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Zhang Y, Taylor E, Huang N, Hamilton J, Cheng JX. Survival intravascular photoacoustic imaging of lipid-rich plaque in cholesterol fed rabbits. TRANSLATIONAL BIOPHOTONICS 2022; 4:e202200012. [PMID: 38283396 PMCID: PMC10812843 DOI: 10.1002/tbio.202200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
Intravascular photoacoustic (IVPA) imaging is a promising modality for quantitative assessment of lipid-laden atherosclerotic plaques. Yet, survival IVPA imaging of the same plaque in the same animal is not demonstrated. Here, using a sheathed IVUS/PA catheter of 0.9 mm in diameter, we demonstrate MRI-guided survival IVPA imaging of same plaque in an aorta of a well-established rabbit model mimicking atherosclerosis in human patients. The IVUS/PA results were confirmed by histology. These advances open the opportunity to evaluate the effectiveness of a therapy that aims to reduce the size of atherosclerotic plaques and demonstrates the potential of translating the IVPA catheter into clinic for detection of lipid-rich plaques that are at high risk for thrombosis.
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Affiliation(s)
- Yi Zhang
- Department of Physics, Boston University, Boston, 02215, USA
| | - Erik Taylor
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - Nasi Huang
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - James Hamilton
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, 02118, USA
| | - Ji-Xin Cheng
- Department of Physics, Boston University, Boston, 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, 02215, USA
- Department of Electrical and Computer Engineering, Boston University, Boston, 02215, USA
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Daghem M, Bing R, Fayad ZA, Dweck MR. Noninvasive Imaging to Assess Atherosclerotic Plaque Composition and Disease Activity: Coronary and Carotid Applications. JACC Cardiovasc Imaging 2020; 13:1055-1068. [PMID: 31422147 PMCID: PMC10661368 DOI: 10.1016/j.jcmg.2019.03.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease is one of the leading causes of mortality and morbidity worldwide. Atherosclerosis imaging has traditionally focused on detection of obstructive luminal stenoses or measurements of plaque burden. However, with advances in imaging technology it has now become possible to noninvasively interrogate plaque composition and disease activity, thereby differentiating stable from unstable patterns of disease and potentially improving risk stratification. This manuscript reviews multimodality imaging in this field, focusing on carotid and coronary atherosclerosis and how these novel techniques have the potential to complement current imaging assessments and improve clinical decision making.
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Affiliation(s)
- Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Paritala PK, Yarlagadda PKDV, Kansky R, Wang J, Mendieta JB, Gu Y, McGahan T, Lloyd T, Li Z. Stress-Relaxation and Cyclic Behavior of Human Carotid Plaque Tissue. Front Bioeng Biotechnol 2020; 8:60. [PMID: 32117939 PMCID: PMC7026010 DOI: 10.3389/fbioe.2020.00060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic plaque rupture is a catastrophic event that contributes to mortality and long-term disability. A better understanding of the plaque mechanical behavior is essential for the identification of vulnerable plaques pre-rupture. Plaque is subjected to a natural dynamic mechanical environment under hemodynamic loading. Therefore, it is important to understand the mechanical response of plaque tissue under cyclic loading conditions. Moreover, experimental data of such mechanical properties are fundamental for more clinically relevant biomechanical modeling and numerical simulations for risk stratification. This study aims to experimentally and numerically characterize the stress-relaxation and cyclic mechanical behavior of carotid plaque tissue. Instron microtester equipped with a custom-developed setup was used for the experiments. Carotid plaque samples excised at endarterectomy were subjected to uniaxial tensile, stress-relaxation, and cyclic loading protocols. Thirty percent of the underlying load level obtained from the uniaxial tensile test results was used to determine the change in mechanical properties of the tissue over time under a controlled testing environment (Control tests). The stress-relaxation test data was used to calibrate the hyperelastic (neo-Hookean, Ogden, Yeoh) and linear viscoelastic (Prony series) material parameters. The normalized relaxation force increased initially and slowly stabilized toward the end of relaxation phase, highlighting the viscoelastic behavior. During the cyclic tests, there was a decrease in the peak force as a function of the cycle number indicating mechanical distension due to repeated loading that varied with different frequencies. The material also accumulated residual deformation, which increased with the cycle number. This trend showed softening behavior of the samples. The results of this preliminary study provide an enhanced understanding of in vivo stress-relaxation and cyclic behavior of the human atherosclerotic plaque tissue.
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Affiliation(s)
- Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Prasad K D V Yarlagadda
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rhys Kansky
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - YuanTong Gu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tim McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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Higashi M, Yamada N, Imakita S, Yutani C, Ishibashi-Ueda H, Iihara K, Naito H. CT-pathologic correlation of non-calcified atherosclerotic arterial plaques: a study using carotid endarterectomy specimens. Br J Radiol 2020; 93:20190901. [PMID: 31999208 DOI: 10.1259/bjr.20190901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Pathologic features of atherosclerotic plaques on CT are not established. We compared CT values among pathologically confirmed plaque constituents and evaluated their ability to distinguish plaque constituents. METHODS 50 histopathological images of carotid endarterectomy samples from 10 males and 2 females (age 54-74 years, average 65.9 years) were examined. We compared pre-operative CT [pre-contrast (CT-P), early post-contrast phase (CT-E), delayed post-contrast phase (CT-D)] of lipid-rich necrotic core (NC) and fibrous tissue (F) plaque components with pathological images. The ability of features to differentiate plaque components using several discrimination techniques were compared. RESULTS CT values of NC and F were 36 ± 13, 45 ± 11 (mean ± standard deviation, Hounsfield unit, HU), 41 ± 17, 69 ± 18, and 44 ± 16, 70 ± 13 in CT-P (p < 0.01), CT-E (p < 0.0001), and CT-D (p < 0.0001), respectively. The threshold, sensitivity, and accuracy for distinguishing NC from F were 44 HU, 74%, and 68%; 55 HU, 85%, and 85%; and 63 HU, 92%, and 84% in CTP, CT-E, and CT-D, respectively. CT-P had lower accuracy than CT-E and CT-D (both p < 0.05), but CT-E and CT-D were similar. CT-E and CT-D yielded 90 and 91% sensitivity and accuracy, respectively in linear discrimination analysis. CONCLUSION In both pre- and post-contrast CT, CT values were lower in NC than F. Although values overlapped, using two-phase post-contrast CTs improved discrimination ability. ADVANCES IN KNOWLEDGE Our findings may help to establish computer-aided diagnosis of vulnerable atherosclerotic plaques in future.
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Affiliation(s)
- Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoaki Yamada
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Chikao Yutani
- Department of Pathology, Amagasaki Central Hospital, Amagasaki, Japan.,Department of Pathology, Cardiovascular Center Osaka Gyoumeikan Hospital, Osaka, Japan
| | | | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Science Kyushu University, Fukuoka, Japan
| | - Hiroaki Naito
- Department of Radiology, Nippon Life Hospital, Osaka, Japan
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Berchiolli R, Erba PA, Slart RHJA. Hunting the Carotid Culprit: An Intriguing Game. Stroke 2020; 51:701-702. [PMID: 31948358 DOI: 10.1161/strokeaha.119.027945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raffaella Berchiolli
- From the Vascular Surgery Unit, Cardiothoracic and Vascular Department (R.B.), University of Pisa, Italy
| | - Paola A Erba
- Department of Nuclear Medicine (P.A.E.), University of Pisa, Italy.,Department of Translational Research and New Technology in Medicine (P.A.E.), University of Pisa, Italy.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, the Netherlands (P.A.E., R.H.J.A.S.)
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, the Netherlands (P.A.E., R.H.J.A.S.).,Department of Biomedical Photonic Imaging, TechMed Centre, University of Twente, Enschede, the Netherlands (R.H.J.A.S.)
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Hori S, Hori E, Shibata T, Umemura K, Okamoto S, Kubo M, Horie Y, Kuroda S. Correlation Between Cerebral Microbleeds and Vulnerable Plaque in Patients with Severe Carotid Artery Stenosis; Comparative Magnetic Resonance Imaging Study. J Stroke Cerebrovasc Dis 2019; 28:104300. [PMID: 31358356 DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 02/05/2023] Open
Abstract
GOAL There are an increasing idea that the inflammation contributes to vascular diseases in various organs. The pathogenesis of both cerebral small vessel disease such as cerebral microbleeds and carotid plaque may be associated with chronic inflammation. This study was aimed to evaluate the correlation between microbleeds and carotid plaque characteristics. MATERIALS AND METHODS This study enrolled 85 patients who underwent surgical/endovascular treatments for carotid artery stenosis between January 2009 and July 2016. Their clinical data were precisely analyzed. T2*-weighted magnetic resonance (MR) imaging was performed to detect the cerebral microbleeds. The carotid plaque with high signal intensity on T1-weighted MR imaging was categorized into vulnerable plaque. FINDINGS The microbleeds was detected in 17 of 85 (20%). The prevalence of vulnerable carotid plaque and previous symptomatic lacunar infarction was significantly greater in the patients with microbleeds than in those without (P = .001 and P = .03, respectively). Multiple logistic regression analysis showed that the vulnerable plaque was significantly associated with the presence of microbleeds when adjusted for age, alcohol intake, antiplatelet drug use, the presence of previous symptomatic lacunar infarction, and coronary artery disease (P = .009, OR = 5.38, 95% CI = 1.51-21.0). CONCLUSIONS These findings suggest the correlation between microbleeds and vulnerable plaque in patients with severe (>70%) carotid artery stenosis. Systemic, chronic inflammation may play a key role in both small and large arteries' disease of the brain. The knowledge may be valuable to fully understand the entity of cerebrovascular diseases as one of systemic, chronic inflammation.
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Affiliation(s)
- Satoshi Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan.
| | - Emiko Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Takashi Shibata
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Kimiko Umemura
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Soushi Okamoto
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Michiya Kubo
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Yukio Horie
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
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Roy TL, Chen HJ, Dueck AD, Wright GA. Magnetic resonance imaging characteristics of lesions relate to the difficulty of peripheral arterial endovascular procedures. J Vasc Surg 2017; 67:1844-1854.e2. [PMID: 29248239 DOI: 10.1016/j.jvs.2017.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Limitations with current peripheral arterial imaging modalities make selection of patients for percutaneous vascular interventions difficult. The purpose of this study was to determine whether a novel preprocedural magnetic resonance imaging (MRI) method can identify lesions that would be more challenging to cross during percutaneous vascular intervention. METHODS Fourteen patients with peripheral arterial disease underwent MRI before their intervention. A novel steady-state free precession flow-independent magnetic resonance (MR) angiogram was used to locate lesions, and an ultrashort echo time image was used to characterize hard lesion components including calcium and dense collagen. Lesions were characterized as hard if ≥50% of the lumen was occluded with calcium or collagen (as determined by MR image characteristics) in the hardest cross section within the lesion. The primary outcome was the time it took to cross a guidewire through the target lesion. The secondary outcome was the need for stenting. RESULTS Of 14 lesions, 8 (57%) were defined as hard and 6 (43%) were soft on the basis of MR image characteristics. Hard lesions took significantly longer to cross than soft lesions (average, 14 minutes 49 seconds vs 2 minutes 17 seconds; P = .003). Hard lesions also required stenting more often than soft lesions (Fisher exact test, P = .008). Of 14 lesions, 2 (14%) could not be crossed with a guidewire, and both lesions were hard. MR images also detected occult patencies and noncalcified hard lesions that could not be seen on X-ray angiography. CONCLUSIONS MRI can be used to determine which peripheral arterial lesions are more difficult to cross with a guidewire. Future work will determine whether MRI lesion characterization can predict long-term endovascular outcomes to aid in procedure planning.
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Affiliation(s)
- Trisha L Roy
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Hou-Jen Chen
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Dueck
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Graham A Wright
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Mehaffey JH, LaPar DJ, Tracci MC, Cherry KJ, Kern JA, Kron I, Upchurch GR. Modifiable Factors Leading to Increased Length of Stay after Carotid Endarterectomy. Ann Vasc Surg 2016; 39:195-203. [PMID: 27554691 DOI: 10.1016/j.avsg.2016.05.126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/11/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is a commonly performed vascular operation. Yet, postoperative length of stay (LOS) varies greatly even within institutions. In this study, the morbidity and mortality, as well as financial impact of increased LOS were reviewed to establish modifiable factors associated with prolonged hospital stay. METHODS The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients undergoing primary CEA at a single institution between June 1, 2011 and November 28, 2014. Preoperative patient characteristics, intraoperative details, postoperative factors, long-term outcomes, and cost data were reviewed using an Institutional Review Board-approved prospectively collected database. Multivariate analysis was used to determine statistical difference between patients with LOS ≤1 day and >1 day. RESULTS Complete 30-day variable and cost data were available for 219 patients with an average follow-up of 12 months. Seventy-nine (36%) patients had an LOS > 1 day. Variables determined to be statistically significant predictors of prolonged LOS included preoperative creatinine (P = 0.02) and severe congestive heart failure (P = 0.05) with self-pay status (P = 0.02) and preoperative beta-blocker therapy (P = 0.04) being protective. Shunt placement (P = 0.04), arterial re-exploration, and postoperative cardiac (P = 0.001) or neurological (P = 0.03) complications also resulted in prolonged hospitalization. Specific modifiable risk factors that contributed to increased LOS included operative start time after noon (P = 0.04), drain placement (P = 0.05), prolonged operative time (101 vs. 125 min, P = 0.01), return to the operating room (P = 0.01), and postoperative hypertension (P = 0.02) or hypotension (P = 0.04). Of note, there was no difference in LOS associated with technique (conventional versus eversion), patch use (P = 0.49), protamine administration (P = 0.60), electroencephalogram monitoring (P = 0.45), measurement of stump pressure (P = 0.63), Doppler (P = 0.36), or duplex (P = 0.92). Both hospital charges (P = 0.0001) and costs (P = 0.0001) were found to be significantly higher in patients with prolonged LOS, with no difference in physician charges (P = 0.10). Increased LOS after CEA was associated with an increase in 12-month mortality (P = 0.05). CONCLUSIONS Increased LOS was associated with increased hospital charges, costs, as well as significant morbidity and midterm mortality following CEA. Furthermore, this study highlights several modifiable risk factors leading to increased LOS. Identified factors associated with increase LOS can serve as targets for improving care in vascular surgery.
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Affiliation(s)
- James H Mehaffey
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA.
| | - Damien J LaPar
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
| | - Margret C Tracci
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
| | - Kenneth J Cherry
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
| | - John A Kern
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
| | - Irving Kron
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
| | - Gilbert R Upchurch
- Department of Vascular Surgery, University of Virginia, Charlottesville, VA
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Coutinho JM, Derkatch S, Potvin ARJ, Tomlinson G, Kiehl TR, Silver FL, Mandell DM. Nonstenotic carotid plaque on CT angiography in patients with cryptogenic stroke. Neurology 2016; 87:665-72. [PMID: 27412144 DOI: 10.1212/wnl.0000000000002978] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/21/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine whether large (≥3 mm thick) but nonstenotic (<50%) carotid artery atherosclerotic plaque predominantly occurs ipsilateral rather than contralateral to cryptogenic stroke. METHODS This was a cross-sectional observational study. Using a stroke registry, we identified consecutive patients with anterior circulation embolic stroke of undetermined source (ESUS). Using CT angiography, we measured carotid plaque size (thickness, mm) and carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial method) for each patient. We dichotomized plaque size at several predefined thresholds and calculated the frequency of plaque size above each threshold ipsilateral vs contralateral to stroke. RESULTS We included 85 patients with ESUS. Plaque with thickness ≥5 mm was present ipsilateral to stroke in 11% of patients, and contralateral in 1% (9/85 vs 1/85; p = 0.008). Plaque with thickness ≥4 mm was present ipsilateral to stroke in 19% of patients, and contralateral in 5% (16/85 vs 4/85; p = 0.002). Plaque with thickness ≥3 mm was present ipsilateral to stroke in 35% of patients, and contralateral in 15% (30/85 vs 13/85; p = 0.001). There was no difference in percentage stenosis ipsilateral vs contralateral to stroke (p = 0.98), and weak correlation between plaque size and stenosis (R(2) = 0.26, p < 0.001). CONCLUSIONS Large but nonstenotic carotid artery plaque is considerably more common ipsilateral than contralateral to cryptogenic stroke, suggesting that nonstenotic plaque is an underrecognized cause of stroke. We measured plaque size using CT angiography, a method that could be easily implemented in clinical practice.
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Affiliation(s)
- Jonathan M Coutinho
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Sheldon Derkatch
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Alphonse R J Potvin
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - George Tomlinson
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Tim-Rasmus Kiehl
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Frank L Silver
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Daniel M Mandell
- From the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
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Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke. Int J Mol Sci 2016; 17:298. [PMID: 26927082 PMCID: PMC4813162 DOI: 10.3390/ijms17030298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/21/2022] Open
Abstract
Mechanical thrombectomy is a novel treatment option for patients with acute ischemic stroke (AIS). Only a few studies have previously suggested strategies to categorize retrieved clots according to their histologic composition. However, these reports did not analyze potential biomarkers that are of importance in stroke-related inflammation. We therefore histopathologically investigated 37 intracerebral thrombi mechanically retrieved from patients with AIS, and focused on the composition of immune cells and platelets. We also conducted correlation analyses of distinctive morphologic patterns (erythrocytic, serpentine, layered, red, white, mixed appearance) with clinical parameters. Most T cells and monocytes were detected in erythrocytic and red clots, in which the distribution of these cells was random. In contrast, von Willebrand factor (vWF)-positive areas co-localized with regions of fibrin and collagen. While clots with huge amounts of vWF seem to be associated with a high National Institute of Health Stroke Scale score at admission, histologic findings could not predict the clinical outcome at discharge. In summary, we provide the first histologic description of mechanically retrieved intracerebral thrombi regarding biomarkers relevant for inflammation in ischemic stroke.
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