 published studies and unpublished data from the US Registry for Fibromuscular Dysplasia and the European/International FMD Registry. In the pooled analysis (289 CeAD, 1933 patients), male sex was significantly associated with CeAD (OR, 2.04; 95% CI, 1.41-2.95; I2=0%). Conclusions In patients with FMD, male sex and multisite involvement are associated with CeAD, in addition to other previously known risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02884141.
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Affiliation(s)
- Charlotte Arnaud
- Department of Neurology Inserm U1237 Normandie UniversitéUniversité Caen NormandieCHU Caen Normandie Caen France
| | - Marion Boulanger
- Department of Neurology Inserm U1237 Normandie UniversitéUniversité Caen NormandieCHU Caen Normandie Caen France
| | - Aurélien Lorthioir
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France
| | - Laurence Amar
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France
| | - Arshid Azarine
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France.,Department of Radiology Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France
| | - Louis Boyer
- Department of Radiology CHU Clermont-Ferrand, Hopital Gabriel Montpied Clermont Ferrand France
| | - Gilles Chatellier
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France.,Clinical Research Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges Pompidou Paris France
| | - Silvia Di Monaco
- Division of Internal Medicine and Hypertension Unit Department of Medical Sciences University of Turin Italy.,Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-LucUniversité Catholique de Louvain Brussels Belgium
| | - Xavier Jeunemaitre
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France.,Department of Genetics Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France
| | | | - Elie Mousseaux
- Department of Radiology Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France
| | - Catherine Oppenheim
- Department of Radiology and INSERM U1266 GHU Paris Psychiatry and Neurosciences Université de Paris France
| | | | - Alexandre Persu
- Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-LucUniversité Catholique de Louvain Brussels Belgium
| | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY
| | - Michel Azizi
- Hypertension Unit Assistance Publique-Hôpitaux de Paris Hôpital Européen Georges PompidouUniversité de Paris France.,INSERM CIC1418 Paris France
| | - Emmanuel Touzé
- Department of Neurology Inserm U1237 Normandie UniversitéUniversité Caen NormandieCHU Caen Normandie Caen France
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5
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Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection. BMC Neurol 2020; 20:445. [PMID: 33302898 PMCID: PMC7731460 DOI: 10.1186/s12883-020-02020-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. Methods All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. Results A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). Conclusions The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.
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6
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Han L, Dai L, Zhao YF, Li HY, Liu O, Lan F, Jiang WJ, Zhang HJ. CD40L promotes development of acute aortic dissection via induction of inflammation and impairment of endothelial cell function. Aging (Albany NY) 2019. [PMID: 29514135 PMCID: PMC5892687 DOI: 10.18632/aging.101394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute aortic dissection is one of the most lethal cardiovascular disease. The major histopathological feature of AAD is medial degradation, especially breakdown of elastin and collagen. However, the underlying mechanism remains a mystery. Platelets expressed CD40 Ligand (CD40L) is recently recognised as a key effector of cardiovascular disease development through its pro-inflammatory effect. To clarify the role of CD40L in AAD, we examined level of CD40L in human blood serum samples and found that it is significantly higher in AAD patients compared with healthy subjects (26.8±5.52 ng/mL versus 13.4±4.00 ng/mL). To further investigate if CD40L is involve in the development of AAD, we applied β-aminopropionitrile (BAPN) induced mouse model of AAD. Consistent with the human data, circulating CD40L in AAD mice much higher than normal mice (148.40±75.96 pg/mL versus 44.09±19.65 pg/mL). Meanwhile, multiple pro-inflammatory chemokines significantly increased in AAD mice. Importantly, the CD40L-/- mice treated with BAPN did not develop these phenotypes. Lastly, we confirmed that endothelial cells migration was significantly inhibited by CD40L, suggesting impaired recovery from intimal injury. In summary, we found that CD40L promoted AAD development through its pro-inflammatory effects and inhibition of endothelial cell function.
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Affiliation(s)
- Lu Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Lu Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yuan-Fei Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Hai-Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Ou Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Feng Lan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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7
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Wang K, Zhao S, Zhang Q, Yuan J, Liu J, Ding X, Song X, Lin J, Du R, Zhou Y, Sugimoto M, Chen W, Yuan B, Liu J, Yan Z, Liu B, Zhang Y, Li X, Niu Y, Long B, Shen Y, Zhang S, Abe K, Su J, Wu Z, Wu N, Liu P, Yang X. Whole-exome sequencing reveals known and novel variants in a cohort of intracranial vertebral-basilar artery dissection (IVAD). J Hum Genet 2018; 63:1119-1128. [PMID: 30115950 DOI: 10.1038/s10038-018-0496-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 01/25/2023]
Abstract
Intracranial vertebral-basilar artery dissection (IVAD) is an arterial disorder leading to life-threatening consequences. Genetic factors are known to be causative to certain syndromic forms of IVAD. However, systematic study of the molecular basis of sporadic and isolated IVAD is lacking. To identify genetic variants contributing to the etiology of IVAD, we enrolled a cohort of 44 unrelated cases with a clinical diagnosis of isolated IVAD and performed whole-exome sequencing (WES) for all the participants; a trio exome sequencing approach was used when samples from both parents were available. Four previously reported disease-causing heterozygous variants (three in COL3A1 and one in FBN1) and seven novel heterozygous variants in IVAD-related genes were identified. In addition, six variants in novel IVAD genes including two de novo heterozygous nonsynonymous variants (each in VPS52 and CDK18), two stop-gain variants (each in MYH9 and LYL1), and two heterozygous biallelic variants in TNXB were considered to be possibly contributing to the phenotype, with unknown significance according to the existing knowledge. A significantly higher mutational rate of IVAD candidate genes was observed in patients versus our in-house controls (P = 0.002) (DISCO study, http://www.discostudy.org/ , n = 2248). Our study provided a mutational landscape for patients with isolated IVAD.
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Affiliation(s)
- Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sen Zhao
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qianqian Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Yuan
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Jiaqi Liu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinghuan Ding
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaofei Song
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jiachen Lin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Renqian Du
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Yangzhong Zhou
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Michihiko Sugimoto
- Technology and Development Team for Mammalian Cellular Dynamics, RIKEN BioResource Center, Tsukuba, Japan
| | - Weisheng Chen
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Yuan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zihui Yan
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bowen Liu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxin Li
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuchen Niu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.,Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Long
- Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Shen
- Division of Genetics and Genomics, Boston Childrens Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA.,Birth Defect Prevention Research Institute, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kuniya Abe
- Technology and Development Team for Mammalian Cellular Dynamics, RIKEN BioResource Center, Tsukuba, Japan
| | - Jianzhong Su
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Zhihong Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China. .,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China. .,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Groden PJ, Lee TC, Bhattacharyya S, Connors J, Lorch J. Lenvatinib-Associated Cervical Artery Dissections in a Patient with Radioiodine-Refractory Metastatic Papillary Thyroid Carcinoma. Front Med (Lausanne) 2018. [PMID: 29527527 PMCID: PMC5829091 DOI: 10.3389/fmed.2017.00220] [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] [Indexed: 11/21/2022] Open
Abstract
Lenvatinib is a tyrosine kinase inhibitor (TKI) approved by the FDA for the treatment of radioiodine-refractory (RAIR) thyroid cancers. Side effects can be severe, however, and include headaches, hypertension, arterial and venous thromboembolic events, and fatalities. Cervical artery dissections (CADs) are leading contributors of cerebral ischemia in young adults, yet the pathophysiology is poorly understood. Here, we describe a case of a 34-year-old female with recurrent, metastatic, RAIR papillary thyroid cancer who, following her second week of lenvatinib treatment, developed significant CAD which resolved following the termination of the TKI therapy. Given the lack of risk factors for the disorder in the patient’s history, the known cardiovascular events associated with the drug, previously described cases of arterial dissections linked to VEGF inhibitors, and the temporal relationship between the onset of symptoms and the treatment start date, a causal relationship between the CAD and lenvatinib is suggested.
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Affiliation(s)
- Phillip J Groden
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Thomas C Lee
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Jean Connors
- Hematology Division, Brigham and Women's Hospital, Boston, MA, United States
| | - Jochen Lorch
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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9
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for cervicocerebral artery dissection (CCD). RECENT FINDINGS CCD incidence has increased over time largely because of improvements in and increasing availability of noninvasive imaging. CCD can be detected on computed tomography angiography, MRI, magnetic resonance angiography, carotid duplex ultrasonography and conventional catheter-based digital subtraction angiography. Additionally, ischemic stroke treatment with intravenous tissue plasminogen-activator for patients with suspected CCD appears to be well tolerated and effective. Moreover, a randomized clinical trial has shown antiplatelet agents to be as effective as anticoagulants at preventing recurrent ischemia. Surgical and endovascular techniques can be considered particularly for patients presenting with intracranial arterial dissection causing subarachnoid hemorrhage, developing recurrent ischemia due to hemodynamic impairment and whose dissecting aneurysms cause brainstem compression. SUMMARY CCD is an important and one of the most common causes of ischemic stroke in young patients without traditional vascular risk factors. Cases can occur shortly after trauma. However, spontaneous CCD is common and is associated with many genetic, acquired and anatomical risk factors. CCD should be detected early to avoid complications and prevent long-term disability.
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10
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Stirn SL, Freilinger C, Roeben B, Tünnerhoff J, Berg D, Freilinger T. Bilateral vertebral artery dissection in the setting of ADEM. J Neurol Sci 2016; 365:212-3. [PMID: 27206909 DOI: 10.1016/j.jns.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/10/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sören L Stirn
- Abteilung Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany; Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Caroline Freilinger
- Abteilung Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany
| | - Benjamin Roeben
- Abteilung Neurologie mit Schwerpunkt Neurodegeneration, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany
| | - Johannes Tünnerhoff
- Abteilung Neurologie mit Schwerpunkt vaskuläre Neurologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany
| | - Daniela Berg
- Abteilung Neurologie mit Schwerpunkt Neurodegeneration, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany
| | - Tobias Freilinger
- Abteilung Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Germany.
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TGFBR2 mutation and MTHFR-C677T polymorphism in a Mexican mestizo population with cervico-cerebral artery dissection. J Neurol 2016; 263:1066-73. [PMID: 27017342 DOI: 10.1007/s00415-016-8101-8] [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: 02/01/2016] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Spontaneous cervico-cerebral artery dissection (CCAD) is a common condition found among young patients with ischemic stroke. We examined the possible association between the polymorphism of methylenetetrahydrofolate reductase (MTHFR)-C677T and the gene mutation in transforming growth factor beta receptor II (TGFBR2) in a cohort of CCAD patients. One-hundred CCAD cases (65 males; mean age: 38.08 ± 10.68 years) and 100 matching controls were included. Ancestry informative markers (AIMs) were used to increase internal validity of the genetic analysis. Genotypes of the C677T polymorphism in the MTHFR gene were determined by polymerase chain reaction and restriction fragment length polymorphism; direct sequencing was used for a mutation analysis of the TGFBR2 gene. Associations were evaluated using a multivariate statistics, and Hardy-Weinberg equilibrium was analyzed. We also incorporated our data into a meta-analysis of the MTHFR-C677T. Sixty-three patients presented with vertebral and 37 with carotid artery dissection. Ancestry markers found a call rate on each over 95 %. All AIMs did not deviate from Hardy-Weinberg equilibrium (p > 0.05). The homozygous TT genotype was more frequent in cases (OR 2.04, CI 95 % 1.53-2.72, p = 0.005), whereas no significant difference was found on heterozygous CT genotype. TGFBR2 mutation was not present in our samples. In the meta-analysis of MTHFR/C677T variant, a total 613 cases and 1547 controls were analyzed; we found a moderate association for the recessive model genotype (OR 2.04, CI 95 % 1.53-2.72; p = 0.342; Z = 4.83; I (2) = 11.3). This study supports a positive association between the MTHFR-C677T polymorphism and genetically confirmed Mexican mestizo CCAD patients.
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12
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Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection. Nat Genet 2014; 47:78-83. [PMID: 25420145 DOI: 10.1038/ng.3154] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year). Minor cervical traumas, infection, migraine and hypertension are putative risk factors, and inverse associations with obesity and hypercholesterolemia are described. No confirmed genetic susceptibility factors have been identified using candidate gene approaches. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69-0.82; P = 4.46 × 10(-10)), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10(-3); combined P = 1.00 × 10(-11)). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction. Deciphering the mechanisms underlying this pleiotropy might provide important information on the biological underpinnings of these disabling conditions.
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13
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Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? Curr Opin Neurol 2014; 27:20-8. [PMID: 24300790 DOI: 10.1097/wco.0000000000000056] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young and middle-aged adults, although relatively uncommon in the community. Recent large collaborative projects have provided new insights into mechanisms and risk factors of CeAD. RECENT FINDINGS Pathologic changes observed at the media-adventitia border in temporal arteries of CeAD patients suggest a predisposing arterial wall weakness. In large multicenter series of CeAD patients, compared to age-matched healthy controls and patients with an ischemic stroke of another cause, hypertension and migraine, especially without aura, were confirmed as risk factors for CeAD, in addition to cervical trauma and recent infection. Hypercholesterolemia and being overweight were shown to be inversely associated with CeAD. Differences in risk factor profile and structural features between carotid and vertebral dissection suggest that their pathophysiology may partly differ. An association of CeAD with fibromuscular dysplasia and reversible cerebral vasoconstriction syndrome was described. Genetic risk factors of CeAD are still poorly understood. SUMMARY Large cohorts of CeAD patients have refined our understanding of the pathophysiology and risk factors of CeAD, but the molecular mechanisms are still poorly understood. Ongoing high-throughput genetic projects will hopefully provide novel insight into the biological substrate of CeAD.
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Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, Noorollah LD, Panagos PD, Schievink WI, Schwartz NE, Shuaib A, Thaler DE, Tirschwell DL. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2014; 45:3155-74. [PMID: 25104849 DOI: 10.1161/str.0000000000000016] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults. The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. RESULTS Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard. CONCLUSIONS CD is an important cause of ischemic stroke in young and middle-aged patients. CD is most prevalent in the upper cervical spine and can involve the internal carotid artery or vertebral artery. Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and VAD stroke in young patients. Although the incidence of CMT-associated CD in patients who have previously received CMT is not well established, and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine.
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15
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Lu CH, Hwang CW, Chen NF, Liu WS, Wu WT. Association of intercellular adhesion molecular-1 gene polymorphism in ischemic stroke patients. Ann Indian Acad Neurol 2013; 16:380-3. [PMID: 24101821 PMCID: PMC3788285 DOI: 10.4103/0972-2327.116950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/03/2012] [Accepted: 10/31/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ischemic stroke (IS) is a prevalent disease causing a body disability, the third leading cause of death in Taiwan. It shows that the level of intercellular adhesion molecular-1 (ICAM-1) in IS patients is higher than control subjects. OBJECTIVE This study is to investigate the possible association of ICAM-1 (G1548A) polymorphism in IS patients. MATERIALS AND METHODS A total of 646 subjects were enrolled in this study, including 312 IS patients, and 334 controls without a history of symptomatic IS. The ICAM-1 (G1548A) polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Clinical factors were also determined. RESULTS The frequencies of the ICAM-1 (G1548A) polymorphism for G/G, G/A, and A/A were 74.8%, 23.9%, and 0.3%, respectively, in healthy controls, and 62.8%, 32.1%, and 5.1%, respectively, in patients. The frequency of the ICAM-1 (G1548A) A allele (21.2% versus 13.2%, respectively; P = 0.007) and the carriers of the ICAM-1 (G1548A) A allele (37.2% versus 25.2%; P = 0.019, OR 1.76, 95% CI 1.1-2.83) are great in IS patients compared with healthy controls. There is a higher risk of IS associated with homozygosity for the ICAM-1 (G1548A) A allele (AA genotype) compared with the control population (5.1% vs. 0.3%, respectively, P = 0.04; OR 5.1, 95% CI 1.19-21.66). We also observed both hypertension and diabetes has shown a positive association with IS. CONCLUSIONS The ICAM-1 (G1548A) polymorphism was associated with independent risk factor for the development of IS.
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Affiliation(s)
- Ching-Hsiang Lu
- Department of Professional Medicine, Neurosurgery Division, Kaohsiung Armed Forces General Hospital, VAC, EY, Taiwan
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16
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Mohan IV. Current optimal assessment and management of carotid and vertebral spontaneous and traumatic dissection. Angiology 2013; 65:274-83. [PMID: 23401625 DOI: 10.1177/0003319712475154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dissection of the internal carotid or vertebral artery has been recognized as a cause of stroke in young patients. It is disproportionate in its representation as a cause of stroke in this age group. Intimal tears, intramural hematomas, and dissection aneurysms may be the result of trauma or may occur spontaneously. Spontaneous dissection may be the result of inherent arterial weakness or in association with other predisposing factors. Clinical diagnosis is often difficult, but increased awareness and a range of modern investigations such as computerized tomography or magnetic resonance imaging may aid in diagnosis. Management options include antiplatelet therapy, anticoagulation, thrombolysis, and surgical or endovascular procedures. Prognosis is variable, and dissection may be asymptomatic but may lead to profound neurological deficit and death.
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Affiliation(s)
- Irwin V Mohan
- 1Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
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17
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Motawi T, Shaker O, Taha N, Abdel Raheem M. Genetic variations in E-selectin and ICAM-1: relation to atherosclerosis. Med Sci Monit 2012; 18:CR381-9. [PMID: 22648254 PMCID: PMC3560716 DOI: 10.12659/msm.882908] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background This study aimed to investigate the association of both intercellular adhesion molecule-1 (ICAM-1) and endothelial cell adhesion molecule (E-selectin) polymorphisms using PCR technique and their role in the pathogenesis of atherosclerosis. Material/Methods The study enrolled 285 individuals, classified into 4 groups: 63 cerebrovascular atherosclerotic patients, 75 cardiovascular patients, 72 peripheral atherosclerotic patients and 75 normal healthy individuals. Results The frequency of the mutant AC genotype of E-selectin in peripheral, cerebral and cardiovascular atherosclerotic patients was significantly higher than in control subjects (29.17%, 28.53% and 28% vs. 8%, respectively). However, no significant difference was observed in the frequency of mutant CC allele between all atherosclerotic patients and control groups. The frequency of the mutant EE homozygotes of ICAM-1 in peripheral, cerebral and cardiovascular atherosclerotic patients was significantly higher compared to controls (45.8%, 42.9% and 36% vs. 12%, respectively). The frequency of EK of ICAM-1 showed no significant difference between atherosclerotic patients and the control group. The frequency of the mutant E allele of ICAM-1 was significantly higher in peripheral, cerebral and cardiovascular patients compared to controls (58.3%, 54.8% and 54% vs. 26%, respectively). Conclusions Ser 128Arg of E-selectin and the K469E of ICAM-1 polymorphisms may be involved in predisposition to atherosclerosis.
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Affiliation(s)
- Tarek Motawi
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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18
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Abstract
Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.
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Abstract
Cervical artery dissection (CeAD) occurs in healthy young individuals and often entails ischemic stroke. Skin biopsies from most CeAD-patients show minor connective tissue alterations. We search for rare genetic deletions and duplication that may predispose to CeAD. Forty-nine non-traumatic CeAD-patients with electron microscopic (EM) alterations of their dermal connective tissue (EM+ patients) and 21 patients with normal connective tissue in skin biopsies (EM- patients) were analyzed. Affymetrix 6.0 microarrays (Affymetrix) from all patients were screened for copy number variants (CNVs). CNVs absent from 403 control subjects and from 2402 published disease-free individuals were considered as CeAD-associated. The genetic content of undentified CNVs was analyzed by means of the Gene Ontology (GO) Term Mapper to detect associations with biological processes. In 49 EM+ patients we identified 13 CeAD-associated CNVs harboring 83 protein-coding genes. In 21 EM- patients we found five CeAD-associated CNVs containing only nine genes (comparison of CNV gene density between the groups: Mann-Whitney P=0.039). Patients' CNVs were enriched for genes involved in extracellular matrix organization (COL5A2, COL3A1, SNTA1, P=0.035), collagen fibril organization COL5A2, COL3A1, (P=0.0001) and possibly for genes involved in transforming growth factor beta (TGF)-beta receptor signaling pathway (COL3A1, DUPS22, P=0.068). We conclude that rare genetic variants may contribute to the pathogenesis of CeAD, in particular in patients with a microscopic connective tissue phenotype.
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Yaghi S, Maalouf N, Keyrouz SG. Cervical Artery Dissection: Risk Factors, Treatment, and Outcome; A 5-Year Experience From a Tertiary Care Center. Int J Neurosci 2012; 122:40-4. [DOI: 10.3109/00207454.2011.622453] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Haneline MT, Rosner AL. The etiology of cervical artery dissection. J Chiropr Med 2011; 6:110-20. [PMID: 19674705 DOI: 10.1016/j.jcme.2007.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 04/29/2007] [Indexed: 10/22/2022] Open
Abstract
The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.
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Affiliation(s)
- Michael T Haneline
- Professor, Palmer College of Chiropractic West, Department of Research, San Jose, CA 95134
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22
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Debette S, Metso T, Pezzini A, Abboud S, Metso A, Leys D, Bersano A, Louillet F, Caso V, Lamy C, Medeiros E, Samson Y, Grond-Ginsbach C, Engelter ST, Thijs V, Beretta S, Béjot Y, Sessa M, Lorenza Muiesan M, Amouyel P, Castellano M, Arveiler D, Tatlisumak T, Dallongeville J. Association of Vascular Risk Factors With Cervical Artery Dissection and Ischemic Stroke in Young Adults. Circulation 2011; 123:1537-44. [DOI: 10.1161/circulationaha.110.000125] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stéphanie Debette
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Tiina Metso
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Alessandro Pezzini
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Shérine Abboud
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Antti Metso
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Didier Leys
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Anna Bersano
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Fabien Louillet
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Valeria Caso
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Chantal Lamy
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Elisabeth Medeiros
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Yves Samson
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Caspar Grond-Ginsbach
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Stefan T. Engelter
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Vincent Thijs
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Simone Beretta
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Yannick Béjot
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Maria Sessa
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Maria Lorenza Muiesan
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Philippe Amouyel
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Maurizio Castellano
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Dominique Arveiler
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Turgut Tatlisumak
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
| | - Jean Dallongeville
- From the Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., P.A., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France (S.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.M., A.M., T.T.); Department of Medical and Surgical
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Divjak I, Slankamenac P, Jovićević M, Zikić TR, Popović N. [Factors predisposing to cervical artery dissection]. MEDICINSKI PREGLED 2011; 64:198-201. [PMID: 21905600 DOI: 10.2298/mpns1104198d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Cervical artery dissection is a major cause of cerebral ischemia in young adults and can lead to various clinical symptoms, some of which are benign (e.g. headache, neck pain, Horner's syndrome, and cranial nerve palsy). However, most patients have a stroke or transient ischemic attack. EPIDEMIOLOGY The incidence of cervical artery dissection is low and is estimated to be around 2.6 per 100,000 inhabitants. Mortality and short-term recurrence rates are low: however; they may have been underestimated. PATHOPHYSIOLOGY Although the pathophysiology is still unclear constitutional and partly genetic susceptibility of the arterial wall has been proposed as a causal factor; triggered by infection or minor trauma. PREDISPOSING FACTORS: In addition to the trauma to the neck, other risk fractors have been suggested, such as infection, migraine, hyperhomocisteinamia, and the 67TT genotype of the 5,10-methylene-tetrahydrofolate reductase gene although evidence is sparse. GENETIC FACTORS Cervical artery dissection is now considered a multifactorial disease caused by several genetic abnormalities and environmental factors acting synergistically. CONCLUSION Research aimed at improving our understanding of the environmental and genetic factors predisposing to cervical artery dissection and assessment of long-term outcomes of this disease is needed. Better understanding of the underlying pathophysiology and the natural history of the disease through large prospective multicentre cohorts could also be helpful to improve therapeutic and preventive strategies. Several mutlticentre efforts are already under way to meet these needs.
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Fusco MR, Harrigan MR. Cerebrovascular Dissections—A Review Part I: Spontaneous Dissections. Neurosurgery 2011; 68:242-57; discussion 257. [DOI: 10.1227/neu.0b013e3182012323] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
abstract
Spontaneous cerebrovascular dissections are subintimal or subadventitial cervical carotid and vertebral artery wall injuries and are the cause of as many as 2% of all ischemic strokes. Spontaneous dissections are the leading cause of stroke in patients younger than 45 years of age, accounting for almost one fourth of strokes in this population. A history of some degree of trivial trauma is present in nearly one fourth of cases. Subsequent mortality or neurological morbidity is usually the result of distal ischemia produced by emboli released from the injury site, although local mass effect produced by arterial dilation or aneurysm formation also can occur. The gold standard for diagnosis remains digital subtraction angiography. Computed tomography angiography, magnetic resonance angiography, and ultrasonography are complementary means o evaluation, particularly for injury screening or treatment follow-up. The annual rate of stroke after injury is approximately 1% or less per year. The currently accepted method of therapy remains antithrombotic medication, either in the form of anticoagulation or antiplatelet agents; however, no class I medical evidence exists to guide therapy. Other options for treatment include thrombolysis and endovascular therapy, although the efficacy and indications for these methods remain unclear.
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Affiliation(s)
- Matthew R. Fusco
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark R. Harrigan
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Micheli S, Paciaroni M, Corea F, Agnelli G, Zampolini M, Caso V. Cervical artery dissection: emerging risk factors. Open Neurol J 2010; 4:50-5. [PMID: 21270941 PMCID: PMC3026338 DOI: 10.2174/1874205x01004010050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 12/31/2009] [Accepted: 12/31/2009] [Indexed: 01/13/2023] Open
Abstract
Cervical artery dissection (CAD) represents an increasingly recognized cause of stroke and the most common cause of ischemic stroke in young adults. Many factors have been identified in association with CAD such as primary disease of arterial wall (fibrodysplasia) and other non-specific diseases related to CAD like Ehlers Danlos-syndrome IV, Marfan's syndrome, vessel tortuosity. Moreover, an underlying arteriopathy which could be in part genetically determined, has been suspected. The rule of emerging risk factors for CAD such as recent respiratory tract infection, migraine and hyperhomocysteinemia are still a matter of research. Other known risks factors for CAD are major head/neck trauma like chiropractic maneuver, coughing or hyperextension injury associated to car. We examined emerging risks factors for CAD detected in the last years, as CAD pathogenesis is still not completely understood and needs further investigations.
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Affiliation(s)
- S Micheli
- Department of Rehabilitation, SC Riabilitazione Intensiva Neuromotoria, Trevi, Italy
| | - M Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - F Corea
- Department of Rehabilitation, UO Gravi Cerebrolesioni Acquisite, Ospedale San Giovanni, Foligno, Italy
| | - G Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - M Zampolini
- Department of Rehabilitation, UO Gravi Cerebrolesioni Acquisite, Ospedale San Giovanni, Foligno, Italy
| | - V Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
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Abstract
Cervical-artery dissection (CAD) is a major cause of cerebral ischaemia in young adults and can lead to various clinical symptoms, some of which are benign (eg, headache, neck pain, Horner's syndrome, and cranial-nerve palsy), but most patients have a stroke or transient ischaemic attack. In addition to trauma to the neck, other risk factors have been suggested, such as infection, migraine, hyperhomocysteinaemia, and the 677TT genotype of the 5,10-methylenetetrahydrofolate reductase gene (MTHFR 677TT), although evidence is sparse. An underlying arteriopathy, which could in part be genetically determined, is believed to have a role in the development of CAD. Importantly, both research on and optimum management of CAD strongly rely on diagnostic accuracy. Although the functional outcome of CAD is good in most patients, socioprofessional effects can be important. Incidence of the disorder in the general population is underestimated. Mortality and short-term recurrence rates are low but possibly also underestimated. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.
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Affiliation(s)
- Stéphanie Debette
- Université Lille II (EA 2691), Department of Neurology, Stroke Department, F-59037 Lille, France
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Debette S, Metso TM, Pezzini A, Engelter ST, Leys D, Lyrer P, Metso AJ, Brandt T, Kloss M, Lichy C, Hausser I, Touze E, Markus HS, Abboud S, Caso V, Bersano A, Grau A, Altintas A, Amouyel P, Tatlisumak T, Dallongeville J, Grond-Ginsbach C. CADISP-Genetics: An International Project Searching for Genetic Risk Factors of Cervical Artery Dissections. Int J Stroke 2009; 4:224-30. [DOI: 10.1111/j.1747-4949.2009.00281.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Cervical artery dissection (CAD) is a frequent cause of ischemic stroke, and occasionally death, in young adults. Several lines of evidence suggest a genetic predisposition to CAD. However, previous genetic studies have been inconclusive mainly due to insufficient numbers of patients. Our hypothesis is that CAD is a multifactorial disease caused by yet largely unidentified genetic variants and environmental factors, which may interact. Our aim is to identify genetic variants associated with an increased risk of CAD and possibly gene-environment interactions. Methods We organized a multinational European network, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP), which aims at increasing our knowledge of the pathophysiological mechanisms of this disease in a large group of patients. Within this network, we are aiming to perform a de novo genetic association analysis using both a genome-wide and a candidate gene approach. For this purpose, DNA from approximately 1100 patients with CAD, and 2000 healthy controls is being collected. In addition, detailed clinical, laboratory, diagnostic, therapeutic, and outcome data are being collected from all participants applying predefined criteria and definitions in a standardized way. We are expecting to reach the above numbers of subjects by early 2009. Conclusions We present the strategy of a collaborative project searching for the genetic risk factors of CAD. The CADISP network will provide detailed and novel data on environmental risk factors and genetic susceptibility to CAD.
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Affiliation(s)
- S. Debette
- Department of Neurology, University Hospital of Lille, Lille, France
| | - T. M. Metso
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - A. Pezzini
- Department of Neurology, University Hospital of Brescia, Brescia, Italy
| | - S. T. Engelter
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - D. Leys
- Department of Neurology, University Hospital of Lille, Lille, France
| | - P. Lyrer
- Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - A. J. Metso
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - T. Brandt
- Department of Neurology, Schmieder-Klinik Heidelberg, Heidelberg, Germany
| | - M. Kloss
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - C. Lichy
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - I. Hausser
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - E. Touze
- Department of Neurology, Paris Descartes University Sainte-Anne Hospital, Paris, France
| | - H. S. Markus
- Department of Neurology, Saint-George's University of London, London, UK
| | - S. Abboud
- Department of Neurology, Erasmus University Hospital of Brussels, Brussels, Belgium
| | - V. Caso
- Department of Neurology, University Hospital of Perugia, Perugia, Italy
| | - A. Bersano
- Department of Neurology, University Hospital of Milano, Milano, Italy
| | - A. Grau
- Department of Neurology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - A. Altintas
- Department of Neurology, University Hospital of Istanbul, Istanbul, Turkey
| | - P. Amouyel
- Inserm, U744, Pasteur Institute, Lille, France
| | - T. Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - C. Grond-Ginsbach
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
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Abstract
BACKGROUND AND PURPOSE The pathophysiology of cervical artery dissections (CAD), a major cause of ischemic stroke in young adults, is poorly understood. Several arguments suggest a genetic predisposition. METHODS We systematically reviewed all published data on genetic risk factors for CAD and performed a meta-analysis of association studies with the MTHFR C677T polymorphism. RESULTS Rarely, CAD is associated with a known monogenic connective tissue disease, mainly vascular Ehlers-Danlos syndrome. However, in the large majority of CAD cases, there is no evidence for a known monogenic disease. Several arguments, including the association of CAD with dermal connective tissue abnormalities that are inherited, suggest that genetic factors also play a role in "sporadic" CAD as part of a multifactorial predisposition. We identified 15 genetic association studies: 10 were negative and 5 reported associations of 3 genetic variants in 3 different candidate genes. Two studies reported associations with polymorphisms in ICAM-1 and COL3A1, but neither has been replicated. Three studies reported an association with the MTHFR 677TT genotype, but 3 other studies did not replicate this. A meta-analysis of these data identified an overall significant association of the MTHFR 677TT genotype with CAD (OR, 1.67; 95% CI, 1.21 to 2.31). We also identified 9 studies screening candidate genes for mutations and 4 linkage studies, yielding mostly negative results. CONCLUSIONS Although several interesting hypotheses were generated, the majority of genetic studies in CAD have been negative until now, but they were markedly underpowered. Progress in unraveling the genetics of CAD will require the collection of DNA samples from large multicenter series.
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Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res 2009; 123:810-21. [PMID: 19269682 DOI: 10.1016/j.thromres.2009.01.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/16/2009] [Accepted: 01/19/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cervical artery dissection is often treated with anticoagulants to prevent ischemic stroke. The risk-benefit ratio of anticoagulation versus antiplatelet therapy is unclear. OBJECTIVES To provide an educational review of current data on the disease to explain the rationale for the treatment options and to explore the results of management studies in order to determine if anticoagulation is justified. METHODS We searched the databases MEDLINE and EMBASE as well as bibliographies for information on anticoagulants and antiplatelet agents in cervical, i.e. carotid and/or vertebral artery, dissection. RESULTS There are no randomized controlled trials on the treatment. One systematic review from 2003 identified 20 case series or cohort studies. We identified 9 additional studies with a total of 1,033 patients. Of those, 731 received anticoagulation sometimes followed by platelet inhibition vs. 282 patients treated with antiplatelet agents alone. The rate of ischemic stroke was 2.3% vs. 6.9% and bleeding complications were reported in 0.7% vs. 0%. CONCLUSION It cannot be excluded that there is a net benefit from anticoagulant therapy in cervical dissection, but the studies are flawed by considerable bias. Very ill patients at a high risk of ischemic stroke may have been given aspirin due to fear of hemorrhagic complications. A randomized controlled trial is planned and will be crucial to resolve this issue.
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Affiliation(s)
- Yang-Ki Kim
- Department of Medicine, McMaster University, Hamilton ON, Canada
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A Gastric Artery Aneurysm Complicated by a Dissection of Gastric and Hepatic Arteries. Am J Forensic Med Pathol 2008; 29:191-5. [DOI: 10.1097/paf.0b013e318174f0b9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin JJ, Hausser I, Lyrer P, Busse O, Schwarz R, Schneider R, Brandt T, Kloss M, Schwaninger M, Engelter S, Grond-Ginsbach C. Familial Cervical Artery Dissections. Stroke 2006; 37:2924-9. [PMID: 17053184 DOI: 10.1161/01.str.0000248916.52976.49] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Genetic risk factors are thought to play a role in the etiology of spontaneous cervical artery dissections (CAD). However, familial CAD is extremely rare. In this study we analyzed patients with familial CAD and asked the question whether familial CAD has particular features.
Methods—
Seven families with 15 CAD patients were recruited. All patients were carefully investigated by a neurologist, a neuroradiologist, and a dermatologist for clinical characteristics. From 11 patients a skin biopsy was performed to study the morphology of the connective tissue and to analyze the coding sequences of COL3A1, COL5A1, COL5A2, and part of COL1A1.
Results—
The mean age of the patients (n=15, 9 women) at their first dissection was 36.2 years (median age 32 years, range 18 to 59). Two patients had bilateral CAD. One patient had a right and a left internal carotid artery dissection in successive weeks, another patient had 5 dissections over a period of 8 years. A high intrafamilial correlation was found between the affected vessels (ie, the carotid and the vertebral arteries) and between ages at the first dissection. In 1 patient we found clear and reproducible ultrastructural abnormalities in the skin biopsy, but the second patient from the family was not studied, because he died as a result of CAD before this study. The dermal connective tissue aberrations in the examined patient were similar to mild findings in patients with vascular Ehlers-Danlos syndrome (EDS type IV), but might be iatrogenic and related to long-term corticosteroid inhalation therapy. All other analyzed patients showed normal connective tissue morphology. In patients from 6 families we analyzed the whole coding sequence of COL3A1, COL5A1, and COL5A2, and from part of COL1A1. A missense mutation in the COL3A1 gene (leading to a G157S substitution in type III procollagen) was detected in both patients from 1e family. Two patients from another family carried a rare nonsynonymous coding polymorphism in COL5A1 (D192N); 1 of them carried also a rare variant in COL5A2 (T12337).
Conclusions—
Familial CAD patients are young and probably are at high risk for recurrent or multiple CAD. Ultrastructural alterations of the dermal connective tissue might not be an important risk factor for familial CAD. However, the finding of a COL3A1 mutation revealed the presence of an inherited connective tissue disorder in 1 family.
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Affiliation(s)
- Juan Jose Martin
- Department of Neurology, Sanatorio Allende, Hipólito Irigoyen 384, CP 5000, Córdoba, Argentine.
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Pezzini A, Del Zotto E, Mazziotti G, Ruggeri G, Franco F, Giossi A, Giustina A, Padovani A. Thyroid Autoimmunity and Spontaneous Cervical Artery Dissection. Stroke 2006; 37:2375-7. [PMID: 16888275 DOI: 10.1161/01.str.0000236500.15976.f3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The possibility that a disorder of immunity might have a role in the mechanism of local inflammatory alterations leading to spontaneous cervical artery dissection (sCAD) has been recently advocated. METHODS We explored this hypothesis in a case-control study, including patients with sCAD (n=29) and patients with non-CAD ischemic stroke (non-CAD; n=29). Serum levels of antithyroperoxidase, antithyroglobulin, and antithyroid-stimulating hormone receptor antibodies, antinuclear antibodies, antineutrophil cytoplasmic antibodies, antidouble-stranded deoxyribonucleic acid antibodies, antiextractable nuclear antigen antibodies, rheumatoid factor, C3 and C4 complement fraction, and cryoglobulins were measured in all subjects. RESULTS Antithyroid autoimmunity was found in 31.0% (9 of 29) of patients with sCAD and 6.9% (2 of 29) of patients with non-CAD ischemic stroke (P=0.041). CONCLUSIONS Autoimmunity may be involved in the process of local inflammation related to sCAD occurrence. The hypothesis that the arterial disease might be one phenotypic expression of a generalized activation of immunity warrants further investigations.
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Affiliation(s)
- Alessandro Pezzini
- Dipartimento di Scienze Mediche e Chirurgiche, Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia.
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