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Xu T, Li S, Wu S, Zhang S, Wang X. Non-alcoholic fatty liver disease: A new predictor of recurrent ischemic stroke and transient ischemic attack in patients with carotid atherosclerosis. Eur J Radiol 2024; 181:111754. [PMID: 39341166 DOI: 10.1016/j.ejrad.2024.111754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/21/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. This study focused on assessing the predictive significance of NAFLD for recurrent stroke and transient ischemic attack (TIA) risk to determine the value of NAFLD. METHOD This study included 742 participants (mean age: 64.26 ± 9.42 years, 497 males) with carotid atherosclerosis who underwent carotid CT angiography (CTA) between January 2013 and December 2021 in this retrospective study. NAFLD was diagnosed by non-enhanced abdominal CT. The clinical endpoint was a recurrent ischemic stroke or TIA. Cox proportional hazards and Kaplan-Meier analysis assessed whether NAFLD was associated with the endpoint. We accessed the predictive values of NAFLD, clinical, plaque characteristics, and combined model by the C statistics. The predictive performance of the combined model was assessed by receiver operating characteristic curve (ROC) analysis. RESULTS A total of 742 participants (mean age: 64.26 ± 9.42 years, 497 males) were included. During 2.9 years of follow-up (interquartile range, 2.1-3.9), 166 patients reached the clinical endpoint. Multivariable cox analyses showed NAFLD was associated with recurrent stroke or TIA in all groups (all P<0.05). Patients with NAFLD had a lower event-free survival (EFS) rate than those without NAFLD (P<0.05). The combined model, including NAFLD, clinical data and plaque features, showed the best performance in predicting the clinical endpoint (AUC=0.79). CONCLUSIONS NAFLD contributes to the prediction of recurrent ischemic stroke or TIA. NAFLD may be a novel imaging marker that offers a new perspective on preventing cardiovascular disease in the clinic.
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Affiliation(s)
- Tianqi Xu
- Cheeloo College of Medicine, Shandong University, No. 44, Wenhua West Road, Jinan 250012, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China
| | - Sha Li
- Cheeloo College of Medicine, Shandong University, No. 44, Wenhua West Road, Jinan 250012, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China
| | - Siyu Wu
- Cheeloo College of Medicine, Shandong University, No. 44, Wenhua West Road, Jinan 250012, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China
| | - Shuai Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong, China.
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Song X, Chen W, Zhao X, Zheng Z, Sang Z, Li R, Wu J. Decreased flow in ischemic stroke with coexisting intracranial artery stenosis and white matter hyperintensities. J Cent Nerv Syst Dis 2024; 16:11795735241266572. [PMID: 39055050 PMCID: PMC11271110 DOI: 10.1177/11795735241266572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background Stroke patients with coexisting intracranial artery stenosis (ICAS) and white matter lesions (WML) usually have a poor outcome. However, how WML affects stroke prognosis has not been determined. Objective To investigate the quantitative forward flow at the middle cerebral artery in ICAS patients with different degrees of WML using 4D flow. Design Single-center cross-sectional cohort study. Methods Ischemic stroke patients with symptomatic middle cerebral artery (MCA) atherosclerosis were included, and they were divided into 2 groups based on Fazekas scale on Flair image (mild group = Fazekas 0-2, and severe group = Fazekas >2), TOF-MRA and 4D flow were performed to quantify the stenosis degree and forward flow at the proximal of stenosis. The flow parameters were compared between different white matter hyperintensity (WMH) groups, as well as in different MCA stenosis groups, logistic regression was used to validate the association between forward flow and WMH. Results A total of 66 patients were included in this study (mean age 56 years old, 68.2% male). 77.3% of them presented with WMH (Fazekas 1-5). Comparison of flow index between mild and severe WMH groups found a significantly lower forward flow (2.34 ± 1.09 vs 3.04 ± 1.35), higher PI (0.75 ± 0.43 vs 0.66 ± 0.32), and RI (0.49 ± 0.19 vs 0.46 ± 0.15) at ipsilateral infarction MCA in the severe WMH group, all P-values <0.05. After adjusting for other covariates, forward mean flow at ipsilateral infarction MCA is still associated with severe WMH independently, OR = 0.537, 95% CI (0.294, 0.981), P = 0.043. Conclusion Intracranial artery stenosis patients with coexisting severe WMH suffer from significantly decreased flow, which could explain the poor clinical outcome in this population, and also provide some insight into recanalization therapy in the future.
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Affiliation(s)
- Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenwen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhenhua Sang
- Department of Information Technology Service, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
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Zhao Y, Song P, Feng P, Yuan S, Wu H, Cui J, Liu L, Zhang S, Miao R, Guo L, Xu W, Liu X. Plaque enhancement predicts recurrence in acute ischemic stroke patients with large artery intracranial atherosclerosis. J Stroke Cerebrovasc Dis 2023; 32:107406. [PMID: 37837801 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND The association between the degree of plaque enhancement and ischemic brain stroke recurrence remains unclear. We aimed to establish models to predict plaque enhancement and stroke recurrence. METHODS Seventy-eight participants with acute ischemic brain stroke due to intracranial arterial stenosis were recruited and divided into high enhancement (HE) and non-HE groups. The relationship between imaging characteristics (degree of stenosis, minimal lumen area, intraplaque hemorrhage, and plaque burden) and the degree of plaque contrast enhancement was analyzed. Inflammatory cytokine expression was examined by flow cytometry. Independent predictors of stroke recurrence were investigated via multivariate Cox proportional hazards regression analysis. Nomogram was used to construct a prediction model. Harrell's concordance indices (c-indices) and calibration curves were used to assess the discrimination of the nomogram. A risk prediction nomogram for prognosis was constructed. RESULTS Thirty-three participants were assigned to the HE group and 45 to the non-HE group. The degree of stenosis and plaque burden in the HE group was higher than that in the non-HE group (P<0.05). Multiple linear regression analysis showed the degree of stenosis was associated with HE (β=0.513; P=0.000). After adjusting for confounding factors, age (HR=1.115; 95%CI=1.034-1.203, P=0.005) and HE plaques (HR=10.457; 95%CI=1.176-93.018; P=0.035) were independent risk factors of stroke recurrence, whereas cytokine levels were not statistically significant between two group. CONCLUSIONS HE of intracranial atherosclerosis plaques is an independent factor for ischemic brain stroke recurrence.
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Affiliation(s)
- Yanying Zhao
- Department of Psychosomatic Medicine, Department of Neurology, The Second Hospital of Medical University, No. 215 Heping West Road, Shijiazhuang, Hebei 050000, China
| | - Peng Song
- Department of Radiology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Pingyong Feng
- Department of Radiology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Si Yuan
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Haoran Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Junzhao Cui
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Lijuan Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Shaoru Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei 050000, China
| | - Ruihan Miao
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Weihai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan, Dongcheng District, Beijing 100730, China
| | - Xiaoyun Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, West 215, Heping Road, Shijiazhuang, Hebei 050000, China.
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Zhang Y, Pan Y, Cai X, Jing J, Yan H, Wang S, Meng X, Mei L, Zhang Y, Li S, Wei T, Zhou Y, Wang Y. Association between Urine Albumin-to-creatinine Ratio and Intracranial Atherosclerotic Plaque in Chinese Adults - Results from the PRECISE Study. J Atheroscler Thromb 2023; 30:1828-1837. [PMID: 37197951 DOI: 10.5551/jat.64156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
AIMS Intracranial plaque may cause stroke in the absence of luminal stenosis. Although urine albumin-to-creatinine ratio (ACR) has been proved an established risk factor for cardiovascular disease, stroke and carotid atherosclerosis, little is known on the relationship between urine ACR and intracranial plaque. METHODS Subjects with history of stroke or coronary heart disease (CHD) were excluded in the PRECISE study. The intracranial plaque was assessed by vessel wall magnetic resonance imaging (MRI). Subjects were stratified according to ACR tertiles. Logistic regression and ordinal regression were performed to analyze the association between ACR and the presence of intracranial plaque or sum of the stenosis score for each artery. RESULTS 2962 individuals were included with the mean age of 61.0±6.6 years. The median ACR was 11.7mg/g (interquartile range 7.0-22.0 mg/g), and the mean estimated glomerular filtration rate (eGFR) based on combination of creatinine and cystatin C was 88.5±14.8 ml/min·1.73m2. 495 (16.7%) participants had intracranial plaque. The highest ACR tertile with ACR >16.00mg/g was independently associated with the presence of intracranial plaque (OR 1.38, 95% CI: 1.05-1.82, p=0.02) and the odds of higher intracranial plaque burden (common OR 1.39, 95% CI: 1.05-1.83, p=0.02) after adjustment of confounding factors. No significant association was observed between eGFR and intracranial plaque presence or intracranial plaque burden. CONCLUSIONS Among a low-risk community-dwelling population without prior stroke or CHD in China, ACR was independently associated with intracranial plaque presence and plaque burden measured by vessel wall MRI.
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Affiliation(s)
- Yin Zhang
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine
| | - Jing Jing
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Hongyi Yan
- China National Clinical Research Center for Neurology Disease
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Xia Meng
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Yanli Zhang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan hospital, Capital Medical University
- China National Clinical Research Center for Neurology Disease
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences
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Cai X, Sun J, Jin A, Jing J, Wang S, Mei L, Meng X, Li S, Wei T, Wang Y, Pan Y. Association of insulin resistance with intra- and extra-cranial atherosclerotic burden in the nondiabetic community population. Neurobiol Dis 2023; 186:106268. [PMID: 37625526 DOI: 10.1016/j.nbd.2023.106268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023] Open
Abstract
AIMS Few population-based studies have investigated the association between insulin resistance and atherosclerotic burden in intra- and extra-cranial arteries. The purpose of this study is to explore the relationship between insulin resistance and intra- and extra-cranial atherosclerotic burden in community-based nondiabetic participants. METHODS This is a cross-sectional analysis from a population-based prospective cohort-PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study in China. The homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices (ISI0-120) were stratified by the quartiles, respectively. The atherosclerotic presence of plaques and burden was evaluated by high-resolution MRI. Binary or ordinal logistic regression was performed to assess the association between HOMA-IR or ISI0-120 and the presence and burden of atherosclerosis. RESULTS Among the 2754 participants, the mean age was 60.9 ± 6.6 years, and 1296 (47.1%) were males. Compared with the lowest quartile of HOMR-IR, the highest quartile of HOMA-IR (indicating a higher level of insulin resistance) was associated with an increased presence of plaques (OR:1.54, 95% CI:1.14-2.08), and atherosclerotic burden (OR:1.53, 95%CI:1.14-2.07) in intracranial arteries. Meanwhile, we observed a similar relationship between HOMA-IR and the presence or burden in extracranial atherosclerosis. The first (indicating a higher level of insulin resistance) quartiles of ISI0-120 were associated with the intracranial plaques (Q1, OR:1.56, 95%CI:1.16-2.11) and atherosclerotic burden (Q1, OR:1.57, 95%CI:1.17-2.12), but not extracranial plaques or atherosclerotic burden, compared with the fourth quartile of ISI0-120. CONCLUSIONS Insulin resistance was associated with an increased intra-and extra-cranial atherosclerotic burden in the nondiabetic elderly Chinese population.
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Affiliation(s)
- Xueli Cai
- Department of Neurology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Jingping Sun
- Department of Neurology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Suying Wang
- Department of Neurology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Lerong Mei
- Department of Neurology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Li
- Department of Neurology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Tiemin Wei
- Department of Cardiology, The Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Sui Y, Sun J, Chen Y, Wang W. Multimodal MRI study of the relationship between plaque characteristics and hypoperfusion in patients with transient ischemic attack. Front Neurol 2023; 14:1242923. [PMID: 37840913 PMCID: PMC10568067 DOI: 10.3389/fneur.2023.1242923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Transient ischemic attack is a significant risk factor for acute cerebral infarction. Previous studies have demonstrated that hypoperfusion in patients with transient ischemic attack was associated with the recurrence of transient ischemic attack, stroke, and persistent worsening of neurological symptoms. Moreover, transient ischemic attack patients classified as high-risk group according to the ABCD2 score have a higher incidence of stroke. Therefore, the objective of this study was to investigate the plaque characteristics of transient ischemic attack patients with concomitant cerebral hypoperfusion using multimodal MRI, as well as hemodynamic changes in the high-risk group with transient ischemic attack patients. Materials and methods A total of 151 patients with transient ischemic attack were prospectively recruited for this study. All enrolled patients underwent multimodal MRI, including DWI, TOF-MRA, HR-VWI, and DSC-PWI. Finally, 56 patients met the inclusion criteria. Based on DSC-PWI images, patients were divided into two groups: hypoperfusion (n = 41) and non-hypoperfusion (n = 15). Clinical baseline characteristics and plaque characteristics were analyzed between the two groups. Furthermore, within the hypoperfusion group, patients were further classified into low-risk (n = 11) and high-risk (n = 30) subgroups based on the ABCD2 score. Hemodynamic differences between these subgroups were also analyzed. Results Compared with the non-hypoperfusion group, the hypoperfusion group had a significantly higher prevalence of hypertension (68.3% vs. 33.3%, p = 0.019) and hyperhomocysteinemia (65.9% vs. 33.3%, p = 0.029). Moreover, the hypoperfusion group exhibited more significant luminal stenosis degree [41.79 ± 31.36 vs. 17.62± 13.62, p = 0.006] and greater NWI (57.1%± 20.47% vs. 40.21%± 21.56%, p = 0.009) compared to the non-hypoperfusion group. In addition, the high-risk group identified by the ABCD2 score had a higher rMTT [117.6(109.31-128.14) vs. 108.36(100.67-119.92), p = 0.037]. Conclusion Transient ischemic attack patients with hypoperfusion exhibited a higher prevalence of hypertension and hyperhomocysteinemia, as well as higher luminal stenosis degree, and greater NWI. Furthermore, Transient ischemic attack patients in the high-risk group demonstrated higher MTT.
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Affiliation(s)
| | | | | | - Wei Wang
- Department of MRI, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Yang Y, He Y, Xu Y, Han W, Zhao T, Shao Y, Yu M. Poststroke neutrophil count is predictive of the outcomes of large-artery atherosclerotic stroke and associated with craniocervical atherosclerosis. Sci Rep 2023; 13:11486. [PMID: 37460533 DOI: 10.1038/s41598-023-37815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
Elevation of the neutrophil count is detrimental to the outcome of patients with stroke. The effect of poststroke neutrophil count on the outcome of patients with large-artery atherosclerosis (LAA) stroke is unclear. This study aims to explore the relationship of poststroke neutrophil count with the functional outcome of patients with LAA stroke, and the relationship of poststroke neutrophil count and craniocervical atherosclerotic stenosis (AS) number in these patients. The AS was defined as ≥ 50% stenosis or occlusion attributed to atherosclerosis on craniocervical large arteries. A total of 297 participants were enrolled in the cohort. In multivariable analyses, neutrophil count [adjusted relative risk (aRR) = 1.23, 95% confidence interval (CI) 1.09-1.40, p = 0.001] was an independent predictor of 90-day poor functional outcome [modified Rankin Scale (mRS) > 2 points]. The neutrophil count was significantly associated with the craniocervical AS number in a multivariable ordinal logistic regression analysis [adjusted odds ratio (aOR) = 1.41, 95% CI 1.16-1.72, p = 0.001]. The poststroke neutrophil count is a valuable predictor of 90-day poor functional outcome of patients with LAA stroke. The poststroke neutrophil count is positively correlated with the craniocervical AS number in these patients.
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Affiliation(s)
- Yi Yang
- Department of Neurology, Affiliated Hospital of Jiangsu University, Jiangsu University, No.438 Jiefang Street, Zhenjiang, Jiangsu, China
| | - Yue He
- Department of Neurology, Affiliated Hospital of Jiangsu University, Jiangsu University, No.438 Jiefang Street, Zhenjiang, Jiangsu, China
| | - Yuhao Xu
- Department of Neurology, Affiliated Hospital of Jiangsu University, Jiangsu University, No.438 Jiefang Street, Zhenjiang, Jiangsu, China
| | - Wei Han
- Department of Neurology, Affiliated Hospital of Jiangsu University, Jiangsu University, No.438 Jiefang Street, Zhenjiang, Jiangsu, China
| | - Tian Zhao
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuanwei Shao
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Ming Yu
- Department of Neurology, Affiliated Hospital of Jiangsu University, Jiangsu University, No.438 Jiefang Street, Zhenjiang, Jiangsu, China.
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Li C, Zhang Y, Mei L, Jin A, Cai X, Pan Y, Jing J, Wang S, Meng X, Li S, Wang M, Wei T, Wang Y, Chen R, Tian Y. Discordantly high Apo B with LDL-C or non-HDL-C in relation to presence and burden of cerebral atherosclerotic plaques. J Clin Lipidol 2023; 17:519-528. [PMID: 37316392 DOI: 10.1016/j.jacl.2023.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/08/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Data are limited on associations between apolipoprotein B (Apo B) and cerebral atherosclerosis. OBJECTIVE Our study aimed to estimate associations between discordant Apo B with low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (Non-HDL-C) and the odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques. METHODS This cross-sectional study was based on the baseline survey from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study, a population-based prospective cohort study. Participants with complete baseline data but without taking lipid-lowering medication were included in this analysis. Discordant Apo B with LDL-C or Non-HDL-C were defined by residuals and cut-off values (LDL-C: 3.4 mmol/L, Non-HDL-C: 4.1 mmol/L). We used binary and ordinal logistic regression models to explore associations between discordant Apo B with LDL-C or Non-HDL-C and the presence and burden of intra-/extra-cranial atherosclerotic plaques. RESULTS A total of 2,943 participants were enrolled in this study. Discordantly high Apo B with LDL-C was associated with an increased odds of the presence of intracranial atherosclerotic plaque [odds ratio (OR),1.28; 95%CI,1.01-1.61], intracranial atherosclerotic burden [common odds ratio (cOR), 1.31; 95%CI,1.04-1.64], the presence of extracranial atherosclerotic plaque (OR, 1.37; 95%CI,1.14-1.66), and extracranial atherosclerotic burden (cOR, 1.32; 95%CI,1.10-1.58) compared with the concordant group. Discordantly low Apo B with Non-HDL-C was associated with decreased odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques. CONCLUSION Discordantly high Apo B with LDL-C or Non-HDL-C were associated with an increased odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques. This demonstrated that discordantly high Apo B might be important for early assessment of risk of cerebral atherosclerotic plaques in addition to LDL-C and Non-HDL-C.
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Affiliation(s)
- Chao Li
- School of Public Health, Capital Medical University, Beijing, China; National Center for Neurological Diseases, Beijing, China
| | - Yanli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lerong Mei
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Suying Wang
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China; Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rui Chen
- School of Public Health, Capital Medical University, Beijing, China.
| | - Yu Tian
- School of Public Health, Capital Medical University, Beijing, China.
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Wang Y, Liu T, Li Y, Zhang K, Fan H, Ren J, Li J, Li Y, Li X, Wu X, Wang J, Xue L, Gao X, Yan Y, Li G, Liu Q, Niu W, Du W, Liu Y, Niu X. Triglyceride-glucose index, symptomatic intracranial artery stenosis and recurrence risk in minor stroke patients with hypertension. Cardiovasc Diabetol 2023; 22:90. [PMID: 37076850 PMCID: PMC10114394 DOI: 10.1186/s12933-023-01823-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index, a simple measure of insulin resistance, is associated with intracranial atherosclerosis (ICAS) and stroke. In hypertensive populations, this association may be pronounced. The aim was to investigate the relationship between TyG and symptomatic intracranial atherosclerosis (sICAS) and recurrence risk in ischemic stroke patients with hypertension. METHODS This prospective, multicenter cohort study included patients with acute minor ischemic stroke with a preadmission diagnosis of hypertension from September 2019 to November 2021 with a 3-month follow-up. The presence of sICAS was determined by a combination of clinical manifestations, the location of the infarction, and the corresponding artery with moderate-to-severe stenosis. ICAS burden was determined by the degree and number of ICAS occurrences. Fasting blood glucose (FBG) and triglyceride (TG) were measured to calculate TyG. The main outcome was ischemic stroke recurrence during the 90-day follow-up. Multivariate regression models were used to explore the association of TyG, sICAS, and ICAS burden with stroke recurrence. RESULTS There were 1281 patients with a mean age of 61.6 ± 11.6 years; 70.1% were male, and 26.4% were diagnosed with sICAS. There were 117 patients who experienced stroke recurrence during follow-up. Patients were categorized according to quartiles of TyG. After adjusting for confounders, the risk of sICAS was greater (OR 1.59, 95% CI 1.04-2.43, p = 0.033) and the risk of stroke recurrence was significantly higher (HR 2.02, 95% CI 1.07-3.84, p = 0.025) in the fourth TyG quartile than in the first quartile. The restricted cubic spline (RCS) plot revealed a linear relationship between TyG and sICAS, and the threshold value for TyG was 8.4. Patients were then dichotomized into low and high TyG groups by the threshold. Patients with high TyG combined with sICAS had a higher risk of recurrence (HR 2.54, 95% CI 1.39-4.65) than patients with low TyG without sICAS. An interaction effect on stroke recurrence between TyG and sICAS was found (p = 0.043). CONCLUSION TyG is a significant risk factor for sICAS in hypertensive patients, and there is a synergistic effect of sICAS and higher TyG on ischemic stroke recurrence. TRIAL REGISTRATION NUMBER The study was registered on 16 August 2019 at https://www.chictr.org.cn/showprojen.aspx?proj=41160 (No. ChiCTR1900025214).
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Affiliation(s)
- Yongle Wang
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Street, Yingze District, Taiyuan, Shanxi, China
- Clinical College, Shanxi Medical University, No. 58, Xinjiannan Street, Yingze District, Taiyuan, Shanxi, China
| | - Tingting Liu
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Street, Yingze District, Taiyuan, Shanxi, China
| | - Yanan Li
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Street, Yingze District, Taiyuan, Shanxi, China
| | - Kaili Zhang
- Department of Neurology, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Haimei Fan
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Jing Ren
- Shanxi Province Cardiovascular Disease Hospital, Taiyuan, Shanxi, China
| | - Juan Li
- Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yali Li
- Clinical College, Shanxi Medical University, No. 58, Xinjiannan Street, Yingze District, Taiyuan, Shanxi, China
| | - Xinyi Li
- Department of Neurology, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuemei Wu
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Junhui Wang
- Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, Shanxi, China
| | - Lixi Xue
- Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, Shanxi, China
| | - Xiaolei Gao
- Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, Shanxi, China
| | - Yuping Yan
- Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, Shanxi, China
| | - Gaimei Li
- China Railway 17th Bureau Group Company Central Hospital, Shanxi, Taiyuan, China
| | - Qingping Liu
- China Railway 17th Bureau Group Company Central Hospital, Shanxi, Taiyuan, China
| | - Wenhua Niu
- First People's Hospital of JIN ZHONG, Jinzhong, Shanxi, China
| | - Wenxian Du
- First People's Hospital of JIN ZHONG, Jinzhong, Shanxi, China
| | - Yuting Liu
- Shanxi Province Cardiovascular Disease Hospital, Taiyuan, Shanxi, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefangnan Street, Yingze District, Taiyuan, Shanxi, China.
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10
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Sun J, Meng X, Huang H, Jing J, Pan Y, Mei L, Jin A, Wang Y, Wei T, Cai X. Higher visceral adiposity index and lipid accumulation product in relation to increased risk of atherosclerotic burden in community-dwelling older adults. Exp Gerontol 2023; 174:112115. [PMID: 36758647 DOI: 10.1016/j.exger.2023.112115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIMS Visceral adiposity index (VAI) and lipid accumulation product (LAP), as anthropometric indices, have been applied to predict the risk of cardiovascular diseases (CVD). However, few studies investigated the correlation between these two indicators and cardio-cerebro-vascular atherosclerosis in community populations. Our study was to explore the association of VAI and LAP with coronary, intracranial and extracranial atherosclerosis in a community-based asymptomatic middle-aged and older population. METHODS Participants without a history of CVD in the study of PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) were included. The sex-special indicators of VAI and LAP were calculated and stratified by the tertiles. The presence of plaque and coronary segmental stenosis score (SSS) were assessed by coronary computed tomography (CTA), as well as intracranial and extracranial atherosclerotic burden were evaluated by high-resolution magnetic resonance imaging (HR-MRI), respectively. Binary or ordinal logistic regression was conducted to assess the association between each of the indexes and the presence and burden of atherosclerosis. RESULTS A total of 2875 subjects were included in the final analysis. The mean age was 60.9 ± 6.6 years and 1329 (46.2 %) participants were males. Compared with the first tertile of VAI, the higher tertile was associated with the presence of plaques (T3 vs T1, OR, 1.49, 95%CI, 1.12-1.98, for males; OR, 1.64, 95%CI, 1.24-2.17, for females) and atherosclerotic burden (T3 vs T1, adjusted cOR, 1.63, 95%CI, 1.24-2.14, for males; adjusted cOR, 1.70, 95%CI, 1.29-2.24, for females) in major coronary arteries. A similar association was found for LAP. VAI level has presented an association with the extracranial atherosclerotic plaques (T3 vs T1, OR, 1.34, 95%CI, 1.02-1.77) and burden (T3 vs T1, adjusted cOR 1.32, 95 % CI 1.00-1.73) only in females. Whereas, for intracranial atherosclerosis, the results failed to show any statistically significant association. CONCLUSIONS Among community-dwelling asymptomatic older adults, VAI and LAP were associated with the presence and burden of coronary atherosclerotic plaques, while VAI presented a weaker significant association with extracranial atherosclerosis in females.
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Affiliation(s)
- Jingping Sun
- Department of Neurology, the Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huifen Huang
- Department of Neurology, the Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lerong Mei
- Department of Neurology, the Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, the Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China.
| | - Xueli Cai
- Department of Neurology, the Central Hospital of Lishui, Lishui Hospital of Zhejiang University, Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China; Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, China.
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11
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Wang L, Li H, Hao J, Liu C, Wang J, Feng J, Guo Z, Zheng Y, Zhang Y, Li H, Zhang L, Hou H. Thirty-six months recurrence after acute ischemic stroke among patients with comorbid type 2 diabetes: A nested case-control study. Front Aging Neurosci 2022; 14:999568. [PMID: 36248006 PMCID: PMC9562049 DOI: 10.3389/fnagi.2022.999568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/09/2022] [Indexed: 12/08/2022] Open
Abstract
Background Stroke patients have to face a high risk of recurrence, especially for those with comorbid T2DM, which usually lead to much more serious neurologic damage and an increased likelihood of death. This study aimed to explore determinants of stroke relapse among patients with comorbid T2DM. Materials and methods We conducted this case-control study nested a prospective cohort of ischemic stroke (IS) with comorbid T2DM. During 36-month follow-up, the second stroke occurred in 84 diabetic IS patients who were allocated into the case group, while 613 patients without recurrence were the controls. We collected the demographic data, behaviors and habits, therapies, and family history at baseline, and measured the variables during follow-up. LASSO and Logistic regression analyses were carried out to develop a prediction model of stroke recurrence. The receiver operator characteristic (ROC) curve was employed to evaluate the performance of the prediction model. Results Compared to participants without recurrence, the higher levels of pulse rate (78.29 ± 12.79 vs. 74.88 ± 10.93) and hypertension (72.6 vs. 61.2%) were recorded at baseline. Moreover, a lower level of physical activity (77.4 vs. 90.4%), as well as a higher proportion of hypoglycemic therapy (36.9 vs. 23.3%) was also observed during 36-month follow-up. Multivariate logistic regression revealed that higher pulse rate at admission (OR = 1.027, 95 %CI = 1.005–1.049), lacking physical activity (OR = 2.838, 95% CI = 1.418–5.620) and not receiving hypoglycemic therapy (OR = 1.697, 95% CI = 1.013–2.843) during follow-up increased the risk of stroke recurrence. We developed a prediction model using baseline pulse rate, hypoglycemic therapy, and physical activity, which produced an area under ROC curve (AUC) of 0.689. Conclusion Physical activity and hypoglycemic therapy play a protective role for IS patients with comorbid diabetes. In addition to targeted therapeutics, the improvement of daily-life habit contributes to slowing the progress of the IS.
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Affiliation(s)
- Lu Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Hongyun Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jiheng Hao
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Chao Liu
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Jingjun Feng
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
| | - Zheng Guo
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Yulu Zheng
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Yanbo Zhang
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China
- *Correspondence: Yanbo Zhang,
| | - Hongxiang Li
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China
- Hongxiang Li,
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China
- Liyong Zhang,
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Pan Y, Cai X, Jing J, Wang S, Meng X, Mei L, Yang Y, Jin A, DongXiao Y, Li S, Li H, Wei T, Wang Y, Wang Y. Differential associations of lipoprotein(a) level with cerebral large artery and small vessel diseases. Stroke Vasc Neurol 2022; 7:svn-2022-001625. [PMID: 35851316 PMCID: PMC9811597 DOI: 10.1136/svn-2022-001625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral large artery and small vessel diseases are related to different pathogenetic mechanisms and have different risk factor profile. Lipoprotein(a) (Lp(a)) was shown to promote atherosclerosis but data was limited on its association with cerebral small vessel diseases (cSVD). The objective of this study was to assess the associations of Lp(a) level with the two types of cerebrovascular diseases. METHODS Community-dwelling subjects aged 50-75 years from the baseline survey of The PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events study were included. Lp(a) concentrations was measured and categorised into three groups according to the tertiles. Eligible participants were scanned by a 3.0T MRI scanner and assessed for intracranial atherosclerosis and cSVD burden based on four imaging markers. RESULTS This study included 3059 subjects. The average age of the participants was 61.2±6.7 years, and 53.5% (1636) were female. Compared with the first tertile, subjects with the second and third tertiles of Lp(a) concentrations were associated with an increased odds of presence of intracranial plaque (18.7% vs 15.4%, adj.OR 1.37, 95% CI 1.08 to 1.75; 18.9% vs 15.4%, adj.OR 1.34, 95% CI 1.05 to 1.72). Similar associations were observed for intracranial atherosclerotic burden. Whereas, subjects with the third tertile of Lp(a) level had a decreased odds of presence of cSVD (25.9% vs 31.7%, adj.OR 0.74, 95% CI 0.60 to 0.92) and lower cSVD burden (adj.cOR 0.76, 95% CI 0.62 to 0.94). CONCLUSIONS In this study, Lp(a) concentrations were positively associated with presence and burden of intracranial atherosclerosis, but was inversely associated with cSVD. TRIAL REGISTRATION NUMBER NCT03178448.
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Affiliation(s)
- Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Suying Wang
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Yao DongXiao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Diener HC, Easton JD, Hart RG, Kasner S, Kamel H, Ntaios G. Review and update of the concept of embolic stroke of undetermined source. Nat Rev Neurol 2022; 18:455-465. [PMID: 35538232 DOI: 10.1038/s41582-022-00663-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 12/28/2022]
Abstract
Ischaemic strokes have traditionally been classified according to the TOAST criteria, in which strokes with unclear aetiology are classified as cryptogenic strokes. However, the definition of cryptogenic stroke did not meet the operational criteria necessary to define patient populations for randomized treatment trials. To address this problem, the concept of embolic stroke of undetermined source (ESUS) was developed and published in 2014. A hypothesis that underpinned this concept was that most strokes in patients with ESUS are caused by embolic events, perhaps many cardioembolic, and that anticoagulation would prevent secondary ischaemic events. On this basis, two large randomized trials were conducted to compare the non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran and rivaroxaban with aspirin. Neither NOAC was superior to aspirin in these trials, although subgroups of patients with ESUS seemed to benefit specifically from anticoagulation or antiplatelet therapy. The neutral results of the trials of anticoagulation and insights into ESUS from research conducted since the concept was introduced warrant reassessment of the ESUS construct as a research concept and a treatment target. In this Review, we discuss the evidence produced since the concept of ESUS was introduced, and propose updates to the criteria and diagnostic algorithm in light of the latest knowledge.
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Affiliation(s)
- Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE) Medical Faculty of the University Duisburg-Essen, Essen, Germany.
| | - J Donald Easton
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Robert G Hart
- Population Health Research Institute/McMaster University, David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI), Hamilton, Ontario, Canada
| | - Scott Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Wu G, Wang H, Zhao C, Cao C, Chai C, Huang L, Guo Y, Gong Z, Tirschwell D, Zhu C, Xia S. Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging. AJNR Am J Neuroradiol 2022; 43:207-215. [PMID: 35058299 PMCID: PMC8985671 DOI: 10.3174/ajnr.a7402] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence. MATERIALS AND METHODS Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke. RESULTS One hundred seventy-five patients (mean age, 59 [SD, 12] years; 115 men) were included. Compared with the first-time stroke group (n = 100), the recurrent-stroke group (n = 75) had a larger culprit volume (P = .006) and showed more intracranial plaques (P < .001) and more enhanced plaques (P = .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10-mm3 increase; 95% CI, 1.03-1.30; P = .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P < .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71. CONCLUSIONS Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.
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Affiliation(s)
- G. Wu
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - H. Wang
- From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China
| | - C. Zhao
- Department of Radiology (C. Zhao), First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - C. Cao
- Department of Radiology (C. Cao), Tianjin Huanhu Hospital, Tianjin, China
| | - C. Chai
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - L. Huang
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Y. Guo
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
| | - Z. Gong
- Neurology (Z.G.), Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | | | - C. Zhu
- Radiology (C. Zhu), University of Washington, Seattle, Washington
| | - S. Xia
- Department of Radiology (C. Chai, L.H., Y.G., S.X.)
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15
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Wang Y, Fan H, Duan W, Ren Z, Liu X, Liu T, Li Y, Zhang K, Fan H, Ren J, Li J, Li X, Wu X, Niu X. Elevated stress hyperglycemia and the presence of intracranial artery stenosis increase the risk of recurrent stroke. Front Endocrinol (Lausanne) 2022; 13:954916. [PMID: 36699024 PMCID: PMC9868694 DOI: 10.3389/fendo.2022.954916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Stress hyperglycemia has served as a reliable biomarker to predict poor outcomes after ischemic stroke. However, recent studies have reported some contrary conclusions. Different stroke subtypes may respond inconsistently to stress hyperglycemia. The progression of intracranial atherosclerotic stenosis (ICAS) is tightly related to hyperglycemia. Thus, this study aims to determine the relationship between stress hyperglycemia and recurrent stroke in ischemic stroke patients with or without intracranial atherosclerotic stenosis. METHODS This is a multicenter retrospective observational cohort study. Patients with acute minor ischemic stroke and eligible computed tomography and magnetic resonance imaging data were enrolled. The severity of stress hyperglycemia is measured by the stress hyperglycemia ratio (SHR). SHR was calculated based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels. The primary outcome was stroke recurrence during hospitalization. The interaction of SHR levels with the presence of ICAS on the primary outcome was investigated using univariable and multivariable Cox proportional hazards models. Restricted cubic splines were applied to determine the nonlinear relationship between SHR and primary outcome. A two-piecewise linear regression model was used to identify the threshold of SHR. RESULTS A total of 610 participants were included in the study. The average age of the patients was 61.4 ± 12.9 years old, and approximately 70% of participants were males. A total of 189 (30.98%) patients had ICAS. The patients were categorized into 3 groups based on the tertiles of SHR. Compared with the group with a lower SHR, a higher SHR was significantly associated with the risk of stroke recurrence in the ICAS group (hazard ratio [HR], 8.52, 95% confidence interval [CI], 3.16-22.96, P<0.001). When SHR was treated as a continuous variable, each 0.1-unit increase in SHR in the ICAS group was associated with a 1.63-fold increase in the risk of recurrence (HR, 1.63, 95% CI, 1.39-1.9, P<0.001) with a threshold of 0.75. FPG but not HbA1c was associated with stroke recurrence in ICAS patients (HR, 1.17, 95% CI, 1.08-1.26, P<0.001). Sensitive analyses showed consistent results after adjusting for previous diabetes mellitus, oral hypoglycemic agents and insulin injection. CONCLUSIONS SHR represents a better biomarker to predict the risk of stroke recurrence in patients with ICAS than FPG and HbA1c regardless of previous diabetes mellitus. TRIAL REGISTRATION https://www.chictr.org.cn/showproj.aspx?proj=125817; Identifier, [ChiCTR2100046958].
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Affiliation(s)
- Yongle Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongxuan Fan
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weiying Duan
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhaoyu Ren
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuchang Liu
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tingting Liu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Clinical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanan Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Kaili Zhang
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Haimei Fan
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Jing Ren
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Juan Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinyi Li
- Department of Neurology, The Bethune Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Xuemei Wu
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- *Correspondence: Xiaoyuan Niu,
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17
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Yang Y, Kong Q, Ma X, Wang C, Xue S, Du X. A Whole-Scope Evaluation of Cervicocephalic Atherosclerotic Burden is Essential to Predict 90-Day Functional Outcome in LargeArtery Atherosclerotic Stroke. J Atheroscler Thromb 2021; 29:1522-1533. [PMID: 34803087 PMCID: PMC9529387 DOI: 10.5551/jat.63226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cervicocephalic atherosclerosis (AS) of patients with large-artery atherosclerotic (LAA) stroke might be more closely correlated to the functional outcome than patients with stroke of other etiologies. We aimed to investigate whether a whole-scope evaluation of cervicocephalic AS condition was better at predicting the 90-day functional outcome of LAA stroke than evaluation of intracranial or cervical AS condition alone. METHODS Patients with LAA stroke were consecutively enrolled in this study. Computed tomography angiography was performed to evaluate AS condition of various cervicocephalic arterial segments. AS conditions ranging from no AS plaque to complete arterial occlusion scored 0-4 points. Intracranial atherosclerotic burden (IAB) and cervical atherosclerotic burden (CAB) were in respective the sums of AS scores of all intracranial arterial segments and all cervical arterial segments. And the sum of them was intracranial and cervical atherosclerotic burden (ICAB). Relationships of these three scores with the 90-day unfavorable functional outcome (modified Rankin Scale[mRS] score >2 points) were compared. RESULTS Of 172 patients who finished 90-day follow-up, only ICAB (adjusted odds ratio[OR]=1.10, 95% confidence interval[CI]:1.00-1.21, p=0.044) predicted 90-day unfavorable functional outcome independently of clinical factors, National Institutes of Health Stroke Scale (NIHSS) and mRS scores at admission. ICAB (adjusted hazard ratio[HR]=1.16, 95%CI:1.02-1.32, p=0.029) was related to 90-day recurrent ischemic stroke/death independently of clinical factors and was independently, positively correlated with NIHSS score at admission (r=0.16, p=0.047), whereas IAB and CAB were not. CONCLUSION A whole-scope evaluation of cervicocephalic AS condition using ICAB outperformed evaluation of intracranial or cervical AS condition alone in predicting 90-day functional outcome of patients with LAA stroke.
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Affiliation(s)
- Yi Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Qi Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Chen Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University
| | - Sufang Xue
- National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University.,Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Xiangying Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University
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18
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Sun B, Wang L, Li X, Zhang J, Zhang J, Liu X, Wu H, Mossa-Basha M, Xu J, Zhao B, Zhao H, Zhou Y, Zhu C. Intracranial Atherosclerotic Plaque Characteristics and Burden Associated With Recurrent Acute Stroke: A 3D Quantitative Vessel Wall MRI Study. Front Aging Neurosci 2021; 13:706544. [PMID: 34393761 PMCID: PMC8355600 DOI: 10.3389/fnagi.2021.706544] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intracranial atherosclerotic disease (ICAD) tends to affect multiple arterial segments, and previous studies rarely performed a comprehensive plaque analysis of the entire circle of Willis for the evaluation of recurrent stroke risk. We aimed to investigate the features of circle of Willis ICAD on 3D magnetic resonance vessel wall imaging (MR-VWI) and their relationships with recurrent acute stroke. Methods: Patients with either acute ischemic stroke (within 4 weeks after stroke) or chronic ischemic stroke (after 3 months of stroke) due to intracranial atherosclerotic plaque underwent 3D contrast-enhanced MR-VWI covering major cerebral arteries. Participants were divided into three groups: first-time acute stroke, recurrent acute stroke, and chronic stroke. Culprit plaque (defined as the only lesion or the most stenotic lesion when multiple plaques were present within the same vascular territory of the stroke) and non-culprit plaque characteristics, including total plaque number, plaque thickness, plaque area, plaque burden (calculated as plaque area divided by outer wall area), enhancement ratio (ER), eccentricity, and stenosis, were measured and compared across the three groups. Associations between plaque characteristics and recurrent acute stroke were investigated by multivariate analysis. Results: A total of 176 participants (aged 61 ± 10 years, 109 men) with 702 intracranial plaques were included in this study. There were 80 patients with first-time acute stroke, 42 patients with recurrent acute stroke, and 54 patients with chronic stroke. More intracranial plaques were found per patient in the recurrent acute stroke group than in the first-time acute stroke or chronic stroke group (5.19 ± 1.90 vs. 3.71 ± 1.96 and 3.46 ± 1.33, p < 0.001). Patients in the recurrent acute stroke group had greater culprit plaque burden (p < 0.001) and higher culprit ER (p < 0.001) than the other two groups. After adjustment of clinical demographic factors, in multivariate analysis, coronary artery disease (CAD) (odds ratio, OR = 4.61; p = 0.035), total plaque number (OR = 1.54; p = 0.003), culprit plaque ER (OR = 2.50; p = 0.036), and culprit plaque burden (OR per 10% increment = 2.44; p = 0.010) were all independently associated with recurrent acute stroke compared to the first-time acute stroke. Conclusion: Increased intracranial atherosclerotic plaque number, higher culprit plaque ER, greater culprit plaque burden, and CAD are independently associated with recurrent acute stroke.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hengqu Wu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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19
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Ntaios G, Wintermark M, Michel P. Supracardiac atherosclerosis in embolic stroke of undetermined source: the underestimated source. Eur Heart J 2021; 42:1789-1796. [PMID: 32300781 DOI: 10.1093/eurheartj/ehaa218] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 03/12/2020] [Indexed: 01/17/2023] Open
Abstract
The term 'embolic stroke of undetermined source' (ESUS) is used to describe patients with a non-lacunar ischaemic stroke without any identified embolic source from the heart or the arteries supplying the ischaemic territory, or any other apparent cause. When the ESUS concept was introduced, covert atrial fibrillation was conceived to be the main underlying cause in the majority of ESUS patients. Another important embolic source in ESUS is the atherosclerotic plaque in the carotid, vertebrobasilar, and intracranial arteries, or the aortic arch-collectively described as supracardiac atherosclerosis. There is emerging evidence showing that the role of supracardiac atherosclerosis is larger than it was initially perceived. Advanced imaging methods are available to identify plaques which high embolic risk. The role of novel antithrombotic strategies in these patients needs to be assessed in randomized controlled trials. This review presents the evidence which points towards a major aetiological association between atherosclerotic plaques and ESUS, summarizes the imaging features which may aid to identify plaques more likely to be associated with ESUS, discusses strategies to reduce the associated stroke risk, and highlights the rationale for future research in this field.
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Affiliation(s)
- George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University and Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
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20
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Wu L, Rajah GB, Cosky EE, Wu X, Li C, Chen J, Zhao W, Wu D, Ding Y, Ji X. Outcomes in Endovascular Therapy for Basilar Artery Occlusion: Intracranial Atherosclerotic Disease vs. Embolism. Aging Dis 2021; 12:404-414. [PMID: 33815873 PMCID: PMC7990363 DOI: 10.14336/ad.2020.0704] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022] Open
Abstract
Acute ischemic stroke due to basilar artery occlusion (BAO) carries a very poor prognosis. Functional outcomes in BAO patients undergoing endovascular therapy (EVT) may differ according to the specific pathological mechanisms. We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with EVT. We analyzed consecutive BAO patients undergoing EVT from December 2012 to December 2018 at a single center (Xuanwu Hospital). Patients were classified into either an intracranial atherosclerotic disease (ICAD) group or an embolic group according to the corresponding angiographic findings. The baseline characteristics and functional outcomes were compared between the two groups. Multivariable logistic regression analysis was performed. Among the 167 patients enrolled, 78 patients (46.7%) were in the ICAD group and 89 patients (53.3%) were assigned to the embolic group. Overall, 149 patients (89.2%) achieved successful reperfusion post-EVT. There were no significant differences in functional outcomes at 90-days and long-term follow-up between the two groups. Similarly, a Kaplan-Meier survival analysis showed similar long-term survival probabilities (P = 0.438). The pathological mechanism was not associated with functional independence (OR, 1.818; 95% CI, 0.694-4.761; P = 0.224), favorable outcome (OR, 1.476; 95% CI, 0.592-3.681; P = 0.403), or mortality (OR, 1.249; 95% CI, 0.483-3.226; P = 0.646). However, based on subgroup analysis, embolic BAO versus ICAD was significantly associated with better functional independence in those aged 60 years and younger (OR, 4.513; 95% CI, 1.138-17.902). In this study, no differences in either 90-days or long-term functional outcomes between ICAD-related BAO and embolic BAO patients undergoing EVT were observed. However, in BAO patients aged ≤ 60 years, the pathological mechanism of embolism was associated with better functional independence.
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Affiliation(s)
- Longfei Wu
- 1Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gary B Rajah
- 2Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.,3Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.,4Department of Neurosurgery, Munson Healthcare, Traverse City, Michigan, USA
| | - Eric E Cosky
- 5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xiling Wu
- 6Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- 7Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- 8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- 1Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- 1Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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21
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Zhang J, Zhang K, Jia B, Qi Z, Mo D, Ma N, Gao F, Miao Z. Risk of Recurrence of Symptomatic Intracranial Atherosclerosis in Posterior Circulation Seen to Be Higher Than That in Anterior Circulation in Long-Term Follow-Up. Front Neurol 2020; 11:574926. [PMID: 33240200 PMCID: PMC7677522 DOI: 10.3389/fneur.2020.574926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke. In Asians, intracranial atherosclerotic disease leads to 33-50% of ischemic events. At present, treatment with medication vs. endovascular therapy (EVT) for symptomatic ICAS (sICAS) patients is still debatable. The clinical prognosis of patients who are not completely free of stroke symptoms despite regular medication and are not eligible for EVT for various reasons, is not yet investigated. Aim: To report the long-term recurrence rate of stroke in a cohort of symptomatic ICAS patients who intended to undergo EVT upon admission but could not for various reasons after digital subtraction angiography (DSA) evaluation. Method: This is a retrospective analysis of consecutive sICAS patients in a single center from January 1, 2016 to August 31, 2017 who underwent DSA assessment alone and were not eligible for further EVT. Demographic information, risk factors related to cerebrovascular disease, clinical comorbidities, medication, imaging data, and long-term outcomes were reported. Results: A total of 218 patients were included in the study; 42 (19.2%) patients had recurrence of stroke/transient ischemic attack (TIA) at the 1-year follow up. Patients were divided into two groups according to lesions in anterior circulation (n = 120) or posterior circulation (n = 98). There was a higher stroke/TIA recurrence rate in the posterior circulation than anterior circulation group (25.5 vs. 14.2%, p = 0.035). Given the advanced age, higher prevalence of coronary heart disease, larger stenosis length, and poorer collateral circulation, the posterior circulation group showed a higher risk of recurrent stroke/TIA and death than the anterior circulation group [HR = 3.092, 95% CI (1.335-7.164), p = 0.0084], after adjusting for all confounding factors in the COX regression model. Kaplan-Meier analysis showed that sICAS recurrence and mortality risk in the posterior circulation group was consistently higher than that in the anterior circulation group (log-rank-test, p = 0.033). Conclusions: Patients with posterior circulation sICAS have higher recurrence risk than those with anterior circulation managed with medication alone. Further, posterior circulation lesion is an independent risk factor for recurrence in sICAS patients.
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Affiliation(s)
- Jingyu Zhang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongqi Qi
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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22
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Song X, Zhao X, Liebeskind DS, Wang L, Xu W, Xu Y, Hou D, Zheng Z, Wu J. Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis. Neuroradiology 2020; 62:1123-1131. [DOI: 10.1007/s00234-020-02418-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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23
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Song X, Zhao Q, Hua Y, Wang C, Liu B, Guan S, Li J, Zhang Z, Fang X, Wu J. Association between blood pressure and intracranial artery stenosis in a Chinese population. J Clin Hypertens (Greenwich) 2019; 22:77-85. [PMID: 31873981 DOI: 10.1111/jch.13770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/15/2019] [Accepted: 12/01/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Xiaowei Song
- Department of Neurology Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Changping District Beijing China
| | - Qiannan Zhao
- Evidence Based Medicine Center Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Yang Hua
- Department of Vascular Ultrasound Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Chunxiu Wang
- Evidence Based Medicine Center Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Beibei Liu
- Department of Vascular Ultrasound Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Shaochen Guan
- Evidence Based Medicine Center Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Jun Li
- Department of Neurology Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Changping District Beijing China
| | - Zhongying Zhang
- Evidence Based Medicine Center Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Xianghua Fang
- Evidence Based Medicine Center Xuanwu Hospital of Capital Medical University Xicheng District Beijing China
| | - Jian Wu
- Department of Neurology Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Changping District Beijing China
- Tsinghua University Hospital Haidian District Beijing China
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