Middle Cerebral Artery Stenosis Research Articles

High-Resolution MRI to Evaluate Benefit of Middle Cerebral Artery Stenosis in Secondary Prevention in Patients with Acute Cerebral Infarction

High-resolution magnetic resonance (HRMRI) combined with magnetic resonance angiography (MRA) was used to analyze the correlation between the degree of infarction and the degree of cerebral vascular stenosis, and these patients are all have the trend to contain acute infarction. All patients were examined by CT cerebral angiography, which was analysed by conventional magnetic resonance imaging (MRI), high-Resolution (HRMRI) imaging, and cerebral vascular (MRA) imaging. The infarct size of each patient with cerebral infarction was calculated. The degree of middle cerebral artery stenosis was evaluated. Moreover, agnosis of acute cerebral infarction in middle cerebral artery region was calculated, and the correlation between acute cerebral infarction in middle cerebral artery region and the degree of cerebral vascular stenosis was analyzed. The specificity, sensitivity, and accuracy of magnetic resonance angiography (MRA) in the diagnosis of acute cerebral infarction in the blood supply area of the middle cerebral artery were 90.48%, 94.87%, and 93.94%. The coincidence rates for the degree of middle cerebral artery stenosis were 90.91% for mild stenosis, 92.31% for moderate stenosis, 93.75% for severe stenosis, and 85.71% for vascular occlusion, respectively. The K value was in good agreement with the results of CTA diagnosis (≥0.75). In conclusion, HRMRI can clearly indicated that the location of lesions with acute cerebral infarction, and MRA can show the degree of vascular stenosis, there is a close relationship between them.

Analysis of cerebral perfusion of leptomeningeal branch and perforating branch of unilateral middle cerebral artery with severe stenosis or occlusion based on multi-delay arterial spin labeling

Objective: To compare the cerebral perfusion differences between the symptomatic patients and the asymptomatic patients with unilateral middle cerebral artery (MCA) severe stenosis or occlusion by using three post labeling delays (PLD) of the three-dimensional pseudo-continuous arterial spin labeling (pCASL) technique. Methods: The clinical characteristics and ASL data of the 27 patients with severe stenosis or occlusion of unilateral MCA (18 symptomatic, 9 asymptomatic) were prospectively enrolled from April 2018 to November 2019 in the Department of Radiology of China-Japan Friendship Hospital. There were 16 males and 11 females, age range from 29 to 85 (55±13) years. According to the symptoms, they were divided into symptomatic group (18 cases) and asymptomatic group (9 cases). The parameters of cerebral blood flow (CBF), mean cerebral blood flow (mCBF), arterial transit time (ATT) and arterial cerebral blood volume (aCBV) were obtained using the Cereflow software. One-way multivariate analysis of variance (one-way MANOVA) was used to compare the differences of cerebral perfusion parameters between symptomatic group and asymptomatic group, and between the affected side and the control side in the two groups. Two-way ANOVA was used to evaluate the effects of symptoms, hemisphere (affected and control side), PLD times (1.5, 2.0 and 2.5 s) and the interaction between the two factors. Results: The CBF of the affected leptomeningeal branch and perforating branch of MCA in symptomatic group was lower than that in asymptomatic group [(36.8±10.2) ml·100 g-1·min-1 versus (46.6±13.9) ml·100 g-1·min-1, F(1, 75)=13.279, P=0.000 49; (32.3±8.3) ml·100 g-1·min-1 versus (36.2±7.5) ml·100 g-1·min-1, F (1, 75)=4.065, P=0.047], and there was no interaction between the symptom and PLD [F(2, 75) =0.061, P=0.940]. In the symptomatic group, the CBF of the leptomeningeal branch and perforating branch of MCA in affected side was lower than that in control side [(36.8±10.2) ml·100 g-1·min-1 versus (43.7±10.0) ml·100 g-1·min-1, F(1, 102)=12.559, P=0.000 59; (32.3±8.3) ml·100 g-1·min-1 versus (36.4±8.0) ml·100 g-1·min-1, F(1, 102)=6.493, P=0.012]. In the symptomatic group, the CBF of leptomeningeal branch of MCA when PLD was 2.5 s was 7.34 ml·100 g-1·min-1, which were higher than that when PLD of 1.5 s (95%CI: 0.72-13.9, P=0.03). There was no interaction between PLD and hemisphere [F(2, 102) =0.307, P=0.736]. Conclusions: The collateral circulation in the blood supply area of MCA in asymptomatic patients with severe unilateral MCA stenosis or occlusion is more abundant than that in symptomatic patients. ASL can be an effective technique for evaluating the cerebral perfusion of collateral circulation in patients with severe stenosis or occlusion of MCA.

Can 3D Pseudo‐Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis?

A typical patient with R-MCA undergoing stenting before (top row) and after (bottom row) surgery. A 65-year-old male with severe R-MCA stenosis. (a) DSA showed that after stenting, the R-MCA stenosis was significantly alleviated, the blood flow was recanalized, and the distal branches were well visualized. (b) DWI showed no obvious high signal before and after the operation. (c) Preoperative 3D pcASL showed that low perfusion area was visible in M6, and postoperative low perfusion had returned to normal. (d) and (e) Preoperative tASL showed that the perfusion in M3, M5, and M6 areas was lower than that of the contralateral side, and the postoperative hypoperfusion area had returned to normal by Wang et al (175–183).

A Comparison of Safety and Effectiveness Between Wingspan and Neuroform Stents in Patients With Middle Cerebral Artery Stenosis.

Background: Percutaneous transluminal angioplasty and stenting with the Wingspan stent has proven safe and effective in patients with middle cerebral artery stenosis (MCAS), but the off-label use of the Neuroform stent might be an alternative treatment. This study aimed to compare the safety and effectiveness of the above two intracranial stents in patients with MCAS.Methods: We retrospectively analyzed consecutive patients with symptomatic MCAS who had been treated with the Neuroform EZ or the Wingspan stent. A propensity score was generated to control for differences in baseline characteristics. The endpoints were the rate of peri-procedural complications within 30 days after stenting, the in-stent restenosis rate, and any target-vessel-related stroke or deaths during follow-up.Results: After matching for propensity score, the peri-procedural complication rate in the Wingspan group was 7.4% compared with 5.6% in the Neuroform group (p = 1.00), while the follow-up in-stent restenosis rates were 23.3 vs. 14.3%, respectively (p = 0.41). In the restenosis group, the patients tended to be younger (p < 0.01) and the degree of artery stenosis before stenting was higher (p < 0.01).Conclusion: This study indicated that in patients with symptomatic MCAS, Neuroform EZ stents are an alternative to Wingspan. Moreover, younger age and higher degree of artery stenosis before stenting might be a risk factor of in-stent restenosis.

Characteristic Imaging Patterns of Muscle Involvement in Polyarteritis Nodosa: Case Report and Review of the Literature

Objective: Polyarteritis nodosa (PAN) is a rare disease with complex clinical manifestations that are difficult to diagnose. Imaging diagnoses of previously reported patients have focused on vascular manifestations. Magnetic resonance imaging (MRI) has been used to detect muscle involvement in PAN. Here, we reviewed imaging findings pertaining to muscle involvement in patients with PAN. Methods: Twelve articles concerning muscle involvement in PAN were published during the period 1980–2020; 21 patients, including our patient, were examined in this study. Results: Across the published articles, the male to female ratio was 1:1, the mean patient age was 40.76 ± 18.28 years, and there were 17 patients with calf involvement and 3 with thigh involvement. The T1WI and T2WI findings were both isointense in one patient, and the T1WI findings alone were isointense in seven patients. The T1WI findings were slightly hyperintense in five patients, and no T1WI images were available for the remaining seven patients. The T2WI signal was diffusely hyperintense in 10 patients, and “patchy villous hyperintense” in 9 patients. Among the 12 patients with enhanced images, most exhibited diffuse or cotton-like enhancement, while some showed involvement of the fascia and periosteum. The comprehensive imaging analysis of our patient included muscle and blood vessel MRI and computed tomography (CT) examinations. Our patient’s disease involved the calves and thighs, with T1WI isointensity and T2WI patch-like hyperintensity, as well as cotton-like enhancement centered on blood vessels. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) examinations of the lower limbs showed beadlike changes in the arterial branches, and the lower leg arterial branches were obvious. Head MRA revealed stenosis and occlusion of the right middle cerebral artery. Additionally, the superior mesenteric artery was locally dilated around a tumor, with the greatest width being approximately 9 mm. Cerebral perfusion analysis indicated cerebral blood flow (CBF) was lower in the right cerebellar hemisphere.Conclusions: PAN should be considered in the presence of patchiness or diffuse muscle signal changes on MRI of the lower leg (or thigh), followed by vessel-centered cotton-like enhancement accompanied by fascial or periosteal enhancement. Our findings suggest that systemic examination of small and medium arteries in patients with PAN can aid early prevention and treatment.

Cerebral Circulation Time Is a Potential Predictor of Disabling Ischemic Cerebrovascular Events in Patients With Non-disabling Middle Cerebral Artery Stenosis.

Patients with non-disabling middle cerebral artery (MCA) stenosis (ND-MCAS) are at risk for disabling ischemic cerebrovascular events (DICE) despite aggressive medical therapy. In this study, we aimed to verify whether cerebral circulation time (CCT) was a potential predictor of DICE in patients with ND-MCAS. From January 2015 to January 2020, 46 patients with ND-MCAS treated with aggressive medical therapy were enrolled for digital subtraction angiography (DSA) in this convenience sampling study. They were divided into the DICE (–) and DICE (+) groups based on the occurrence of DICE within 3 months after DSA. The CCT was defined as the time from the appearance of the MCA to the peak intensity of the Trolard vein during DSA. The rCCT (relative CCT) was defined as the ratio of the CCT of the stenotic side (sCCT) to the CCT of the healthy side (hCCT). The differences in sCCT, hCCT, and rCCT between the two groups were analyzed with Mann-Whitney U tests. Logistic regression analysis was performed to evaluate the association between the risk factors and DICE. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of rCCT in identifying DICE in ND-MCAS patients. The results showed that DICE appeared in 5 of the 46 patients within 3 months. rCCT were significantly increased in the DICE (+) group compared with the DICE (–) group [1.08 (1.05, 1.14) vs. 1.30 (1.22, 1.54), p < 0.001]. Logistic regression analysis found that prolonged rCCT was an independent positive prognostic factor for DICE (odds ratio = 1.273, p = 0.019) after adjustment for potential confounders (age, diabetes, antithrombotic use, and stenosis degree). ROC analysis showed that rCCT provided satisfactory accuracy in distinguishing the DICE (+) group from the DICE (–) group among ND-MCAS patients (area under the curve = 0.985, p < 0.001), with an optimal cutoff point of 1.20 (100% sensitivity, 97.6% specificity). In conclusion, prolonged rCCT is independently associated with the occurrence of DICE in ND-MCAS patients and may be used to identify individuals at risk of DICE.

Evaluating the Velocity and Extent of Cortical Venous Filling in Patients With Severe Middle Cerebral Artery Stenosis or Occlusion.

Objective: To investigate the velocity and extent of cortical venous filling (CVF) and its association with clinical manifestations in patients with severe stenosis or occlusion of the middle cerebral artery (MCA) using dynamic computed tomography angiography (CTA).Methods: Fifty-eight patients (36 symptomatic and 22 asymptomatic) with severe unilateral stenosis (≥70%) or occlusion of the MCA M1 segment who underwent dynamic CTA were included. Collateral status, antegrade flow, and CVF of each patient were observed using dynamic CTA. Three types of cortical veins were selected to observe the extent of CVF, and the absence of CVF (CVF-) was recorded. Based on the appearance of CVF in the superior sagittal sinus, instances of CVF, including early (CVF1), peak (CVF2), and late (CVF3) venous phases, were recorded. The differences in CVF times between the affected and contralateral hemispheres were represented as rCVFs, and CVF velocity was defined compared to the median time of each rCVF.Results: All CVF times in the affected hemisphere were longer than those in the contralateral hemisphere (p < 0.05). Patients with symptomatic MCA stenosis had more ipsilateral CVF- (p = 0.02) and more delayed CVF at rCVF2 and rCVF21 (rCVF2-rCVF1) (p = 0.03 and 0.001, respectively) compared to those with asymptomatic MCA stenosis. For symptomatic patients, fast CVF at rCVF21 was associated with poor collateral status (odds ratio [OR] 6.42, 95% confidence interval [CI] 1.37–30.05, p = 0.02), and ipsilateral CVF- in two cortical veins was associated with poor 3-month outcomes (adjusted OR 0.025, 95% CI 0.002–0.33, p = 0.005).Conclusions: Complete and fast CVF is essential for patients with symptomatic MCA stenosis or occlusion. The clinical value of additional CVF assessment should be explored in future studies to identify patients with severe MCA stenosis or occlusion at a higher risk of stroke occurrence and poor recovery.

Intracranial stenosis in patients with post-ischemic stroke: a case-control study Rizaldy Pinzon1, Andre Dharmawan Wijono1

Background: Despite its remained position as the main culprit of stroke worldwide, studies on intracranial stenosis in Indonesia are still very limited. It is necessary to research to measure the prevalence and risk factors of intracranial stenosis in post-ischemic stroke. Method: We conducted case-control research with participants of 234 ischemic stroke patients. Each patient was listed for their risk factors and analyzed for their association with intracranial stenosis. Intracranial circulation was determined by transcranial doppler (TCD) sonography TD-DOP 9000 with a 2-MHz probe. A peak systolic velocity (PSV) of &gt;140cm/s or mean systolic velocity of (MSV) &gt;80cm/s were used as criteria for middle cerebral artery (MCA) stenosis. In contrast, PSV&gt;90 cm/s or MSV&gt;60cm/s were used to determine the posterior circulation stenosis. Statistical analysis used SPSS 18.0 software which The Independent t-test and chi-square test were used to assess significant differences in correlation to intracranial stenosis. P-value &lt;0.05 was statistically significant.Result: Intracranial stenosis cases were 38%, with the anterior circulation being the most common stenosis location. Hypertension, diabetes mellitus and dyslipidemia were the most often risk factors. Only hypertension with OR=2.97 (95%CI=1.76-4.98) and diabetes mellitus with OR=1.48 (95%CI=1.12-2.43) were positively correlated with increased risk intracranial stenosis.Conclusion: The occurrence of intracranial stenosis in ischemic stroke patients was high and increased with the presence of hypertension or diabetes mellitus.

Utility of minimum intensity projection images based on three-dimensional CUBE T1 weighted imaging for evaluating middle cerebral artery stenosis.

This study investigated the diagnostic performance of MinIP images based on three-dimensional variable-flip-angle turbo spin echo T1 weighted imaging (3D CUBE T1WI) from high-resolution vessel wall magnetic resonance imaging for detecting middle cerebral artery (MCA) stenosis. A total of 63 consecutive patients were included in this study. MinIP images were reconstructed using 3D CUBE T1WI as the source images. The degree and length of MCA stenosis were measured on MinIP images and were compared with digital subtraction angiography (DSA) as the reference standard. The intra- and interobserver agreement for both the rate and length of MCA stenosis were excellent for the MinIP images. There was also excellent agreement in the degree of MCA stenosis calculated using MinIP images and DSA. MinIP images had a high sensitivity, specificity for diagnosing MCA stenosis. There was a good correlation between the two methods for measuring the rate and length of MCA stenosis. MinIP images based on 3D CUBE T1WI are highly consistent with DSA for evaluating the degree and length of MCA stenosis. MinIP images can be produced as a derivative from vessel wall imaging and implemented as an adjunct to vessel wall imaging without extra acquisition time.

Watershed subarachnoid hemorrhage after middle cerebral artery rescue stenting in patients with acute ischemic stroke

Cortical subarachnoid hemorrhage is an infrequent subtype of non-aneurysmal subarachnoid hemorrhage, rarely reported in watershed territories (wSAH) after carotid stenting. It has never been reported after treatment of middle cerebral artery stenosis (MCAS) that is increasingly used in selected patients, as rescue treatment of failed mechanical thrombectomy, due to recent advancements in endovascular interventions. We present a series of patients with MCAS that developed a wSAH after stenting.

Association of Plaque Features with Infarct Patterns in Patients with Acutely Symptomatic Middle Cerebral Artery Atherosclerotic Disease

Background and PurposeUnderstanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis is important for stroke triage and future trial design. The aim of this study was to characterize intrinsic MCA plaque and acute cerebral infarct in vivo by using high-resolution black-blood (BB) and diffusion-weighted magnetic resonance (MR) imaging and to investigate the relationship between plaque features and infarct patterns. MethodsA single-center retrospective study was conducted at a tertiary referral center between March 2017 and August 2019. Patients consecutively admitted for acute ischemic stroke with MCA stenosis underwent diffusion-weighted and BB MR imaging. Plaque features and infarct patterns were assessed. The association between plaque features and infarct patterns (binary variable: single/multiple) was evaluated using a multivariate logistic regression model. ResultsOf 49 patients with MCA atherosclerotic stenosis, diffusion-weighted MR imaging showed that 28 patients (57%) had multiple acute cerebral infarcts and 21 patients had single acute cerebral infarcts. In contrast to single infarct, multiple infarcts were associated with greater plaque burden (81.9±7.24 versus 71.3±13.7; P=0.012). A multivariate logistic regression model adjusted for 7 potential confounders confirmed a statistically significant positive association between plaque burden and multiple acute infarcts (adjusted R2 =0.432, P< 0.001). The rate of plaque surface irregularity was significantly greater in patients with multiple infarcts than those with single infarct (71% versus 43%, P=0.044). For single acute penetrating artery infarct, patients with infarct size > 2cm had greater plaque burden compared with patients with infarct size < 2cm (75.3±13.4 versus 63.4±10.9; P = 0.016). ConclusionsIncreased plaque burden, plaque surface irregularity in patients with MCA stenosis is associated with its likelihood to have caused an artery-to-artery embolism that produces multiple cerebral infarcts, especially along the border zone region, and increased plaque burden may promote subcortical single infarct size by occluding penetrating arteries. Our results provide important insight into stroke mechanism of MCA atherosclerosis.

Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BackgroundEtiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations.MethodsYoung patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome.ResultsTwo hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome.ConclusionsForty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Abstract P575: Impaired Distal Perfusion Predicts In-Hospital Outcome in Patients With Symptomatic Middle Cerebral Artery Stenosis

Background: Perfusion imaging is increasingly used to risk stratify patients with symptomatic intracranial stenosis. Length of hospital stay (LOS) in patients with ischemic stroke is a surrogate marker of increased morbidity. We aim to determine the association between perfusion delay on T max (&lt; 4 sec, 4-6 sec, and &gt; 6 sec) on perfusion weighted imaging and LOS in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods: We included consecutive patients with left MCA stenosis admitted with ischemic stroke or TIA &lt;7 days from onset who underwent perfusion imaging (CT or MR perfusion) processed with RAPID software. We excluded patients with core infarct ≥ 30 mL. Perfusion mismatch was divided into three groups: mismatch volume ≥ 15 mL based on T max &gt; 6 sec delay, mismatch volume ≥ 15 mL based on T max 4-6 sec delay, and neither of the above mismatch patterns. The primary outcome was LOS, both as a continuous variable and categorical (≥ 7 days (prolonged LOS) vs. &lt;7 days). Results: 179 out of 194 patients met the inclusion criteria; mean age was 70.2 ± 15.4 years, 53.1% were women, median (IQR) NIHSS was 4 (1-9); 83.2% underwent MR perfusion; 38.5% had a mismatch volume ≥ 15 mL based on T max &gt; 6 sec and 31.3% had a mismatch volume ≥ 15 mL based on T max 4-6 sec and the median (IQR) LOS was 4 days (2-8). After adjusting for age and NIHSS, T max &gt; 6 sec mismatch definition was associated with prolonged LOS (OR 2.90 95% CI 1.06-8.18; p=0.039) but T max 4-6 sec definition was not (OR 1.45 95% CI 0.46-4.58, p=0.528), without any interaction based on perfusion imaging modality (p interaction = 0.568). We found similar associations when LOS was considered as a continuous variable for T max &gt; 6 sec (β coefficient=2.01, 95% CI 0.05-3.97, p=0.044) and T max 4-6 sec (β coefficient=1.24, 95% CI -0.85-3.34, p=0.244). In receiver operating curves, the optimal mismatch volume for T max &gt; 6 sec was 10 mL (sensitivity 0.61 and specificity 0.63) whereas for T max 4-6 sec it was 39 mL (sensitivity 0.61 specificity 0.56). Conclusion: In patients with recently symptomatic MCA stenosis, the T max &gt; 6 sec definition for mismatch, but not T max 4-6 sec, is associated with prolonged LOS. Prospective studies are needed to validate our findings and define the optimal mismatch threshold in patients with symptomatic MCA stenosis.

Acute thromboembolic complication after stent-assisted aneurysm embolization of ruptured dissecting aneurysm in communicating internal carotid artery segment

Abstract Introduction: Dissecting aneurysms in the communicating segment of the internal carotid artery (ICA) is uncommon. Clinical evidence to support the use of endovascular treatment for dissecting aneurysms in the communicating segment of ICA has not been established. Patient concerns: A 48-year-old woman presented with complaints of sudden headaches with nausea and vomiting. Computed Tomography Head taken in another hospital showed subarachnoid hemorrhage. Diagnoses: Digital Subtraction Angiography examination of the head showed ruptured dissecting aneurysm in the communicating segment of ICA. Interventions: The patient underwent stent-assisted aneurysm embolization and acute thromboembolic complication occurred intra-operatively. Tirofiban was injected through the microcatheter and a Percutaneous Transluminal Angioplasty (PTA) balloon catheter was inserted in the stent. Following the treatment, a repeat digital subtraction angiography showed no aneurysm development and the right middle cerebral artery was unobstructed. The right ICA was observed for 30 minutes, and it remained patent. Outcomes: Seven hours after the procedure, the patient became drowsy, the right limb was paralyzed, and her speech was slurred. Magnetic resonance angiography and 3D time of flight showed severe stenosis of the right middle cerebral artery and anti-platelet drug was administered. At seven-month follow-up, the patient showed residual mild motor dysfunction of right hand and leg. Conclusion: For ruptured dissecting aneurysm in the communicating segment of ICA, endovascular treatment may be a suitable treatment. But there is a risk of acute thromboembolic complication during and after the procedure and hence requires careful monitoring.

Abstract P358: Association of Kidney Function and Cerebral Arterial Stiffness

Background and Purpose: Chronic kidney disease (CKD) is known to have affected the systemic vasculature and its remodeling, which eventually led to the systemic arterial stiffness. However, the relationship between cerebral circulation and impaired renal function is poorly understood. To evaluate the effect of renal dysfunction to increase systemic and intracranial arterial stiffness, we assessed the relation between renal resistive index (RRI) and pulsatility index (PI) of the middle cerebral artery (MCA). Methods: We included patients with acute lacunar infarction. Demographic and clinical data were collected by retrospective chart review. Bilateral transcranial Doppler ultrasound (TCD) examination of the MCAs was performed using the ST3 Ultrasound system (Spencer Technologies) and PI were calculated. RRI was obtained through kidney Doppler sonography. Subjects with occlusion or significant stenosis of MCA, atrial fibrillation, bilaterally absent transtemporal sonographic windows were excluded. Results: Of the 283 included subjects (mean age 67.8 ± 10.2), 74 patients had renal dysfunction (glomerular filtration rate &lt; 60ml/min/1.73m2 at admission) and 49 patients underwent kidney Doppler ultrasound within 1 year since their acute stroke. Renal dysfunction was significantly associated with higher arterial stiffness (median PI 1.12, IQR 0.85 to 1.57 vs. controls PI 0.84, IQR 0.54 to 1.22 [p&lt;0.0001]). There was a proportional relationship between the degree of renal dysfunction and the distal vascular resistance. In multivariate adjusted regression analysis, renal function was related to high PI (p&lt;0.001). Furthermore, there is strong correlation between RRI and PI ( r =0.65, p &lt;0.001). Conclusions: In patients with lacunar infarction, renal impairment is an independent determinant of increased arterial stiffness in cerebral circulations. In addition, PI is significantly associated with RRI.

Can 3D Pseudo-Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis?

Unilateral middle cerebral artery (MCA) stenosis, as an independent risk factor for stroke, requires an intervention operation for vessel recanalization. Accurate perfusion measurement is thus essential after the operation. To explore the feasibility of three-dimensional (3D) pseudo-continuous territorial arterial-spin-labeling (tASL) in evaluating MCA recanalization. Prospective and longitudinal. Forty-seven patients with unilateral MCA stenosis or occlusion. A 3.0 T, 3D time-of-flight fast-field-echo magnetic resonance (MR) angiography sequence, spin-echo echo-planar diffusion-weighted imaging sequence, 3D fast-spin-echo pseudo-continuous ASL (pcASL) and tASL sequences. All patients underwent MR examination before and after MCA recanalization and scored using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admission and discharge. An mRS score <2 was defined as a good prognosis. 3D-pcASL and tASL cerebral blood flow (CBF) maps were obtained, and the corresponding Alberta Stroke Program Early CT Score (ASPECTS)-based scores were evaluated. The Kolmogorov-Smirnov test, intra-class correlation coefficient, paired t-test, receiver operating characteristic (ROC) curve, and multivariable logistic regression analysis. After recanalization, tASL derived absolute CBFs between the affected and contralateral sides were significantly higher than before the operation (mean: 34.3 ± 8.5 mL/100 g/min vs. 40.6 ± 9.2 mL/100 g/min, 42.6 ± 9.8 mL/100 g/min vs. 43.5 ± 9.9 mL/100 g/min, both P < 0.05). In ROC analysis, tASL provided good prognosis (area under ROC curve [AUC]=0.829; 95% CI: 0.651-1.000, P < 0.05), while pcASL had lower prognostic value (AUC=0.760; 95% CI: 0.574-0.946, P < 0.05). The NIHSS score before recanalization, pcASL, and tASL-based ASPECTS scores were significantly associated with good clinical outcome (P < 0.05). Multivariable analysis revealed that ASPECTS-based scores of pcASL and tASL before and after surgery were independent predictors of good clinical outcome (all P < 0.05). DATA CONCLUSION: tASL can determine hypoperfusion in the responsible vascular perfusion area and predict clinical outcome. 4 TECHNICAL EFFICACY: Stage 2.

Stenosis diagnosis based on peripheral arterial and artificial neural network

The current diagnosis methods of arterial stenosis need to rely on large-scale equipment, which cannot provide early warning for patients with arterial stenosis and make them miss the best treatment opportunity. Therefore, we present an algorithm for the diagnosis of arterial stenosis, which is based on neural network. The input of neural network is peripheral pulse wave signal, and the output is the degree and location of arterial stenosis. The acquisition of peripheral pulse wave signal is convenient, and patients can detect it at home. In this paper, we extend firstly the existing human arterial transmission line model to include cerebral vessels, so that we can study cerebral artery stenosis. Then, we use the extended transmission line model to verify the effect of arterial stenosis (including carotid stenosis, renal artery stenosis, middle cerebral artery stenosis) on peripheral pulse wave signal. Finally, a database of peripheral pulse wave was established to simulate the actual conditions of artery stenosis based on the transmission line model. In addition, a diagnosis model of artery stenosis was constructed by using artificial neural network (ANN). The diagnostic results showed that when the degree of stenosis varied from 10 to 90%, the diagnostic accuracy was 88.7%. For moderate (50%) and severe (90%) degrees of stenosis, the diagnostic accuracy was 90.5% and 98.7%, respectively. Moreover, when the degree of stenosis was greater than 50%, the diagnostic accuracy of narrow positioning is greater than 95%. In general, the proposed algorithm does not rely on large equipment and has high accuracy, which can provide patients with early warning of arterial stenosis.

Impaired Distal Perfusion Predicts Length of Hospital Stay in Patients with Symptomatic Middle Cerebral Artery Stenosis.

Perfusion imaging can risk stratify patients with symptomatic intracranial stenosis. We aim to determine the association between perfusion delay and length of hospital stay (LOS) in symptomatic middle cerebral artery (MCA) stenosis patients. This is a retrospective study of consecutive patients admitted to a comprehensive stroke center over 5 years with ischemic stroke or transient ischemic attack (TIA) within 7 days of symptom onset due to MCA stenosis (50-99%) and underwent perfusion imaging. Patients were divided into three groups: mismatch volume ≥ 15 cc based on T max > 6 second delay, T max 4-6 second delay, and <4second delay. The outcome was LOS, both as a continuous variable and categorical (≥7 days [prolonged LOS] vs. <7days). We used adjusted regression analyses to determine the association between perfusion categories and LOS. One hundred and seventy eight of 194 patients met the inclusion criteria. After adjusting for age and NIHSS, T max >6 second mismatch was associated with prolonged LOS (OR 2.94 95% CI 1.06-8.18; P = .039), but T max 4-6 second was not (OR 1.45 95% CI .46-4.58, P = .528). We found similar associations when LOS was a continuous variable for T max > 6 second (β coefficient = 2.01, 95% CI .05-3.97, P = .044) and T max 4-6 second (β coefficient = 1.24, 95% CI -.85 to 3.34, P = .244). In patients with symptomatic MCA stenosis, T max > 6 second perfusion delay is associated with prolonged LOS. Prospective studies are needed to validate our findings.

Lenticulostriate artery combined with neuroimaging markers of cerebral small vessel disease differentiate the pathogenesis of recent subcortical infarction

Recent subcortical infarction (RSI) in the lenticulostriate artery (LSA) territory with a non-stenotic middle cerebral artery is a heterogeneous entity. We aimed to investigate the role of LSA combined with neuroimaging markers of cerebral small vessel disease (CSVD) in differentiating the pathogenic subtypes of RSI by whole-brain vessel-wall magnetic resonance imaging (WB-VWI). Fifty-two RSI patients without relevant middle cerebral artery (MCA) stenosis on magnetic resonance angiography were prospectively enrolled. RSI was dichotomized as branch atheromatous disease (BAD; a culprit plaque located adjacent to the LSA origin) (n = 34) and CSVD-related lacunar infarction (CSVD-related LI; without plaque or plaque located distal to the LSA origin) (n = 18). Logistic regression analysis showed lacunes (odds ratio [OR] 9.68, 95% confidence interval [CI] 1.71–54.72; P = 0.010) and smaller number of LSA branches (OR 0.59, 95% CI 0.36–0.96; P = 0.034) were associated with of BAD, whereas severe deep white matter hyperintensities (DWMH) (OR 0.11, 95% CI 0.02–0.71; P = 0.021) was associated with CSVD-related LI. In conclusion, the LSA branches combined with lacunes and severe DWMH may delineate subtypes of SSI. The WB-VWI technique could be a credible tool for delineating the heterogeneous entity of SSI in the LSA territory.

Neurocognitive improvement after angioplasty in patients with chronic middle cerebral artery stenosis and cerebral ischemia.

The use of middle cerebral artery (MCA) angioplasty compared with drug therapy has been controversial. Few studies have reported the correlations between cognitive function improvement and MCA angioplasty. This study aimed to explore neurocognitive function after angioplasty in patients with middle cerebral artery stenosis (MCAS) and objective cerebral ischemia. We identified 14 patients diagnosed with MCAS aged 45-65 years. Neurocognitive function evaluation was performed by 2 independent clinical psychologists using the Mini-Mental State Examination (MMSE), Montreal cognitive assessment scale (MoCA), and Multi-Dimensional Psychology. All patients received general anesthesia, underwent diagnostic cerebral angiography (DSA) via the femoral route and angioplasty, and then were sent to the neurologic intensive care unit (NICU) for overnight hemodynamic and neurologic monitoring. Aspirin and clopidogrel treatments were continued for 3 months after successful intervention. Complete neurologic examinations, including assessment with the National Institutes of Health Stroke (NIHSS), and modulate RANK score (MRS) were conducted by 2 independent neurologists. The patients received a family follow-up at 1 week, 1 month, and 3 months after the interventional procedure. Neurologic sequelae, intracranial hemorrhages, and deaths were recorded as an endpoint. Follow-up clinical and imageological examinations were scheduled at 6 months after the intervention. Follow-up brain computed tomography (CT) perfusion or magnetic resonance angiography (MRA) perfusion scans performed by 2 imageological scanners were scheduled 6 months after the procedure. Angioplasty technical success was achieved in 14 parents (100%). We found that 10 patients did not have recurrent MCAS in the angioplasty site and had significant improvements in the associated brain perfusion situation and cognitive founction as compared before and after angioplasty. Also, 4 patients had evident restenosis in the angioplasty site. In the nonstenosis group, we found significant improvements in the MMSE, 3-dimensional (3D) mental rotation, simple calculation, and spatial working memory. In the recurrent stenosis group, we found no statistically significant changes in cognitive function compared with the baseline and after a 6-month follow up. There were high correlations between the changes in perfusion and the changes in word and picture memory. There was a significant correlation between the change in perfusion with MMSE (-0.522), spatial working memory (0.655), and Raven's progressive matrices test (0.637); a moderate correlation with 3D rotation (0.413), and simple calculation (-0.359); and weak correlation with visual tracking (0.026) and MoCA (0.279). Angioplasty surgery significantly improves neurocognitive function in patients with middle cerebral artery stenosis (MCAS) and objective cerebral ischemia.