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1.
Stroke ; 51(10): 3064-3073, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883193

RESUMO

BACKGROUND AND PURPOSE: Understanding the mechanisms underlying progression/regression of symptomatic intracranial atherosclerotic stenosis (sICAS) will inform secondary prevention of the patients. Focal wall shear stress (WSS) may play an important role, which, however, had seldom been investigated. METHODS: Patients with acute ischemic stroke or transient ischemic attack (TIA) attributed to 50% to 99% intracranial atherosclerotic stenosis were recruited. All patients underwent cerebral computed tomography angiography at baseline, and a computational fluid dynamics model was built based on computed tomography angiography to simulate blood flow and quantify WSS in the vicinity of the sICAS lesion. All patients received optimal medical treatment and a second computed tomography angiography at 1 year. The change in the luminal stenosis from baseline to 1 year in sICAS was defined as progression (increased >10%), quiescence (±10%), or regression (decreased >10%). Associations between baseline WSS metrics and sICAS regression were analyzed. RESULTS: Among 39 patients (median age 62 years; 27 males), sICAS luminal stenosis progressed, remained quiescent and regressed in 6 (15.4%), 15 (38.5%), and 18 (46.2%) cases, respectively. A higher maximum WSS and larger high-WSS area, throughout the sICAS lesion or obtained separately in the proximal and distal parts of the lesion, were independently associated with regression of luminal stenosis in sICAS over 1 year. CONCLUSIONS: A majority of sICAS lesions regress or stay quiescent in the luminal stenosis over 1 year after stroke under optimal medical treatment, when higher focal WSS may facilitate stenosis regression. Further studies of the effects of hemodynamics including WSS in altering plaque vulnerability and stroke risks are needed.


Assuntos
Isquemia Encefálica/fisiopatologia , Arteriosclerose Intracraniana/fisiopatologia , Estresse Mecânico , Acidente Vascular Cerebral/fisiopatologia , Idoso , Isquemia Encefálica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Humanos , Hidrodinâmica , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem
2.
J Stroke Cerebrovasc Dis ; 29(10): 105135, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912521

RESUMO

BACKGROUND: Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry. METHODS: The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living in rural Ecuadorian villages. ICAD was identified by means of CT determinations of carotid siphon calcifications (CSC) or MRA findings of significant stenosis of intracranial arteries. Fully-adjusted logistic regression models were fitted with biomarkers of ICAD as the dependent variables. RESULTS: A total of 205 (35%) of 581 participants had ICAD, including 185 with high calcium content in the carotid siphons and 40 with significant stenosis of at least one intracranial artery (20 subjects had both biomarkers). Increasing age, high fasting blood glucose, >10 enlarged basal ganglia-perivascular spaces and non-lacunar strokes were associated with high calcium content in the carotid siphons. In contrast, male gender, moderate-to-severe white matter hyperintensities, lacunar and non-lacunar strokes were associated with significant stenosis of intracranial arteries. Stroke was more common among subjects with any biomarker of ICAD than in those with no biomarkers (29% versus 9%, p < 0.001). Significant stenosis of intracranial arteries was more often associated with stroke than high calcium content in the carotid siphons, suggesting that CSC are more likely an ICAD biomarker than causally related to stroke. CONCLUSIONS: ICAD prevalence in Amerindians is high, and is significantly associated with stroke. CSC and significant stenosis of intracranial arteries may represent different phenotypes of ICAD.


Assuntos
Vida Independente , Índios Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Saúde da População Rural/etnologia , Acidente Vascular Cerebral/etnologia , Calcificação Vascular/etnologia , Fatores Etários , Idoso , Envelhecimento/etnologia , Comorbidade , Equador/epidemiologia , Feminino , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem
3.
J Stroke Cerebrovasc Dis ; 29(10): 105148, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912534

RESUMO

OBJECTIVES: To identify whether intracranial atherosclerotic disease large vessel occlusion strokes differ compared to embolic large vessel occlusion strokes in angiographic response to mechanical thrombectomy and clinical course. METHODS: Retrospective analysis of acute ischemic stroke patients with large vessel occlusion, due to intracranial atherosclerotic disease or embolic etiology, who underwent mechanical thrombectomy in a primary stroke center from 11/2015 to 4/2018. We categorized patients into intracranial atherosclerotic disease or embolic large vessel occlusion based on the procedural findings. We compared pretreatment, procedural variables, and post-procedural outcomes. RESULTS: Ninety-five patients were included, 13 with intracranial atherosclerotic disease large vessel occlusion strokes and 82 with embolic large vessel occlusion strokes. Between the two groups, there was no statistically significant difference in angiographic success (100% for intracranial atherosclerotic disease and 89% for embolic large vessel occlusion strokes); first pass success (38% for intracranial atherosclerotic disease and 34% for embolic large vessel occlusion strokes); puncture-to-first-pass time; puncture-to-recanalization time (68 minutes for intracranial atherosclerotic disease and 62 minutes for embolic large vessel occlusion strokes); number of passes; or clinical outcomes. Intracranial angioplasty was performed in 6 (46%) of intracranial atherosclerotic disease large vessel occlusion patients, and in 5 (6%) of embolic large vessel occlusion patients (p < 0.0001). CONCLUSIONS: Similar angiographic success and procedural time metrics are achievable with intracranial atherosclerotic disease large vessel occlusion and embolic large vessel occlusion therapy. This occurred with more frequent intracranial angioplasty for intracranial atherosclerotic disease large vessel occlusion strokes.


Assuntos
Angiografia Cerebral , Procedimentos Endovasculares , Arteriosclerose Intracraniana/terapia , Embolia Intracraniana/terapia , Acidente Vascular Cerebral/terapia , Trombectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Trombectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
J Stroke Cerebrovasc Dis ; 29(10): 105051, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912558

RESUMO

RATIONALE: Intracranial atherosclerotic disease (ICAD) is the most common cause of ischemic stroke with the highest rate of recurrence, despite aggressive medical management. Diverse mechanisms may be responsible for ICAD-related cerebral ischemia, with potential therapeutic implications. Here we present the rationale, design and methods of the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) study. The aim of MyRIAD is to determine the mechanisms of stroke in ICAD through physiologic imaging biomarkers that evaluate impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, artery to artery embolism, and their interaction. METHODS AND DESIGN: This is a prospective observational study of patients with recently symptomatic (<21 days) ICAD with 50-99% stenosis treated medically and monitored for up to 1 year. An estimated 110 participants are recruited at 10 sites to identify the association between the presence of each mechanism of ischemia and recurrent stroke. The primary outcome is ischemic stroke in the territory of the symptomatic artery. Secondary outcomes include new cerebral infarction on MRI at 6-8 weeks and recurrent TIA in the territory of the symptomatic artery. DISCUSSION: MyRIAD is positioned to define the role of specific mechanisms of recurrent ischemia in patients with symptomatic ICAD. This knowledge will allow the development and implementation of effective and specific treatments for this condition.


Assuntos
Infarto Encefálico/etiologia , Circulação Cerebrovascular , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/etiologia , Angiografia por Ressonância Magnética , Projetos de Pesquisa , Ultrassonografia Doppler Transcraniana , Adulto , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/fisiopatologia , Infarto Encefálico/terapia , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/fisiopatologia , Arteriosclerose Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/fisiopatologia , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Fatores de Risco , Fatores de Tempo
5.
Stroke ; 51(9): 2801-2809, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32757756

RESUMO

BACKGROUND AND PURPOSE: We aimed to use novel whole-brain vessel-wall magnetic resonance imaging (WB-VWI) to investigate the association between plaque distribution of middle cerebral artery (MCA) and morphological changes of the lenticulostriate arteries (LSAs) in single subcortical infarctions. METHODS: Forty single subcortical infarction patients with no relevant MCA disease on magnetic resonance angiography were prospectively enrolled. Plaque location in the MCA was dichotomized as proximal (located adjacent to the LSA origin) or distal (located distal to the LSA origin) on whole-brain vessel-wall magnetic resonance imaging. The MCAs with proximal plaques were divided into the symptomatic and asymptomatic side, and asymptomatic side MCAs without proximal plaques were the control group. The morphological characteristics of the LSAs and features of proximal plaques were analyzed. RESULTS: A total of 71 MCAs in 40 patients were analyzed (31 on the symptomatic side, 22 on the asymptomatic side, and 18 in the control group). Superior-wall plaques of MCAs were observed more frequently on the symptomatic side than the asymptomatic side (45.2% versus 9.1%, P=0.005). The wall area index, plaque burden, and remodeling index did not differ significantly between the symptomatic and asymptomatic side. The number of LSA branches was smaller (P=0.011) in the symptomatic side (5.48±1.88) compared with the control group (6.83±1.92). The symptomatic side exhibited shorter average length of the LSAs (23.23±3.44 versus 25.75±3.76 mm, P=0.025) and shorter average distance of the LSAs (16.47±3.11 versus 21.53±4.76 mm, P<0.001) compared with the asymptomatic side. CONCLUSIONS: Superiorly distributed MCA plaques at the LSA origin are closely associated with morphological changes of the LSA in symptomatic MCAs, suggesting that the distribution, rather than the inherent features of plaques, determines the occurrence of single subcortical infarctions. Our findings provide insight into the etiologic mechanism of branch atheromatous disease in single subcortical infarctions.


Assuntos
Artérias Cerebrais/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Lateralidade Funcional , Humanos , Processamento de Imagem Assistida por Computador , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
6.
Stroke Vasc Neurol ; 5(2): 128-137, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32606085

RESUMO

BACKGROUND: The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear. METHODS: Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models. RESULTS: Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability. INTERPRETATION: CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes. TRIAL REGISTRATION NUMBER: NCT00979589.


Assuntos
Doenças de Pequenos Vasos Cerebrais/complicações , Arteriosclerose Intracraniana/complicações , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Angiografia Cerebral , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/tratamento farmacológico , China , Clopidogrel/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/tratamento farmacológico , Ataque Isquêmico Transitório/diagnóstico , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prognóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico
7.
J Stroke Cerebrovasc Dis ; 29(8): 104936, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689594

RESUMO

BACKGROUND: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. METHODS: Exploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed. RESULTS: Among 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5). CONCLUSIONS: East Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis.


Assuntos
Aspirina/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Fibrinolíticos/administração & dosagem , Arteriosclerose Intracraniana/tratamento farmacológico , Embolia Intracraniana/prevenção & controle , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Rivaroxabana/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Idoso , Aspirina/efeitos adversos , Método Duplo-Cego , Inibidores do Fator Xa/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Prevalência , Recidiva , Medição de Risco , Fatores de Risco , Rivaroxabana/efeitos adversos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento
8.
Cerebrovasc Dis ; 49(3): 262-268, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526736

RESUMO

BACKGROUND: Genetic variants may play a role in determining the location of cerebral atherosclerosis. We aimed to investigate the association between RNF213, MMP2, and genetic polymorphisms linked to vascular tortuosity with the location of cerebral arterial atherosclerosis. METHODS: A prospective case-control study was conducted on patients with ischemic stroke and age- and sex-matched stroke-free controls. The stroke patients were categorized into those with intracranial artery atherosclerosis (ICAS), extracranial artery atherosclerosis (ECAS), and small vessel occlusion (SVO). Six single nucleotide polymorphisms (SNPs) including rs2118181 (FBN1), rs2179357 (SLC2A10), rs1036095 (TGFBR2), rs243865 (MMP2), rs1800470 (TGFB1), and rs112735431 (RNF213) were analyzed with the TaqMan Genotyping Assay, and the distribution of genotypes across groups was compared. RESULTS: None of the 6 SNPs were associated with stroke on comparing the 449 stroke patients (71 with ECAS, 169 with ICAS, and 209 with SVO) to the 447 controls. In the subgroup analysis, the adjusted odds ratios (aORs) for age and sex indicated a significant association between rs112735431 and ICAS in the allele comparison analysis and in the additive and dominant model analyses. rs112735431 was associated with anterior circulation involvement and increased burden of cerebral atherosclerosis. rs2179357 was significantly associated with ICAS in the recessive model analysis, and rs1800470 was significantly associated with ECAS in the recessive model analysis when compared to controls. CONCLUSION: rs112735431 was associated with ICAS and increased atherosclerosis burden in Korean stroke patients. Further studies are needed to elucidate the role of rs112735431 and to confirm the association of rs2179357 and rs1800470 with cerebral atherosclerosis.


Assuntos
Adenosina Trifosfatases/genética , Doenças de Pequenos Vasos Cerebrais/genética , Arteriosclerose Intracraniana/genética , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/genética , Ubiquitina-Proteína Ligases/genética , Idoso , Estudos de Casos e Controles , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Feminino , Fibrilina-1/genética , Predisposição Genética para Doença , Proteínas Facilitadoras de Transporte de Glucose/genética , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Metaloproteinase 2 da Matriz/genética , Pessoa de Meia-Idade , Fenótipo , Receptor do Fator de Crescimento Transformador beta Tipo II/genética , Medição de Risco , Fatores de Risco , Seul , Acidente Vascular Cerebral/diagnóstico por imagem , Fator de Crescimento Transformador beta1/genética
9.
Stroke ; 51(7): 2161-2169, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568660

RESUMO

BACKGROUND AND PURPOSE: Intracranial atherosclerosis is one of the main causes of stroke, and high-resolution magnetic resonance imaging provides useful imaging biomarkers related to the risk of ischemic events. This study aims to evaluate differences in histogram features between culprit and nonculprit intracranial atherosclerosis using high-resolution magnetic resonance imaging. METHODS: Two hundred forty-seven patients with intracranial atherosclerosis who underwent high-resolution magnetic resonance imaging sequentially between January 2015 and December 2016 were recruited. Quantitative features, including stenosis, plaque burden, minimum luminal area, intraplaque hemorrhage, enhancement ratio, and dispersion of signal intensity (coefficient of variation), were analyzed based on T2-, T1-, and contrast-enhanced T1-weighted images. Step-wise regression analysis was used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs. RESULTS: In total, 190 plaques were identified, of which 88 plaques (37 culprit and 51 nonculprit) were located in the middle cerebral artery and 102 (57 culprit and 45 nonculprit) in the basilar artery. Nearly 90% of culprit lesions had a degree of luminal stenosis of <70%. Multiple logistic regression analyses showed that intraplaque hemorrhage (OR, 16.294 [95% CI, 1.043-254.632]; P=0.047), minimum luminal area (OR, 1.468 [95% CI, 1.032-2.087]; P=0.033), and coefficient of variation (OR, 13.425 [95% CI, 3.987-45.204]; P<0.001) were 3 significant features in defining culprit plaques in middle cerebral artery. The enhancement ratio (OR, 9.476 [95% CI, 1.256-71.464]; P=0.029), intraplaque hemorrhage (OR, 2.847 [95% CI, 0.971-10.203]; P=0.046), and coefficient of variation (OR, 10.068 [95% CI, 2.820-21.343]; P<0.001) were significantly associated with plaque type in basilar artery. Coefficient of variation was a strong independent predictor in defining plaque type for both middle cerebral artery and basilar artery with sensitivity, specificity, and accuracy being 0.79, 0.80, and 0.80, respectively. CONCLUSIONS: Features characterized by high-resolution magnetic resonance imaging provided complementary values over luminal stenosis in defined lesion type for intracranial atherosclerosis; the dispersion of signal intensity in histogram analysis was a particularly effective predictive parameter.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Arteriosclerose Intracraniana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Placa Aterosclerótica/complicações
10.
J Stroke Cerebrovasc Dis ; 29(7): 104852, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404286

RESUMO

BACKGROUND: Branch atheromatous disease is an ischemic stroke, involving occlusion or severe stenosis of the perforating artery, causing neurologic symptoms and serious sequelae. We aimed to investigate initial morphometric and hemodynamic characteristics of the vertebral artery immediately post-onset to predict lesion expanding. METHODS: This case-control study collected demographic, historical, and physical examination data from 44 patients with branch atheromatous disease in the pons at admission. The maximum ischemic pons area and stenosis rate in the basilar artery were calculated using magnetic resonance images. Diameter, velocity, and flow volume of the vertebral arteries were measured using carotid artery ultrasonography. Correlations between ischemic lesion extent and these parameters were investigated. RESULTS: Patients were assigned to groups of less (Group 1) or more (Group 2) than the median maximum ischemic area in the pons, calculated from magnetic resonance images (121.6 mm2). Modified Rankin scale scores were significantly worse in Group 2. Blood pressure and blood findings were similar between groups. Group 2 showed significantly higher basilar artery stenosis rates. Flow volume, velocity, peak systolic velocity, and end-diastolic velocity in the vertebral artery on both sides were significantly decreased in Group 2. CONCLUSIONS: Deteriorated vertebral artery hemodynamics caused a more extensive ischemic lesion in branch atheromatous disease in the pons. Evaluation of the vertebral using carotid artery ultrasonography in the acute phase may be useful for predicting disease progression.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Hemodinâmica , Arteriosclerose Intracraniana/diagnóstico por imagem , Placa Aterosclerótica , Ponte/irrigação sanguínea , Ultrassonografia Doppler de Pulso , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/fisiopatologia
11.
J Vasc Res ; 57(4): 206-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396894

RESUMO

BACKGROUND: Atherosclerosis has been extensively studied in thalassemia major (TM) and sickle cell disease but not yet in ß thalassemia intermedia (TI). Previous studies concerned with TM were performed in children. TI patients usually live longer and, thus, are more prone to complications of atherosclerosis. AIM: In our study, we applied color Doppler for the determination of arterial conduit and flow velocities in ß TI patients. METHODS: For central circulation, we measured right and left middle cerebral arteries (MCAs) and basilar artery (BA) mean flow velocity (MFV), pulsatility index (PI), and peak systolic velocity (PSV) as well as carotid intimal media thickness, and to assess peripheral circulation, we studied ankle/brachial index and posterior and anterior tibial arteries' (ATA, PTA) pressure and PSV. This was applied for 30 adult TI patients and 20 age-, sex-, and ethnic group-matched controls. RESULTS: Transcranial Doppler findings among cases and controls showed that the MFV, PSV of MCAs, and PSV, PI, and MFV of the BA were statistically higher in cases than controls. A comparison between splenectomized and nonsplenectomized patients showed that total leukocyte count, platelet count, lactate dehydrogenase, ferritin, PSV and MFV of the left MCA were all statistically higher in splenectomized cases. Differences between males and females with TI with respect to laboratory and Doppler findings were all statistically insignificant except for intima media thickness, PTA pressure, ATA pressure, and PSV. CONCLUSION: More than one parameter should be applied to assess atherosclerosis in TI. There is evidence of an increased risk of central ischemia rather than peripheral ischemia in these patients.


Assuntos
Artéria Braquial/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Arteriosclerose Intracraniana/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Artérias da Tíbia/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Transcraniana , Talassemia beta/complicações , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiopatologia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Circulação Cerebrovascular , Egito , Feminino , Humanos , Arteriosclerose Intracraniana/etiologia , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Artéria Cerebral Média/fisiopatologia , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fluxo Pulsátil , Fatores de Risco , Fatores Sexuais , Esplenectomia , Artérias da Tíbia/fisiopatologia , Adulto Jovem , Talassemia beta/diagnóstico , Talassemia beta/cirurgia
12.
J Stroke Cerebrovasc Dis ; 29(7): 104845, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389559

RESUMO

BACKGROUND: A systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador). METHODS: Participants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association. RESULTS: Out of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (n = 78) or frail (n = 77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (p = 0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate. CONCLUSIONS: This study found no independent relationship between cognitive frailty and LAA burden.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Envelhecimento Cognitivo , Idoso Fragilizado , Fragilidade/epidemiologia , Vida Independente , Arteriosclerose Intracraniana/epidemiologia , Doença Arterial Periférica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral , Envelhecimento Cognitivo/psicologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Equador/epidemiologia , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Fragilidade/psicologia , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Saúde Mental , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Medição de Risco , Fatores de Risco , Ultrassonografia
13.
Stroke Vasc Neurol ; 5(1): 59-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411409

RESUMO

This review highlights the recent evolution of the imaging, medical management, surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease (ICAD). Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed, not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment. Potential future developments in the treatment of ICAD are discussed, including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries, new iterations of self-expanding intracranial stents with easier delivery systems, and the re-examination of indirect surgical bypass techniques for revascularisation. In addition to these important technological developments, however, is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Procedimentos Endovasculares , Arteriosclerose Intracraniana/terapia , Procedimentos Neurocirúrgicos , Comportamento de Redução do Risco , Fármacos Cardiovasculares/efeitos adversos , Circulação Cerebrovascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/mortalidade , Arteriosclerose Intracraniana/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Placa Aterosclerótica , Medição de Risco , Fatores de Risco , Stents , Resultado do Tratamento
14.
J Clin Neurosci ; 78: 259-263, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32340844

RESUMO

INTRODUCTION: Asymptomatic intracranial atherosclerotic stenosis (AICAS) is a common cause of stroke. Elderly women were more likely than men to develop AICAS, although it indicated that a lifelong exposure to estrogen could lower the risks of cardiovascular disease (CVDs). OBJECTIVE: The present study aims to ascertain whether postmenopausal time is a risk factor of AICAS. Fostering a correct perception of menopause is of great significance for the overall well-being of the elderly women. METHODS: All participants received a questionnaire, physical examination, laboratory testing and transcranial Doppler. The menopausal population (n = 701) was divided into three groups by tertiles of postmenopausal time. Two-tailed testing and trend test were used to reveal the relationship between postmenopausal time and newly discovered AICAS. Other potential risk factors were also analyzed to ascertain whether there was a relation between postmenopausal time and the newly discovered ICAS. RESULTS: Both mean age and mean postmenopausal time were gradually increased from G0 to G2. The same trend occurred in hypertension, diabetes mellitus, total cholesterol, triglyceride, C-reactive protein and serum homocysteine. Adjusting for various confounding factors, postmenopausal time was not a risk factor for newly discovered AICAS. Multifactor analysis and stratifying analysis showed no correlation between newly discovered AICAS and postmenopausal time. CONCLUSIONS: Postmenopausal time is not an independent risk factor of AICAS. No relationship was detected between postmenopausal time and newly discovered AICAS, while vigorous control of body weight, blood pressure/glucose/lipids and smoke cessation are vital for preventing the occurrence of AICAS.


Assuntos
Doenças Assintomáticas , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Pós-Menopausa/fisiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Ultrassonografia Doppler Transcraniana/tendências , Adulto Jovem
15.
Stroke ; 51(6): 1862-1864, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32312220

RESUMO

Background and Purpose- There is debate over an optimal systolic blood pressure (SBP) in secondary stroke prevention of patients with symptomatic intracranial atherosclerotic stenosis (sICAS). We investigated whether translesional pressure gradient across sICAS would alter the relationship between SBP and risk of recurrent stroke in such patients. Methods- We recruited patients with sICAS (50%-99% stenosis) confirmed in computed tomography angiography. We simulated blood flow across sICAS with computed tomography angiography-based computational fluid dynamics models. Translesional pressure ratio (PR=Pressurepost-stenotic/Pressurepre-stenotic) was calculated in each case. Pressure ratio (PR) ≤ median was defined as low PR, indicating larger translesional pressure gradient across sICAS. All patients received optimal medical treatment. We investigated the interaction of translesional PR and mean SBP during follow-up (SBPFU) in determining the risk of the primary outcome, recurrent ischemic stroke in the same territory within 1 year. Results- Among 157 patients with sICAS, the median PR was 0.93. Multivariate Cox regression revealed significant PR-SBPFU interaction on the primary outcome (P=0.008): in patients with normal PR, risk of primary outcome significantly decreased with lower SBPFU (hazard ratio for 10 mm Hg decrement =0.46; P=0.018); however, in those with low PR, SBPFU≤130 mm Hg was associated with significantly increased risk of primary outcome, compared with 130

Assuntos
Pressão Sanguínea , Isquemia Encefálica , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Arteriosclerose Intracraniana , Modelos Cardiovasculares , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Feminino , Seguimentos , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
16.
Neurology ; 94(22): e2361-e2372, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32303651

RESUMO

OBJECTIVE: To test the association between reduced kidney function (assessed by estimated glomerular filtration rate [eGFR] and cystatin C [CysC]) and kidney damage (assessed by urinary albumin-to-creatinine ratio [ACR]) and intracranial atherosclerotic disease (ICAD) by high-resolution vessel wall MRI (VWMRI) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS: We conducted a cross-sectional analysis of ARIC participants with data on kidney measures and VWMRI in 2011 to 2013. The main outcomes were presence of intracranial plaques and luminal stenosis. Multivariable models were adjusted for demographics, cardiovascular risk factors, and use of antithrombotic medications. RESULTS: A total of 1,762 participants (mean ± SD age, 76.3 ± 5.3) were included. eGFR based on CysC (eGFRcysc) <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) was associated with plaque presence (adjusted odds ratio [OR] 1.29, 95% confidence interval [CI] 1.04-1.60), any detectable stenosis (adjusted OR 1.31, 95% CI 1.04-1.63), and >70% stenosis or occlusion (adjusted OR 2.15, 95% CI 1.32-3.50). Neither ACR nor CysC showed statistically significant associations with ICAD features in adjusted models. In adjusted multinomial models, participants with eGFRcysc <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) had an increased OR of 1.41 (95% CI 1.06-1.87) for having 1 plaque (vs none) but no significant increase for multiple plaques; ACR ≥30 was associated with moderate (50%-70%) stenosis (OR 2.01, 95% CI 1.14-3.55) vs absent or less than 50% stenosis. CONCLUSION: In community-dwelling older adults, reduced kidney function or elevated kidney damage was associated with ICAD measured by VWMRI. This finding may help to better identify a population at high risk for ICAD.


Assuntos
Vida Independente , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Testes de Estado Mental e Demência , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Arteriosclerose Intracraniana/sangue , Testes de Função Renal/métodos , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/sangue , Fatores de Risco
17.
Medicine (Baltimore) ; 99(9): e19247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118730

RESUMO

RATIONALE: The capsular warning syndrome (CWS) is a rare and special type of transient ischemic attacks (TIAs) syndrome. The pathophysiology of CWS is very complicate, and intracranial atherosclerotic stenosis (ICAS) is rare cause. Moreover, the effective and standard therapy has not yet been established. PATIENT CONCERNS: A 47-year-old man experienced repeated and exacerbated TIAs of right hemiparesis and dysarthria. Fourteen hours after the first episode of TIAs, he developed more severe right hemiparesis and dysarthria, the National Institute of Health Stroke Scale (NIHSS) score was 12 points, and did not recover in a long time. DIAGNOSIS: The computed tomography (CT) angiography displayed high stenosis in the M1 segment of the left middle cerebral artery. The patient was diagnosed as CWS with ICAS. INTERVENTIONS: Loading dose of clopidogrel and aspirin were started but were ineffective, then we used recombinant tissue plasminogen (r-tPA) for thrombolysis therapy after repeat CT scan that showed small acute infarcts in the right putamen and no bleeding. OUTCOMES: The patient was successfully treated by r-tPA intravenous thrombolysis after loading dose of dual-anti-platelet. He recovered rapidly, and the NIHSS score was 0 point, modified Rankin Scale score was 0 point, and Barthel Index score was 100 points at 3-month follow-up. LESSONS: r-tPA combined with loading dose of dual antiplatelet appears safe and effective in carefully selected CWS patients with ICAS. The collection of similar cases and further randomized controlled trial research would be desirable.


Assuntos
Fibrinolíticos/uso terapêutico , Arteriosclerose Intracraniana/tratamento farmacológico , Ataque Isquêmico Transitório/tratamento farmacológico , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Clopidogrel/administração & dosagem , Clopidogrel/uso terapêutico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Fibrinolíticos/administração & dosagem , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Síndrome , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X
18.
Radiology ; 295(1): 162-170, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32013790

RESUMO

Background Intracranial atherosclerosis is an important cause of ischemic stroke and is associated with several vascular risk factors. Current imaging is mainly based on the assessment of luminal narrowing rather than abnormalities in the vessel wall. Purpose To investigate the relationship between vascular risk factors and atherosclerotic lesion burden of intracranial arteries assessed with vessel wall MRI at 7 T in participants with ischemic stroke or transient ischemic attack (TIA). Materials and Methods In this prospective study (trial identification number: NTR2119; www.trialregister.nl), study participants who presented with ischemic stroke or TIA of the anterior circulation between December 2009 and September 2017 underwent pre- and postcontrast 7-T vessel wall MRI within 3 months of symptom onset. All large arteries of the intracranial circulation were assessed for number, location, and enhancement of vessel wall lesions. Generalized estimating equations for Poisson regression were used to investigate the relationship between vascular risk factors and number or enhancement of vessel wall lesions. Results Ninety participants (52 men; mean age, 60 years) were evaluated. Increasing age (relative risk [RR], 1.02; 95% confidence interval [CI]: 1.01, 1.03), hypertension (RR, 1.46; 95% CI: 1.06, 2.02), diabetes mellitus (RR, 1.67; 95% CI: 1.20, 2.33), and a higher multivariable vascular risk score (Second Manifestations of Arterial Disease risk score) (RR, 1.01; 95% CI: 1.00, 1.02) were associated with a higher number of vessel wall lesions in the anterior circulation. Contrast material-enhancing vessel wall lesions were associated only with increasing age (RR, 1.03; 95% CI: 1.01, 1.05). No association was found between smoking and the number of vessel wall lesions. Conclusion Except for smoking, traditional common cardiovascular risk factors were associated with a higher number and enhancement of intracranial vessel wall lesions at 7-T MRI in individuals evaluated after ischemic stroke or transient ischemic attack. Published under a CC BY 4.0 license. Online supplemental material is available for this article.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Arteriosclerose Intracraniana/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Isquemia Encefálica/complicações , Isquemia Encefálica/etiologia , Feminino , Humanos , Arteriosclerose Intracraniana/complicações , Ataque Isquêmico Transitório/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
19.
J Vasc Interv Radiol ; 31(5): 747-753, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32107127

RESUMO

PURPOSE: To compare clinical characteristics and treatment outcomes of intra-arterial thrombectomy (IAT) in acute basilar artery occlusion (BAO) with and without underlying intracranial atherosclerotic stenosis (ICAS) and to investigate the usefulness of preprocedural CT angiography findings in the diagnosis of ICAS. MATERIALS AND METHODS: Twenty patients who received IAT for acute BAO between September 2014 and March 2019 were included. Additional therapies such as angioplasty, stent placement, and tirofiban infusion were provided while treating ICAS. Clinical and angiographic results of treatment were recorded. Preprocedural CT angiography findings in ICAS and non-ICAS groups were compared to assess (i) basilar tip opacification, (ii) partial occlusion, (iii) presence of convex border, (iv) occlusion segment longer than two thirds of the basilar artery or 20 mm, (v) dense basilar artery, and (vi) wall calcification in the occluded segment. RESULTS: Among the 20 patients (mean age, 71.3 y; mean stroke score, 24.8), optimal recanalization was achieved in 19 (95%). Three patients had good clinical outcomes. There were 6 patients with underlying ICAS. No difference was observed between ICAS and non-ICAS groups in terms of optimal angiographic recanalization and good outcome. On CT angiography, basilar tip occlusion (100% vs 29%), partial occlusion (100% vs 83%), and long occlusion length (100% vs 14%) significantly differed between the groups (P ≤ .01). CONCLUSIONS: In acute BAO, underlying ICAS does not affect optimal recanalization rate or clinical outcome. Preprocedural CT angiography is a potentially useful tool to detect it.


Assuntos
Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Arteriosclerose Intracraniana/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Trombectomia , Insuficiência Vertebrobasilar/terapia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Arteriosclerose Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Trombectomia/efeitos adversos , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
20.
J Stroke Cerebrovasc Dis ; 29(5): 104713, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32089436

RESUMO

BACKGROUND: Previous studies have reported that different locations of intracranial atherosclerosis (ICAS) are associated with different demographic features and vascular risk factors. We aimed to examine this observation in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial population. METHODS: SAMMPRIS was a randomized controlled trial that enrolled 451 patients with recent transient ischemic attack or stroke-related due to severe (70%-99%) stenosis of a major intracranial artery. We compared the baseline demographic features and vascular risk factors between the symptomatic artery locations. Wilcoxon test was used to compare continuous variables, and chi-square test was used for categorical variables. RESULTS: Of 449 patients included in the analysis; 289 (64.4%) had ICAS in the anterior circulation and 160 (35.6%) in the posterior circulation. Features that were significantly different between patients with anterior versus posterior ICAS were: median age (58.3 years versus 64.0 years, P < .001), males/females (52.9%/47.1% versus 74.4%/25.6% P < .001), white/black (66.8%/26.6% versus 79.4%/16.9%, P = .02), and history of hyperlipidemia (85.5% versus 92.5%, P = .03). CONCLUSIONS: The observed differences in the distribution of demographic characteristics and vascular risk factors depending on the location of symptomatic ICAS suggest the possibility of different underlying pathological processes involved in the formation of atherosclerotic plaques in different locations.


Assuntos
Arteriosclerose Intracraniana/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Hiperlipidemias/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/prevenção & controle , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Fatores Raciais , Recidiva , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , South Carolina/epidemiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/prevenção & controle , Artéria Vertebral/diagnóstico por imagem
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