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Suo Y, Jing J, Meng X, Li Z, Pan Y, Yan H, Jiang Y, Liu L, Zhao X, Wang Y, Li H, Wang Y. Intracranial arterial stenosis and recurrence in stroke patients with different risk stratifications by Essen stroke risk score. Neurol Res 2023; 45:1069-1078. [PMID: 37724803 DOI: 10.1080/01616412.2023.2257415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/29/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES We sought to investigate whether the prognostic value of intracranial arterial stenosis (ICAS) is consistent across different risk stratifications using the Essen Stroke Risk score (ESRS). METHODS We derived data from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial. Patients without complete baseline brain imaging data were excluded. Participants were categorized into different risk groups based on ESRS (low risk, 0-2, and high risk ≥ 3). The main outcome was stroke recurrence within 3 and 12 months. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of ICAS, and other factors associated with stroke recurrence within 3 and 12 months were estimated using the Cox regression method. RESULTS During the 3-month follow-up, 54 patients (7.9%) had recurrent stroke in the low-risk group, and 39 patients (9.6%) had recurrent stroke in the high-risk group. ICAS was associated with a higher risk of stroke within 3 months (HR = 2.761; 95%CI = 1.538-4.957; P < 0.001) in the low-risk group, but not in the high-risk group (HR = 1.501; 95%CI = 0.701-3.213; P = 0.296). ICAS was independently associated with higher recurrent risk in the low-risk group (HR = 2.540; 95%CI = 1.472-4.381; P < 0.001), but not in the high-risk group (HR = 1.951; 95%CI = 0.977-3.893; P = 0.058) within 12 months. CONCLUSION ICAS was an independent predictor of both 3- and 12-month stroke recurrence in low-risk but not high-risk patients with minor ischemic stroke or transient ischemic attack according to ESRS stratification.
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Affiliation(s)
- Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- 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
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- 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
| | - 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
| | - Hao Li
- 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
- Tiantan Neuroimaging Center of Excellence, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
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Shen Y, Wang J, Wang A, Zhao X. Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis: Results From the APAC Study. Neurologist 2023; 28:300-303. [PMID: 37083844 PMCID: PMC10521774 DOI: 10.1097/nrl.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS. METHODS The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS. RESULTS During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively). CONCLUSIONS LDL-C is not an independent predictor of AICAS incidence in the Chinese population.
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Affiliation(s)
- Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Jing Wang
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
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Wang X, Pan Y, Zhang R, Wang M, Qin H, Meng X, Li Z, Li H, Wang Y, Zhao X, Wang Y, Liu G. The Association Between the Fibrinogen-to-Albumin Ratio and Intracranial Arterial Stenosis in Patients With Acute Ischemic Stroke. Angiology 2023:33197231190514. [PMID: 37477872 DOI: 10.1177/00033197231190514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The association between the fibrinogen-to-albumin ratio (FAR) and intracranial arterial stenosis (ICAS) in patients with acute ischemic stroke (AIS) has not yet been reported. In this large-scale investigation, 7894 AIS patients with ICAS-evaluation imaging data from the Third China National Stroke Registry were included. ICAS was defined as >50% stenosis of the intracranial arteries. We dichotomized the degree of ICAS into stenosis and occlusion. The number of ICAS lesions was the total number of intracranial stenotic arteries. Fibrinogen and albumin levels were assessed in the central laboratory of Beijing Tiantan Hospital. Univariate and multivariate analyses with logistic regression were used to determine the association between the FAR quartiles and ICAS. A total of 3900 (49.66%) patients had ICAS. Compared with those of the lowest FAR quartile, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the highest FAR quartile were 1.26 (1.10-1.44), 1.15 (.99-1.33), and 1.19 (1.01-1.39) for ICAS, symptomatic ICAS, and asymptomatic ICAS, respectively. An elevated FAR was also associated with occlusion (adjusted OR: 1.28, 95% CI: 1.10-1.49) and lesion number ≥2 (adjusted OR: 1.25, 95% CI: 1.07-1.45).
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Affiliation(s)
- Xiaoyu Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- 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
| | - Hao Li
- 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
| | - Xingquan Zhao
- 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
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Niu J, Ran Y, Chen R, Zhang F, Lei X, Wang X, Li T, Zhu J, Zhang Y, Cheng J, Zhang Y, Zhu C. Use of PETRA-MRA to assess intracranial arterial stenosis: Comparison with TOF-MRA, CTA, and DSA. Front Neurol 2023; 13:1068132. [PMID: 36726752 PMCID: PMC9884682 DOI: 10.3389/fneur.2022.1068132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023] Open
Abstract
Background and purpose Non-invasive and accurate assessment of intracranial arterial stenosis (ICAS) is important for the evaluation of intracranial atherosclerotic disease. This study aimed to evaluate the performance of 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) and compare its performance with that of 3D time-of-flight (TOF) MRA and computed tomography angiography (CTA), using digital subtraction angiography (DSA) as the reference standard in measuring the degree of stenosis and lesion length. Materials and methods This single-center, prospective study included a total of 52 patients (mean age 57 ± 11 years, 27 men, 25 women) with 90 intracranial arterial stenoses who underwent PETRA-MRA, TOF-MRA, CTA, and DSA within 1 month. The degree of stenosis and lesion length were measured independently by two radiologists on these four datasets. The degree of stenosis was classified according to DSA measurement. Severe stenosis was defined as a single lesion with >70% diameter stenosis. The smaller artery stenosis referred to the stenosis, which occurred at the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery, except for the first segment of them. The continuous variables were compared using paired t-test or Wilcoxon signed rank test. The intraclass correlation coefficients (ICCs) were used to assess the agreement between MRAs/CTA and DSA as well as inter-reader variabilities. The ICC value >0.80 indicated excellent agreement. The agreement of data was assessed further by Bland-Altman analysis and Spearman's correlation coefficients. When the difference between MRAs/CTA and DSA was statistically significant in the degree of stenosis, the measurement of MRAs/CTA was larger than that of DSA, which referred to the overestimation of MRAs/CTA for the degree of stenosis. Results The four imaging methods exhibited excellent inter-reader agreement [intraclass correlation coefficients (ICCs) > 0.80]. PETRA-MRA was more consistent with DSA than with TOF-MRA and CTA in measuring the degree of stenosis (ICC = 0.94 vs. 0.79 and 0.89) and lesion length (ICC = 0.99 vs. 0.97 and 0.73). PETRA-MRA obtained the highest specificity and positive predictive value (PPV) than TOF-MRA and CTA for detecting stenosis of >50% and stenosis of >75%. TOF-MRA and CTA overestimated considerably the degree of stenosis compared with DSA (63.0% ± 15.8% and 61.0% ± 18.6% vs. 54.0% ± 18.6%, P < 0.01, respectively), whereas PETRA-MRA did not overestimate (P = 0.13). The degree of stenosis acquired on PETRA-MRA was also more consistent with that on DSA than with that on TOF-MRA and CTA in severe stenosis (ICC = 0.78 vs. 0.30 and 0.57) and smaller artery stenosis (ICC = 0.95 vs. 0.70 and 0.80). In anterior artery circulation stenosis, PETRA-MRA also achieved a little bigger ICC than TOF-MRA and CTA in measuring the degree of stenosis (0.93 vs. 0.78 and 0.88). In posterior artery circulation stenosis, PETRA-MRA had a bigger ICC than TOF-MRA (0.94 vs. 0.71) and a comparable ICC to CTA (0.94 vs. 0.91) in measuring the degree of stenosis. Conclusion PETRA-MRA is more accurate than TOF-MRA and CTA for the evaluation of intracranial stenosis and lesion length when using DSA as a reference standard. PETRA-MRA is a promising non-invasive tool for ICAS assessment.
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Affiliation(s)
- Junxia Niu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Chen
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Zhang
- Department of Magnetic Resonance, Pingmei Shenma Medical Group General Hospital, Pingdingshan, China
| | - Xiaowen Lei
- Department of Magnetic Resonance, Xuchang Central Hospital, Xuchang, China
| | - Xiao Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tengfei Li
- Department of Intervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,*Correspondence: Yan Zhang ✉
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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Reale G, Zauli A, La Torre G, Mannocci A, Mazya MV, Zedde M, Giovannini S, Moci M, Iacovelli C, Caliandro P. Dual anti-platelet therapy for secondary prevention in intracranial atherosclerotic disease: a network meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864221114716. [PMID: 35958039 PMCID: PMC9358568 DOI: 10.1177/17562864221114716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Intracranial arterial stenosis (ICAS) is a non-marginal cause of stroke/transient ischemic attacks (TIAs) and is associated with high stroke recurrence rate. Some studies have investigated the best secondary prevention ranging from antithrombotic therapy to endovascular treatment (ET). However, no direct comparison between all the possible treatments is currently available especially between single and dual anti-platelet therapies (SAPT and DAPT). Aim: To establish whether DAPT is more effective than SAPT in preventing the recurrence of ICAS-related stroke, by means of a network meta-analysis (NMA). Design: Systematic review and NMA in accordance to PRISMA guidelines. Data sources and methods: We performed a systematic review of trials investigating secondary prevention (SAPT or DAPT, anticoagulant treatment or ET) in patients with symptomatic ICAS available in MEDLINE, Scopus and Web of Science from January 1989 to May 2021. We defined our primary efficacy outcome as the recurrence of ischemic stroke/TIA. We analysed the extracted data with Bayesian NMA approach. Results: We identified 815 studies and included 5 trials in the NMA. Sequence generation was adequate in all the selected studies while the allocation concealment method was described in one study. All the included studies reported the pre-specified primary outcomes, and outcome assessment was blinded in all the studies. We used the fixed-effect approach as the heterogeneity was not significant (p > 0.1) according to the Cochran’s Q statistic. DAPT was superior to SAPT and DAPT + ET in preventing stroke/TIA recurrence [respectively, odds ratio (OR), 0.59; confidence interval (CI), 0.39–0.9; and OR, 0.49, CI, 0.26–0.88], while no difference was found between DAPT and oral anticoagulant therapy (OAC). DAPT was safer than OAC (OR, 0.48; CI, 0.26–0.89) and DAPT + ET (OR, 0.50; CI, 0.35–0.71), while no difference was found between DAPT and SAPT. Conclusion: DAPT is more effective than SAPT for secondary stroke prevention in patients with symptomatic ICAS, without increasing the risk of haemorrhage. Registration: Prospero/CRD42019140033.
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Affiliation(s)
- Giuseppe Reale
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aurelia Zauli
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, Rome, Italy
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, Reggio Emilia 42122, Italy
| | - Silvia Giovannini
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Moci
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Iacovelli
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pietro Caliandro
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Abdollahifard S, Yousefi O, Kamran H, Mowla A. Balloon-mounting stent for intracranial arterial stenosis: A comprehensive and comparative systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221100620. [PMID: 35549530 PMCID: PMC10399500 DOI: 10.1177/15910199221100620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As one of the major causes of acute ischemic stroke, intracranial arterial stenosis necessitates an intervention that ranges from medical treatment to balloon angioplasty and stenting. Self-expandable stents (SES) and balloon-mounted stents (BMS) are two types of stents and their comparative efficacy and safety for intracranial stenosis are not well established. METHODS Studies that investigate balloon-mounted stenting for intracranial stenosis were extracted from PubMed, Scopus, and Cochrane library. We sought to gather data on the success rate, change in mean arterial stenosis, and complications such as minor and major stroke and death (MMD), symptomatic intracranial hemorrhage, myocardial infarction, all-cause mortality, and in-stent re-stenosis. RESULTS 3049 patients from 35 studies were included in this study. 20 studies investigated BMS alone and others compared BMS with SES. BMS was significantly more effective in reducing the degree of stenosis compared to SES (Difference in mean -5.953, CI 95% -7.727 to -4.179), had less complications compared to SES such as MMD (8.5% vs. 11.2%) and less in-stent re-stenosis (18.6% vs. 19.6%), but patients with SES experienced a lower rate of all-cause mortality(1.7% vs. 4.1%). CONCLUSION Intracranial stenting with BMS is more effective in reducing the degree of stenosis and has lower rates of complications when compared to SES.
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Affiliation(s)
- Saeed Abdollahifard
- Research center for neuromodulation and pain, Shiraz, Iran.,Student research committee, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student research committee, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, 5116University of Southern California (USC), Los Angeles, CA, USA
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Wang X, Qiao T, Liu M, Wang X. Homocysteine Associated With Low Cognitive Function Independent of Asymptomatic Intracranial and Carotid Arteries Stenoses in Chinese Elderly Patients: An Outpatient-Based Cross-Sectional Study. J Geriatr Psychiatry Neurol 2022; 35:302-308. [PMID: 33504251 DOI: 10.1177/0891988720988914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A high homocysteine (Hcy) concentration is correlated with cognitive impairment; however, the exact underlying mechanism is still not fully elucidated. The present study aimed to investigate whether asymptomatic intracranial and carotid arteries stenoses are involved in Hcy-related low cognitive function. METHODS This was a cross-sectional study in outpatient clinics. Residents aged ≥60 years, who came to the Stroke and Rehabilitation Clinic of Shandong Provincial Third Hospital in Jinan, Shandong Province from December 2019 to May 2020 to seek consultation due to abnormal transcranial Doppler reports (eg., increased cerebral blood flow velocity) were eligible. Information including demographics, medical history, lifestyle habits were collected. Fasting blood was used to detect total serum homocysteine level (tHcy). Cerebrovascular magnetic resonance angiography and neck vascular ultrasound examination were used to confirm the diagnosis of intracranial and carotid artery stenoses. The Mini-Mental State Examination was used to assess the cognitive function of each participant. Logistic regression was used to evaluate the relationship between tHcy levels and cognitive function. RESULTS This study included 236 participants (mean age: 64.0 (SD, 7.5) years, female: 58.1%). Multivariable analyses adjusted for several potential confounders, including creatinine and cardiovascular risk factors, showed that tHcy was associated with carotid artery stenosis (CAS). After adjusting for CAS, ICAS and several potential confounders, the association between tHcy level and low cognitive function remained significant (odds ratio: 1.09, 95% confidence interval: (1.03, 1.16), P = 0.032) . CONCLUSION Increased serum tHcy level was associated with low cognitive function independent of asymptomatic intracranial and carotid arteries stenoses.
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Affiliation(s)
- Xiaona Wang
- Department of Rehabilitation, 34708Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shangdong Province, China
| | - Tian Qiao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Min Liu
- Department of Rehabilitation, 34708Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shangdong Province, China
| | - Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Chen H, Pan Y, Zong L, Jing J, Meng X, Xu Y, Yan H, Zhao X, Liu L, Li H, Johnston SC, Wang Y, Wang Y. Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. Stroke Vasc Neurol 2020; 5:128-137. [PMID: 32606085 PMCID: PMC7337361 DOI: 10.1136/svn-2019-000305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/26/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear. Methods Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models. Results Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability. Interpretation CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes. Trial registration number NCT00979589
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Affiliation(s)
- Huimin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Lixia Zong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuyuan Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | | | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
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9
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Sun YA, Han Q, Hou XH, Peng XZ, Tong L, Zheng X, Yu JT, Tan L. Association of antinuclear antibodies with the risk of intracranial arterial stenosis. Aging (Albany NY) 2020; 12:1322-1331. [PMID: 31961801 PMCID: PMC7053607 DOI: 10.18632/aging.102685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/25/2019] [Indexed: 12/05/2022]
Abstract
The prevalence of intracranial arterial stenosis (IAS) as well as antinuclear antibody (ANA) positivity was found to be higher in Asians than that in the Western population. To investigate the relation of ANAs with IAS in patients with acute ischemic cerebrovascular disease, we enrolled 2492 patients with acute ischemic stroke or transient ischemic attack into the study. All the patients were categorized into 3 groups according to the IAS burden. Multinomial logistic regression analyses were used in statistical analysis. The positive rate of ANAs in the IAS ≥ 2 group was higher than that in the single IAS group and the no IAS group (p<0.001). The adjusted odds ratio (OR) for IAS ≥ 2 in ANAs-positive patients was 3.737 (95%CI=2.676-5.220, p<0.001) compared with the ANAs-negative patients. ANAs were associated with multiple IAS rather than single IAS in both male and female subgroups. Besides, ANAs were significantly associated with single and multiple IAS in individuals ≤ 60 years. However, ANAs were only associated with two or more IAS in two age groups (between 61 to 75 years and >75 years old). In summary, ANAs are associated with IAS in patients with acute ischemic cerebrovascular disease.
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Affiliation(s)
- Yong-An Sun
- Department of Neurology, First Affiliated Hospital of Kangda College, Nanjing Medical University, Lianyungang, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China
| | - Qiu Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.,Department of Neurology, Huai'an First People's Hospital, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xian-Zhen Peng
- Department of Public Health and Preventive Medicine, Kangda College of Nanjing Medical University, Lianyungang, China
| | - Lin Tong
- Department of Neurology, Yantai Affiliated Hospital of Binzhou Medical Universtiy, Yantai, China
| | - Xu Zheng
- Department of Clinical Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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10
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Bartolini E, Filippi A, Cafforio G. Transcranial color-coded sonography may indirectly reveal an intracranial meningioma. J Clin Ultrasound 2020; 48:52-55. [PMID: 31120556 DOI: 10.1002/jcu.22737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
Meningiomas are extra-axial tumors with a long-standing indolent clinical course. Sphenoid wing meningiomas may slowly grow, spreading toward the orbitofrontal and temporal regions as well as encasing the middle cerebral artery (MCA). Herein, we report the incidental finding of a sphenoid wing meningioma compressing the MCA in a patient who undergone a transcranial sonography study for recurrent speech disorders. We illustrate the associated sonographic "red flags" which should prompt to suspect an underlying compressive space-occupying lesion.
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Affiliation(s)
| | - Andria Filippi
- USL Nordovest Toscana, Neurology Unit, San Luca Hospital, Lucca, Italy
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11
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Kim BS, Lim JS, Jeong JU, Mun JH, Kim SH. Regression of asymptomatic intracranial arterial stenosis by aggressive medical management with a lipid-lowering agent. J Cerebrovasc Endovasc Neurosurg 2019; 21:144-151. [PMID: 31886149 PMCID: PMC6911929 DOI: 10.7461/jcen.2019.21.3.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/02/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The incidence rate of stroke as a result of intracranial arterial stenosis (ICAS) is higher in Asian countries than in the West. We aimed to analyze the regression, lack of change, or progression of asymptomatic ICAS after the administration of rosuvastatin and associated factors. Methods The patients who had undergone computed tomography angiography (CTA) at our hospital and had been diagnosed with ICAS with no ischemic event in the stenosed vascular territory were included in the study. They were administered 20mg of rosuvastatin per day. After a follow-up period of at least 6 months after treatment, the patients were examined using CTA again and the clinical information and imaging results were analyzed. Results In total, 48 patients were diagnosed with asymptomatic ICAS. During the final follow-up examination, it was found that the stenotic lesion regressed in 30 patients, whereas it remained unchanged or progressed without any adverse effects in 18 patients. In univariate analysis, the regressed group showed significantly higher differences in the levels of total cholesterol and low-density lipoprotein (LDL) between their initial and final values (both, p=0.031 for both). In the multivariate analysis, a significantly higher difference in the levels of LDL between its initial and final measurement was seen in the regressed group (p=0.035, odds ratio(OR) 3.9). Conclusions Rosuvastatin was found to have better lipid-lowering effects for total cholesterol and particularly LDL in patients whose ICAS had regressed. We concluded that rosuvastatin administration can be recommended for the treatment of patients with asymptomatic ICAS.
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12
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Chen HX, Wang LJ, Yang Y, Yue FX, Chen LM, Xing YQ. The prevalence of intracranial stenosis in patients at low and moderate risk of stroke. Ther Adv Neurol Disord 2019; 12:1756286419869532. [PMID: 31447935 PMCID: PMC6693021 DOI: 10.1177/1756286419869532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Previous studies assessing the risk of stroke in the general population
performed screening with Doppler ultrasonography only for high-risk patients
and neglected low- and moderate-risk patients. The aims of this study were
to explore the current prevalence of intracranial arterial stenosis (ICAS)
and analyze its association with different levels of stroke risk and risk
factors based on the risk assessment scale for stroke used in China. Methods: A total of 3654 participants who underwent transcranial Doppler ultrasound
(TCD) were eligible for inclusion. Information regarding demographic
characteristics and risk factors such as alcohol consumption and
hypertension was collected through interviews and questionnaires and used to
analyze the association of ICAS with different levels of stroke risk and
risk factors. Results: The mean age of 501 subjects diagnosed with at least one ICAS was higher than
that of participants without ICAS (57.13 ± 9.56 years and
55.52 ± 9.35 years, respectively). After adjusting for confounding factors,
gender, education, residence, hypertension and personal history of stroke
were associated with ICAS. The odds ratios for ICAS in patients with
hypertension and a personal history of stroke were 1.655 [95% confidence
interval (CI): 1.341–2.043] and 1.854 (95% CI: 1.371–2.508), respectively.
In addition, participants in the low- and moderate-risk stroke groups
accounted for an unexpectedly high proportion of individuals with ICAS (up
to 38.3%). Results from multivariate analyses indicated that the adjusted
odds ratios for ICAS in patients with moderate and high stroke risks
versus those with a low stroke risk were 1.603 (95% CI:
1.171–2.195) and 1.612 (95% CI: 1.272–2.042), respectively. Conclusion: The prevalence of ICAS is high in northeast China and increases with the
level of stroke risk. However, the proportion of patients with ICAS among
those with low and moderate stroke risks should also be noted.
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Affiliation(s)
- Hong-Xiu Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Fei-Xue Yue
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Li-Min Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
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13
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Matsuzono K, Nagaoka L, Suzuki M, Kim Y, Ozawa T, Mashiko T, Shimazaki H, Koide R, Fujimoto S. Catastrophic Secondary Infarctions with Onset Seizure Following Tissue Plasminogen Activator Therapy. J Stroke Cerebrovasc Dis 2019; 28:e24-e26. [PMID: 30655041 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/24/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022] Open
Abstract
Fatalities following intravenous recombinant tissue-type plasminogen activator therapy have been reported. Major fatal complications following intravenous recombinant tissue-type plasminogen activator therapy include intracranial hemorrhage, aortic dissection, and extracranial bleeding. However, the possibility that intravenous recombinant tissue-type plasminogen activator therapy itself paradoxically induces synchronized multiple cerebral novel infarctions has never been considered. We herein report the first case of bilateral internal carotid artery infarction with onset seizure following intravenous recombinant tissue-type plasminogen activator therapy for a vertebral-basilar artery infarction. A 75-year-old man was transferred to our hospital and diagnosed with acute ischemic stroke in the basilar artery. His National Institute of Health Stroke Scale score was 4. The intravenous recombinant tissue-type plasminogen activator therapy was initiated 234 minutes after stroke onset because no contraindications were present. Almost 2 hours after the intravenous recombinant tissue-type plasminogen activator therapy, the patient suddenly fell into a deep coma with generalized convulsions. A huge secondary infarction was found in the bilateral anterior circulation territories, and he died 7 days after stroke onset. This case alerts clinicians to the possibility of synchronized multiple cerebral infarctions following intravenous recombinant tissue-type plasminogen activator therapy as a dangerous complication in patients with multiple severe stenoses in the cerebral arteries.
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Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
| | - Lisa Nagaoka
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Masayuki Suzuki
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Younhee Kim
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Haruo Shimazaki
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Reiji Koide
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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14
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Du Z, Mang J, Yu S, Tian C, Cao X, Liu X, Ma R, Zhang R, Lv B, Wang J. Weighing in on the Off-Label Use: Initial Experience of Neuroform EZ Stenting for Intracranial Arterial Stenosis in 45 Patients. Front Neurol 2018; 9:852. [PMID: 30364175 PMCID: PMC6191497 DOI: 10.3389/fneur.2018.00852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background: The role of stenting for intracranial arterial stenosis (ICAS) has been increasingly debated due to negative results of randomized trials. Thus, exploration of more appropriate devices may hopefully shed light on the endovascular approach, especially for patients with recalcitrant ICAS related to a high risk of stroke. We sought to present and analyze the data of Neuroform EZ stenting for medically refractory ICAS in a single-center series. Materials and methods: Between November 2016 and January 2018, 45 consecutive patients treated with the Neuroform EZ stent were included in our retrospective study. Outcomes evaluation included successful procedure rate, vascular event within 30 days and recurrent stenosis for at least 6 months after the procedure. Results: The technical success rate was 100% for all 46 stenotic lesions. Mean pre-stent stenosis was 86.5 ± 8.7%, improving to 23.7 ± 18.1% after stenting. Combined procedure related vascular event rate was 2.2% (n = 1) within 30 days after the procedure. No in-stent restenosis was observed during an average follow-up period of 7.3 months. Conclusion: The Neuroform EZ stent system could serve as an off-label but promising optional device for ICAS stenting in a carefully selected subgroup of patients. Further longer-term clinical follow-up is mandatory to validate our initial results.
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Affiliation(s)
- Zhihua Du
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chenglin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xinfeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Renzheng Ma
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Rongju Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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15
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Guo J, Su W, Fang J, Chen N, Zhou M, Zhang Y, He L. Elevated CRP at admission predicts post-stroke cognitive impairment in Han Chinese patients with intracranial arterial stenosis. Neurol Res 2018; 40:292-296. [PMID: 29451096 DOI: 10.1080/01616412.2018.1438224] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Elevated C-reactive protein (CRP) levels have been associated with cognitive deficits in certain patient populations, but whether this is also true of ischemic stroke patients is controversial. This study aims to examine the possible association between CRP concentration and post-stroke cognitive impairment (PSCI) in Han Chinese patients and to determine whether this association depends on intracranial arterial stenosis (ICAS). METHODS Patients with mild or moderate stroke admitted to a large regional medical center in Western China were consecutively enrolled in our study. Serum levels of CRP and ICAS severity were assessed at admission and cognitive status was assessed 6 months after stroke using the Six-Item Screener. RESULTS Of the 1116 patients included in our study, no association was observed between CRP levels at admission and cognitive performance at 6 months. However, among the subgroup of 311 patients with ICAS, a significant association did exist, and it persisted even after adjusting for potential confounders (OR 1.038, 95% CI 1.015-1.061). We did not find the same association in the subgroup of the patients without ICAS. CONCLUSIONS To our knowledge, this is the first study to explore the effects of CRP on PSCI in Han Chinese with ICAS. Our findings indicate that higher CRP levels at admission are associated with subsequent cognitive decline in Han Chinese patients with ICAS following ischemic stroke. Further studies in other ethnic groups are needed to validate the use of CRP to predict dementia in ICAS patients.
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Affiliation(s)
- Jian Guo
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Wei Su
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Jinhuan Fang
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Ning Chen
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Muke Zhou
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Yang Zhang
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
| | - Li He
- a Department of Neurology , West China Hospital of Sichuan University , Chengdu , PR China
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16
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Liu H, Lan L, Leng X, Ip HL, Leung TWH, Wang D, Wong KS. Impact of Side Branches on the Computation of Fractional Flow in Intracranial Arterial Stenosis Using the Computational Fluid Dynamics Method. J Stroke Cerebrovasc Dis 2018; 27:44-52. [PMID: 29107636 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 02/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Computational fluid dynamics (CFD) allows noninvasive fractional flow (FF) computation in intracranial arterial stenosis. Removal of small artery branches is necessary in CFD simulation. The consequent effects on FF value needs to be judged. METHODS An idealized vascular model was built with 70% focal luminal stenosis. A branch with one third or one half of the radius of the parent vessel was added at a distance of 5, 10, 15 and 20 mm to the lesion. With pressure and flow rate applied as inlet and outlet boundary conditions, CFD simulations were performed. Flow distribution at bifurcations followed Murray's law. By including or removing side branches, five patient-specific intracranial artery models were simulated. Transient simulation was performed on a patient-specific model, with a larger branch for validation. Branching effect was considered trivial if the FF difference between paired models (branches included or removed) was within 5%. RESULTS Compared with the control model without a branch, in all idealized models the relative differences of FF was within 2%. In five pairs of cerebral arteries (branches included/removed), FFs were 0.876 and 0.877, 0.853 and 0.858, 0.874 and 0.869, 0.865 and 0.858, 0.952 and 0.948. The relative difference in each pair was less than 1%. In transient model, the relative difference of FF was 3.5%. CONCLUSION The impact of removing side branches with radius less than 50% of the parent vessel on FF measurement accuracy is negligible in static CFD simulations, and minor in transient CFD simulation.
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17
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Yi X, Ming B, Wang C, Chen H, Ma C. Variants in COX-2, PTGIS, and TBXAS1 Are Associated with Carotid Artery or Intracranial Arterial Stenosis and Neurologic Deterioration in Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2017; 26:1128-35. [PMID: 28108096 DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/01/2016] [Accepted: 12/28/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Eicosanoids may play a role in ischemic stroke (IS). However, the association of variants in eicosanoid genes with symptomatic carotid artery or intracranial arterial stenosis and neurologic deterioration (ND) is not fully understood. The aim of the present study was to investigate the association of 11 variants in eicosanoid genes with symptomatic carotid artery or intracranial arterial stenosis and ND. METHODS Eleven variants in eicosanoid genes were examined using mass spectrometry method in 297 IS patients. The symptomatic carotid artery or intracranial arterial stenosis was assessed by computed tomographic angiography. Platelet aggregation and platelet-leukocyte aggregates were measured. The primary outcome was ND within 10 days of admission. ND was defined as an increase of 2 or more points in National Institutes of Health Stroke Scale score. RESULTS Among 297 IS patients, 182 (61.3%) cases had symptomatic carotid artery or intracranial arterial stenosis, and 88 (29.6%) patients experienced ND within 10 days after admission. Symptomatic carotid artery or intracranial arterial stenosis was significantly associated with higher ND (P < .001). Rs20417CC, rs41708TT, and rs5629CC were independent risk factors for symptomatic carotid artery or intracranial arterial stenosis and ND, and associated with higher platelet aggregation and platelet-leukocyte aggregates. CONCLUSIONS Symptomatic carotid artery or intracranial arterial stenosis was associated with higher ND. Rs20417CC, rs41708TT, and rs5629CC were not only independent risk factors for symptomatic carotid artery or intracranial arterial stenosis, but also independent risk predictors for ND.
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18
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Lee KY, Chen DYT, Hsu HL, Chen CJ, Tseng YC. Undersized angioplasty and stenting of symptomatic intracranial tight stenosis with Enterprise: Evaluation of clinical and vascular outcome. Interv Neuroradiol 2015; 22:187-95. [PMID: 26542728 DOI: 10.1177/1591019915609165] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/03/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Severe intracranial arterial stenosis results in more than 10% incidence of stroke and transient ischemic attack. Using undersized angioplasty with off-label closed-cell Enterprise stent may be a feasible alternative option for treating patients with intracranial atherosclerotic disease who fail dual-antiplatelet medical therapy. The results of the authors' study are presented in this paper. MATERIALS AND METHODS Between January 2013 and July 2014, 24 symptomatic patients with a total of 30 intracranial arterial stenotic lesions refractory to medical therapy, who underwent undersized angioplasty and Enterprise stenting, were retrospectively reviewed in the authors' institution. The results evaluated include technical success rate, clinical outcome measured as modified Rankin Scale at presentation and follow-up, peri-procedural morbidity within 30 days and 1 year, and follow-up vessel patency. RESULTS Stent deployment was successfully achieved in all stenotic lesions (30/30). Mean pre-stent and post-stent diameter residual stenosis was 81% and 18%, respectively. The peri-procedural complication rate during 30 days after stenting was 10% per lesion (3/30), including intracranial hemorrhage, in-stent thrombosis and ischemic stroke. No further thromboembolic event or complication occurred in any patient more than 30 days after stenting. Modified Rankin scale ≤ 2 was observed in 64% and 83% of patients at initial presentation and follow-up (mean 15.8 months), respectively. Imaging follow-up was available in 17 of 24 patients (70.8%) and 20 of 30 treated lesions (66.6%) with a mean follow-up period of 15.4 months. Only one asymptomatic in-stent restenosis occurred in 20 available lesions (5.0%). CONCLUSION This preliminary study suggests that using undersized angioplasty and Enterprise stenting may effectively treat high-degree symptomatic intracranial arterial stenosis with favorable clinical and angiographic outcome.
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Affiliation(s)
- Kun-Yu Lee
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taiwan Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - David Yen-Ting Chen
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taiwan Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Hui-Ling Hsu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taiwan Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Chi-Jen Chen
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taiwan Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Ying-Chi Tseng
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, Taiwan Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
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Meng R, Ding Y, Asmaro K, Brogan D, Meng L, Sui M, Shi J, Duan Y, Sun Z, Yu Y, Jia J, Ji X. Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment. Neurotherapeutics 2015; 12:667-77. [PMID: 25956401 PMCID: PMC4489956 DOI: 10.1007/s13311-015-0358-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Symptomatic intracranial arterial stenosis (SIAS) is very common in octo- and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo- and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo- and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (n = 30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (n = 28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all p < 0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (p < 0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo- and nonagenarians with SIAS. A multicenter trial is ongoing. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, unique identifier: NCT01570231.
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Affiliation(s)
- Ran Meng
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yuchuan Ding
- />Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201 USA
| | - Karam Asmaro
- />Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201 USA
| | - David Brogan
- />Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201 USA
| | - Lu Meng
- />Department of Biochemistry and Molecular Biology, Complex Carbohydrate Research Center, University of Georgia, Athens, GA 30602 USA
| | - Meng Sui
- />USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089 USA
| | - Jingfei Shi
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yunxia Duan
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Zhishan Sun
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yang Yu
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
- />The 9th Medical College of Peking University, 100038 Beijing, China
| | - Jianping Jia
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Xunming Ji
- />Neurology Department and Cerebral Vascular Diseases Research Institute (China-America Institute of Neuroscience), Xuanwu Hospital, Capital Medical University and the Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
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20
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Gonzalez NR, Dusick JR, Connolly M, Bounni F, Martin NA, Van de Wiele B, Liebeskind DS, Saver JL. Encephaloduroarteriosynangiosis for adult intracranial arterial steno-occlusive disease: long-term single-center experience with 107 operations. J Neurosurg 2015; 123:654-61. [PMID: 26067617 DOI: 10.3171/2014.10.jns141426] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Encephaloduroarteriosynangiosis (EDAS) is a form of revascularization that has shown promising early results in the treatment of adult patients with moyamoya disease (MMD) and more recently in patients with intracranial atherosclerotic steno-occlusive disease (ICASD). Herein the authors present the long-term results of a single-center experience with EDAS for adult MMD and ICASD. METHODS Patients with ischemic symptoms despite intensive medical therapy were considered for EDAS. All patients undergoing EDAS were included. Clinical data, including recurrence of transient ischemic attack (TIA) and/or stroke, functional status, and death, were collected from a retrospective data set and a prospective cohort. Perren revascularization and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grades were recorded from angiograms. RESULTS A total of 107 EDAS procedures were performed in 82 adults (36 with ICASD and 46 with MMD). During a median follow-up of 22 months, 2 (2.4%) patients had strokes; both patients were in the ICASD group. TIA-free survival and stroke-free survival analyses were performed using the product limit estimator (Kaplan-Meier) method. The probability of stroke-free survival at 2 years in the ICASD group was 94.3% (95% CI 80%-98.6%). No patient in the MMD group suffered a stroke. The probability of TIA-free survival at 2 years was 89.4% (95% CI 74.7%-96%) in ICASD and 99.7% (95% CI 87.5%-99.9%) in MMD. There were no hemorrhages or stroke-related deaths. Angiograms in 85.7% of ICASD and 92% of MMD patients demonstrated Perren Grade 3 and improvement in ASITN/SIR grade in all cases. CONCLUSIONS EDAS is well tolerated in adults with MMD and ICASD and improves collateral circulation to territories at risk. The rates of stroke after EDAS are lower than those reported with other treatments, including intensive medical therapy in patients with ICASD.
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Affiliation(s)
| | | | | | | | | | | | - David S Liebeskind
- Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California
| | - Jeffrey L Saver
- Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California
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21
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Bouvier J, Detante O, Tahon F, Attye A, Perret T, Chechin D, Barbieux M, Boubagra K, Garambois K, Tropres I, Grand S, Barbier EL, Krainik A. Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study. Hum Brain Mapp 2014; 36:695-706. [PMID: 25307948 DOI: 10.1002/hbm.22657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
Multiparametric quantitative blood oxygenation level dependent (mqBOLD) magnetic resonance Imaging (MRI) approach allows mapping tissular oxygen saturation (StO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). To identify hemodynamic alteration related to severe intracranial arterial stenosis (SIAS), functional MRI of cerebrovascular reserve (CVR BOLD fMRI) to hypercapnia has been proposed. Diffusion imaging suggests chronic low grade ischemia in patients with impaired CVR. The aim of the present study was to evaluate how oxygen parameters (StO2 and CMRO2 ), assessed with mqBOLD approach, correlate with CVR in patients (n = 12) with SIAS and without arterial occlusion. The perfusion (dynamic susceptibility contrast), oxygenation, and CVR were compared. The MRI protocol conducted at 3T lasted approximately 1 h. Regions of interest measures on maps were delineated on segmented gray matter (GM) of middle cerebral artery territories. We have shown that decreased CVR is spatially associated with decreased CMRO2 in GM of patients with SIAS. Further, the degree of ipsilateral CVR reduction was well-correlated with the amplitude of the CMRO2 deficit. The altered CMRO2 suggests the presence of a moderate ischemia explained by both a decrease in perfusion and in CVR. CVR and mqBOLD method may be helpful in the selection of patients with SIAS to advocate for medical therapy or percutaneous transluminal angioplasty-stenting.
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Affiliation(s)
- Julien Bouvier
- Inserm, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France; Philips France (Healthcare Activity), Suresnes, France
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22
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Tanaka M, Sakaguchi M, Yagita Y, Gon Y, Yoshikawa K, Takahashi T, Fukunaga R, Mochizuki H, Kitagawa K. Thyroid antibodies are associated with stenotic lesions in the terminal portion of the internal carotid artery. Eur J Neurol 2014; 21:867-73. [PMID: 24602238 DOI: 10.1111/ene.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have reported moyamoya syndrome associated with thyroid disease, and the mechanism involved in this relationship is unknown. This study aimed to clarify the involvement of thyroid antibodies and thyroid function in intracranial arterial stenosis. METHODS The study included 30 patients <65 years of age with intracranial arterial steno-occlusion. Patients with definitive moyamoya disease were excluded. Thyroid function and thyroid antibody levels were evaluated. The steno-occlusive site and the presence of moyamoya vessels were evaluated using digital subtraction angiography. The characteristics of intracranial arterial lesions were compared between patients with and without elevated thyroid antibody levels, and between patients with increased thyroid function and those with normal thyroid function. RESULTS Five patients had increased thyroid function and seven had elevated thyroid antibody levels. Four were diagnosed with Graves' disease, 13 with atherosclerotic intracranial stenosis, two with intracranial arterial dissection, one with vasculitis syndrome and 10 with intracranial stenosis of unknown cause. All patients with Graves' disease and patients with elevated antithyroid peroxidase antibody levels had steno-occlusion in the terminal portion of the internal carotid arteries, whereas most of the patients with normal thyroid function or without elevated thyroid antibody levels had stenosis in the middle cerebral arteries. CONCLUSIONS In young and middle-aged patients, a lesion in the terminal portion of the internal carotid artery was associated with elevated thyroid antibody levels and increased thyroid function. Stenoses found in the terminal portion of the internal carotid artery and immune-mediated thyroid diseases may share a common background.
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Affiliation(s)
- M Tanaka
- Department of Strokology, Stroke Center, Hoshigaoka Koseinenkin Hospital, Osaka, Japan
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23
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Wang J, Liu Y, Zhang L, Li N, Wang C, Gao X, Zhou Y, Wang A, Wu S, Zhao X. Associations of high sensitivity C-reactive protein levels with the prevalence of asymptomatic intracranial arterial stenosis. Eur J Neurol 2014; 21:512-8. [PMID: 24447587 DOI: 10.1111/ene.12342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE High sensitivity C-reactive protein (hs-CRP), an inflammatory biomarker, has been demonstrated to contribute to the process of atherosclerosis and artery stenosis. The aim of this study was to evaluate whether hs-CRP level is associated with asymptomatic intracranial artery stenosis (ICAS). METHODS A random sample of 5440 participants aged 40 years or older (40.1% women) were enrolled in the Asymptomatic Polyvascular Abnormalities Community study in 2010-2011. Information on the potential risk factors for ICAS was collected and the presence of ICAS was assessed by transcranial Doppler in 5309 participants. Participants were stratified into three groups according to hs-CRP levels. A multivariate logistic regression was used to examine the association between hs-CRP levels and asymptomatic ICAS. RESULTS The prevalence of asymptomatic ICAS was 13.2% in this cohort. The median of hs-CRP levels was positively associated with the increasing numbers of ICASs. After adjusting for possible risk factors, hs-CRP ≥ 3 mg/l remained significantly associated with asymptomatic ICAS (odds ratio 1.28, 95% confidence interval 1.02-1.61). CONCLUSIONS In this large community-based study, subjects with higher hs-CRP levels showed a mild increase in the prevalence of asymptomatic ICAS, independent of traditional vascular risk factors. hs-CRP is an independent predictor of asymptomatic ICAS and intracranial atherosclerotic burden.
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Affiliation(s)
- J Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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24
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Abstract
Patients with symptomatic intracranial atherosclerotic disease have a high risk of recurrent stroke, and secondary prevention in these patients remains a challenge. Aggressive medical management of vascular risk factors is safe and effective for most high risk patients, but the role of endovascular and surgical therapies still remain uncertain. Future studies may identify novel therapeutic strategies for patients with intracranial atherosclerotic disease, but aggressive risk factor control remains the mainstay of evidenced-based treatment at this time.
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Affiliation(s)
- Tanya N Turan
- MUSC Stroke Program, Suite 501, Harborview Office Tower, 19 Hagood Ave, Charleston, SC, 29425, USA,
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Kim SM, Ryu CW, Jahng GH, Kim EJ, Choi WS. Two different morphologies of chronic unilateral middle cerebral artery occlusion: evaluation using high-resolution MRI. J Neuroimaging 2013; 24:460-6. [PMID: 23323598 DOI: 10.1111/jon.12009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Characterizing the morphologies of occluded artery segments may help elucidate the etiology of chronic intracranial artery occlusion. We acquired high-resolution MRI (HR-MRI) of the middle cerebral artery (MCA) in patients with chronic unilateral MCA occlusion and evaluated the MRI and clinical findings. METHODS We selected 20 consecutive patients who presented with unilateral MCA occlusion. Proton-density weighted HR-MRI of the occluded MCA was acquired using a 3.0 Tesla MRI. We surveyed the morphology of the MCA at the occluded segment. Symptoms, the presence of other stenotic arteries, and atherosclerosis risk factors were compared for patients grouped by different findings on HR-MRI. RESULTS MCA occlusions were classified into the following two groups: plugged MCA (13/20) with a clear view of the MCA trunk or vanishing MCA (7/20) with no MCA trunk visible in the Sylvian cistern. The presence of other stenotic arteries was more frequent in the plugged MCA group than in the vanishing MCA group. CONCLUSIONS HR-MRI can characterize the morphology of pathologic segments of chronic unilateral MCA occlusions in vivo. In chronic MCA occlusion, morphological analysis using HR-MRI may enhance the effort to assess the etiology in company with the angiographic finding.
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Affiliation(s)
- Sun Mi Kim
- Department of Radiology, Gangdong Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, South Korea
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