Middle Cerebral Artery Stenosis Research Articles

DL-3-n-butylphthalide improves cerebral hypoperfusion in patients with large cerebral atherosclerotic stenosis: a single-center, randomized, double-blind, placebo-controlled study

BackgroundDL-3-n-butylphthalide (NBP) was demonstrated to increase the cerebral blood flow (CBF) in the animal models, but there are no clinic studies to verify this. We aimed to explore the effect of NBP on improving cerebral hypoperfusion caused by cerebral large-vessel stenosis.MethodsIn this single-center, randomized, double-blind, placebo-controlled study, 120 patients with severe carotid atherosclerotic stenosis and cerebral hypoperfusion in the ipsilateral middle cerebral artery (MCA) were included and randomly assigned into NBP or placebo group as 1:1 radio. Patients in NBP or placebo group received 200 mg or 20 mg of NBP capsules three times daily for four weeks respectively. Single photon emission computed tomography (SPECT) was used to assess regional CBF (rCBF) in four regions of interest (ROIs) corresponding to MCA before and 12 weeks after the treatment. After therapy, the rCBF change for every ROI and the whole CBF change in MCA territory for every patient were classified into amelioration, stabilization and deterioration respectively.Results48 NBP patients (6 with bilateral stenosis) and 46 placebo patients (8 with bilateral stenosis) completed the trial. Overall, both groups had 54 stenotic carotid arteries and 216 ROIs for rCBF change analysis. After therapy, the rCBF in ROIs increased in NBP group (83.5% ± 11.4% vs. 85.8% ± 12.5%, p = 0.000), whereas no change was found in placebo group (86.9% ± 11.6% vs. 87.8% ± 11.7%, p = 0.331). Besides, there was higher percentages of ROIs with rCBF amelioration and stabilization in NBP group than in placebo group (93.1% vs. 79.2%, p = 0.000). Furthermore, ordinal regression analysis showed that compared with placebo, NBP independently made more patients to have whole CBF amelioration in ipsilateral MCA (Wald-χ2 = 5.247, OR = 3.31, p = 0.022).ConclusionsNBP might improve the cerebral hypoperfusion in the patients with carotid artery atherosclerotic stenosis.Trial registrationChinese Clinical Trial Registry, ChiCTR1900028005, registered December 8th 2019- Retrospectively registered (http://www.chictr.org.cn/index.aspx).

Association Between Steno-Occlusive Middle Cerebral Artery and Basal Ganglia Perivascular Spaces.

Objectives: Enlarged perivascular spaces in the basal ganglia (BG-EPVS) share common vascular risk factors with atherosclerosis. However, little is known about the relationship between steno-occlusive middle cerebral artery (MCA) and BG-EPVS. In this cross-sectional study, we aimed to test the hypothesis that severe MCA stenosis or occlusion is associated with increased MRI-visible BG-EPVS.Methods: We retrospectively reviewed 112 patients with a steno-occlusive MCA from Fujian Medical University Union Hospital between January 2014 and December 2018. We rated BG-EPVS, white matter hyperintensities (WMH), and lacunes as markers of cerebral small vessel disease (CSVD) on magnetic resonance image (MRI). The severity of steno-occlusive MCA was assessed by computed tomography angiography (CTA) and was classified into moderate (50–69%), severe (70–99%), and occlusion (100%). We evaluated the association of steno-occlusive MCA for >10 BG-EPVS using logistic regression model adjusted for age, gender, hypertension, MR-visible WMH, and lacunes. We also compared the number of BG-EPVS between the affected side and unaffected side in patients with only unilateral steno-occlusive MCA.Results: In multivariable logistic regression analysis, age (OR = 1.07, 95%CI: 1.03–1.13, p = 0.003), hypertension (OR = 2.77, 95%CI: 1.02–7.51, p = 0.046), severe MCA stenosis (OR = 3.65, 95%CI: 1.12–11.87, p = 0.032), or occlusion (OR = 3.67, 95%CI: 1.20–11.27, p = 0.023) were significantly associated with >10 BG-EPVS. The number of BG-EPVS in the affected side was higher than the unaffected side in patients with severe MCA stenosis (12 [9−14] vs. 8 [6−11], p = 0.001) or occlusion (11 [7−14] vs. 8 [5−11], p = 0.028).Conclusions: BG-EPVS were more prevalent in patients with severe MCA atherosclerosis. Our findings suggest a biological link between severe steno-occlusive MCA and increased BG-EPVS. These results need confirmation in prospective studies.

Hemodynamic Significance of Middle Cerebral Artery Stenosis Associated With the Severity of Ipsilateral White Matter Changes.

Background: Previous studies conflicted in the association between intracranial atherosclerotic stenosis (ICAS) and the severity of white matter changes (WMC).Aims: We aimed to investigate the relationships between the severity of luminal stenosis and the hemodynamic significance of middle cerebral artery (MCA) stenosis, and the severity of ipsilateral WMC.Methods: In this cross-sectional study, patients with a recent ischemic stroke or transient ischemic attack and a 50–99% MCA-M1 stenosis in the Chinese Intracranial Atherosclerosis study cohort were analyzed. The post- to pre-stenotic signal intensity ratio (SIR) was obtained in time-of-flight MR angiography (MRA) to represent the hemodynamic significance of MCA-M1 stenosis, with a lower SIR indicating a hemodynamically more severe lesion. The severity of ipsilesional WMC was assessed by an age-related WMC (ARWMC) scale in T2-weighted fluid attenuated inversion recovery MR imaging. The relationships between the degree of MCA-M1 stenosis, SIR, and ipsilesional ARWMC scale were analyzed. The MCA-M1 lesion with a higher percentage of stenosis was chosen for analyses in patients with bilateral MCA-M1 stenoses.Results: Among 180 subjects (mean age, 64 years), a lower SIR of MCA-M1 stenosis (Spearman correlation coefficient, −0.543; p < 0.001), but not the degree of stenosis (p = 0.93), was significantly linearly correlated with a higher ipsilateral ARWMC. Multivariate ordinal logistic regression identified older age (OR = 1.037; 95% CI, 1.008–1.066; p = 0.011) and lower SIR (OR = 0.010; 95% CI, 0.002–0.058; p < 0.001) as independent predictors for more severe ipsilateral WMC.Conclusion: Patients with hemodynamically more severe ICAS are more likely to have more severe ipsilateral WMC. Longitudinal studies with sequential imaging exams may further reveal the impact of hemodynamic significance of ICAS on the development and progression of WMC.

Application value of preoperative high-resolution magnetic resonance vessel wall imaging evaluation on symptomatic middle cerebral artery stenosis stenting

Objective To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) in stenosis stenting for symptomatic middle cerebral artery. Methods The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery (MCA) M1 segment who were treated with stenting therapy (stenting angioplasty) at Department of Neurosurgery, Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively. HRMR-VWI results were used to evaluate the location, composition and stability of plaques before operation. The mortality and morbidity at 30 days post operation were determined by clinical follow-up. The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up. Results The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall, those in 12 on the inferior, and those in 8 on the upper vessel wall. Seven patients had unstable plaques in the M1 segment of MCA. The stents were successfully placed in 35 patients and well adhered with smooth blood flow. Technical complications occurred in 2 (5.7%) patients. One patient (2.8%) died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery, although decompressive craniectomy and hematoma clearing were performed. One patient (2.8%) had residual neurological dysfunction. Twelve months after the operation, no ischemic stroke occurred in 34 patients, and no restenosis occurred in the 5 patients who were followed up by imaging. Conclusion HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA, which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis. Key words: Middle cerebral artery; Endovascular procedures; Stents; Atherosclerotic stenosis; High resolution magnetic resonance vessel wall imaging

Double stenting in T configuration with safety micro-guidewire technique in a complex middle cerebral artery stenosis

Intracranial arterial stenosis is a frequently misdiagnosed cause of ischemic stroke, associated with high rates of recurrence under medical therapy alone. Endovascular intracranial angioplasty and stenting has increasingly been used worldwide for treatment of symptomatic intracranial stenoses, despite controversial results of the first randomized trials. Lesion morphology and etiology must be considered during endovascular treatment planning. Complex morphologies can lead to serious complications during the endovascular procedure. We present a case of a symptomatic complex middle cerebral artery stenosis that was successfully treated with a double stenting in T configuration, using a safety micro-guidewire technique. During follow-up, intracranial Doppler revealed a non-significant residual stenosis and the patient remained asymptomatic.

Abstract WP168: Association of Stenosis, Proximal Flow and Distal Perfusion in Subjects With Middle Cerebral Artery Stenosis

Introduction: Hemodynamic compromise caused by intracranial artery stenosis is one of the critical factors contributing to ischemic stroke. However, the association between flow and stenosis has not been well determined quantitatively, nor its correlation with distal perfusion. The purpose of this study was to investigate the association of blood flow in different grades of stenosis, as well as its association with distal brain tissue perfusion. Methods: Intracranial 4D flow and perfusion were obtained in 33 patients (mean 56 years old) with different grades of unilateral middle cerebral artery (MCA) stenosis. GTFlow was used to measure the flow at the proximal of stenosis and the symmetrical location of contralateral side (Fig 1a). Olea was accessed to calculate the perfusion parameters in MCA area. The average net flow at the proximal of stenosis was compared in patients with different grades(&lt;30%,30-49%,50-69%, and ≥70%) of stenosis. Correlation between relative flow(stenosis/contralateral) and perfusion parameters were also compared in different pial collateral status. Results: Blood flow at the proximal of stenosis changes with the grades of stenosis increasing (Fig 1b, p =0.01). Subjects with &lt;50% and ≥50% stenosis differ in MCA flow, rCBF and rTTP, but not in rCBV (Fig 1c).Spearman correlation analysis indicated that the relative flow was also associated with rTTP shown in distal brain tissue in subjects with poor collateral (Fig 1d, r=-0.69, p =0.02), but not in patients with good collateral. No association between relative flow and rCBF was detected in this group of population. Conclusion: In conclusion, decreased flow at the proximal of stenosis could result in the delay of perfusion in distal brain tissue in patients with poor collateral. Association of flow and stenosis, as well as its relationship with distal perfusion need further study, collateral status and potential compensatory mechanism should be considered in future study.

Characteristics of single subcortical small infarction in the middle cerebral artery territory

Objective: To investigate the characteristics and possible mechanisms of differtent stroke patterns of single subcortical small infarction (SSSI) in the middle cerebral artery (MCA) territory. Methods: The clinical and imaging data of patients with acute SSSI in MCA territory admitted to the Neurology Department of People's Hospital of Zhengzhou City from January 2016 to December 2017 were retrospectively analyzed. According to the presence of MCA stenosis and whether the lesion sites on axial DWI-MRI involved the lowest basal ganglia, SSSl were divided into different patterns. The clinical and imaging characteristics of patients with different stroke patterns were compared. Results: Of the 91 patients, 24 (26.37%) were SSSI with parental artery disease (SSSIPAD), 28 (30.77%) were proximal SSSI without PAD (pSSSI-PAD) and 39 (42.86%) were distal SSSI without PAD (dSSSI-PAD). There were significant differences in age, hypertension, diabetes mellitus, smoking, NIHSS score, low density lipoprotein cholesterin (LDL-C) level, infarct layers ≥3, lesion diameter, white matter hyperintensity, lacunar infarction, enlarged perivascular space, cerebral microbleed, concomitant intracranial and extracranial atherosclerotic stenosis among the three groups (all P<0.05). Compared with SSSIPAD(-), patients with SSSIPAD(+) had significantly higher prevalence of smoking, proximal SSSI, ICAS, ECAS, NIHSS score, LDL-C level and larger lesion diameter (all P<0.05). Conclusions: The clinical characteristics and imaging features were different among different SSSI stroke patterns. SSSIPAD is an important infarct type. pSSSI-PAD may showed intermediate features of SSSIPAD and dSSSI-PAD, and evidence of atherosclerosis should be carefully searched for such patients.

A New Transcranial Doppler Scoring System for Evaluating Middle Cerebral Artery Stenosis.

Transcranial Doppler (TCD) criteria for cerebrovascular stenosis are only based on velocity with unsatisfactory positive predictive value (PPV) in previous studies. We refined a published scoring system that integrates several characteristics of TCD data in diagnosing middle cerebral artery (MCA) stenosis. Using the TCD-digital subtraction angiography (DSA) database from Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial, velocity, spectrum pattern, diffuse ratio, and asymmetry ratio were assessed. The cutpoints were defined for each parameter and a point value was assigned to each category within that parameter. A summed score was calculated for each MCA. The accuracy was assessed for different cutpoints in predicting ≥50% MCA stenosis measured by DSA. Logistic regression and C-statistics were used for analysis. A total of 114 MCAs were included in vessel-based and 87 patients were included in patient-based analysis. Compared to the velocity-only cutpoints in SONIA, the score results in much improved PPV while negative predictive value (NPV) remains unchanged. The score based on mean velocity (score 0: <140cm/s, score 3: ≥140cm/s), spectrum pattern (score 0: no turbulence; score 1: mild turbulence; 2: significant turbulence), and asymmetry ratio (score 0: ratio<1.5, score 1: ratio 1.5-2; score 2: ratio ≥2.1) has the highest NPV while PPV remains favorable (PPV: 72% [95% CI 54-90%]; NPV: 84% [95% CI: 75-93%], area under curve [AUC]: .76 [95% CI: .66-.86]). The multiparameter scoring system incorporating several characteristics of TCD measures yielded higher PPV while maintaining high NPV compared with the single-parameter velocity criteria in diagnosing MCA ≥50% stenosis.

Comparative Characteristics of the Expression of Inducible NO Synthase in the Hippocampus of Humans and Experimental Animals

Objective: To study the characteristics of the expression of inducible NO synthase (iNOS) in hippocampal fields CA1 and CA3 in adult male humans and adult rats exposed to combined stress. Materials and methods. The hippocampi of 10 men in the second period of adulthood (35–60 years) with pathology of the cardiovascular system and pain stress due to acute myocardial infarct and 10 subjects who died for reasons other than cardiovascular disease were studied. The experimental material included the brains of 20 white adult male rats divided into a control group and an experimental group subjected to combined stress. The levels of expression and relative areas of iNOS-immunoreactive material (IRM) were determined. Results. Hippocampal fields CA1 and CA3 in humans with >50% stenosis of the middle cerebral artery (MCA) showed increases in the relative area and increases in the level of expression of iNOS-IRM. Stressed animals showed increases over controls in the relative area of iNOS-IRM in field CA3 and in the level of expression of iNOS-IRM in fields CA1 and CA3. Conclusions. Marked changes in the form of damage to neurons in the pyramidal layer of the hippocampus and increases in the level of expression of iNOS were seen in field CA3 both in humans with MCA stenosis and in experimental animals subjected to combined stress.

Comparative Evaluation of North American Symptomatic Carotid Endarterectomy Trial and Warfarin-Aspirin Symptomatic Intracranial Disease Methods for Measurement of Middle Cerebral Artery Stenosis in Digital Subtraction Angiography and Magnetic Resonance Angiography

Comparative Evaluation of North American Symptomatic Carotid Endarterectomy Trial and Warfarin-Aspirin Symptomatic Intracranial Disease Methods for Measurement of Middle Cerebral Artery Stenosis in Digital Subtraction Angiography and Magnetic Resonance Angiography

Ultra-low-dose multiphase CT angiography derived from CT perfusion data in patients with middle cerebral artery stenosis.

Computed tomography (CT) perfusion (CTP) source images contain both brain perfusion and cerebrovascular information, and may allow a dynamic assessment of collaterals. The purpose of the study was to compare the image quality and the collaterals identified on multiphase CT angiography (CTA) derived from CTP datasets (hereafter called CTPA) reconstructed with iterative model reconstruction (IMR) algorithm in patients with middle cerebral artery (MCA) steno-occlusion with those of routine CTA. Consecutive patients with a unilateral MCA steno-occlusion underwent non-contrast CT (NCCT), CTP, and CTA. CTPA images were reconstructed from CTP datasets. The vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of routine CTA and CTPA were measured and analyzed by Student's t test. Subjective image quality and collaterals were scored and compared using the Wilcoxon signed-rank test. Fifty-eight patients (mean age 61.7 years, 78% males, median National Institutes of Health Stroke Scale score = 12) were included. The effective radiation dose of CTP was 1.28 mSv. The vascular attenuation, SNR, CNR, and the image quality of CTPA were considerably higher than that of CTA (all, p < 0.001). Collaterals were rated higher on CTPA compared with CTA (1.79 ± 0.64 vs. 1.22 ± 0.84, p < 0.001). Fifty-three percent of patients with poor collaterals assessed on single-phase CTA had good collaterals on CTPA. CTPA derived from CTP datasets reconstructed with IMR algorithm offers image quality comparable to routine CTA and provides time-resolved evaluation of collaterals in patients with MCA ischemic disease.

Reversible middle cerebral artery stenosis and stroke symptoms after correcting severe iron deficiency anemia

Little has been known about the relationship between iron deficiency anemia (IDA) and acute ischemic stroke. We present a case of patient with acute ischemic infarction with bilateral MCA stenosis complicated by severe IDA, which resolved rapidly after correcting IDA. A 67-year-old woman was referred to emergency department with right hemiparesis on wake-up. On examination she had MRC grade 3 weakness of the right upper and lower extremities with a NIH Stroke Scale score (NIHSS) of 4. DWI showed multifocal diffusion restriction foci involving Lt. temporal, both parietal and occipital lobes. MRA revealed segmental severe stenosis at both proximal MCA. Her haemoglobin level of 1.9 g/dL, which rose to 4.0 g/dL after RBC transfusion. In 2 hours, her neurologic symptoms improved to NIHSS 1. Gastrofiberscopy, colonoscopy, and CT scan of the chest and abdomen revealed no signs of malignancy or acute internal bleeding. The results of hematological and biochemical studies were compatible with the diagnosis of IDA. Follow-up MRA on 5th days showed remarkably improved bilateral MCA stenosis compared with baseline MRA. Results of the baseline and follow-up TCD also suggested improved MCA stenosis. She was discharged with a haemoglobin level of 7.8 g/dL and without significant neurologic deficit. We report an acute ischemic stroke patient with bilateral MCA stenosis and severe IDA. Stroke severity and the degree MCA stenosis improved promptly by correcting anemia with RBC transfusion. Severe anemia may be a trigger factor for aggravating stenosis of intracranial arteries and stroke symptoms.

Vascular Morphology has No Direct Relationship with Atherosclerotic Plaque Burden in Patients with Symptomatic Middle Cerebral Artery Stenosis.

The vascular morphology and the characteristics of atherosclerotic plaques in the middle cerebral artery (MCA) have not been fully studied with high-resolution magnetic resonance imaging (HR-MRI). HR-MRI was applied to investigate vascular morphology and atherosclerotic plaque in patients with symptomatic MCA stenosis. A total of 343 patients with symptomatic MCA stenosis were enrolled in this study. All the patients were examined by HR-MRI to analyze the morphology of MCA and the M1 segment (MCA-M1), the characteristics and the location of the plaques. The proportion of L-shaped MCA-M1 decreased, while the proportion of S-shaped MCAM1 increased with age. The anterior plaques were the most common in all the patients. The superior plaques were relatively common in patients with L-shaped and U-shaped MCA-M1, while the inferior plaques were relatively common in patients with inverted U-shaped and S-shaped MCAM1. Among all the plaques, the majority were isointense or heterogeneous. The MCA-M1 morphology had no direct relationship with the common risk factors of atherosclerosis and the clinical outcomes of the patients after 12 months of follow up. The morphology of MCA-M1 is not directly related to the plaque burden or the degree of stenosis in patients with symptomatic MCA stenosis. The morphology of MCA-M1 is not associated with the risk factors of atherosclerosis, or the clinical outcomes of the patients.

Restoration of a stent-assisted thrombectomy-related middle cerebral artery stenosis: a case with 3 years’ follow-up

Restoration of a stent-assisted thrombectomy-related middle cerebral artery stenosis: a case with 3 years’ follow-up

On the Validation of a Multiple-Network Poroelastic Model Using Arterial Spin Labeling MRI Data.

The Multiple-Network Poroelastic Theory (MPET) is a numerical model to characterize the transport of multiple fluid networks in the brain, which overcomes the problem of conducting separate analyses on individual fluid compartments and losing the interactions between tissue and fluids, in addition to the interaction between the different fluids themselves. In this paper, the blood perfusion results from MPET modeling are partially validated using cerebral blood flow (CBF) data obtained from arterial spin labeling (ASL) magnetic resonance imaging (MRI), which uses arterial blood water as an endogenous tracer to measure CBF. Two subjects—one healthy control and one patient with unilateral middle cerebral artery (MCA) stenosis are included in the validation test. The comparison shows several similarities between CBF data from ASL and blood perfusion results from MPET modeling, such as higher blood perfusion in the gray matter than in the white matter, higher perfusion in the periventricular region for both the healthy control and the patient, and asymmetric distribution of blood perfusion for the patient. Although the partial validation is mainly conducted in a qualitative way, it is one important step toward the full validation of the MPET model, which has the potential to be used as a testing bed for hypotheses and new theories in neuroscience research.

Effects of superficial temporal artery-middle cerebral artery bypass on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and middle cerebral artery

ObjectiveTo observe the effects of superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and (or) middle cerebral artery. Patients and methodsThe data of 63 patients who had the symptoms of cerebral ischemia in recent 3 months, intracranial segment of internal carotid artery (ISICA) and (or) middle cerebral artery (MCA) stenoses or occlusion showed by digital subtraction angiography (DSA), and reduced cerebral perfusion displayed by CT perfusion (CTP) imaging were retrospectively collected in this study. According to the patient's choice of different treatment methods (STA-MCA bypass and drugs), these patients were allocated into two groups: Bypass group (30 cases) and Drug group (33 cases). Postoperative symptoms, anastomotic patency and hemodynamics were observed in the Bypass group. Post-treatment ischemic events and clinical outcomes were recorded in the two groups and were compared between the two groups. ResultsIn the Bypass group, DSA all showed anastomotic patency in 28 patients (93.3%, 28/30), and the improvement rate of CTP was all significantly higher in the patients with stage-III CTP than in the patients with stage-II CTP at post-operative 3 days and 6 months (95% vs 60%). Post-treatment ischemic event incidence (13.3% vs 48.5%) and annual stroke rate (6.7% vs 25.6%) were significantly lower in the Bypass group than in the Drug group (All P < 0.05). Pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (MRS) score were not significantly different between the two groups, but the NIHSS (2.87±0.19 and 2.4±0.19 vs 4.03±0.47 and 3.97±0.49) and MRS (1.13±0.09 and 1.0±0.07 vs 1.55±0.14 and 1.52±0.15) all were significantly lower in the Bypass group than in the Drug group at post-treatment 6 and 24 months (all P < 0.05). ConclusionSTA-MCA bypass can improve cerebral blood perfusion and reduce the incidence of stroke in the patients who have ISICA and (or) MCA-related symptoms, 70%-100% of stenosis, and above stage-ⅠCTP. However, this conclusion remains to be further confirmed.

Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis

Background and purposeWe investigated the baseline demographics of patients with severe unilateral atherosclerotic stenosis of the middle cerebral artery (MCA) using multimodal MRI and evaluated the haemodynamic impairments and plaque...

Why is middle cerebral artery plaque augmented by contrast media? A phantom study using middle cerebral arterystenotic silicon model.

The pathophysiologic mechanisms of contrast enhancement (CE) of middle cerebral artery (MCA) plaque remain unclear since histologic and imaging findings have never been compared. The purpose of this study was to assess the pattern of CE between patients with MCA stenosis or occlusion and in an MCA stenotic silicone model. We retrospectively reviewed black blood (BB) contrast-enhanced T1-weighted (CE-T1W) imaging of patients who presented with acute stroke symptoms between January 2017 and January 2018. We subdivided the enrolled subjects according to whether the cerebral angiography findings suggested stenosis or occlusion. Silicone models were made with 4 degrees of MCA stenosis (stenotic area: 0.8mm, 1.0mm, 1.2mm, and 1.4mm) with a 3-mm lumen. BB CE-T1W imaging on silicone models with stenosis was obtained 5min after contrast injection. During the period of this study, 19 patients with complete MCA occlusion and 22 with MCA stenosis, as shown by the cerebral angiography, were enrolled in this study. The CE of the silicone models with stenosis were 0.8 (74%)mm and 1.0 (66.7%)mm. The SI ratios of the CE of the plaque and the lumen were similar between the silicone models and the MCA stenosis/occlusion groups (silicone models: 31.0 ± 11.2; MCA occlusion: 27.6 ± 19.6; MCA stenosis: 22.8 ± 9.8). The silicone stenotic MCA model was characterized by luminal enhancement through contrast stagnation. The findings of the CE of the MCA plaque may be partially associated with stagnation of the contrast media.

比较经颅超声造影和数字减影血管造影对大脑中动脉狭窄的诊断价值研究 Diagnostic Value of Transcranial Contrast-enhanced Ultrasound and Digital Subtraction Angiography for Middle Cerebral Artery Stenosis

比较经颅超声造影和数字减影血管造影对大脑中动脉狭窄的诊断价值研究 Diagnostic Value of Transcranial Contrast-enhanced Ultrasound and Digital Subtraction Angiography for Middle Cerebral Artery Stenosis

Lack of association between serum homocysteine level and middle cerebral artery stenosis

ObjectivesLowering homocysteine (HCY) has beneficial effects on vascular events in primary prevention but not in secondary prevention. Research on serum HCY level and middle cerebral artery (MCA) stenosis is lacking. The purpose of the study was to determine the association between these factors and provide more evidence for the prevention of ischemic stroke.MethodsA total of 412 patients (35–93 years old) in the Neurology Department were recruited. Data of clinical and biochemical vascular risk factors were collected. MCA stenosis, including M1, M2, and M3, was determined by brain magnetic resonance angiography (MRA) and classified into stenosis or no stenosis. The differences and associations were analyzed by relevant statistical methods.ResultsThere was no significant difference (p = 0.325) in HCY levels between the MCA stenosis and no stenosis groups at baseline. Logistic regression analysis demonstrated that there was no significant association between HCY levels and MCA stenosis (p = 0.447). After the two groups were matched for age and sex, there was still no difference (p = 0.540 for males and 0.061 for females) or association (p = 0.709 for males and 0.098 for females). In addition, we found that ischemic stroke was more prevalent in the MCA stenosis group and uric acid was higher in males with MCA stenosis.ConclusionsThe study indicates a lack of association between serum HCY level and MCA stenosis, which may partially explain the negative results of secondary prevention clinical trials focused on lowering serum HCY level. Future studies on HCY reduction should focus more on primary prevention of ischemic stroke.