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Huang J, Liu C, Jiao S, Chen Y, Xu L, Gong T, Zhu C, Song Y. Application of high-resolution MRI in evaluating statin efficacy on symptomatic intracranial atherosclerosis. Eur Radiol 2024:10.1007/s00330-024-10968-1. [PMID: 39030372 DOI: 10.1007/s00330-024-10968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/28/2024] [Accepted: 06/30/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To investigate the efficacy of statins on symptomatic intracranial atherosclerotic plaques using high-resolution 3.0 T MR vessel wall imaging (HR-MRI). METHODS Patients with symptomatic intracranial atherosclerotic plaques (cerebral ischemic events within the last three months) confirmed by HR-MRI from July 2017 to August 2022 were retrospectively included in this study. The enrolled patients started statin therapy at baseline. All the patients underwent the follow-up HR-MRI examination after statin therapy for at least 3 months. A paired sample t-test and Wilcoxon rank sum test were used to evaluate the changes in plaque characteristics after statin therapy. Multivariate linear regression was further used to investigate the clinical factors associated with statin efficacy. RESULTS A total of 48 patients (37 males; overall mean age = 60.2 ± 11.7 years) were included in this study. The follow-up time was 7.0 (5.6-12.0) months. In patients treated with statins for > 6 months (n = 31), plaque length, wall thickness, plaque burden, luminal stenosis and plaque enhancement were significantly reduced. Similar results were found in patients with good lipid control (n = 21). Younger age, lower BMI and hypertension were associated with decreased plaque burden. Lower BMI, hypertension and longer duration of statin therapy were associated with decreased plaque enhancement. Younger age and hypertension were associated with decreased luminal stenosis (all p < 0.05). CONCLUSION HR-MRI can effectively evaluate plaques changes after statin therapy. Statins can reduce plaque burden and stabilize plaques. The effect of statin may have a relationship with age, BMI, hypertension, and duration of statin therapy. CLINICAL RELEVANCE STATEMENT High-resolution MRI can be applied to evaluate the efficacy of statins on symptomatic intracranial atherosclerotic plaques. Long-term statin use and well-controlled blood lipid levels can help reduce plaque burden and stabilize plaques. KEY POINTS High-resolution MRI provides great help evaluating the changes of plaque characteristics after statin therapy. Efficacy of statins is associated with duration of use, controlled lipid levels, and clinical factors. High-resolution MRI can serve as an effective method for following-up symptomatic intracranial atherosclerosis.
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Affiliation(s)
- Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cong Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhui Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Xu
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
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Chen Z, Liu J, Wang A, Wu B, Cheng Z, Jiang Y, Gu H, Ding L, Mo J, Jiang Y, Liu L, Jing L, Jing J, Wang Y, Zhao X, Wang Y, Qin H, Li Z. Hemodynamic Impairment of Blood Pressure and Stroke Mechanisms in Symptomatic Intracranial Atherosclerotic Stenosis. Stroke 2024; 55:1798-1807. [PMID: 38836360 DOI: 10.1161/strokeaha.123.046051] [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: 12/01/2023] [Accepted: 05/14/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Hemodynamic impairment of blood pressure may play a crucial role in determining the mechanisms of stroke in symptomatic intracranial atherosclerotic stenosis). We aimed to elucidate this issue and assess the impacts of modifications to blood pressure on hemodynamic impairment. METHODS From the Third China National Stroke Registry III, computed fluid dynamics modeling was performed using the Newton-Krylov-Schwarz method in 339 patients with symptomatic intracranial atherosclerotic stenosis during 2015 to 2018. The major exposures were translesional systolic blood pressure (SBP) drop and poststenotic mean arterial pressure (MAP), and the major study outcomes were cortex-involved infarcts and borderzone-involved infarcts, respectively. Multivariate logistic regression models and the bootstrap resampling method were utilized, adjusting for demographics and medical histories. RESULTS In all, 184 (54.3%) cortex-involved infarcts and 70 (20.6%) borderzone-involved infarcts were identified. In multivariate logistic model, the upper quartile of SBP drop correlated with increased cortex-involved infarcts (odds ratio, 1.92 [95% CI, 1.03-3.57]; bootstrap analysis odds ratio, 2.07 [95% CI, 1.09-3.93]), and the lower quartile of poststenotic MAP may correlate with increased borderzone-involved infarcts (odds ratio, 2.07 [95% CI, 0.95-4.51]; bootstrap analysis odds ratio, 2.38 [95% CI, 1.04-5.45]). Restricted cubic spline analysis revealed a consistent upward trajectory of the relationship between translesional SBP drop and cortex-involved infarcts, while a downward trajectory between poststenotic MAP and borderzone-involved infarcts. SBP drop correlated with poststenotic MAP negatively (rs=-0.765; P<0.001). In generating hemodynamic impairment, simulating blood pressure modifications suggested that ensuring adequate blood pressure to maintain sufficient poststenotic MAP appears preferable to the reverse approach, due to the prolonged plateau period in the association between the translesional SBP drop and cortex-involved infarcts and the relatively short plateau period characterizing the correlation between poststenotic MAP and borderzone-involved infarcts. CONCLUSIONS This research elucidates the role of hemodynamic impairment of blood pressure in symptomatic intracranial atherosclerotic stenosis-related stroke mechanisms, underscoring the necessity to conduct hemodynamic assessments when managing blood pressure in symptomatic intracranial atherosclerotic stenosis.
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Affiliation(s)
- Zimo Chen
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jia Liu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China (J.L., B.W., Z. Cheng), Chinese Academy of Sciences, Shanghai, China
| | - Anqi Wang
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Bokai Wu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China (J.L., B.W., Z. Cheng), Chinese Academy of Sciences, Shanghai, China
| | - Zaiheng Cheng
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China (J.L., B.W., Z. Cheng), Chinese Academy of Sciences, Shanghai, China
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (Yingyu Jiang, H.G., Yongjun Wang, Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (Yingyu Jiang, H.G., Yongjun Wang, Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Lingling Ding
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jinglin Mo
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Liping Liu
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Lina Jing
- Department of Radiology (L.J.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jing Jing
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yilong Wang
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Xingquan Zhao
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Yongjun Wang
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (Yingyu Jiang, H.G., Yongjun Wang, Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- Center for Excellence in Brain Science and Intelligence Technology (Yongjun Wang, Z.L.), Chinese Academy of Sciences, Shanghai, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China (Yongjun Wang, Z.L.)
| | - Haiqiang Qin
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
| | - Zixiao Li
- Department of Neurology (Z. Chen, A.W., L.D., J.M., L.L., J.J., Y.W., X.Z., Yilong Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases (Z. Chen, A.W., Yingyu Jiang, H.G., L.D., J.M., Yong Jiang, L.L., J.J., Yilong Wang, X.Z., Yongjun Wang, H.Q., Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (Yingyu Jiang, H.G., Yongjun Wang, Z.L.), Beijing Tiantan Hospital, Capital Medical University, China
- Center for Excellence in Brain Science and Intelligence Technology (Yongjun Wang, Z.L.), Chinese Academy of Sciences, Shanghai, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China (Yongjun Wang, Z.L.)
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Pavone C, Bonacini L, Di Cecco G, D’Aniello S, Stoenoiu MS, Persu A, Valzania F, Pascarella R. RNF213 Polymorphisms in Intracranial Artery Dissection. Genes (Basel) 2024; 15:725. [PMID: 38927660 PMCID: PMC11203323 DOI: 10.3390/genes15060725] [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: 04/26/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
The ring finger protein 213 gene (RNF213) is involved in several vascular diseases, both intracranial and systemic ones. Some variants are common in the Asian population and are reported as a risk factor for moyamoya disease, intracranial stenosis and intracranial aneurysms. Among intracranial vascular diseases, both moyamoya disease and intracranial artery dissection are more prevalent in the Asian population. We performed a systematic review of the literature, aiming to assess the rate of RNF213 variants in patients with spontaneous intracranial dissections. Four papers were identified, providing data on 53 patients with intracranial artery dissection. The rate of RNF213 variants is 10/53 (18.9%) and it increases to 10/29 (34.5%), excluding patients with vertebral artery dissection. All patients had the RNF213 p.Arg4810Lys variant. RNF213 variants seems to be involved in intracranial dissections in Asian cohorts. The small number of patients, the inclusion of only patients of Asian descent and the small but non-negligible coexistence with moyamoya disease familiarity might be limiting factors, requiring further studies to confirm these preliminary findings and the embryological interpretation.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (I.G.); (F.A.); (F.V.)
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (I.G.); (F.A.); (F.V.)
| | - Federica Assenza
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (I.G.); (F.A.); (F.V.)
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Claudio Moratti
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Claudio Pavone
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Lara Bonacini
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Giovanna Di Cecco
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Serena D’Aniello
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
| | - Maria Simona Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium;
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (I.G.); (F.A.); (F.V.)
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (C.M.); (C.P.); (L.B.); (G.D.C.); (S.D.); (R.P.)
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Li B, Bian Q, Li H, He Y, Chen S, Zhang K, Wang Z. Effect of Drug-Coated Balloon Versus Stent Angioplasty in Patients With Symptomatic Intracranial Atherosclerotic Stenosis. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01176. [PMID: 38781497 DOI: 10.1227/ons.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Drug-coated balloons (DCBs) have exhibited promising results in coronary and peripheral artery diseases, but conclusive evidence is lacking in intracranial vasculature. We assessed the safety and efficacy of DCBs vs stent angioplasty for symptomatic intracranial atherosclerotic stenosis (sICAS) and initially identified patients who might have benefited most from DCB treatment. METHODS A single-center, retrospective cohort study was conducted from June 2021 to May 2022 with 154 patients with sICAS divided into 2 treatment groups: a DCB group (with or without remedial stenting, n = 47) and a stent group (n = 107). The treatment outcomes were compared using 1:2 propensity score matching. The primary safety end point was perioperative stroke or mortality, and the primary efficacy end point was the rate of target vessel restenosis at 12 months. The degree of luminal change was analyzed as a subgroup, defined as the difference between the degree of stenosis at follow-up and immediately after intervention. RESULTS One hundred eighteen patients were enrolled using propensity score matching, with 43 patients in the DCB group and 75 in the stent group. The incidence of perioperative adverse events was 2.3% in the DCB group and 8.0% in the stent group (P = .420). At a median follow-up of 12 months, the incidence of restenosis (11.9% [5/43] vs 28.0% [21/75], P = .045) and the median degree of stenosis (30% [20%, 44%] vs 30% [30%, 70%], P = .009, CI [0-0.01, 0.2]) were significantly lower in the DCB group than in the stent group. DCB angioplasty effectively prevented adverse events in the target vessel area and significantly reduced the degree of luminal change in the M1 segment of the middle cerebral artery (0 [0, 15%] vs 10% [0, 50%], P = .016). CONCLUSION DCB angioplasty might be a safe and effective alternative to stent angioplasty to treat sICAS, particularly among patients with M1 segment of the middle cerebral artery stenosis.
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Affiliation(s)
- Bei Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Qiang Bian
- Department of Pathophysiology, Weifang Medical University, Weifang, Shandong, P.R. China
| | - Heju Li
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Songtao Chen
- Cerebrovascular Department of Interventional Center, Henan University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Kun Zhang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Ziliang Wang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
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Eun MY, Song HN, Choi JU, Cho HH, Kim HJ, Chung JW, Song TJ, Jung JM, Bang OY, Kim GM, Park H, Liebeskind DS, Seo WK. Global intracranial arterial tortuosity is associated with intracranial atherosclerotic burden. Sci Rep 2024; 14:11318. [PMID: 38760396 DOI: 10.1038/s41598-024-61527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
The effect of arterial tortuosity on intracranial atherosclerosis (ICAS) is not well understood. This study aimed to evaluate the effect of global intracranial arterial tortuosity on intracranial atherosclerotic burden in patients with ischemic stroke. We included patients with acute ischemic stroke who underwent magnetic resonance angiography (MRA) and classified them into three groups according to the ICAS burden. Global tortuosity index (GTI) was defined as the standardized mean curvature of the entire intracranial arteries, measured by in-house vessel analysis software. Of the 516 patients included, 274 patients had no ICAS, 140 patients had a low ICAS burden, and 102 patients had a high ICAS burden. GTI increased with higher ICAS burden. After adjustment for age, sex, vascular risk factors, and standardized mean arterial area, GTI was independently associated with ICAS burden (adjusted odds ratio [adjusted OR] 1.33; 95% confidence interval [CI] 1.09-1.62). The degree of association increased when the arterial tortuosity was analyzed limited to the basal arteries (adjusted OR 1.48; 95% CI 1.22-1.81). We demonstrated that GTI is associated with ICAS burden in patients with ischemic stroke, suggesting a role for global arterial tortuosity in ICAS.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
- Department of Neurology, Graduate School, Korea University, Seoul, South Korea
| | - Ha-Na Song
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jong-Un Choi
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hwan-Ho Cho
- Department of Electronics Engineering, Incheon National University, Incheon, South Korea
| | - Hyung Jun Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jong-Won Chung
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Oh-Young Bang
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hyunjin Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, South Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea
| | - David S Liebeskind
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| | - Woo-Keun Seo
- Department of Neurology and Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
- Department of Digital Health, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Lv Y, Ma X, Zhao W, Ju J, Yan P, Li S, Xue Y, Sui Y, Shao S, Sun Q, Qiu C. Association of plaque characteristics with long-term stroke recurrence in patients with intracranial atherosclerotic disease: a 3D high-resolution MRI-based cohort study. Eur Radiol 2024; 34:3022-3031. [PMID: 37870623 PMCID: PMC11126465 DOI: 10.1007/s00330-023-10278-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 07/31/2023] [Accepted: 08/12/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES To evaluate the predictive ability of plaque characteristics for long-term stroke recurrence among patients with symptomatic intracranial atherosclerotic disease (ICAD). METHODS This cohort study included 132 patients with acute ischemic stroke (AIS) attributed to ICAD who were recruited between July 2017 and December 2020 and followed until stroke recurrence or December 2021. Plaque surface irregularity, degree of stenosis, plaque burden, remodeling ratio, enhancement ratio, and intraplaque hemorrhage were assessed with 3-dimensional high-resolution magnetic resonance vessel wall imaging (3D HR-MRI). Data were analyzed using Cox models, receiver operating characteristic (ROC) curves, and Kaplan-Meier survival analysis. RESULTS Of the 132 patients, during a median follow-up of 2.8 years, stroke recurrence occurred in 35 patients. The multivariable-adjusted hazard ratio (95% confidence interval) of stroke recurrence was 3.15 (1.34-7.42) per 10% increase in plaque burden and 2.17 (1.27-3.70) for enhancement ratio. The area under the curve (AUC) to predict stroke recurrence was 0.725 (95% CI 0.629-0.822) for plaque burden, 0.692 (95% CI 0.593-0.792) for enhancement ratio, and only 0.595 (95% CI 0.492-0.699) for the Essen stroke risk score. The Kaplan-Meier survival analysis further demonstrated significant differences in survival of free recurrent stroke between patients with plaque burden or enhancement ratio below and above the optimum cut-offs (both p < 0.001). CONCLUSION Higher plaque burden and enhancement ratio are independent risk factors for long-term stroke recurrence among patients with symptomatic ICAD, and valuable imaging markers for predicting and stratifying risk of stroke recurrence. CLINICAL RELEVANCE STATEMENT In patients with symptomatic ICAD, the results of this high-resolution magnetic resonance vessel wall imaging study have potential implications for optimal management of intracranial plaques and secondary prevention of stroke recurrence based on plaque burden and enhancement ratio. KEY POINTS • Identification of intracranial plaque characteristics responsible for stroke recurrence is essential to preventing stroke recurrence in patients with symptomatic intracranial atherosclerotic disease. • Higher plaque burden and enhancement ratio are independent risk factors for stroke recurrence. • Plaque burden and enhancement ratio are valuable imaging markers in the prediction and stratification of the risk of stroke recurrence.
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Affiliation(s)
- Yaodong Lv
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xiaotong Ma
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Weihua Zhao
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jiachen Ju
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Peng Yan
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shan Li
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Yuan Xue
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - YanLing Sui
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Sai Shao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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Lucci C, Rissanen I, Takx RAP, van der Kolk AG, Harteveld AA, Dankbaar JW, Geerlings MI, de Jong PA, Hendrikse J. Imaging of intracranial arterial disease: a comparison between MRI and unenhanced CT. FRONTIERS IN RADIOLOGY 2024; 4:1338418. [PMID: 38426079 PMCID: PMC10902099 DOI: 10.3389/fradi.2024.1338418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Background and purpose Arterial calcifications on unenhanced CT scans and vessel wall lesions on MRI are often used interchangeably to portray intracranial arterial disease. However, the extent of pathology depicted with each technique is unclear. We investigated the presence and distribution of these two imaging findings in patients with a history of cerebrovascular disease. Materials and methods We analyzed CT and MRI data from 78 patients admitted for stroke or TIA at our institution. Vessel wall lesions were assessed on 7 T MRI sequences, while arterial calcifications were assessed on CT scans. The number of vessel wall lesions, severity of intracranial internal carotid artery (iICA) calcifications, and overall presence and distribution of the two imaging findings were visually assessed in the intracranial arteries. Results At least one vessel wall lesion or arterial calcification was assessed in 69 (88%) patients. Only the iICA and vertebral arteries (VA) showed a substantial number of both calcifications and vessel wall lesions. The other vessels showed almost exclusively vessel wall lesions. The number of vessel wall lesions was associated with the severity of iICA calcification (p = 0.013). Conclusions The number of vessel wall lesions increases with the severity of iICA calcifications. Nonetheless, the distribution of vessel wall lesions on MRI and arterial calcifications on CT shows remarkable differences. These findings support the need for a combined approach to examine intracranial arterial disease.
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Affiliation(s)
- Carlo Lucci
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Richard A. P. Takx
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anja G. van der Kolk
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Anita A. Harteveld
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jan W. Dankbaar
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Mirjam I. Geerlings
- Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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8
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Yu S, Zheng Y, Dai X, Chen H, Yang S, Ma M, Huang F, Zhu P. The value of coordinated analysis of multimodal atherosclerotic plaque imaging in the assessment of cardiovascular and cerebrovascular events. Front Cardiovasc Med 2024; 11:1320222. [PMID: 38333417 PMCID: PMC10850297 DOI: 10.3389/fcvm.2024.1320222] [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: 10/15/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Background Although atherosclerosis (AS) can affect multiple vascular beds, previous studies have focused on the analysis of single-site AS plaques. Objective The aim of this study is to explore the differences or similarities in the characteristics of atherosclerotic plaque found in the internal carotid artery, cerebral artery, and coronary artery between patients with atherosclerotic cardiovascular disease (ASCVD) and those without events. Methods Patients aged ≥ 18 years who underwent both high-resolution vessel wall imaging (HR-VWI) and coronary computed tomography angiography (CCTA) were retrospectively collected and categorized into the ASCVD group and the non-event group. The plaques were then categorized into culprit plaques, non-culprit plaques, and non-event plaques. Plaque morphological data such as stenosis, stenosis grades, plaque length (PL), plaque volume (PV), minimal lumen area (MLA), enhancement grade, and plaque composition data such as calcified plaque volume (CPV), fibrotic plaque volume (FPV), fibro-lipid plaque volume (FLPV), lipid plaque volume (LPV), calcified plaque volume ratio (CPR), fibrotic plaque volume ratio (FPR), fibro-lipid plaque ratio (FLPR), lipid plaque volume ratio (LPR), intraplaque hemorrhage volume (IPHV), and intraplaque hemorrhage volume ratio (IPHR)were recorded and analyzed. Results A total of 44 patients (mean age 66 years, SD 9 years, 28 men) were included. In cervicocephalic plaques, the ASCVD group had more severe stenosis grades (p = 0.030) and demonstrated significant differences in LPV, LPR, and CPV (p = 0.044, 0.030, 0.020) compared with the non-event group. In coronary plaques, the ASCVD group had plaques with greater stenosis (p < 0.001), more severe stenosis grades (p < 0.001), larger volumes (p = 0.001), longer length (p = 0.008), larger FLPV (p = 0.012), larger FPV (p = 0.002), and higher FPR (p = 0.043) compared with the non-event group. There were significant differences observed in stenosis (HR-VWI, CCTA: p < 0.001, p < 0.001), stenosis grades (HR-VWI, CCTA: p < 0.001, p < 0.001), plaque length (HR-VWI, CCTA: p = 0.028, p < 0.001), and plaque volume (HR-VWI, CCTA: p = 0.013, p = 0.018) between the non-event plaque, non-culprit plaque, and culprit plaque. In the image analysis of HR-VWI, there were differences observed between IPHR (p < 0.001), LPR (p = 0.001), FPV (p = 0.011), and CPV (p = 0.015) among the three groups of plaques. FLPV and FPV were significantly different among the three different plaque types from the coronary artery (p = 0.043, p = 0.022). Conclusion There is a consistent pattern of change in plaque characteristics between the cervicocephalic and coronary arteries in the same patient.
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Affiliation(s)
- Shun Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Yonghong Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Xiaomin Dai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Huangjing Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Shengsheng Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Mingping Ma
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
| | - Feng Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
- Fujian Key Laboratory of Geriatrics, Fuzhou, Fujian, Republic of China
- Fujian Provincial Center for Geriatrics, Fuzhou, Fujian, Republic of China
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, Republic of China
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, Republic of China
- Fujian Key Laboratory of Geriatrics, Fuzhou, Fujian, Republic of China
- Fujian Provincial Center for Geriatrics, Fuzhou, Fujian, Republic of China
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9
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Kang DW, Kim DY, Kim J, Baik SH, Jung C, Singh N, Song JW, Bae HJ, Kim BJ. Emerging Concept of Intracranial Arterial Diseases: The Role of High Resolution Vessel Wall MRI. J Stroke 2024; 26:26-40. [PMID: 38326705 PMCID: PMC10850450 DOI: 10.5853/jos.2023.02481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
Intracranial arterial disease (ICAD) is a heterogeneous condition characterized by distinct pathologies, including atherosclerosis. Advances in magnetic resonance technology have enabled the visualization of intracranial arteries using high-resolution vessel wall imaging (HR-VWI). This review summarizes the anatomical, embryological, and histological differences between the intracranial and extracranial arteries. Next, we review the heterogeneous pathophysiology of ICAD, including atherosclerosis, moyamoya or RNF213 spectrum disease, intracranial dissection, and vasculitis. We also discuss how advances in HR-VWI can be used to differentiate ICAD etiologies. We emphasize that one should consider clinical presentation and timing of imaging in the absence of pathology-radiology correlation data. Future research should focus on understanding the temporal profile of HR-VWI findings and developing quantitative interpretative approaches to improve the decision-making and management of ICAD.
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Affiliation(s)
- Dong-Wan Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Do Yeon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Jonguk Kim
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nishita Singh
- Department of Internal Medicine-Neurology Division, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jae W. Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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10
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Semin KS, Demyashkin GA, Zakharova NE, Eliava SS, Kheireddin AS, Konovalov AN, Kalaeva DB, Batalov AI, Pronin IN. [Analysis of intracranial saccular aneurysm wall: neuroimaging and histopathological correlates]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:52-58. [PMID: 38881016 DOI: 10.17116/neiro20248803152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
BACKGROUND Contrast enhancement of intracranial aneurysm wall during MRI with targeted visualization of vascular wall correlates with previous aneurysm rupture and, according to some data, may be a predictor of further rupture of unruptured aneurysms. OBJECTIVE To analyze possible causes of aneurysm contrast enhancement considering morphological data of aneurysm walls. MATERIAL AND METHODS The study included 44 patients with intracranial aneurysms who underwent preoperative MRI between November 2020 and September 2022. Each aneurysm was assessed regarding contrast enhancement pattern. Microsurgical treatment of aneurysm was accompanied by resection of its wall for subsequent histological and immunohistochemical analysis regarding thrombosis, inflammation and neovascularization. Specimens were subjected to histological and immunochemical analysis. Immunohistochemical analysis was valuable to estimate inflammatory markers CD68 and CD3, as well as neurovascularization marker SD31. RESULTS Aneurysms with contrast-enhanced walls were characterized by higher number of CD3+, CD68+, CD31+ cells and parietal clots. Intensity of contrast enhancement correlated with aneurysm wall abnormalities. CONCLUSION Contrast enhancement of aneurysm wall can characterize various morphological abnormalities.
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Affiliation(s)
- K S Semin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - G A Demyashkin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | | | | | - D B Kalaeva
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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11
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Zuo M, Chen W, Zhou Z. Multimodal Neuroimaging Reveals and Guides Treatment of a Middle Cerebral Artery Web. JAMA Neurol 2024; 81:79-80. [PMID: 37955912 DOI: 10.1001/jamaneurol.2023.4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
This case report describes how neuroimaging was used to determine treatment for episodic sudden-onset weakness and numbness in the left limbs.
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Affiliation(s)
- Meng Zuo
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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12
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Deng G, Chu YH, Xiao J, Shang K, Zhou LQ, Qin C, Tian DS. Risk Factors, Pathophysiologic Mechanisms, and Potential Treatment Strategies of Futile Recanalization after Endovascular Therapy in Acute Ischemic Stroke. Aging Dis 2023; 14:2096-2112. [PMID: 37199580 PMCID: PMC10676786 DOI: 10.14336/ad.2023.0321-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/22/2023] [Indexed: 05/19/2023] Open
Abstract
Endovascular therapy is the first-line treatment for acute ischemic stroke. However, studies have shown that, even with the timely opening of occluded blood vessels, nearly half of all patients treated with endovascular therapy for acute ischemic stroke still have poor functional recovery, a phenomenon called "futile recanalization.". The pathophysiology of futile recanalization is complex and may include tissue no-reflow (microcirculation reperfusion failure despite recanalization of the occluded large artery), early arterial reocclusion (reocclusion of the recanalized artery 24-48 hours post endovascular therapy), poor collateral circulation, hemorrhagic transformation (cerebral bleeding following primary ischemic stroke), impaired cerebrovascular autoregulation, and large hypoperfusion volume. Therapeutic strategies targeting these mechanisms have been attempted in preclinical research; however, translation to the bedside remains to be explored. This review summarizes the risk factors, pathophysiological mechanisms, and targeted therapy strategies of futile recanalization, focusing on the mechanisms and targeted therapy strategies of no-reflow to deepen the understanding of this phenomenon and provide new translational research ideas and potential intervention targets for improving the efficacy of endovascular therapy for acute ischemic stroke.
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Affiliation(s)
- Gang Deng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yun-hui Chu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jun Xiao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ke Shang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Luo-Qi Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chuan Qin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, 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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He Z, Luo J, Lv M, Li Q, Ke W, Niu X, Zhang Z. Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques. Front Neurol 2023; 14:1159288. [PMID: 37900593 PMCID: PMC10603250 DOI: 10.3389/fneur.2023.1159288] [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: 02/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.
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Affiliation(s)
- Zhiwei He
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiaying Luo
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengna Lv
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingwen Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Ke
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuan Niu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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15
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Ahmed R, Maqsood H, Bains RS, Gulraiz A, Kamal M. Intracranial atherosclerotic disease: current management strategies. Ann Med Surg (Lond) 2023; 85:4903-4908. [PMID: 37811034 PMCID: PMC10552953 DOI: 10.1097/ms9.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 10/10/2023] Open
Abstract
A stroke due to underlying intracranial large artery occlusion, which is atherosclerotic in nature, is known as intracranial atherosclerotic disease (ICAD). It is important to recognize that ischaemic stroke due to ICAD differs from extracranial disease and other stroke aetiologies and requires a nuanced approach. It is a significant cause of stroke worldwide, and severe symptomatic ICAD can present challenges from a therapeutic standpoint, including recurrent ischaemic stroke despite optimal management. Furthermore, exploring the underlying pathophysiological mechanisms responsible for the disease may be necessary while considering treatment options. This narrative review aims to provide an all-encompassing overview of this disease. Epidemiology and clinical pathophysiology will be explored in detail. The findings of large clinical trials will serve as a guide to finding the most optimized management strategies. Another critical question that arises is the treatment of acute ischaemic stroke due to large vessel occlusion with underlying intracranial atherosclerosis, is the treatment and clinical diagnosis the same as for other aetiologies of stroke (i.e. extracranial disease and nonvalvular atrial fibrillation)? Consequently, secondary prevention of patients with ischaemic stroke or transient ischaemic attack will be divided into medical therapy, risk factor control, and endovascular and surgical treatment options.
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Affiliation(s)
| | | | | | | | - Meraj Kamal
- BP Koirala Institute of Health Sciences, Dharan-18, Nepal
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16
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Wang D, Shang ZY, Cui Y, Yang BQ, Ntaios G, Chen HS. Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion. Stroke Vasc Neurol 2023; 8:387-398. [PMID: 36914215 PMCID: PMC10648047 DOI: 10.1136/svn-2022-002071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI). METHODS We retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI. RESULTS Among 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque. CONCLUSION This is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.
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Affiliation(s)
- Dan Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Zi-Yang Shang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - Ben-Qiang Yang
- Radiology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China
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17
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Zhang P, Zhang Z, Li D, Han R, Li H, Ma J, Xu P, Qi Z, Liu L, Zhang A. Association of remnant cholesterol with intracranial atherosclerosis in community-based population: The ARIC study. J Stroke Cerebrovasc Dis 2023; 32:107293. [PMID: 37604080 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To evaluate the association between remnant cholesterol (remnant-C) and intracranial atherosclerotic disease (ICAD) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS We studied 1,564 participants with data on lipid profiles and high-resolution vessel wall MRI (VWMRI) from the ARIC-NCS. Remnant-C was computed as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C). The primary outcomes were the presence of intracranial plaques and luminal stenosis. Contributors were separated into four different groups based on remnant-C (22 mg/dL) and LDL-C (100 mg/dL) levels to investigate the function of remnant-C vs. LDL-C on ICAD. Multivariable logistic regression models were utilized to estimate the correlation among the discordant/concordant remnant-C and LDL-C, and ICAD. RESULTS A total of 1,564 participants were included (age 76.2 ± 5.3). After multivariable adjustment, log remnant-C was correlated with greater ICAD risk [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.01 to 1.83]. The lower remnant-C/higher LDL-C group and the higher remnant-C/lower LDL-C group manifested a 1.53-fold (95% CI 1.06 to 2.20) and 1.52-fold (95% CI 1.08 to 2.14) greater risk of ICAD, relative to those having lower remnant-C/low LDL-C. Additionally, remnant-C ≥ 22 mg/dL distinguished participants at a greater risk of the presence of any stenosis compared to those at lower levels, even in participants with optimal levels of LDL-C. CONCLUSIONS Elevated levels of remnant-C were connected to ICAD independent of LDL-C and traditional risk factors. The mechanisms of remnant-C association with ICAD probably offer insight into preventive risk-factor of ischemic stroke.
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Affiliation(s)
- Peng Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Ziheng Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Daojing Li
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Rongrong Han
- Clinical Medical College, Jining Medical University, Jining, China
| | - Hongfang Li
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Jinfeng Ma
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Peng Xu
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Ziyou Qi
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Lixia Liu
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Aimei Zhang
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China.
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Lin CJ, Chung CP, Liao NC, Chen PL, Chi NF, Lai YJ, Tang CW, Wu CH, Chang FC, Luo CB, Fay LY, Lin CF, Chou CH, Lee TH, Lee JT, Jeng JS, Lee IH. The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease. J Chin Med Assoc 2023; 86:697-714. [PMID: 37341526 DOI: 10.1097/jcma.0000000000000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, especially in Asian populations, which has a high risk of recurrent stroke and cardiovascular comorbidities. The present guidelines aim to provide updated evidence-based recommendations for diagnosis and management of patients with ICAD. Taiwan Stroke Society guideline consensus group developed recommendations for management of patients with ICAD via consensus meetings based on updated evidences. Each proposed class of recommendation and level of evidence was approved by all members of the group. The guidelines cover six topics, including (1) epidemiology and diagnostic evaluation of ICAD, (2) nonpharmacological management of ICAD, (3) medical therapy for symptomatic ICAD, (4) endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD, (5) endovascular interventional therapy for postacute symptomatic intracranial arterial stenosis, and (6) surgical treatment of chronic symptomatic intracranial arterial stenosis. Intensive medical treatment including antiplatelet therapy, risk factor control, and life style modification are essential for patients with ICAD.
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Affiliation(s)
- Chun-Jen Lin
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nien-Chen Liao
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Nai-Fang Chi
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Jun Lai
- Radiology Department, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chih-Wei Tang
- Neurology Department and Stroke Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Yu Fay
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Fu Lin
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Hsing Chou
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jiunn-Tay Lee
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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19
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Adarsh KM, Pavithra H, Abdul Rasheed V. Vertebrobasilar Artery Calcification as a Risk Factor for the Development of Stroke: Case-Control Study From a Tertiary Care Center, Southern India. Cureus 2023; 15:e42196. [PMID: 37605701 PMCID: PMC10440145 DOI: 10.7759/cureus.42196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Background Stroke is an important cause of morbidity and mortality in developing countries. Many risk factors are well-established for the development of stroke. Atherosclerosis involving the media and intima layer of vertebrobasilar arteries has not been studied well as a risk factor for stroke. Objective To assess the degree of calcification of vertebrobasilar arteries among patients with stroke (cases), age- and gender-matched controls, and the risk of the development of stroke. Methods This was a hospital record-based case-control study with individuals with stroke as cases and age- and gender-matched individuals without stroke as controls, who underwent computed tomography imaging. The degree of calcification of vertebrobasilar arteries was assessed among cases and controls. Various other risk factors for the development of stroke such as the presence of hypertension, diabetes mellitus, and impaired lipid profile were also assessed. Results Among the 150 cases and their age- and gender-matched controls, the mean age of the subjects was 58.38 (±14.06) years. Forty percent of the individuals were males. Among the cases, right vertebral, left vertebral, and basilar artery calcifications were observed among 114 (76%), 102 (68%), and 52 (34.7%), respectively. Among controls, 71 (47.3%), 77 (51.3%), and 29 (19.3%) individuals had right vertebral, left vertebral, and basilar artery calcifications, respectively. The degree of calcification was higher among the cases in the right and left vertebral arteries than the controls (adjusted odds (aOR) of 6.61 and 2.32 and p-value <0.001 and 0.032, respectively). The risk of stroke increased with higher degrees of calcification, the presence of diabetes mellitus, and raised cholesterol levels (aOR of 9.98, 2.32, and 4 and p-value <0.001, 0.007, and 0.001, respectively). The risk of stroke increases with the presence of multiple risk factors. Conclusion The presence of higher grades of calcifications in the vertebrobasilar arteries is a major risk factor for stroke. Hence, its presence in asymptomatic individuals needs to be taken as a warning sign for the development of stroke.
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Affiliation(s)
- Kibballi M Adarsh
- Radiodiagnosis and Medical Imaging, Yenepoya Medical College Hospital, Mangaluru, IND
| | - H Pavithra
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
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20
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Huang R, Yang B, Gao F, Mo D, Yang M, Hou Z, Liu Y, Cui R, Kang K, Gu W, He J, Lou X, Miao Z, Ma N. Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting. Interv Neuroradiol 2023:15910199231164840. [PMID: 36987683 DOI: 10.1177/15910199231164840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND AND PURPOSE We investigated the relationship between basilar artery (BA) atherosclerotic stenosis features and vertebral artery (VA) stenosis and explored whether BA stenosis features are associated with perforator stroke after stenting. METHODS Patients with BA stenosis who underwent HRMRI and DSA were recruited. Patients were divided into proximal BA stenosis and middle-or-distal BA stenosis groups, and then subgroup analyses were performed based on whether they had VA stenosis. BA plaque features were evaluated by HRMRI. Artery stenosis was measured by DSA. The incidence of perforator stroke after BA stenting was recorded, and the potential association between BA stenosis features and perforator stroke was analyzed. RESULTS One hundred and seventy-four patients were consecutively enrolled. Patients with proximal BA stenosis had a higher proportion of severe stenosis than those with middle-or-distal BA stenosis (P = 0.027). In the subgroup analysis, this difference mainly existed in patients complicated with VA stenosis (P = 0.023). Patients with proximal BA stenosis had a higher proportion of strong plaque enhancement than those with middle-or-distal BA stenosis (P < 0.001), especially in those with vertebrobasilar junction (VBJ) stenosis (P < 0.001). Perforator stroke after BA stenting occurred in five patients, of whom four had lateral wall BA plaques, four had plaque enhancement and four had proximal BA stenosis. CONCLUSION Patients with proximal BA stenosis had a higher proportion of severe stenosis and strong plaque enhancement, particularly in patients complicated with VA stenosis and VBJ stenosis. Perforator stroke after BA stenting may be related to distribution, burden and characteristics of BA lesions.
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Affiliation(s)
- Rui Huang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Bo Yang
- Department of Neurology, 626035Beijing Jiangong Hospital, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ming Yang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Zhikai Hou
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Yifan Liu
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Rongrong Cui
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Kaijiang Kang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Disease, Beijing, China
- Department of Radiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianfeng He
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
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21
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Gómez-Vicente B, Hernández-Pérez M, Martínez-Velasco E, Rodríguez-Velasco M, Munuera J, Rubiera M, Vert C, Dorado L, de Lera M, Calleja AI, Cortijo E, Agulla J, López-Cancio E, Arenillas JF. Intracranial atherosclerotic plaque enhancement and long-term risk of future strokes: A prospective, longitudinal study. J Neuroimaging 2023; 33:289-301. [PMID: 36536493 DOI: 10.1111/jon.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The prognostic significance of postcontrast enhancement of intracranial atheromatous plaque is uncertain. Prospective, long-term follow-up studies in Caucasians, using a multicenter design, are lacking. We aimed to evaluate whether this radiological sign predicts long-term new stroke in symptomatic and asymptomatic intracranial atherosclerotic disease (ICAD) patients. METHODS This was a prospective, observational, longitudinal, multicenter study. We included a symptomatic and an asymptomatic cohort of ICAD patients that underwent 3T MRI including high-resolution sequences focused on the atheromatous plaque. We evaluated grade of stenosis, plaque characteristics, and gadolinium enhancement ratio (postcontrast plaque signal/postcontrast corpus callosum signal). The occurrence of new events was evaluated at 3, 6, 9, and 12 months and annually thereafter. The association between plaque characteristics and new stroke was studied using Cox multiple regression survival analysis and Kaplan-Meier curves. RESULTS Forty-eight symptomatic and 13 asymptomatic patients were included. During 56.3 ± 16.9 months, 11 patients (18%) suffered a new event (seven ischemic, two hemorrhagic, and two transient ischemic attacks). A receiver operating characteristic curve identified an enhancement ratio of >1.77 to predict a new event. In a multivariable Cox regression, postcontrast enhancement ratio >1.77 (hazard ratio [HR]= 3.632; 95% confidence interval [CI], 1.082-12.101) and cerebral microbleeds (HR = 5.244; 95% CI, 1.476-18.629) were independent predictors of future strokes. Patients with a plaque enhancement ratio >1.77 had a lower survival free of events (p < .05). CONCLUSIONS High intracranial postcontrast enhancement is a long-term predictor of new stroke in ICAD patients. Further studies are needed to elucidate whether postcontrast enhancement reflects inflammatory activity of intracranial atheromatous plaque.
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Affiliation(s)
- Beatriz Gómez-Vicente
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain
| | - María Hernández-Pérez
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - Elena Martínez-Velasco
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Josep Munuera
- Imatge Diagnòstica i Terapèutica, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Servei de Diagnòstic per la Imatge, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carla Vert
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Laura Dorado
- Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - Mercedes de Lera
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Ana Isabel Calleja
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Elisa Cortijo
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
| | - Jesús Agulla
- Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain.,Molecular Neurobiology Laboratory, Instituto de Biología Funcional y Genómica (IBFG), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Salamanca, Salamanca, Spain
| | - Elena López-Cancio
- Department of Neurology, Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Juan Francisco Arenillas
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.,Neurovascular Research Laboratory, Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Consejo Superior de Investigaciones Científicas (CSIC) y Universidad de Valladolid, Valladolid, Spain
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22
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Sun J, Feng XR, Yang X, Feng PY, Liu YB, Yang HX, Zhang TZ. Correlation between characteristics of intracranial atherosclerotic plaques and ischemic stroke in high-resolution vascular wall MRI. Acta Radiol 2023; 64:732-740. [PMID: 35345899 DOI: 10.1177/02841851221088917] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis is a major cause of ischemic stroke, accounting for 30% of ischemic strokes in Asian populations. PURPOSE To investigate the relationship between the degree of arterial stenosis and enhancement grade of intracranial atherosclerotic disease (ICAD), the plaque characteristics in different remodeling patterns, and its potential impact. MATERIAL AND METHODS A total of 210 patients diagnosed with ICAD were enrolled in this retrospective study. Patients were divided into the middle cerebral artery (MCA) group (101 cases), posterior cerebral artery (PCA) group (14 cases), basilar artery (BA) group (71 cases), and intracranial segment of vertebral artery (VA) group (90 cases) according to the difference of diseased vessels. Data on presence or absence of ischemic infarction, intracranial vascular position of lesions, plaque characteristics, ICAD enhancement grade, remodeling index, and degree of arterial stenosis were collected for analysis. RESULTS The incidence of ischemic infarction in enhancement grade 2 was significantly higher than that in enhancement grade 1 in MCA group (P = 0.019). Enhancement grade 2 of ICAD was an independent risk factor for the development of ischemic infarction (odds ratio = 4.60; 95% confidence interval: 1.91-11.03; P = 0.001). There was no significant statistical difference in infarct rate between different remodeling modalities (P>0.05). CONCLUSION Enhancement grade of ICAD is significantly associated with the degree of stenosis and the occurrence of ischemic stroke, which varies in different intracranial vessels. The pattern of vascular remodeling varies among different intracranial vessels, and the pattern of vascular remodeling has a significant impact on plaque characteristics.
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Affiliation(s)
- Jie Sun
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xu-Ran Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xuan Yang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Ping-Yong Feng
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Yu-Bo Liu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Hai-Xiao Yang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Tian-Zi Zhang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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23
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Meng Y, Zhang Y, Chu X, Song Y, Zhao W, Zheng M, Zhang J, Han J. Plaque modification and stabilization after drug-coated balloon angioplasty for intracranial atherosclerotic lesions. Eur Radiol 2023; 33:1112-1120. [PMID: 36136108 DOI: 10.1007/s00330-022-09129-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). We aimed to evaluate changes of vessel wall features of ICAD lesions after DCB treatment by using vessel wall MRI (VWMRI). METHODS We retrospectively included patients with symptomatic ICAD who underwent DCB angioplasty alone. The incidences of stenosis of the lumen area, vessel wall thickening, hyperintense plaques, and prominent wall enhancement were compared between the baseline and follow-up VWMRI. RESULTS There were 29 ICAD lesions from 29 patients, of which 22 were stenosis and 7 were occlusion. The median interval between DCB treatment and follow-up VWMRI was 4.1 [3.3, 6.7] months. After DCB treatment, follow-up VWMRI showed a significant decrease in the stenosis degree of the lumen area (83% [71%, 96%] vs 15% [3%, 41%], p < 0.001). Thirty-eight percent (11/29) of the patients observed normal appearance of the target vessel wall on follow-up VWMRI. In the stenosis group, the prevalence of hyperintense plaques decreased from 66.7% (14/21) at baseline to 23.8% (5/21) at follow-up, and prominent wall enhancement decreased from 66.7% (14/21) at baseline to 19.0%(4/21) at follow-up. The incidence of hyperintense plaques (p = 0.028) and vessel wall thickening (p = 0.018) tended to decrease with follow-up time. Although not significant (p = 0.106), a similar trend was observed between the incidence of prominent wall enhancement and follow-up time. CONCLUSION Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions. KEY POINTS • A drug-coated balloon (DCB) has potential applications in the treatment of intracranial atherosclerotic disease (ICAD). • Vascular healing with plaque modification and stabilization occurred following DCB treatment of ICAD lesions.
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Affiliation(s)
- Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yuyan Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Xi Chu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yun Song
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Wei Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Meimei Zheng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
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24
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Ge P, Li H, Ya X, Xu Y, Ma L, He Q, Wang R, Liu Z, Zhang Q, Zhang Y, Wang W, Zhang D, Zhao J. Single-cell atlas reveals different immune environments between stable and vulnerable atherosclerotic plaques. Front Immunol 2023; 13:1085468. [PMID: 36741406 PMCID: PMC9889979 DOI: 10.3389/fimmu.2022.1085468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Regardless of the degree of stenosis, vulnerable plaque is an important cause of ischemic stroke and thrombotic complications. The changes of the immune microenvironment within plaques seem to be an important factor affecting the characteristics of the plaque. However, the differences of immune microenvironment between stable and vulnerable plaques were remained unknown. Methods In this study, RNA-sequencing was performed on superficial temporal arteries from 5 traumatic patients and plaques from 3 atherosclerotic patients to preliminary identify the key immune response processes in plaques. Mass cytometry (CyTOF) technology was used to explore differences in immune composition between 9 vulnerable plaques and 12 stable plaques. Finally, immunofluorescence technique was used to validate our findings in the previous analysis. Results Our results showed that more CD86+CD68+ M1 pro-inflammatory macrophages were found in vulnerable plaques, while CD4+T memory cells were mainly found in stable plaques. In addition, a CD11c+ subset of CD4+T cells with higher IFN-r secretion was found within the vulnerable plaque. In two subsets of B cells, CD19+CD20-B cells in vulnerable plaques secreted more TNF-a and IL-6, while CD19-CD20+B cells expressed more PD-1 molecules. Conclusion In conclusion, our study suggested that M1-like macrophages are the major cell subset affecting plaque stability, while functional B cells may also contribute to plaque stability.
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Affiliation(s)
- Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaolong Ya
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yiqiao Xu
- Capital Medical University, Beijing, China
| | - Long Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zechen Liu
- Department of Biostatistics, Harvard School of Public Health, Huntington Avenue, Boston, MA, United States
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenjing Wang
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China,*Correspondence: Wenjing Wang, ; Dong Zhang, ; Jizong Zhao,
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China,Department of Neurosurgery, Beijing Hospital, Beijing, China,*Correspondence: Wenjing Wang, ; Dong Zhang, ; Jizong Zhao,
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China,China National Clinical Research Center for Neurological Diseases, Beijing, China,*Correspondence: Wenjing Wang, ; Dong Zhang, ; Jizong Zhao,
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25
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Liu H, Liu Y, Ip BYM, Ma SH, Abrigo J, Soo YOY, Leung TW, Leng X. Effects of stent shape on focal hemodynamics in intracranial atherosclerotic stenosis: A simulation study with computational fluid dynamics modeling. Front Neurol 2022; 13:1067566. [PMID: 36582612 PMCID: PMC9792661 DOI: 10.3389/fneur.2022.1067566] [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: 10/12/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background and aims The shape of a stent could influence focal hemodynamics and subsequently plaque growth or in-stent restenosis in intracranial atherosclerotic stenosis (ICAS). In this preliminary study, we aim to investigate the associations between stent shapes and focal hemodynamics in ICAS, using computational fluid dynamics (CFD) simulations with manually manipulated stents of different shapes. Methods We built an idealized artery model, and reconstructed four patient-specific models of ICAS. In each model, three variations of stent geometry (i.e., enlarged, inner-narrowed, and outer-narrowed) were developed. We performed static CFD simulation on the idealized model and three patient-specific models, and transient CFD simulation of three cardiac cycles on one patient-specific model. Pressure, wall shear stress (WSS), and low-density lipoprotein (LDL) filtration rate were quantified in the CFD models, and compared between models with an inner- or outer-narrowed stent vs. an enlarged stent. The absolute difference in each hemodynamic parameter was obtained by subtracting values from two models; a normalized difference (ND) was calculated as the ratio of the absolute difference and the value in the enlarged stent model, both area-averaged throughout the arterial wall. Results The differences in focal pressure in models with different stent geometry were negligible (ND<1% for all cases). However, there were significant differences in the WSS and LDL filtration rate with different stent geometry, with ND >20% in a static model. Observable differences in WSS and LDL filtration rate mainly appeared in area adjacent to and immediately distal to the stent. In the transient simulation, the LDL filtration rate had milder temporal fluctuations than WSS. Conclusions The stent geometry might influence the focal WSS and LDL filtration rate in ICAS, with negligible effect on pressure. Future studies are warranted to verify the relevance of the changes in these hemodynamic parameters in governing plaque growth and possibly in-stent restenosis in ICAS.
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Affiliation(s)
- Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Yu Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Bonaventure Y. M. Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Thomas W. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Xinyi Leng
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26
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Zhang S, Wang J, Lu J, Qi P, Hu S, Yang X, Chen K, Wang D. Plaque characteristics after endovascular treatment in patients with intracranial atherosclerotic disease. Chin Neurosurg J 2022; 8:37. [PMID: 36461080 PMCID: PMC9716672 DOI: 10.1186/s41016-022-00302-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Endovascular treatment (EVT) is an alternative option for symptomatic intracranial atherosclerotic disease (ICAD). However, the effect of EVT treatment on ICAD plaques is still unclear. This study describes the ICAD plaque characteristics after EVT treatment and analyzes the effect of different EVT treatments on plaque characteristics. METHOD From 2017 January to 2022 January, ICAD patients who underwent endovascular treatment and had follow-up high-resolution magnetic resonance image (HRMRI) were enrolled in the study. Multiple plaque characteristics, including plaque enhancement, plaque burden, were measured based on preoperative, and follow-up HRMRI. Plaque characteristics and postoperative plaque changes were analyzed between different treatment groups. RESULT Finally, 50 intracranial atherosclerotic plaques in 45 patients were included. Including 28 male patients and 17 female, media age 63.0 years old. Among 50 plaques, 41 received percutaneous angioplasty (including 22 plain balloons and 19 drug-coated balloons (DCB)) and the other 9 underwent stenting. Stenosis rate, plaque burden and eccentricity index at the lesion site were significantly decreased after EVT compared with preoperative periods (p <0.001). And only the DCB group showed a significant reduction in plaque enhancement at follow-up (p < 0.001). No significant preoperative and postoperative changes in other plaque characteristics were found. CONCLUSION EVT treatment could compromise the characteristics of intracranial periarterial atherosclerotic plaques, and DCB treatment may result in a reduction in plaque enhancement after treatment.
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Affiliation(s)
- Shun Zhang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China ,grid.506261.60000 0001 0706 7839Graduate School of Peking Union Medical College, Dongcheng, Beijing, China
| | - Junjie Wang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Jun Lu
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Peng Qi
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Shen Hu
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Ximeng Yang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Kunpeng Chen
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China
| | - Daming Wang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Dongcheng, Beijing, China ,grid.506261.60000 0001 0706 7839Graduate School of Peking Union Medical College, Dongcheng, Beijing, China
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27
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Han N, Zhang G, Yang S, Ma H, Ge H, Zhang X, Li S, Wang Y, Fan X, Yin Y, Gao Y, Shi W, Zhang X, Chang M, Tian Y. The relationship between vertebrobasilar artery calcification and intracranial atherosclerosis-related occlusion in thrombectomy. Front Neurol 2022; 13:965362. [PMID: 36267885 PMCID: PMC9577291 DOI: 10.3389/fneur.2022.965362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeDistinguishing between intracranial atherosclerosis-related occlusion (ICAS-O) and non-ICAS-O can benefit strategies of identifying the need for surgical plans prior to thrombectomy. We investigated the association between vertebrobasilar artery calcification (VBAC) and ICAS-O in acute ischemic stroke patients undergoing thrombectomy.MethodsPatients were recruited from a prospective single-center registration study who had undergone thrombectomy between October 2017 and October 2021. The enrolled patients were divided into ICAS-O and non-ICAS-O, as determined by the intraarterial therapy process. The occurrences of VBAC were recorded on intracranial non-contrast computed tomography (NCCT) scans before thrombectomy. The association between VBAC and ICAS-O was assessed using binary logistic regression.ResultsA total of 2732 patients who had undergone digital subtraction angiography were reviewed, and 314 thrombectomy patients (mean age: 65.4 years, 36.6% female) with NCCT were enrolled in this study. VBAC was detected before thrombectomy in 113 (36%) out of 314 patients. Age, hypertension, and diabetes were associated with VBAC, and a higher frequency of VBAC was identified in patients presenting posterior circulation. ICAS-O accounts for 43% (135/314) in eligible patients. From multivariable analyses, VBAC was identified as an independent predictor of ICAS-O (adjusted odds ratio, 6.16 [95% CI, 2.673–14.217], P < 0.001). Meanwhile, the (VBAC[+] atrial fibrillation[-]) group displayed higher rates of ICAS-O than the (VBAC[-] atrial fibrillation [-]) group (P < 0.001).ConclusionsWe demonstrated that VBAC is an independent risk factor for ICAS-O in patients who underwent thrombectomy. Patients free of atrial fibrillation with VBAC have more trend to be ICAS-O.
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Affiliation(s)
- Nannan Han
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Gejuan Zhang
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Shiyao Yang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Haojun Ma
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Hanming Ge
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xiao Zhang
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Medical Research Center, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Shilin Li
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanfei Wang
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xiaonan Fan
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanling Yin
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Yanjun Gao
- Department of Radiology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Wenzhen Shi
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Medical Research Center, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Xiaobo Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Mingze Chang
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- *Correspondence: Mingze Chang
| | - Ye Tian
- Department of Neurology, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China
- Ye Tian
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28
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Zhang C, Li Z, Liu L, Pu Y, Zou X, Yan H, Pan Y, Zhao X, Wang Y, Wang Y. Posterior circulation stroke due to intracranial artery disease in the Chinese population. Brain Behav 2022; 12:e2717. [PMID: 35981314 PMCID: PMC9480928 DOI: 10.1002/brb3.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Little is known about the distribution of the intracranial arteries that are responsible for noncardiogenic posterior circulation stroke (PCS) in the Chinese population. Furthermore, few studies have compared the imaging manifestations and outcomes across PCS due to the disease of different intracranial arteries. Therefore, our aim was to demonstrate the distribution of the intracranial arteries that were responsible for noncardiogenic PCS and to compare the imaging manifestations and outcome across PCS due to the disease of different intracranial arteries. METHODS We prospectively enrolled 690 patients from 22 Chinese centers with noncardiogenic PCS due to intracranial artery disease. Intracranial artery disease was classified as intracranial vertebral artery disease (IVAD) and intracranial nonvertebral artery disease (INVAD). Clinical-radiologic patterns and outcomes were compared between IVAD and INVAD. RESULTS INVAD was more frequent than IVAD. Compared to the INVAD group, the IVAD group more frequently had hypertension, coronary heart disease, multiple infarcts, border zone infarcts, territorial infarcts, small cortical infarcts, multilevel infarcts, multisector infarcts, and more often had severe stenosis of the responsible artery, more often presented with decreased alertness, gaze palsy, bilateral limb weakness, ataxia, dysphagia, diplopia, vertigo, and headache. In addition, the IVAD group had a higher National Institutes of Health stroke scale score and modified Rankin Scale score at discharge and more deaths and recurrent ischemic cerebrovascular disease within 1 year of onset. Multivariable Cox regression identified IVAD as an independent predictor of recurrent ischemic cerebrovascular disease. CONCLUSIONS PCS due to INVAD was more common in the Chinese population. However, PCS due to IVAD had more serious clinical-radiologic patterns and worse outcomes.
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Affiliation(s)
- Changqing Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xinying Zou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- 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
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Fote GM, Raefsky S, Mock K, Chaudhari A, Shafie M, Yu W. Intracranial Arterial Calcifications: Potential Biomarkers of Stroke Risk and Outcome. Front Neurol 2022; 13:900579. [PMID: 36119671 PMCID: PMC9475140 DOI: 10.3389/fneur.2022.900579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Intracranial artery calcifications (IAC), a common and easily identifiable finding on computed tomorgraphy angiography (CTA), has gained recognition as a possible risk factor for ischemic stroke. While atherosclerosis of intracranial arteries is believed to be a mechanism that commonly contributes to ischemic stroke, and coronary artery calcification is well-established as a predictor of both myocardial infarction (MI) and ischemic stroke risk, IAC is not currently used as a prognostic tool for stroke risk or recurrence. This review examines the pathophysiology and prevalence of IAC, and current evidence suggesting that IAC may be a useful tool for prediction of stroke incidence, recurrence, and response to acute ischemic stroke therapy.
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Affiliation(s)
- Gianna M. Fote
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Sophia Raefsky
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Kelton Mock
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amit Chaudhari
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Amit Chaudhari
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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30
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Long-Term Outcomes of Local Tirofiban Infusion for Intracranial Atherosclerosis-Related Occlusion. Brain Sci 2022; 12:brainsci12081089. [PMID: 36009153 PMCID: PMC9406202 DOI: 10.3390/brainsci12081089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Local tirofiban infusion has been reported as a rescue strategy for intracranial atherosclerotic stenosis (ICAS)-related stroke. However, the long-term outcomes of local tirofiban infusion during endovascular reperfusion therapy (ERT) for ICAS-related stroke are still uncertain. This study aimed to investigate the long-term outcomes of local tirofiban infusion during ERT. We retrospectively analyzed acute patients with ICAS-related stroke who were treated with local tirofiban as a rescue strategy during ERT. The primary outcomes were ischemic stroke, transient ischemic stroke (TIA), and stroke-related death within 30 days. Secondary outcomes included ischemic stroke and TIA beyond 30 days and up to 2 years after ERT in the corresponding treated vessel, symptomatic brain hemorrhage, any stroke, and non-stroke-related death. During a median follow-up of 24.0 months, 12 patients developed an ischemic stroke and TIA (4 within 30 days and 8 afterward). The 1-year risk of stroke and TIA was 9.2% (95% confidence interval, 8.0–18.6%). This study demonstrates that 1-year outcomes of local tirofiban infusion were comparable to the results of intracranial stenting in patients with symptomatic ICAS. Local tirofiban infusion for ICAS-related stroke may be a feasible rescue strategy that can have a bridging role until the maximum effect of antiplatelet agents is achieved.
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Georgieva JV, Katt M, Ye Z, Umlauf BJ, Wenthur CJ, Shusta EV. The 46.1 Antibody Mediates Neurotensin Uptake into the CNS and the Effects Depend on the Route of Intravenous Administration. Pharmaceutics 2022; 14:pharmaceutics14081706. [PMID: 36015332 PMCID: PMC9414616 DOI: 10.3390/pharmaceutics14081706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Central nervous system (CNS) exposure to blood-borne biotherapeutics is limited by the restrictive nature of the brain vasculature. In particular, tightly sealed endothelial cells of the blood-brain barrier (BBB) prevent the uptake of protein and gene medicines. An approach to increase the bioavailability of such therapeutics is harnessing the BBB endothelial cells' own receptor-mediated transcytosis (RMT) mechanisms. Key to this process is a targeting ligand that can engage a BBB-resident RMT receptor. We recently identified an antibody, named 46.1, that accumulates in the mouse brain after intravenous injection. To further characterize the brain targeting and penetrating properties of clone 46.1, we conjugated neurotensin (NT) to an scFv-Fc form of the antibody (46.1-scFv-Fc-LongLinker-NT). While centrally administered NT decreases the core body temperature and locomotor activity, effects attributed to two spatially segregated brain areas, systemically administered NT has limited effects. Hence, NT can be used as a model therapeutic payload to evaluate the brain penetration of BBB-targeting antibodies and their capability to accumulate in discrete brain areas. We demonstrate that intravenously administered 46.1-scFv-Fc-LL-NT can elicit transient hypothermia and reduce drug-induced hyperlocomotion, confirming that 46.1 can deliver drug cargo to the CNS at pharmacologically relevant doses. Interestingly, when two intravenous administration routes in mice, retro-orbital and tail vein, were compared, only retro-orbital administration led to transient hypothermia. We further explored the retro-orbital route and demonstrated that the 46.1-scFv-Fc-LL-NT could enter the brain arterial blood supply directly from the retro-orbital/cavernous sinus. Taken together, the 46.1 antibody is capable of transporting drug cargo into the CNS, and at least of a portion of its CNS accumulation occurs via the cavernous sinus-arterial route.
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Affiliation(s)
- Julia V. Georgieva
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Moriah Katt
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Zhou Ye
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Benjamin J. Umlauf
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Cody J. Wenthur
- Divisions of Pharmaceutical Sciences and Pharmacy Practice, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Eric V. Shusta
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
- Correspondence:
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32
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Yan X, Tang M, Gao J, Wang L, Li L, Ma N, Shi X, Lei X, Zhang X. Sex Differences in Intracranial Atherosclerotic Plaques Among Patients With Ischemic Stroke. Front Cardiovasc Med 2022; 9:860675. [PMID: 35845071 PMCID: PMC9280275 DOI: 10.3389/fcvm.2022.860675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHigh-risk intracranial arterial plaques are the most common cause of ischemic stroke and their characteristics vary between male and female patients. However, sex differences in intracranial plaques among symptomatic patients have rarely been discussed. This study aimed to evaluate sex differences in intracranial atherosclerotic plaques among Chinese patients with cerebral ischemia.MethodsOne hundred and ten patients who experienced ischemic events underwent 3T cardiovascular magnetic resonance vessel wall scanning for the evaluation of intracranial atherosclerotic disease. Each plaque was classified according to its likelihood of causing a stroke (as culprit, uncertain, or non-culprit). The outer wall area (OWA) and lumen area of the lesion and reference sites were measured, and the wall and plaque areas, remodeling ratio, and plaque burden (characterized by a normalized wall index) were further calculated. The composition (T1 hyperintensity, enhancement) and morphology (surface irregularity) of each plaque were analyzed. Sex differences in intracranial plaque characteristics were compared between male and female patient groups.ResultsOverall, 311 plaques were detected in 110 patients with ischemic stroke (81 and 29 male and female patients, respectively). The OWA (P < 0.001) and wall area (P < 0.001) of intracranial arterial lesions were significantly larger in male patients. Regarding culprit plaques, the plaque burden in male patients was similar to that in female patients (P = 0.178, odds ratio [OR]: 0.168, 95% confidence interval [CI]: −0.020 to 0.107). However, the prevalence of plaque T1 hyperintensity was significantly higher than that in female patients (P = 0.005, OR: 15.362, 95% CI: 2.280–103.49). In the overall ischemic stroke sample, intracranial T1 hyperintensity was associated with male sex (OR: 13.480, 95% CI: 2.444–74.354, P = 0.003), systolic blood pressure (OR: 1.019, 95% CI: 1.002–1.036, P = 0.031), and current smoker (OR: 3.245, 95% CI: 1.097–9.598, P = 0.033).ConclusionFor patients with ischemic stroke, the intracranial plaque burden in male patients was similar to that in female patients; however, the plaque characteristics in male patients are associated with higher risk, especially in culprit plaques.
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Affiliation(s)
- Xuejiao Yan
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Lihui Wang
- Department of Radiology, Xi'an International Medical Center Hospital, Xi'an, China
| | - Ling Li
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Niane Ma
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaorui Shi
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Xiaoling Zhang
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Baek MS, Lee KH, Cho SY, Im YJ, Shin BS, Kang HG. Changes of Atherosclerotic Plaque in Cerebral Artery Stenosis According to High-Resolution MR Imaging. Tomography 2022; 8:1690-1701. [PMID: 35894006 PMCID: PMC9326659 DOI: 10.3390/tomography8040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis can affect multiple arteries, and result in stroke and heart disease. Clinical and conventional imaging is insufficient to predict the progression of atherosclerosis. This study investigates risk factors that rely on high-resolution magnetic resonance imaging (HR-MRI). Patients with cerebral artery stenosis who had undergone HR-MRI at least twice were included. The demographics, risk factors, and proportion of patients with cerebral artery stenosis were investigated. The association between atherosclerotic plaque characteristics and the progression or regression of artery stenosis was also analyzed. A total of 42 patients were analyzed, with a median follow-up of 16.88 ± 12.53 months. The mean age of all subjects was 63.1 ± 9.15 years, and 83.3% of them were male. The incidences of stenosis of the basilar, proximal internal carotid, and middle cerebral arteries were 21.4%, 61.9%, and 16.7%, respectively. Intraplaque hemorrhage (IPH) was detected in 20 (47.6%) patients. Multivariate analysis showed that age (odds ratio (OR), 0.87; p = 0.014), smoking (OR, 0.11; p = 0.033), and IPH regression (OR, 10.13; p = 0.027) were associated with stenosis regression. The progression of IPH (OR, 115.80; p = 0.007) was associated with stenosis progression. Results suggest that IPH on HR-MRI is associated with changes in cerebral atherosclerotic stenosis.
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Affiliation(s)
- Min Soo Baek
- Medical School, Jeonbuk National University, Jeonju 54907, Korea; (M.S.B.); (K.H.L.); (S.Y.C.)
| | - Kang Hoon Lee
- Medical School, Jeonbuk National University, Jeonju 54907, Korea; (M.S.B.); (K.H.L.); (S.Y.C.)
| | - Seong Yoon Cho
- Medical School, Jeonbuk National University, Jeonju 54907, Korea; (M.S.B.); (K.H.L.); (S.Y.C.)
| | - Yong-Jin Im
- Center for Clinical Pharmacology, Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju 54907, Korea;
| | - Byoung-Soo Shin
- Department of Neurology, Medical School, Jeonbuk National University Hospital, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Hyun Goo Kang
- Department of Neurology, Medical School, Jeonbuk National University Hospital, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-1590
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Li F, Wang Y, Hu T, Wu Y. Application and interpretation of vessel wall magnetic resonance imaging for intracranial atherosclerosis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:714. [PMID: 35845481 PMCID: PMC9279807 DOI: 10.21037/atm-22-2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Atherosclerosis is a systemic disease that occurs in the arteries, and it is the most important causative factor of ischemic stroke. Vessel wall magnetic resonance imaging (VWMRI) is one of the best non-invasive methods for displaying the vascular features of intracranial atherosclerosis. The main clinical applications of this technique include the exploration of the pathogenesis of intracranial atherosclerotic lesions, follow-up monitoring, and treatment prognosis judgment. As the demand for intracranial VWMRI increases in clinical practice, radiologists should be aware of the selection of imaging parameters and how they affect image quality, clinical indications, evaluation methods, and limitations in interpreting these images. Therefore, this review focused on describing how to perform and interpret VWMRI of intracranial atherosclerotic lesions. Methods We searched the studies on the application of VWMRI in the PubMed database from January 1, 2000 to March 31, 2022, and focused on the analysis of related studies on VWMRI in atherosclerotic lesions, including technical application, expert consensus, imaging characteristics, and the clinical significance of intracranial atherosclerotic lesions. Key Content and Findings We reviewed and summarized recent advances in the clinical application of VWMRI in atherosclerotic diseases. Currently accepted principles and expert consensus recommendations for intracranial VWMRI include high spatial resolution, multiplanar two and three-dimensional imaging, multiple tissue-weighted sequences, and blood and cerebrospinal fluid suppression. Understanding the characteristics of VWMRI of normal intracranial arteries is the basis for interpreting VWMRI of atherosclerotic lesions. Evaluating VWMRI imaging features of intracranial atherosclerotic lesions includes plaque morphological and enhancement characteristics. The evaluation of atherosclerotic plaque stability is the highlight of VWMRI. Conclusions VWMRI has a wide range of clinical applications and can address important clinical questions and provide critical information for treatment decisions. VWMRI plays a key role in the comprehensive evaluation and prevention of intracranial atherosclerosis. However, intracranial VWMRI is still unable to obtain in vivo plaque pathological specimens for imaging—pathological comparison is the most significant limitation of this technique. Further technical improvements are expected to reduce acquisition time and may ultimately contribute to a better understanding of the underlying pathology of lesions on VWMRI.
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Affiliation(s)
- Fangbing Li
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yilin Wang
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Tianxiang Hu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yejun Wu
- Department of Radiology, Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Li J, Fan Y, Zhang J, Xing S, Tang S, Li X, Dang C, Zeng J. Silent brain infarction is associated with carotid siphon calcification in ischemic stroke patients. Neuroimage Clin 2022; 35:103050. [PMID: 35644109 PMCID: PMC9157544 DOI: 10.1016/j.nicl.2022.103050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Silent brain infarction (SBI) had a higher prevalence in ischemic stroke patients than healthy population. Intracranial artery calcification, as the important component of atherosclerosis, is a known risk factor of ischemic stroke. Whether it is also the risk factor of SBI is uncertain. We aimed to assess the association between SBI and carotid siphon calcification (CSC) in ischemic stroke patients. METHODS We retrospectively collected consecutive data of acute ischemic stroke patients with and without SBI by Magnetic Resonance Imaging (MRI) and calcification using non-contrast Computerized Tomography (NCCT). We used a histopathologically validated method to score the circularity, thickness, and morphology of calcification. Clinical characteristics, prevalence and pattern (intimal and medial) of CSC were compared between patients with and without SBI. The association of CSC and SBI was investigated by logistic regression analysis. RESULTS Totally, 303 acute ischemic stroke patients were enrolled, of whom 260 (85.8%) had CSC. Patients with SBI were older (64.5 ± 10.4 years vs. 61.3 ± 12.1 years, P = 0.032), had a higher proportion of hypertension (77.5% vs. 65.7%, P = 0.035). Of the 260 CSC patients, there's no significant difference except for hyperlipidemia between patients with SBI and without SBI. The prevalence of intimal pattern of CSC was higher in those with SBI (adjusted odds ratio 2.42, 95% CI 1.219-4.794). CONCLUSIONS Patients with SBI at acute phase of ischemic stroke have more risk factors than mentioned previously. SBI associated with the intimal pattern of CSC which relate to the atherosclerosis process in symptomatic ischemic stroke patients.
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Affiliation(s)
- Jingjing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Shihui Xing
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Shujin Tang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Xiaoshuang Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Chao Dang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China.
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Hiremath SB, Erdenebold UE, Kontolemos M, Miller W, Zakhari N. Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis. Neuroradiology 2022; 64:2285-2293. [PMID: 35551423 DOI: 10.1007/s00234-022-02974-1] [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: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation. METHODS We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis. RESULTS Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3-40.7%). CONCLUSION Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.
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Affiliation(s)
- Shivaprakash B Hiremath
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Undrakh-Erdene Erdenebold
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Mario Kontolemos
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - William Miller
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Nader Zakhari
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Hu F, Lu F, Xiao H, Dong M, Xu Y. Relationship Between Hypertension and Basilar Atherosclerosis in Chinese Han Population: A High-Resolution Magnetic Resonance Imaging Study. Front Cardiovasc Med 2022; 9:830664. [PMID: 35571152 PMCID: PMC9094699 DOI: 10.3389/fcvm.2022.830664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the relationship between hypertension and basilar atherosclerosis evaluated by high-resolution magnetic resonance imaging (HR-MRI) in the Chinese Han population. Methods High resolution-MRI vessel wall imaging was performed in selected 193 patients for various indications. Multivariable logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to assess the relationship between hypertension and basilar artery (BA) plaque, moderate or severe stenosis of BA plaque, and vulnerable plaque. A linear regression model was used to assess the relationship between hypertension and BA plaque numbers. Results Patients with hypertension had a higher proportion of BA plaque and vulnerable plaque as well as more number of enhancements of BA plaque and serious plaque compared with normotensive patients (all values of p < 0.05). Multivariable logistic regression analysis indicated that patients with hypertension had an increased risk for and more number of enhancements of BA plaque (adjusted-OR: 4.32, 95% CI 1.89–9.88, p < 0.001; adjusted-β: 0.55, 95% CI 0.14–0.96, p = 0.009, respectively) and had a higher proportion of moderate or severe stenosis of BA plaque and vulnerable plaque (adjusted-OR: 3.08, 95% CI 0.77–12.32, p = 0.111; adjusted-OR: 4.52, 95% CI 1.50–13.64, p = 0.007, respectively) compared with the normotensive group. Moreover, there was a saturation effect of age on the prevalence of BA plaque and vulnerable plaque. Conclusion Hypertension was the independent risk factor of BA plaque and vulnerable plaque assessed by HR-MRI in the Chinese Han population.
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Affiliation(s)
- Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Lu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huiling Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meixue Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Xu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yan Xu,
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Jia Y, Liu X, Zhang L, Kong X, Chen S, Zhang L, Wang J, Shu S, Liu J, Fu X, Liu D, Wang J, Shi H. Integrated head and neck imaging of symptomatic patients with stroke using simultaneous non-contrast cardiovascular magnetic resonance angiography and intraplaque hemorrhage imaging as compared with digital subtraction angiography. J Cardiovasc Magn Reson 2022; 24:19. [PMID: 35307027 PMCID: PMC8935695 DOI: 10.1186/s12968-022-00849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both stenosis rate and intraplaque hemorrhage (IPH) are important predictors of stroke risk. Simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) cardiovascular magnetic resonance (CMR) imaging can detect both stenosis rate and IPH. We aimed to evaluate consistency between SNAP and digital subtraction angiography (DSA) to assess symptomatic patients with stroke and explore the performance of SNAP to identify IPH and the clinical factors associated with IPH. METHODS Eighty-one symptomatic patients with stroke, admitted to Wuhan Union Hospital who underwent CMR high-resolution vessel wall imaging (HR-VWI) and SNAP, were retrospectively identified. For patients who received interventional therapy, the imaging functions of SNAP and HR-VWI were compared with DSA. The diameters of the intracranial and carotid vessels were measured, and stenotic vessels were identified. The consistency of SNAP and HR-VWI in identifying IPH was also examined, and the correlations between IPH and clinical factors were analyzed. RESULTS SNAP was more consistent with DSA than HR-VWI in measuring vascular stenosis (intraclass correlation coefficient [ICC]SNAP-DSA = 0.917, ICC HR-VWI-DSA = 0.878). Regarding the diameter measurements of each intracranial and carotid vessel segment, SNAP was superior or similar to HR-VWI, and both were consistent with DSA in the measurement of major intracranial vascular segments. HR-VWI and SNAP exhibited acceptable agreement in identifying IPH (Kappa = 0.839, 95% confidence interval [CI]: 0.704-0.974). Patients who underwent interventional therapy had a higher plaque burden (P < 0.001). Patients with IPH had lower levels of high-density lipoprotein cholesterol (HDL) (P = 0.038) and higher levels of blood glucose (P = 0.007) and cystatin C (P = 0.040). CONCLUSIONS CMR SNAP is consistent with DSA in measuring vessel diameters and identifying atherosclerosis stenosis in each intracranial and carotid vessel segment. SNAP is also a potential alternative to HR-VWI in identifying stenosis and IPH.
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Affiliation(s)
- Yuxi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Haidian District, Beijing, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiazheng Wang
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaona Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Yang W, Wasserman B, Yang H, Liu L, Orman G, Intrapiromkul J, Trout H, Qiao Y. Characterization of Restenosis following Carotid Endarterectomy Using Contrast-Enhanced Vessel Wall MR Imaging. AJNR Am J Neuroradiol 2022; 43:422-428. [PMID: 35177544 PMCID: PMC8910800 DOI: 10.3174/ajnr.a7423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Restenosis is an important determinant of the long-term efficacy of carotid endarterectomy. Our aim was to assess the role of high-resolution vessel wall MR imaging for characterizing restenosis after carotid endarterectomy. MATERIALS AND METHODS Patients who underwent vessel wall MR imaging after carotid endarterectomy were included in this study. Restenotic lesions were classified as myointimal hyperplasia or recurrent atherosclerotic plaques based on MR imaging features of lesion compositions. Imaging characteristics of myointimal hyperplasia were compared with those of normal post-carotid endarterectomy and recurrent plaque groups. Recurrent plaques were matched with primary plaques by categories of stenosis, and differences in plaque features were compared between the 2 groups. RESULTS Twenty-two recurrent lesions from 18 patients (14 unilateral and 4 bilateral) were classified as myointimal hyperplasia or recurrent plaque. Myointimal hyperplasia showed no difference in enhancement compared with normal post-carotid endarterectomy vessels (5 unilateral) but showed stronger enhancement than recurrent plaques (80.10% [SD, 42.42%] versus 56.74% [SD, 46.54%], P = .042). A multivariate logistic regression model of plaque-feature detection in recurrent plaques compared with primary plaques adjusted for maximum wall thickness revealed that recurrent plaques were longer (OR, 4.27; 95% CI, 1.32-13.85; P = .015) and more likely to involve a flow divider and side walls (OR, 6.96; 95% CI, 1.37-35.28; P = .019). Recurrent plaques had a higher prevalence of intraplaque hemorrhage (61.5% versus 30.8%, P = .048) by a χ2 test, but compositional differences were not significant in the multivariate model. CONCLUSIONS Vessel wall MR imaging can distinguish recurrent plaques from myointimal hyperplasia and reveal features that may differ between primary and recurrent plaques, highlighting its value for evaluating patients with carotid restenosis.
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Affiliation(s)
- W. Yang
- From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland
| | - B.A. Wasserman
- From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland
| | - H. Yang
- Department of Radiology (H.Y.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - L. Liu
- From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland
| | - G. Orman
- Department of Radiology (G.O.), Texas Children's Hospital, Houston, Texas
| | - J. Intrapiromkul
- From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland
| | - H.H. Trout
- Department of Surgery (H.H.T.), Suburban Hospital, Bethesda, Maryland
| | - Y. Qiao
- From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland
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Du H, Li J, Yang W, Bos D, Zheng L, Wong LKS, Leung TW, Chen X. Intracranial Arterial Calcification and Intracranial Atherosclerosis: Close but Different. Front Neurol 2022; 13:799429. [PMID: 35211084 PMCID: PMC8861312 DOI: 10.3389/fneur.2022.799429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Intracranial arterial calcification (IAC) may be present in the intimal or medial arterial layer. This study aimed to elucidate the link between the calcification and atherosclerotic disease in the intracranial vasculature. Methods Consecutive patients with acute ischemic stroke were included. Bilateral intracranial segment of the internal carotid artery, M1 segment of the middle cerebral artery, intracranial segment of the vertebral artery, and the basilar artery were visualized by the multi-detector computed tomography (CT) and vessel-wall magnetic resonance imaging (vwMRI) within 14 days after stroke onset. IAC was into the intimal or medial pattern. Subsequently, on the vwMRI, we assessed the luminal stenosis, eccentricity, plaque burden, and intraplaque hemorrhage (IPH) as markers of atherosclerosis at each IAC site. Results Among 69 patients with stroke, IAC was identified in 35% of (161/483) artery segments, of which 61.5% were predominantly intimal calcification and 38.5% were predominantly medial calcification. About 79.8% of intimal calcifications and 64.5% of medial calcifications co-existed with atherosclerotic plaques. Intimal calcification was associated with luminal stenosis (p = 0.003) caused by atherosclerotic lesions. Compared with the medial IAC, intimal IAC was more often accompanied by eccentric plaques (p = 0.02), larger plaque burden (p = 0.001), and IPH (p = 0.001). Conclusion Our multimodal imaging-based comparison study on intracranial arteriosclerosis demonstrated that intimal IAC, compared with medial IAC, was more often accompanied by the luminal stenosis, larger plaque burden, eccentricity, and IPH, providing strong evidence for clinical evaluation on the mechanism, risk, and prognosis of ischemic stroke.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jia Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Clinical Epidemiology, Harvard TH Chan School of Public Health Boston, Cambridge, MA, United States
| | - Lu Zheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Du H, Yang W, Chen X. Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol 2022; 12:789035. [PMID: 35140673 PMCID: PMC8818681 DOI: 10.3389/fneur.2021.789035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial artery calcification (IAC) was regarded as a proxy for intracranial atherosclerosis (ICAS). IAC could be easily detected on routine computer tomography (CT), which was neglected by clinicians in the previous years. The evolution of advanced imaging technologies, especially vessel wall scanning using high resolution-magnetic resonance imaging (HR-MRI), has aroused the interest of researchers to further explore the characteristics and clinical impacts of IAC. Recent histological evidence acquired from the human cerebral artery specimens demonstrated that IAC could mainly involve two layers: the intima and the media. Accumulating evidence from histological and clinical imaging studies verified that intimal calcification is more associated with ICAS, while medial calcification, especially the internal elastic lamina, contributes to arterial stiffness rather than ICAS. Considering the highly improved abilities of novel imaging technologies in differentiating intimal and medial calcification within the large intracranial arteries, this review aimed to describe the histological and imaging features of two types of IAC, as well as the risk factors, the hemodynamic influences, and other clinical impacts of IAC occurring in intimal or media layers.
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Affiliation(s)
- Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wenjie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Xiangyan Chen
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Zhai SJ, Jia L, Kukun HJ, Wang YL, Wang H, Ding S, Jia WX. Predictive power of high-resolution vessel wall magnetic resonance imaging in ischemic stroke. Am J Transl Res 2022; 14:664-671. [PMID: 35173884 PMCID: PMC8829603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Intracranial atherosclerotic disease (ICAD) is a key contributor to ischemic stroke and has a high recurrence rate. This study aimed to investigate the function of high-resolution vessel wall MRI (HR-VW-MRI) and evaluate plaque characteristics in patients with ICAD. METHODS A consecutive series of patients with ICAD who underwent HR-VW-MRI were enrolled, and imaging measurements were acquired. Baseline clinical characteristics were identified. Telephone follow-up was conducted every three months. The endpoint events were the first onset or recurrence of ischemic stroke and new clinical vascular events. Patients were divided into groups with or without events according to whether the endpoint event occurred. RESULTS A total of 70 patients (mean age = 57.6 years old) were enrolled. The median follow-up duration was 182 days. During the follow-up, 10 patients developed ischemic stroke, experienced endpoint events, and were found with 44 plaques in the artery area. A total of 169 plaques were further found in 70 patients. There were significant differences in EI, HST1, surface features, and WA reference between the two groups (P < 0.05). Logistic analysis showed that grade 2 enhancements, stenosis degree ≥ 50%, HST1, and surface features were independent prognostic factors of the onset of stroke, caused by ICAD. CONCLUSION This prospective study demonstrates that HR-VW-MRI can identify atherosclerotic plaques in the cerebral artery and high-risk plaques, which may contribute to the prevention of ICAD and guide clinical treatment.
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Affiliation(s)
- Shu-Jia Zhai
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Lin Jia
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Han-Jiaerbieke Kukun
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Yun-Ling Wang
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Hong Wang
- Department of Radiology, The Second Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830063, China
| | - Shuang Ding
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
| | - Wen-Xiao Jia
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, China
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Al Kasab S, Almallouhi E, Spiotta AM. Rescue Endovascular Treatment for Emergent Large Vessel Occlusion With Underlying Intracranial Atherosclerosis: Current State and Future Directions. Front Neurol 2021; 12:734971. [PMID: 34759882 PMCID: PMC8573125 DOI: 10.3389/fneur.2021.734971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide and is associated with high risk of stroke recurrence. While the most common clinical presentation is acute–subacute transient ischemic attack or ischemic stroke, occasionally, patients with underlying ICAS present with acute occlusion of the affected vessel. Diagnosis and endovascular management of ICAS-related emergent large vessel occlusion (ELVO) can be challenging. Herein, we review the current evidence supporting endovascular management of ICAS-related ELVO and discuss future directions.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Alejandro M Spiotta
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
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Perng PS, Sun YT, Wang HK, Shih YH, Lee JS, Wang LC, Huang CY. Outcome of Wingspan Stent Using Aggressive Post-stent Balloon Dilation for Intracranial Atherosclerosis Stenosis. Front Neurol 2021; 12:757175. [PMID: 34759885 PMCID: PMC8572975 DOI: 10.3389/fneur.2021.757175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Wingspan stent has gained interest for better long-term outcomes for intracranial atherosclerosis disease (ICAD). However, in-stent restenosis still presents as a problem and may cause postoperative neurological events. We aimed to find a way to prevent in-stent restenosis. Method: Patients with stenosis >70% ICAD were treated with wingspan stent and were retrospectively reviewed. The patients were separated into two groups: one with post-dilation and the other without post-dilation. The outcomes of wingspan stenting were compared immediately after the surgery and at a 1-year follow-up. Results: Overall, 28 patients were included for analysis, with 15 patients undergoing post-dilation and 13 patients not undergoing the procedure. The extent of stenosis was significantly lower in the post-dilation group than in the no post-dilation group, both immediately after the surgery (14.8 ± 10.2 vs. 28.5 ± 14.5%, p < 0.01) and at 1-year follow-up (25.8 ± 18.0 vs. 50.1 ± 23.2%, p < 0.01). The post-dilation method immediately expanded the stent diameter (2.89 ± 0.48 vs. 3.05 ± 0.44 mm, p < 0.001), and the diameter still increased at 1-year follow-up (3.05 ± 0.44 vs. 3.12 ± 0.43 mm, p < 0.01) due to the self-expandable property of the wingspan. Similarly, in the no post-dilation group, the stent size was also increased (2.70 ± 0.67 vs. 2.80 ± 0.64 mm, p < 0.01). However, at 1-year follow up, the luminal diameter was stationary in the post-dilation group (2.36 ± 0.73 vs. 2.46 ± 0.82 mm, p = 0.88) and decreased in the no post-dilation group (2.24 ± 0.56 vs. 1.60 ± 0.79 mm, p < 0.01). The periprocedural complication rate was similar between the groups. Conclusion: The post-dilation method can be feasibly performed and can offer better stent expansion and apposition in the wingspan system. By applying this technique, we might prevent in-stent restenosis and improve neurological outcomes.
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Affiliation(s)
- Pang-Shuo Perng
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Advanced Optoelectronic Technology Center, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Hsiang Shih
- Department of Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Chao Wang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A 2 and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis. J Stroke Cerebrovasc Dis 2021; 30:106103. [PMID: 34587576 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 01/29/2023] Open
Abstract
PURPOSE We evaluated the relationship between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration and plaque characteristics in patients with intracranial artery stenosis and their clinical relevance in acute ischemic stroke. METHODS Eighty-seven patients with intracranial atherosclerotic stenosis (66 males, 21 females) were retrospectively enrolled. Plasma Lp-PLA2 concentration was measured, and vessel wall magnetic resonance imaging (VW-MRI) was used to determine intracranial vascular stenosis and plaque characteristics, including plaque enhancement, surface morphology, and T1 hyperintensity. Binary logistic regression was used to evaluate the relationship between Lp-PLA2 concentration and plaque characteristics of intracranial artery after adjusting for demographic and confounding factors and to assess their diagnostic efficacy for the risk of acute ischemic stroke. RESULTS After adjustment for demographic, medication and related lipid factors, Lp-PLA2 elevation was associated with plaque enhancement (odds ratio [OR]=12.7, 95% confidence interval [CI] 2.51-64.82, P=0.002) and surface irregularity (OR=2.9, 95% CI 1.06-7.98, P=0.038). Both Lp-PLA2 elevation (OR=8.8, 95% CI 1.64-47.72, P=0.011) and plaque enhancement (OR=34.3, 95% CI 5.88-200.4, P=0.001) were associated with acute ischemic stroke. Receiver operating characteristic curve analysis showed that the area under the curve for Lp-PLA2 concentration and plaque enhancement combined in the diagnosis of acute ischemic stroke was 0.884, significantly higher than that for Lp-PLA2 concentration (0.724) and plaque enhancement (0.794) alone. CONCLUSION Elevated Lp-PLA2 is associated with plaque enhancement and plaque surface irregularity. Combined assessment of Lp-PLA2 concentration and plaque enhancement is of greater diagnostic value for the risk of acute ischemic stroke in patients with intracranial artery stenosis.
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Montes D, Vranic J, Lim JC, Song JW, Silverman SB, González RG, Romero J. Cardiovascular Risk Factors Affect Specific Segments of the Intracranial Vasculature in High-Resolution (HR) Vessel Wall Imaging (VWI). J Stroke Cerebrovasc Dis 2021; 30:106026. [PMID: 34407497 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106026] [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: 03/24/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Luminal-based imaging have identified different risk factors for extracranial and intracranial atherosclerosis (ICAS), but these techniques are known to underestimate the true extent of the disease. High-resolution (HR) vessel wall imaging (VWI) has recently gained recognition as a valuable tool in the assessment of ICAS. The aim of this study is to determine the association between cardiovascular risk factors and specific intracranial vessel segment involvement using HR-VWI. MATERIALS AND METHODS From January 2017 to January 2020, consecutive patients ≥ 18 years-old undergoing HR-VWI of the brain were identified. Patients with history of primary or secondary vasculitis, reversible cerebral vasoconstriction syndrome, or moya-moya were excluded. The presence of vessel wall thickening and enhancement were assessed in the perpendicular plane for each vessel segment by two neuroradiologists. Univariate and multivariate analyses were performed to assess associations between imaging findings and cardiovascular risk factors. Interrater reliability was calculated. RESULTS Seventy-one patients (39 men; mean age: 55.9 years) were included. Vessel wall enhancement was seen in 39/71 (55%). A total number of 105 vessel segments demonstrated abnormal enhancement and 79/105 (75%) had an eccentric pattern. Eccentric vessel wall enhancement was independently associated with age >65 years-old in the ICA (OR 9.0, CI 2.1 - 38.2, p < 0.01) and proximal MCA (OR 4.0, CI 1.2 - 13.2, p = 0.02), and with hyperlipidemia in the posterior circulation (OR 44.0, CI2.9-661.0, p<0.01). CONCLUSION There is a significant association between eccentric vessel wall enhancement of the ICA and proximal MCA in patients with age > 65; and of the proximal posterior circulation (basilar - PCA1) with hyperlipidemia.
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Affiliation(s)
- Daniel Montes
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US.
| | - Justin Vranic
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Jeewoo C Lim
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Jae W Song
- Department of Radiology, Division of Neuroradiology, Hospital of the University of Pennsylvania, PA, US
| | - Scott B Silverman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
| | - R Gilberto González
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Javier Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
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Xu R, Yang B, Li L, Wang T, Lu X, Luo J, Zhang X, Dong J, Wang Y, Hua Y, Ma Y, Jiao L. Macrocalcification of intracranial vertebral artery may be related to in-stent restenosis: lessons learned from optical coherence tomography. J Neurointerv Surg 2021; 14:neurintsurg-2021-017913. [PMID: 34376557 DOI: 10.1136/neurintsurg-2021-017913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Calcification has been proven to be a marker of atherosclerosis and is related to an increased risk of ischemic stroke. Additionally, calcification was reported to be prevalent in patients with stenotic lesions of the intracranial vertebral artery. Thus, reliable imaging facilities for evaluating plaque calcification have remarkable significance in guiding stenting and predicting patient outcomes. Optical coherence tomography (OCT) has a unique advantage in its ability to detect calcium and to achieve three-dimensional volumetric calcium characterization. METHODS From March 2017 to September 2018, seven cases of calcified lesions with intracranial vertebral artery stenosis were investigated using OCT, before and after the placement of an Apollo balloon-mounted stent. Transcranial color-coded duplex sonography was performed to identify restenosis with a mean follow-up time of 13.3 months in this case series. RESULTS All calcified lesions were evaluated quantitatively and qualitatively using OCT. Among all cases, five had macrocalcifications and two had spotty calcifications. Severe in-stent restenosis was observed in two cases, both with macrocalcifications. CONCLUSIONS This study suggests a potential relationship between macrocalcifications and the risk of in-stent restenosis of the intracranial vertebral artery. These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.
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Affiliation(s)
- Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Jia Dong
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China .,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China .,China International Neuroscience Institute (China-INI), Beijing, People's Republic of China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhao JJ, Lu Y, Cui JY, Ma LQ, Zhang RP, Xu Z. Characteristics of symptomatic plaque on high-resolution magnetic resonance imaging and its relationship with the occurrence and recurrence of ischemic stroke. Neurol Sci 2021; 42:3605-3613. [PMID: 34236554 DOI: 10.1007/s10072-021-05457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events. METHODS The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020. RESULTS We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke. CONCLUSION High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.
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Affiliation(s)
- Jie-Ji Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Yue Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China
| | - Jun-Yi Cui
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China
| | - Lin-Qing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Run-Ping Zhang
- Department of Neurology, The People's Hospital of Suzhou New District, No. 95, Huashan Road, Suzhou, Jiangsu Province, China.
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu Province, China.
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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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50
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Lindenholz A, de Bresser J, van der Kolk AG, van der Worp HB, Witkamp TD, Hendrikse J, van der Schaaf IC. Intracranial Atherosclerotic Burden and Cerebral Parenchymal Changes at 7T MRI in Patients With Transient Ischemic Attack or Ischemic Stroke. Front Neurol 2021; 12:637556. [PMID: 34025551 PMCID: PMC8134532 DOI: 10.3389/fneur.2021.637556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
The relevance of intracranial vessel wall lesions detected with MRI is not fully established. In this study (trial identification number: NTR2119; www.trialregister.nl), 7T MRI was used to investigate if a higher vessel wall lesion burden is associated with more cerebral parenchymal changes in patients with ischemic stroke or transient ischemic attack (TIA). MR images of 82 patients were assessed for the number of vessel wall lesions of the large intracranial arteries and for cerebral parenchymal changes, including the presence and number of cortical, small subcortical, and deep gray matter infarcts; lacunes of presumed vascular origin; cortical microinfarcts; and periventricular and deep white matter hyperintensities (WMHs). Regression analyses showed that a higher vessel wall lesion burden was associated with the presence of small subcortical infarcts, lacunes of presumed vascular origin, and deep gray matter infarcts (relative risk 1.18; 95% CI, 1.03–1.35) and presence of moderate-to-severe periventricular WMHs (1.21; 95% CI, 1.03–1.42), which are all manifestations of small vessel disease (SVD). The burden of enhancing vessel wall lesions was associated with the number of cortical microinfarcts only (1.48; 95% CI, 1.04–2.11). These results suggest an interrelationship between large vessel wall lesion burden and cerebral parenchymal manifestations often linked to SVD or, alternatively, that vascular changes occur in both large and small intracranial arteries simultaneously.
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Affiliation(s)
- Arjen Lindenholz
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.,Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Theodoor D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
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