Intracranial Vascular Stenosis Research Articles

Follow-up Evaluation of Dissection Caused by Percutaneous Transluminal Angioplasty for Intracranial Vascular Stenosis

Follow-up Evaluation of Dissection Caused by Percutaneous Transluminal Angioplasty for Intracranial Vascular Stenosis

Relation of post-stroke headachto cerebrovascular pathology and hemodynamics.

Despite high prevalence of cerebrovascular stroke, headache attributed to ischemic strokes is often undertreated and overlooked. The aim is to detect the relation of a post-stroke headache to cerebrovascular pathology and changes in hemodynamics through a high-resolution duplex ultrasound examination. The present study was a case-control study conducted among 239 patients, who presented with an acute ischemic stroke. Patients were sub-divided into two groups: group I included patients with headache attributed to ischemic stroke (cases) and group II included headache-free stroke patients (controls). History consisted of headache characteristics and risk factors. Clinical and radiological examination were preformed to detect the type of stroke. Ultrasound duplex examination of extra-cranial and intra-cranial cerebrovascular system was carried for both groups. Group I included 112 patients (mean age, 57.66 ±6.59 years), and group II included 127 patients (mean age 57.73 ±7.89 years). Post-stroke headache was more frequent in patients with posterior circulation infarction (58%). Post-stroke headache was reported within 7 days post-stroke in 61.6% of patients. Pre-stroke headache was an independent predictor for post-stroke headache occurrence (OR = 28.187, 95% CI: 6.612-120.158%, p < 0.001). Collateral opening and various degrees of intra-cranial vascular stenosis were strong predictors of headache occurrence (OR = 25.071, 95% CI: 6.498-96.722%, p < 0.001). In conclusion, post-stroke headache is a common phenomenon, especially in patients with pre-stroke headache, history of old stroke, posterior circulation infarction, and large artery disease. This headache was of moderate-intensity with clinical characteristics of tension-type. Intra-cranial cerebrovascular pathological changes including opening of collateral channels and variable degrees of stenosis of cerebrovascular systems were implicated in the production of that headache.

Transcranial color Doppler ultrasonography: methodology and usefulness for the study of patent foramen ovale in cryptogenic stroke

Non-invasive Doppler ultrasonographic study of cerebral arteries (transcranial Doppler, TCD) has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (≤2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays a valid indication for TCD in the outpatient setting is the research of right-to-left shunting, responsible for the so-called "paradoxical embolism", most often due to patency of foramen ovale, which is responsible for the majority of cryptogenic strokes occurring in patients younger than 55 years. TCD also allows to classify the grade of severity of such shunts using the so-called "microembolic signal grading score". Therefore, TCD is an essential cardiological exam for the detection of patent foramen ovale, assuming an important role as a first-level examination to guide the subsequent diagnostic-therapeutic management. In addition, TCD has found many useful applications in neurocritical care practice. It is useful for the identification of intracranial vascular stenosis and for the assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury and brain stem death. It is also used to evaluate cerebral hemodynamic changes after stroke, to investigate cerebral pressure autoregulation, and for the clinical evaluation of cerebral vasomotor reactivity.

Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A2 and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis

PurposeWe 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. MethodsEighty-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. ResultsAfter 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. ConclusionElevated 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.

Recurrent in-stent thrombosis following V4 segment of vertebral artery stenting: A case report.

Introduction and importanceWe report a rare case of subacute recurrent in-stent thrombosis after vertebral artery stenting of the left intracranial segment.Case presentationA 56-year-old man presented with V4 segment severe stenosis of the left vertebral artery. Stent (Apollo, 2.5 mm × 8 mm) implantation was performed for severe stenosis of the left vertebral artery. Approximately 48 h after operation, the patient developed dizziness and drowsiness. DSA showed stent thrombosis, which was treated by PTAS (Apollo, 2.5 mm × 13 mm), and the preoperative symptoms resolved. Two days later, symptoms of posterior circulation ischemia reappeared, DSA showed recurrence of stent thrombosis and CYP2C19 genotypic analysis showed intermediate metabolizers. Revision PTAS (Enterprise, 4.5 mm × 28 mm) was performed followed by administration of Ticagrelor instead of tirofiban. The patient showed good neurological outcomes. CTA performed both one week and four months after the operation showed that the blood flow of the left vertebral artery was unobstructed.Clinical discussionEndovascular therapy is an alternative treatment for severe intracranial vascular stenosis, and reocclusion is one of the serious complications.Conclusionour case report highlights that recurrent in-stent thrombosis maybe be caused by inadequate preoperative assessment and unsuitable therapeutic drug selection for the stents.

Gadolinium enhancement of atherosclerotic plaque in the intracranial artery

ABSTRACT Background: Gadolinium enhancement on high resolution magnetic resonance imaging (HR-MRI) has been considered a sign of instability and inflammation of intracranial atherosclerotic plaques. Our research objective was to explore the relationship between the extent of plaque enhancement (PE), the degree of intracranial artery stenosis, and acute ischemic stroke events. Methods: HR-MRI was performed in 91 patients with intracranial vascular stenosis to determine the existence and intensity of PE. Results: Among 91 patients enrolled in the trial, there were 43 patients in the acute/subacute group (≤1 month from ischemic stroke event), 15 patients in the chronic group (>1 month from ischemic stroke event), and 33 patients in the non-culprit plaques group (no ischemic stroke event). A total of 105 intracranial atherosclerotic plaques were detected in 91 patients. 14 (13.3%) were mild-stenosis plaques, 22 (21.0%) were moderate-stenosis plaques, and 69 (65.7%) were severe-stenosis plaques. There were 12 (11.4%), 18 (17.1%), and 75 (71.4%) plaques in the non-enhanced plaque group, the mild-enhancement group, and the significant-enhancement group, respectively. The degree of PE among the acute/subacute group, the chronic group, and the non-culprit plaque group had a significant difference (P = 0.005). Enhanced plaques were more often observed in culprit plaques (acute/subacute group and chronic group) than non-culprit plaques (96.7% vs 77.3%). Non-enhanced plaques were more often observed in non-culprit plaques than culprit plaques (acute/subacute group and chronic group) (22.7% vs 3.3%). And 36.6% of the enhanced plaques were non-culprit plaques. After performing univariate and multivariate logistic regression analysis, the results showed that strong plaque enhancement (P = 0.025, odds ratio [OR] 3.700, 95% confidence interval [95% CI] 1.182–11.583) and severe stenosis (P = 0.008, OR 4.393, 95%CI 1.481–13.030) were significantly associated with acute ischemic events. Conclusion: Enhanced plaques were more often observed in culprit plaques, and non-enhanced plaques were more often observed in non-culprit plaques. Moreover, significant plaque enhancement and severe ICAS were closely associated with acute ischemic events.

Outcomes of Chronic Automated RBC Exchange Program in Omaha, Nebraska 2015-2020

Background: Red blood cell exchange (RBCX) is an effective therapy in the treatment of different hemoglobinopathies. The University of Nebraska Medical Center (UNMC) established a chronic RBCX program in November 2015, which took care of patients with multiple hemoglobinopathies. In this study, we aim to evaluate the outcomes of this program. Methods: This is a retrospective study. After an IRB approval, we reviewed the charts of patients who were enrolled in the chronic RBCX program between 11/2015-7/2020 at UNMC. Data was collected to evaluate indications of RBCX, types of hemoglobinopathies, hemoglobinopathies' complications before and after the enrollment in the program, and assessment of hospital visits before and after enrollment in the program. Results: In November 2015, the chronic RBCX program was established in Nebraska. Since the start, 24 patients came through the program and 20 patients are still actively enrolled and undergoing regular exchange transfusions. The four patients who left the program did it for the following reasons: moving out of state, stem cell transplant and change to different treatment modality. Four of 24 patients were beta thalassemia patients (two of them with combined HbE/beta thalassemia). Twenty patients had sickle cell disease with two of them having combined beta thalassemia and HbS and one with alpha thalassemia and HbS. The indications ranged from history of stroke, intracranial vascular stenosis, acute chest syndrome (ACS), iron overload, multiple vascular occlusive crises (VOC) and intolerance of medications with most of the patients having multiple indications from the list above (Figure 1). There are several positive outcomes from being on the program. In the patients who had been on the program for at least one year (n=11), nine started the program with iron overload and all of them had a significant decrease in serum ferritin (average 751 ng/mL) with three patients returning to normal range. In the patients who had been in the program at least six months (n=16), 13 patients started with iron overload with five returning to normal range and average decrease in ferritin of 585 ng/mL. Another positive outcome is the number of emergency department (ED) visits for pain crisis. We noted reduction in ED visits in all patients who were in the program for at least six months (n=14), with the exception of one patient where the visits were likely the part of drug seeking behavior. In fact 12 of 13 patients had one or no ED visits within one year after starting on the chronic exchange program having had from 2-11 visits a year prior. None of the patients in the program experienced more severe complications of sickle cell disease, like stroke and acute chest syndrome, while on the program. Due to high volumes of transfusion, there is a big concern about developing red blood cell antibodies in sickle cell disease patients who in general have higher red blood cell antibody burden. Out of 24 patients in the program, six had pre-existing antibodies. For the duration of the program, no new alloantibodies were discovered in the chronically exchanged patients despite high transfusion volumes (range 14L-30L/year). The transfused blood was matched for Rh and Kell antigens for the patients with no antibody history. The patients with previous antibody history had additional matching for the antigen to which antibody was directed. Conclusion:Automated chronic RBCX transfusion program is safe to perform. It leads to significant reduction in volume overload and ED visits. Performing high volume transfusions outside of acute sickle cell crisis and with Rh and Kell matched units prevents formation of RBC antibodies Disclosures Gundabolu: BioMarin:Consultancy;Bristol Myers Squibb pharmaceuticals:Consultancy.

Intracranial and Extracranial Vascular Stenosis as Risk Factors for Stroke in Sickle Cell Disease

BackgroundPrevalence and contribution of intracranial and extracranial arterial stenosis to stroke risk were assessed prospectively in children and young adults with sickle cell disease. MethodsIn this cross-sectional study, children and young adults (mean = 19.4 years) with sickle cell disease underwent neurological examination, brain MRI, and magnetic resonance angiography of the head and neck. Two neuroradiologists independently recorded infarcts and arterial stenosis. Clinical features and stroke outcomes were compared between participants with and without stenosis and between children and young adults. Logistic regression analysis assessed the association of variables of interest with overt stroke and silent cerebral infarct. ResultsOf 167 participants (79 children and 88 young adults), 20 (12.0%) had intracranial stenosis, all in the anterior circulation, and nine had concurrent extracranial stenosis. No participants had isolated extracranial stenosis. Participants with intracranial stenosis were more likely than those without stenosis to have an overt stroke (70% vs 5%, P < 0.001) or silent cerebral infarct (95% vs 35%, P < 0.001). Logistic regression analysis indicated that intracranial stenosis was strongly associated with overt stroke when compared with participants with silent cerebral infarct alone and strongly associated with silent cerebral infarct when compared with participants with normal brain MRI; male sex and age were also significant predictors of silent cerebral infarct. ConclusionsIntracranial stenosis was strongly associated with both overt stroke and silent cerebral infarct; prevalence of intracranial stenosis was similar to prior estimates in sickle cell disease. Extracranial stenosis without concurrent intracranial stenosis did not occur and thus could not be evaluated as an independent risk factor for stroke.

Vascular imaging in the initial evaluation of embolic stroke source

PurposeDuring acute ischemic stroke evaluations, neurovascular imaging is commonly performed to localize the source of a thromboembolus and to identify vascular stenoses. In this study, we aimed to analyze 1) the usefulness of intracranial and/or cervical CTA and MRA and carotid doppler ultrasound (DUS) for identifying the stroke source and 2) the incidence of vascular stenoses across stroke etiologies. MethodsWe retrospectively reviewed intracranial and/or cervical CTA, DUS and MRA studies to identify the source of the acute stroke by Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria for 200 consecutive patients admitted with a stroke to our tertiary hospital. Stroke etiologies were ascertained and the rates of intracranial and cervical vascular stenoses were stratified by stroke type. ResultsOf 200 patients, the most probable sources of stroke were small vessel disease (29%), cardioembolic (26.0%) and atheroembolic (23.5%). Across all groups, 27.5% of patients had ≥70% stenosis on neurovascular imaging. The rate of ≥70% vascular stenosis in the neck was 6.9% and 5.8% in the small vessel and cardioembolic categories, respectively. ConclusionsThe TOAST etiologies of strokes were nearly equally distributed. Neurovascular imaging was of high utility for identifying large vessel intracranial stenoses in patients presenting with acute stroke across all etiologies, although neck CTA/MRA had a lower rate of positive studies with cardiogenic and small vessel strokes. These findings have implications on the use of CTA/MRA in acute stroke work-up.

Comparison of the Diagnostic Performances of Ultrasound, High-Resolution Magnetic Resonance Imaging, and Positron Emission Tomography/Computed Tomography in a Rabbit Carotid Vulnerable Plaque Atherosclerosis Model.

Our study aimed to evaluate the diagnostic performances of 3 routine examination methods for cerebrovascular disease in a rabbit carotid artery atherosclerosis model. A total of 12 New Zealand rabbits were included: 4 in a control group and 8 in an experimental group. A clinically relevant atherosclerosis rabbit model was induced by left common carotid artery ligation and a 12-week high-fat diet. Atherosclerosis was further confirmed by a histopathologic analysis. Then carotid ultrasound (US) imaging, high-resolution magnetic resonance imaging (HRMRI), and positron emission tomography (PET)/computed tomography (CT) were performed on this model to evaluate the diagnostic performances. Carotid US showed plaque formation in the left common carotid artery and little plaque in the right common carotid artery in the experimental group. In addition, HRMRI showed stenosis formation in the left common carotid artery in the experimental group. At the horizontal level, plaques were found in the left common carotid artery, and no plaques were found in the right common carotid artery in the experimental group. Also, PET/CT showed local hypermetabolism and vulnerable plaques in the left common carotid artery of the experimental group, whereas no hypermetabolism was found in the right common carotid artery of the experimental group. Moreover, the soft plaques detected by carotid US were different from the vulnerable plaques detected by PET/CT. The unstable plaques on HRMRI were the same as the hypermetabolic vulnerable plaques on PET/CT. High-resolution MRI is recommended for the evaluation of neck and intracranial vascular stenosis and plaque properties in patients with stroke.

Assessment of cerebral infarction after transient cerebral ischemic attack by ABCD2 score combined with the position of intracranial vascular stenosis.

This study aims to investigate the value of the ABCD2 score combined with the position of the offending vessel stenosis in predicting the risk of transient ischemic attack (TIA) to develop into cerebral infarction.The ABCD2 score and head magnetic resonance imaging + magnetic resonance angiography (MRA) results of 192 patients with TIA were retrospectively analyzed. With the 7th day as the endpoint time, these patients were divided into 3 groups, according to ABCD2 scores: low-risk group (n = 105), moderate-risk group (n = 60), and high-risk group (n = 27). Blood vessels were screened using head MRA results, and patients were accordingly divided into 2 groups: proximal vascular stenosis group (n = 71) and nonproximal vascular stenosis group (n = 171). Then, the association of the position of the intracranial vascular stenosis and ABCD2 score with short-term prognosis was analyzed.Based on the ABCD2 score, the incidence of cerebral infarction after 1 week was significantly higher in the high-risk group (85.7%) than in the moderate-risk group (16.7%) and low-risk group (1.9%), and the differences were statistically significant (P < .05). When the ABCD2 score was ≥4 points, the incidence of cerebral infarction after 1 week was significantly higher in the proximal vascular stenosis group (59.1%) than in the nonproximal vascular stenosis group (30.8%), and the difference was statistically significant (P < .05). When the ABCD2 score was <4 points, the incidence of cerebral infarction after 1 week in the proximal stenosis group (2%) was not significantly different from that in the nonproximal stenosis group (1.9%, P > .05).The ABCD2 score combined with proximal offending vessel stenosis can improve the short-term prediction of cerebral infarction in patients with TIA.

Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis

ObjectiveIn view of recent literature suggesting that stroke recurrence and risks related to intervention may be related to plaque physiology/instability, our study sought to discern the pattern of stroke and...

Abstract WP133: Intra Cerebral Atherosclerosis is the Major Risk Factor for Stroke in Post Coronary Artery Bypass Graft Surgery Patients

Introduction: Stroke is one of the most severe complications after Coronary artery bypass grafting (CABG) and is associated with high rates of morbidity and mortality. Hypothesis: We aimed to define the relationship between extracranial and intracranial carotid artery stenosis and the risk of stroke after CABG. Methods: A retrospective analysis of 1245 consecutive patients who underwent coronary artery bypass grafting (CABG) in our institution from March 2015 till March 2017 was performed. All of them had carotid duplex ultrasound as a routine preoperative assessment. Those patients who had severe extracranial carotid stenosis (&gt;70%), underwent computed tomography angiogram of head and neck cerebral vessels. Our analysis was mainly focused on assessing the relation between incidence of post-CABG stroke and severity of intra and extra cranial cerebral atherosclerosis. Results: Of the 1245 patients who underwent coronary artery bypass grafting(CABG) the routine preoperative carotid Doppler revealed severe extracranial carotid artery stenosis of &gt;70% in 160 patients, who eventually underwent computed tomography angiogram which has shown both extra and intracranial cerebral vascular stenosis in 124 patients. Total number of patients who had post CABG strokes are 42 (3.37%), out of which 39 (3.13%) had extensive extra and intracranial vascular stenosis whereas only 3 (0.24%) had isolated extracranial vascular stenosis. Patients with extensive extra and intracranial cerebral atherosclerosis has high rate of in-hospital strokes (within 14 days) compared with patients with isolated extracranial atherosclerotic disease. Conclusion: Extensive atherosclerosis including intra and extracranial cerebral arteries are major risk factors for stroke in patients undergoing CABG. Pre-operative assessment of both intra and extracranial cerebral arteries increases the probability of risk assessment in high risk CABG patients.

Chinese medicine in the treatment of intracranial vascular stenosis in 1 case

Chinese medicine in the treatment of intracranial vascular stenosis in 1 case

The Association of Intracranial Vascular Calcification and Stenosis With Acute Ischemic Cerebrovascular Events.

The aim of this article was to evaluate the association of intracranial artery calcification (IAC) with acute downstream ischemic stroke (dAIS)/transient ischemic attack while considering stenosis. Consecutive stroke computed tomography angiography head/neck examinations from January 2010 to April 2010 were reviewed. Per-vessel IAC and stenosis of greater than or equal to 30% were documented by 2 neuroradiologists. Associations between calcification and dAIS were assessed using multivariate logistic regression, controlling for traditional risk factors and stenosis. A total of 1287 arterial segments from 99 patients were reviewed. Intracranial artery calcification was significantly associated with dAIS (odds ratio [OR], 2.2; P = 0.009). This association persisted among nonstenotic arteries, with significantly higher likelihood of dAIS for arteries with IAC than those without (OR, 2.5; P = 0.009). However, among stenotic arteries, calcified stenoses had a lower association of dAIS than noncalcified stenoses (OR, 0.55; 95% confidence interval, 0.17-1.8; P = 0.33). Without concurrent stenosis, IAC is a significant risk factor for dAIS. When stenosis is present, IAC does not increase the association with dAIS. Stenotic and nonstenotic calcifications may represent different disease processes, as represented in the histology literature.

Epidemiology of cerebrovascular disease among Chinese-Canadians: A 20 years retrospective case-mix retrospective study

Background: Asians are commonly known to have more intracranial vascular stenosis and a lower incidence of carotid stenosis than Caucasians. A pilot retrospective study by the authors in 1993 had demonstrated that Chinese-Canadians have a higher frequency of subcortical infarctions and lower frequency of carotid stenosis when compared to Caucasians.

The Role of Neurosurgeons in Neurointerventional Surgery

Objective: Although the endovascular technique represents an important, minimally invasive approach to cerebrovascular diseases, only a few neurosurgeons are trained in both endovascular and surgical management of intracranial vascular pathologies. Our aim was to emphasize the importance of the endovascular approach in neurosurgery by analysing the cerebral digital subtraction angiography findings in our patients. Materials and Methods: We analysed 207 patients who underwent cerebral angiography between February 2011 and June 2014. They had previously been diagnosed with cerebral vascular pathology including aneurysm, arteriovenous malformation (AVM), carotid cavernous fistula, vasculitis and Moyamoya disease according to computed tomographic angiography/magnetic resonance angiography findings. Demographic data, indications for cerebral angiography, endovascular and surgical treatments, complications and results were analyzed. Results: This study included a total of 207 patients (108 males and 99 females) with a mean age of 57.43±11.14 (17-83) years. A total of 234 selective angiographies were performed. The indications for procedures were as follows: cerebral aneurysm (n=118, 57%), Moyamoya disease (n=3, 1.4%), AVM (n=13, 6.3%), carotid cavernous fistula (n=2, 1%), and intracranial vascular stenosis (n=2, 1%). No pathology was found in 69 patients (33.3%). Conclusion: Cerebral angiography is important not only in the diagnosis but also in the treatment of cerebrovascular diseases. Neurointerventional surgery is a safe and minimally invasive treatment option based on meticulous protocols, however, it has not been included in the neurosurgery residency program yet. Developing training programs for endovascular neurosurgeons provididing comprehensive patient care should be considered.

Bilateral Borderzone Infarcts in Hypereosinophilic Leukemia without Proximal Vessel Stenosis

Objective: We describe border-zone territory infarctions without evident hypotension or vascular stenoses in a case of hypereosinophilic syndrome (HES). We review the spectrum of neurological changes associated with HES and explore about its relationship with the observed infarction pattern. Methods: This is a case report. A PubMed literature search was conducted searching clinico-radiographic findings of neurological complications associated with HES. Results: A previously healthy 47 year old man presented with progressive encephalopathy, weight loss and general malaise over three weeks. MRI head revealed bilateral hemispheric watershed infarcts at the junction of the anterior and posterior circulations. No intracranial or extracranial vascular stenoses were found and cardiac evaluation via transesophageal echocardiography, telemetry, and cardiac computed tomography (CT revealed no clear cardiac source of emboli. Persistently elevated eosinophil (>5,000/ μL) led to a bone marrow biopsy and diagnosis of eosinophilic leukemia with CHIC-2 mutation. Treatment with Imatinib and high dose prednisone was undertaken with significant clinical improvement. Conclusion: This case highlights a very rare cause of bilateral watershed cerebral infarction in non-hemodynamic stenoses. We hypothesize that the particular pattern of infarct observed in this setting may be explained on the basis of the lower capacity of hypoperfused vessel (borderzone) to eliminate emboli related to in situ-thrombosis from degranulation of eosinophils: Impaired Wash-Out Theory.

The application value of TCD combined with CDUS in the large artery atherosclerosis

Objective: To explore the value of TCD and CDUS on diagnosis of large artery atherosclerosis. Methods: In our study, 90 patients who had been admitted to our hospital and diagnosed as LAA according to CISS typing were selected as the research object. A retrospective analysis was conducted, using CTA as golden standard for diagnoses of stenoses. Explore the risk factors of LAA, the reliability of TCD and CDUS in diagnosis of the stenosis and distribution of stenosis in each vessel. Results: Hypertension and type 2 diabetes are risk factors of LAA vascular stenosis. Middle cerebral artery stenosis detection by TCD carries the highest reliability (sensitivity 90.91%, specificity 97.89%, positive predictive value 96.15%, the negative predictive value was 94.9%, the positive likelihood ratio was 43.18, negative likelihood ratio 0.09, Kappa = 0.9). The consistency of TCD is as good as CTA in head and neck part. The negative coincidence rate was higher in the anterior circulation vessels (97.98%), followed by the coincidence rate of severe stenosis (95.23%). However, the detection rate of posterior circulation vessels positive, moderate and severe stenosis, mild stenosis gradually decreased by TCD. CDUS carries general reliability in detecting intracranial extracranial stenosis, the highest reliability in internal carotid artery (kappa 0.82), and the worst consistency in vertebral artery (kappa 0.38). The negative coincidence rate of CDUS in extracranial cerebrovascular stenosis was highest (97.22), followed by the overall compliance rate (91.55%). 242 branches of vascular stenosis were discovered in our study, among which intracranial artery stenosis 61.15% (148/242) is higher than that in extracranial artery 38.85% (90/242), ratio of moderate to severe stenosis is as high as 82.23% (199/242). Intracranial artery stenosis in ICA is extremely common (51.11%, 46/90), and MCA is the common area of intracranial artery stenosis (37.16%, 55/148). Conclusions: (1) Hypertension, type 2 diabetes are risk factors for LAA stenosis. (2) TCD detection of intracranial vascular stenosis carries the best consistency, and reliability of MCA is the highest. In our search, MCA possesses the highest rate of stenosis, and negative coincidence rate by TCD examination was the highest, which could be used for screening method for stenosis. The reliability of TCD in diagnosis of moderate and severe stenosis was relatively better than mild stenosis. (3) CDUS detection of anterior circulation lesions is better than that of posterior circulation lesions. Evaluate effect on moderate and severe stenosis was better than that of mild one. The ratio of ICA stenosis was the highest, but the effect on VA was poor. (4) The incidence of intracranial vascular stenosis is more common than that of the intracranial vascular stenosis.

Aldehyde dehydrogenase 2 polymorphism as a protective factor for intracranial vascular stenosis in ischemic stroke in Han Chinese

Aim: Aldehyde dehydrogenase 2 (ALDH2) is a key enzyme that metabolizes acetaldehyde to acetic acid. ALDH2 gene polymorphism modifies its activity and the mutation of ALDH2 gene has been reported to be associated with the protection against ischemic stroke. However, the potential association of allelic variation of ALDH2 with intracranial vascular stenosis and the clinical characteristics of ischemic stroke without coronary artery disease remains unclear. Methods: In this study, ischemic stroke patients were recruited, National Institutes of Health Stroke Scale scores were analyzed, intracranial arterial stenosis were evaluated by magnetic resonance angiography and gene typing of ALDH2 was determined by polymerase chain reaction and sequencing. Results: We found that the rate of heavy drinking was significantly lower in the ALDH2 mutation group (*1/*2 and *2/*2) than in wild-type group (*1/*1) (18.6% vs. 38.0%, p = 0.01). Plasma homocysteine (Hcy) levels were significantly different in the two groups (15.45 ± 6.39 vs. 13.14 ± 4.45, p = 0.015). The ALDH2 mutation genotype was negatively correlated with severe intracranial vascular stenosis (OR, 0.34; p = 0.002), even after adjustment for high-density lipoprotein cholesterol, Hcy, and heavy drinking (adjusted OR, 0.44; p = 0.03). Conclusion: ALDH2*2 could be a protective factor and negative predictor for severe intracranial vascular stenosis in ischemic stroke in Han Chinese.