Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 111
Filtrar
1.
J Stroke Cerebrovasc Dis ; 29(2): 104504, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761735

RESUMO

BACKGROUND: Accurate assessment of the frequency of large vessel occlusion (LVO) is important to determine needs for neurointerventionists and thrombectomy-capable stroke facilities. Current estimates vary from 13% to 52%, depending on acute ischemic stroke (AIS) definition and methods for AIS and LVO determination. We sought to estimate LVO prevalence among confirmed and suspected AIS patients at 2 comprehensive US stroke centers using a broad occlusion site definition: internal carotid artery (ICA), first and second segments of the middle cerebral artery (MCA M1,M2), the anterior cerebral artery, vertebral artery, basilar artery, or the proximal posterior cerebral artery. METHODS: We analyzed prospectively maintained stroke databases of patients presenting to the centers between January and December 2017. ICD-10 coding was used to determine the number of patients discharged with an AIS diagnosis. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) was reviewed to determine LVO presence and site. Percentages of patients with LVO among the confirmed AIS population were reported. RESULTS: Among 2245 patients with an AIS discharge diagnosis, 418 (18.6%:95% confidence interval [CI] 17.3%-20.0%) had LVO documented on CTA or MRA. Most common occlusion site was M1 (n=139 [33.3%]), followed by M2 (n=114 [27.3%]), ICA (n=69[16.5%]), and tandem ICA-MCA lesions (n=44 [10.5%]). Presentation National Institutes of Health Stroke Scale scores were significantly different for different occlusion sites (P=.02). CONCLUSIONS: The LVO prevalence in our large series of consecutive AIS patients was 18.6% (95% CI 17.3%-20.0%). Despite the use of a broad definition, this estimate is less than that reported in most previous studies.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Infarto da Artéria Cerebral Anterior/epidemiologia , Infarto da Artéria Cerebral Média/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
2.
Cerebrovasc Dis ; 47(1-2): 40-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30763929

RESUMO

BACKGROUND: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. METHODS: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0-49%; moderate to severe: 50-99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. RESULTS: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01-1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99-2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72-2.83), among patients with VBA occlusion after adjustment of potential confounders. CONCLUSIONS: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Sistema de Registros , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Taiwan/epidemiologia , Fatores de Tempo , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade
3.
Medicine (Baltimore) ; 97(48): e13166, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508895

RESUMO

This study aims to analyze the clinical and imaging features of vertebrobasilar dolichoectasia (VBD) combined with posterior circulation infarction, and to explore risk factors for the occurrence of posterior circulation infarction in VBD patients.VBD patients were divided into 2 groups, according to the results of the imaging examination: posterior circulation infarction group and nonposterior circulation infarction group. The demographics, vascular risk factors, imaging, and other clinical data of the VBD patients were collected and retrospectively compared, and the risk factors for the occurrence of posterior circulation infarction in VBD patients were analyzed. The relationship between imaging features of the VBD blood supply artery and the infarct site was also analyzed.A total of 56 VBD patients were included into the analysis. Among these patients, 26 patients had posterior circulation infarction. Infarction occurred in the blood supply area of the posterior cerebral artery in 14 patients. The difference in the height of the basilar artery bifurcation between patients with vertebrobasilar artery blood supply area infarction and patients with posterior cerebral artery supply area infarction was statistically significant. Hypertension and posterior circulation intracranial atherosclerosis were the risk factors for posterior circulation infarction in VBD patients.Elevated basilar artery bifurcation is a risk factor for infarction in the posterior cerebral artery supply area in VBD patients. Posterior circulation infarction in VBD may be the comprehensive result of multiple factors, such as congenital defects of the basilar artery wall, hypertension, and atherosclerotic lesions.


Assuntos
Infarto Encefálico/epidemiologia , Infarto Encefálico/fisiopatologia , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artéria Basilar/anatomia & histologia , Índice de Massa Corporal , Infarto Encefálico/diagnóstico por imagem , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Insuficiência Vertebrobasilar/diagnóstico por imagem
4.
BMJ Open ; 8(8): e020681, 2018 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-30139894

RESUMO

OBJECTIVE: Serum uric acid (SUA) has been associated with cardiovascular diseases, including atherosclerosis and carotid artery stenosis. However, data on the relationship between SUA level and proximal extracranial artery stenosis (PEAS) are limited. Therefore, this study investigates the association between SUA levels and the risk of PEAS in asymptomatic Chinese population. SETTING: This community-based cross-sectional study was conducted in Jidong Community Hospital, Tangshan, Hebei, China between July 2013 and August 2014. PARTICIPANTS: The study examined 3325 asymptomatic participants (40-60 years) to evaluate the risk of PEAS. RESULTS: For the participants stratified into quartiles based on gender-specific SUA levels, the prevalence of PEAS increased from Q1 to Q4 from 12.3% to 29.8% in the vertebral artery (VA), and from 2.8% to 5.8% in the common carotid artery. The proportion of PEAS relative to the detected number of arterial stenosis was lower in Q1 than in Q2-Q4. The multivariable ORs and 95% CI of PEAS in the second through fourth compared with the lowest quartiles for arterial stenosis were 1.278 (0.980 to 1.665), 1.117 (0.851 to 1.468) and 1.375 (1.033 to 1.830) (ptrend=0.0399); and for VA stenosis, 1.285 (0.966 to 1.709), 1.085 (0.808 to 1.457) and 1.439 (1.061 to 1.952) (ptrend=0.0235). CONCLUSION: Elevated SUA concentration is significantly associated with PEAS in an asymptomatic middle-aged Chinese population, and vertebral arteries appeared to be the most vulnerable vessels.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Ácido Úrico/sangue , Insuficiência Vertebrobasilar/diagnóstico por imagem , Adulto , Grupo com Ancestrais do Continente Asiático , Doenças Assintomáticas , Biomarcadores/sangue , Estenose das Carótidas/epidemiologia , China/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler Dupla , Insuficiência Vertebrobasilar/epidemiologia
5.
J Stroke Cerebrovasc Dis ; 27(11): 3294-3300, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30154053

RESUMO

BACKGROUND: We performed this study to identify demographic, clinical, and angiographic characteristics of adult patients with angiographically confirmed vertebral artery occlusive disease (VAOD) and associated risk factors. METHODS: The demographic and clinical characteristics, and angiographic features were ascertained using predefined criteria. Controls were selected from the National Health and Nutrition Examination Surveys matched according to age, sex, and ethnicity. A stepwise logistic regression for odds ratio (OR) was performed to identify the effects of risk factors on occurrence of VAOD. RESULTS: Of 56 patients with VAOD (mean age ± standard deviation [SD]; 65.4 ± 11.7years, 44.6% women), 37.5% were classified as suffering from moderate stenosis (50%-69%), 16.1% from severe stenosis (70%-99%), and 46.4% from occlusion of at least 1 vertebral artery. There was a significantly higher severity of stenosis (percentage with SD; 88.1 ± 16.5 versus 75.4 ± 20.8, P = .02) and frequency of bilateral vertebral artery disease in patients with ischemic symptoms (40.9% versus 8.8%, P = .004). In the multivariate analysis, hypertension (OR 3.0; 95% confidence interval [CI], 1.4-6.5), diabetes mellitus (OR 2.5; 95% CI, 1.4-4.6), coronary artery disease (OR 3.2; 95% CI, 1.7-6.0), and active cigarette smoking (OR 3.1; 95% CI, 1.5-6.3) were significantly associated with vertebral artery disease. CONCLUSIONS: Severity of stenosis and bilateral involvement were associated with symptomatic VAOD. Hypertension, diabetes mellitus, coronary artery disease, and active cigarette smoking were associated with occurrence of VAOD.


Assuntos
Angiografia Cerebral , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Estados Unidos/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia
6.
J Stroke Cerebrovasc Dis ; 27(11): 3030-3035, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30093203

RESUMO

BACKGROUND: The incidence and predictors for in-stent restenosis (ISR) was not fully explored. We aim to investigate the incidence and predictors of ISR after stenting at the origin of vertebral artery. MATERIALS AND METHODS: Two hundred and six patients with 229 stents implantation between July 1, 2005 and July 31, 2015 were included in the study. All patients underwent conventional clinical and angiographic (digital subtraction angiography) follow-up at around 6 months post procedure. ISR was defined as greater than 50% stenosis within or immediately (within 5 mm) adjacent to the stent. Multivariate Cox regression analyses were utilized to investigate the predictors for ISR. RESULTS: The ISR was found in 30 patients (30/206, 14.6%) with 31 lesions (31/229, 13.5%) with the mean follow-up duration of 11.1-month (range: 3 - 92 months). Stent diameter (hazard ratio 0.504, 95% confidence interval 0.294 - 0.864) was an independent predictor for ISR. CONCLUSION: ISR rate after Vertebral artery ostium stent placement is acceptable, which was conversely associated with the stent diameter.


Assuntos
Procedimentos Endovasculares/instrumentação , Stents , Artéria Vertebral , Insuficiência Vertebrobasilar/terapia , Idoso , Angiografia Digital , China/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Recidiva , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/fisiopatologia
7.
Stroke ; 49(5): 1135-1140, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29581240

RESUMO

BACKGROUND AND PURPOSE: Intracranial arterial dolichoectasia (IADE) is a poorly understood arteriopathy compared with intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of IADE and ICAS and their relationship with neuroimaging markers of cerebral small vessel disease in a population-based study. METHODS: This study comprised 1237 participants (aged 57.2±9.4 years, 37.6% men) who underwent brain magnetic resonance imaging and magnetic resonance angiography. IADE was assessed based on basilar artery dolichoectasia (diameter, height of bifurcation, and laterality of basilar artery) and dilation of basilar artery and internal carotid artery (intracranial volume-adjusted diameter ≥2 SD). ICAS was defined as any degree of stenosis in at least 1 intracranial artery. The neuroimaging markers of cerebral small vessel disease, including lacunes, white matter hyperintensities, microbleeds, dilated perivascular spaces, and brain atrophy, were evaluated. RESULTS: Basilar arterial dolichoectasia was observed in 3.6% (45/1237); intracranial arterial dilation in 5.9% (67/1142); and ICAS in 15.7% (194/1237). Older age, higher systolic blood pressure, diabetes mellitus, higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) were associated with the presence of ICAS (all P<0.001), whereas only older age was associated with IADE. ICAS was associated with lacunes (odds ratio, 2.91; 95% confidence interval, 1.96-4.34; P<0.001), increased white matter hyperintensities volume (ß±SE, 0.54±0.13; P<0.001), and brain atrophy (ß±SE, -1.16±0.21; P<0.001), whereas basilar arterial dolichoectasia was mainly associated with dilated perivascular spaces in basal ganglia (odds ratio, 2.20; 95% confidence interval, 1.20-4.02; P=0.01) and, to a lesser extent, associated with lacunes and microbleeds. CONCLUSIONS: IADE and ICAS had different risk factor profiles and associated with different imaging phenotypes of cerebral small vessel disease, suggesting different underlying mechanisms.


Assuntos
Artéria Basilar/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Fatores Etários , Idoso , Atrofia , Pressão Sanguínea , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Constrição Patológica , Diabetes Mellitus/epidemiologia , Dilatação Patológica , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Leucoaraiose/diagnóstico por imagem , Leucoaraiose/epidemiologia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Fenótipo , Fatores de Risco , Insuficiência Vertebrobasilar/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
8.
Cerebrovasc Dis ; 45(1-2): 68-77, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29439265

RESUMO

BACKGROUND AND PURPOSE: Vertebrobasilar non-saccular and dolichoectatic aneurysms (VBDA) are a rare type of aneurysm and are generally associated with poor prognosis. In order to better characterize the natural history of VBDAs, we performed a systematic review and meta-analysis of the literature to determine rates of mortality, growth, rupture, ischemia, and intraparenchymal hemorrhage. MATERIALS AND METHODS: We searched the literature for longitudinal natural history studies of VBDA patients reporting clinical and imaging outcomes. Studied outcomes included annualized rates of growth, rupture, ischemic stroke, intracerebral hemorrhage (ICH), and mortality. We also studied the association between aneurysm morphology (dolichoectatic versus fusiform) and natural history. Meta-analysis was performed using a random-effects model using summary statistics from included studies. RESULTS: Fifteen studies with 827 patients and 5,093 patient-years were included. The overall annual mortality rate among patients with VBDAs was 13%/year (95% CI 8-19). Patients with fusiform aneurysms had a higher mortality rate than those with dolichoectatic aneurysms, but this did not reach statistical significance (12 vs. 8%, p = 0.11). The overall growth rate was 6%/year (95% CI 4-13). Patients with fusiform aneurysms had higher growth rates than those with dolichoectatic aneurysms (12 vs. 3%, p < 0.0001). The overall rupture rate was 3%/year (95% CI 1-5). Patients with fusiform aneurysms had higher rupture rates than those with dolichoectatic aneurysms (3 vs. 0%, p < 0.0001). The overall rate of ischemic stroke was 6%/year (95% CI 4-9). Patients with dolichoectatic aneurysms had higher ischemic stroke rates than those with fusiform aneurysms, but this did not reach statistical significance (8 vs. 4%, p = 0.13). The overall rate of ICH was 2%/year (95% CI 0-8) with no difference in rates between dolichoectatic and fusiform aneurysms (2 vs. 2%, p = 0.65). CONCLUSION: In general, the natural history of -VBDAs is poor. However, dolichoectatic and fusiform -VBDAs appear to have distinct natural histories with substantially higher growth and rupture associated with fusiform aneurysms. These findings suggest that these aneurysms should be considered separate entities. Further studies on the natural history of vertebrobasilar dolichoectatic and fusiform aneurysms with more complete follow-up are needed to better understand the risk factors for progression of these aneurysms.


Assuntos
Aneurisma Roto/epidemiologia , Aneurisma Intracraniano/epidemiologia , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/mortalidade , Angiografia Cerebral , Progressão da Doença , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/mortalidade , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/mortalidade
9.
World Neurosurg ; 110: e937-e941, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29191532

RESUMO

BACKGROUND AND OBJECTIVES: In-stent restenosis (ISR) remains a challenge for vertebrobasilar artery stenting (VBAS). We aimed to investigate the incidence and risk factors of ISR. METHODS: This was a retrospective study. From July 28, 2005, to July 30, 2015, patients who received VBAS with an angiographic follow-up time of 6 to 12 months after surgery were enrolled. The clinical and angiographic issues were recorded and analyzed. RESULTS: In total, 283 patients with 335 stents were incorporated into the study. Vertebral ostial lesions accounted for 73.4% (246/335) of the lesions. During the follow-up period, 58 patients with 60 stents experienced ISR (>50%). Stepwise logistic regression analysis showed that the degree of residual stenosis, stent diameter, and alcohol consumption were independent predictors of ISR. CONCLUSIONS: Our study demonstrated the incidence and risk factors of ISR after VBAS. This retrospective study with the largest cohort to date provided insight into the occurrence of ISR after VBAS.


Assuntos
Stents , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/cirurgia , Consumo de Bebidas Alcoólicas/epidemiologia , Angiografia Cerebral , Comorbidade , Constrição Patológica , Feminino , Seguimentos , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/cirurgia , Falha de Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem
10.
PLoS One ; 12(11): e0187502, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29121660

RESUMO

Metabolic diseases such as type 2 diabetes mellitus (T2DM) and metabolic syndromes (MetS) have been recognized as the important risk factors for asymptomatic intracranial vertebrobasilar stenosis (IVBS). Although fatty liver index (FLI) is significantly related with these diseases, the association between FLI and IVBS remains unclear. In the present study, 2368 participants (30-75 years) were recruited from a Chinese prospective cohort study of PMMJS. Amongst them, 2281 individuals who did not have IVBS at baseline were enrolled in the 6-year following-up study. In cross-sectional analysis based on the baseline characteristics, the results showed that FLI was positively related with IVBS prevalence. Compared to the participants with FLI < 30, the adjusted OR (95% CI) of IVBS was 2.07 (1.18, 3.62) and 2.85 (1.39, 5.18) in the groups of 30 ≤ FLI < 60 and FLI ≥ 60, respectively. In longitudinal analysis, the results showed that the participants with FLI ≥ 60 had an increased risk of asymptomatic IVBS compared to those with FLI < 30 [adjusted HR (95%CI): 1.65 (1.05, 2.60)]. Moreover, exclusion of persons with hypertension, T2DM and MetS did not alter the associations between FLI and asymptomatic IVBS. Therefore, our results suggest that elevated FLI is an independent risk factor for asymptomatic IVBS in Chinese adults.


Assuntos
Fígado Gorduroso/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Adulto , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático , China , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Fígado Gorduroso/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Insuficiência Vertebrobasilar/fisiopatologia
11.
J Stroke Cerebrovasc Dis ; 26(12): 2909-2914, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28869136

RESUMO

BACKGROUND: Basilar artery (BA) dolichoectasia has been associated with cerebral small vessel disease (SVD). However, studies have focused on stroke patients, and results cannot be extrapolated to the population at large. In this study, we aimed to assess prevalence of BA dolichoectasia and its association with SVD in community-dwelling older adults living in rural Ecuador. METHODS: Atahualpa residents aged ≥60 years underwent brain magnetic resonance imaging and magnetic resonance angiography of intracranial vessels. Following Smoker's criteria, the mean BA diameter plus 2 standard deviation defined ectasia. In addition, a location lateral to the lateral margin of the clivus of dorsum sellae or a bifurcation at the third ventricle floor or higher defined dolichosis. Associations between BA abnormalities and imaging markers of SVD were assessed by the use of regression models adjusted for demographics and cardiovascular risk factors. RESULTS: Of 346 participants, 11 (3.2%) had ectasia, 40 (11.6%) had dolichosis, and 47 (13.6%) had dolichoectasia (ectasia, dolichosis, or both). BA diameter was only associated with severity of white matter hyperintensities (P = .038). Dolichosis was associated with deep cerebral microbleeds (P = .002) but not with white matter hyperintensities. Dolichoectasia was associated with both white matter hyperintensities (P = .031) and cerebral microbleeds (P = .001). There were no associations with lacunar infarcts or enlarged perivascular spaces in any model. CONCLUSIONS: Prevalence of BA dolichoectasia in this rural setting is similar to that reported in other populations. Associations with imaging markers of SVD differ according to whether the subject has ectasia or dolichosis.


Assuntos
Doenças de Pequenos Vasos Cerebrais/epidemiologia , Vida Independente , Insuficiência Vertebrobasilar/epidemiologia , Fatores Etários , Idoso , Angiografia Cerebral/métodos , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Estudos Transversais , Dilatação Patológica , Equador/epidemiologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/epidemiologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde da População Rural , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Acidente Vascular Cerebral Lacunar/epidemiologia , Insuficiência Vertebrobasilar/diagnóstico por imagem
13.
Neuroepidemiology ; 48(3-4): 188-192, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28796991

RESUMO

BACKGROUND: Intracranial large-artery disease (LAD) is a predominant vascular lesion found in patients with stroke of Asian, African, and Hispanic origin, whereas extracranial LAD is more prevalent among Caucasians. These patterns are not well-established in the Middle East. We aimed to characterize the incidence, risk factors, and long-term outcome of LAD strokes in a Middle-Eastern population. METHODS: The Mashhad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. Ischemic strokes were classified according to the TOAST criteria. Duplex-ultrasonography (98.6%), MR-angiography (8.3%), CT-angiography (11%), and digital-subtraction angiography (9.7%) were performed to identify involvements. Vessels were considered stenotic when the lumen was occluded by >50%. RESULTS: We identified 72 cases (15.99 per 100,000) of incident LAD strokes (mean age 67.6 ± 11.7). Overall, 77% had extracranial LAD (58% male, mean age 69.8 ± 10.3; 50 [89%] carotid vs. 6 [11%] vertebral artery), and the remaining 23% (56% male, mean age 60.2 ± 13.4; 69% anterior-circulation stenosis) had intracranial LAD strokes. We were unable to detect differences in case-fatality between extracranial (1-year: 28.6%; 5-year: 59.8%) and intracranial diseases (1-year: 18.8%; 5-year: 36.8%; log-rank; p = 0.1). CONCLUSION: Extracranial carotid stenosis represents the majority of LAD strokes in this population. Thus, public health strategies may best be developed in such a way that they are targeted toward the risk factors that contribute to extracranial stenosis.


Assuntos
Isquemia Encefálica/epidemiologia , Estenose das Carótidas/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Isquemia Encefálica/complicações , Estenose das Carótidas/complicações , Feminino , Humanos , Doenças Arteriais Intracranianas/complicações , Doenças Arteriais Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Oriente Médio/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/epidemiologia
14.
Stroke ; 48(9): 2361-2367, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28754833

RESUMO

BACKGROUND AND PURPOSE: We evaluated whether basilar dolichoectasia is associated with markers of cerebral small vessel disease in younger transient ischemic attack and ischemic stroke patients. METHODS: We used data from the SIFAP1 study (Stroke in Young Fabry Patients), a large prospective, hospital-based, screening study for Fabry disease in young (<55 years) transient ischemic attack/stroke patients in whom detailed clinical data and brain MRI were obtained, and stroke subtyping with TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment) was performed. RESULTS: Dolichoectasia was found in 508 of 3850 (13.2%) of patients. Dolichoectasia was associated with older age (odds ratio per decade, 1.26; 95% confidence interval, 1.09-1.44), male sex (odds ratio, 1.96; 95% confidence interval, 1.59-2.42), and hypertension (odds ratio, 1.39; 95% confidence interval, 1.13-1.70). Dolichoectasia was more common in patients with small infarctions (33.9% versus 29.8% for acute lesions, P=0.065; 29.1% versus 16.5% for old lesions, P<0.001), infarct location in the brain stem (12.4% versus 6.9%, P<0.001), and in white matter (27.8% versus 21.1%, P=0.001). Microbleeds (16.3% versus 4.7%, P=0.001), higher grades of white matter hyperintensities (P<0.001), and small vessel disease subtype (18.1% versus 12.4%, overall P for differences in TOAST (P=0.018) were more often present in patients with dolichoectasia. CONCLUSIONS: Dolichoectasia is associated with imaging markers of small vessel disease and brain stem localization of acute and old infarcts in younger patients with transient ischemic attack and ischemic stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.


Assuntos
Doenças de Pequenos Vasos Cerebrais/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Adulto , Fatores Etários , Infartos do Tronco Encefálico/epidemiologia , Hemorragia Cerebral/epidemiologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hipertensão/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fatores Sexuais , Insuficiência Vertebrobasilar/diagnóstico por imagem , Substância Branca/irrigação sanguínea
15.
J Stroke Cerebrovasc Dis ; 26(2): 403-410, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28029608

RESUMO

BACKGROUND: Despite concerns regarding hypoperfusion in patients with large-artery occlusive disease, strict blood pressure (BP) control has become adopted as a safe strategy for risk reduction of stroke. We examined the relationship between BP control, blood flow, and risk of subsequent stroke in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. METHODS: The VERiTAS study enrolled patients with recent vertebrobasilar (VB) transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion of vertebral or basilar arteries. Hemodynamic status was designated as low or normal based on quantitative magnetic resonance angiography. Patients underwent standard medical management and follow-up for primary outcome event of VB territory stroke. Mean BP during follow-up (<140/90 versus ≥140/90 mm Hg) and flow status were examined relative to subsequent stroke risk using Cox proportional hazards analysis. RESULTS: The 72 subjects had an average of 3.8 ± 1.2 BP recordings over 20 ± 8 months of follow-up; 39 (54%) had mean BP of<140/90 mm Hg. The BP groups were largely comparable for baseline demographics, risk factors, and stenosis severity. Comparing subgroups stratified by BP and hemodynamic status, we found that patients with both low flow and BP <140/90 mm Hg (n = 10) had the highest risk of subsequent stroke, with hazard ratio of 4.5 (confidence interval 1.3-16.0, P = .02), compared with the other subgroups combined. CONCLUSIONS: Among a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90) may increase the risk of subsequent stroke.


Assuntos
Pressão Sanguínea , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Idoso , Encéfalo/diagnóstico por imagem , Angiografia Cerebral , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Constrição Patológica/fisiopatologia , Feminino , Seguimentos , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia
16.
Parkinsonism Relat Disord ; 32: 54-59, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27567723

RESUMO

BACKGROUND: Hemifacial spasm (HFS) is frequently caused by vascular compression of the facial nerve. Vertebrobasilar dolichoectasia (VBDE) may cause vascular crowding in the limited space of the posterior fossa, increasing the chance of vascular compression of the facial nerve. We investigated the prevalence of VBDE in HFS. METHODS: We analyzed the presence of VBDE on 3.0 T magnetic resonance images in patients with HFS and control subjects; age, sex and hypertension were matched. Two blinded readers independently assessed the images. We evaluated the vascular risk factors, including diabetes mellitus, hyperlipidemia, ischemic heart disease, stroke, and presence of lacunes. RESULTS: A total of 310 patients with HFS and 310 control subjects were included. The prevalence of VBDE was higher in patients with HFS (48/310, 15.5%) than in controls (10/310, 3.2%), with an odds ratio (OR) of 5.82 (P < 0.001). Among patients with HFS, the presence of facial nerve compressing vessels was more frequent in dolichoectasia-positive patients (87.5%) than in dolichoectasia-negative patients (58.4%) (OR: 4.99, P < 0.001). Dolichoectasia-positive patients had a higher mean age (58.8 versus 54.8 years, P = 0.03), as well as greater frequency of hypertension (OR: 2.44, P = 0.01) and history of ischemic heart disease (OR: 5.05, P = 0.03) than their dolichoectasia-negative counterparts. CONCLUSIONS: We found that VBDE is associated with HFS in a portion of patients. Since vascular risk factors were more prevalent in dolichoectasia-positive patients, an investigation of VBDE and its risk factors may serve to prevent vascular complications.


Assuntos
Espasmo Hemifacial/epidemiologia , Insuficiência Vertebrobasilar/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Espasmo Hemifacial/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estatísticas não Paramétricas , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem
17.
Neuroradiology ; 58(9): 853-7, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27236563

RESUMO

INTRODUCTION: Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. METHODS: We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50 % from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5 cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. RESULTS: Sixteen out of 46 (35 %) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. CONCLUSION: Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI.


Assuntos
Doenças Cerebelares/epidemiologia , Infarto Cerebral/epidemiologia , Angiografia por Ressonância Magnética/estatística & dados numéricos , Insuficiência Vertebrobasilar/epidemiologia , Insuficiência Vertebrobasilar/cirurgia , Distribuição por Idade , Causalidade , Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/prevenção & controle , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/prevenção & controle , Comorbidade , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Stents/estatística & dados numéricos , Resultado do Tratamento , Insuficiência Vertebrobasilar/diagnóstico por imagem
18.
Clin Neurol Neurosurg ; 143: 132-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26943722

RESUMO

OBJECTIVES: Symptomatic intracranial vertebrobasilar artery stenosis (IVBS) carries a high annual risk of recurrent stroke. Endovascular therapy was a promising technique but recent trials suggest it may carry a risk of periprocedual complications especially in inexperienced hands. This prospective study was to evaluate the safety of endovascular therapy for severe symptomatic IVBS in a high volume stroke centre. PATIENTS AND METHOD: Patients with symptomatic IVBS caused by 70-99% stenosis despite medical treatment of at least one antiplatelet agent and statin were enrolled. The patients were treated either with balloon-mounted stent or balloon pre-dilation plus self-expanding stent as determined by the operators following a guideline. The primary outcome was 30-day stroke, transient ischemic attack (TIA) and death after stenting. The secondary outcome was successful stent deployment. The baseline characteristics and outcomes of patients with basilar artery (BA) lesions and patients with vertebral artery V4 segment lesions (BA group vs V4 group) were compared. And the outcome of different Mori type lesions was also compared. RESULT: From September 2013 to September 2014, 105 patients with stroke or TIA due to intracranial IVBS were screened and 97 patients were treated by stenting, including 52 patients with BA stenosis and 45 patients with V4 stenosis. The rate of 30-day stroke, TIA and death was 7.1%. All the three strokes happened in the BA group and were perforator strokes. The successful stent deployment rate was 100%. General anesthesia was more preferred in the BA group than in the V4 groups (96.2% vs 75.6%, p=0.005). The Apollo stent was used more for Mori A lesions (30.5% vs 7.9%, p=0.011) and had lower degree of residual stenosis (8.6% vs 12.6%, p=0.014) than Wingspan stent. Mori C lesions were more likely to have higher degree of residual stenosis than Mori A lesion (15.3% vs 7.4%, p=0.005). CONCLUSION: The short-term safety of endovascular stenting for patients with severe symptomatic IVBS in a high volume stroke centre was acceptable. Mori A lesions may have lower residual stenosis rate than the Mori C type lesions.


Assuntos
Procedimentos Endovasculares/tendências , Stents , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Adulto , Idoso , China/epidemiologia , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral , Fatores de Tempo , Resultado do Tratamento , Insuficiência Vertebrobasilar/epidemiologia
19.
J Neurol Sci ; 363: 121-5, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27000236

RESUMO

BACKGROUND: Vertebral-basilar artery stenosis is associated with posterior circulation infarction. So correct detection of vertebral basilar artery stenosis is very important. Studies concerning the sensitivity and specificity of 3-dimensional contrast enhanced MR angiography (3D-CE-MRA) in detecting vertebral basilar artery stenosis is generally lacking. METHODS: Retrospectively reviewed the imagines of consecutive one hundred and forty-nine Chinese patients with ischemic stroke or vertigo/dizziness who underwent 3D-CE-MRA and DSA. DSA and CE-MRA images were studied separately and to determine the presence of mild, moderate, or severe stenosis of the vertebral-basilar arteries. Analysis combined with vascular origin image was applied when evaluating the vertebral artery origin stenosis. Sensitivity, specificity, positive and negative predictive values, and the accuracy of 3D-CE-MRA in detecting and grading of vertebral-basilar artery stenosis were calculated. RESULTS: Compared with DSA, sensitivity, specificity and accuracy of 3D-CE-MRA in detecting of vertebral artery origin ≥70% stenosis or occlusion was 97.1%, 77.4% and 81.9%, but diagnostic consistency was poor (K=0.59); Analysis combined with vascular origin images, the specificity (97.8%), accuracy (92.9%) and consistency (K=0.826) was significantly improved. CONCLUSIONS: 3D-CE-MRA is a sensitive and noninvasive technique for the detection of vertebral artery origin stenosis. Furthermore, analysis combined with vascular origin image would improve the diagnostic accuracy.


Assuntos
Angiografia Digital/normas , Meios de Contraste , Imageamento Tridimensional/normas , Angiografia por Ressonância Magnética/normas , Insuficiência Vertebrobasilar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital/métodos , China/epidemiologia , Feminino , Humanos , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Insuficiência Vertebrobasilar/epidemiologia
20.
Clin Neuroradiol ; 26(3): 325-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25588938

RESUMO

BACKGROUND AND PURPOSE: In the past years, technical developments have raised recanalization rates of endovascular treatments of intracerebral artery occlusions in acute ischemic stroke. By using stent retrievers, several prospective trials have reported recanalization rates up to 79 % as well as good neurological outcome in up to 58 % of the cases. The degree of the recanalization and the length of the procedure are factors known to influence the clinical outcome of patients treated endovascularly. Yet, still little is known about factors influencing the angiographic results of thrombectomy procedures. The purpose of this study was to investigate whether the use of intermediate catheters affects the angiographic results of thrombectomy procedures in basilar artery occlusions. MATERIALS AND METHODS: A total of 47 consecutive patients with acute basilar artery occlusions who underwent endovascular treatment with stent retrievers in our department were retrospectively identified. We analyzed the angiographic data regarding the use of intermediate catheters, the lengths of the procedures, the number of passes of the stent retrievers, the angiographic results, and the site of access to the basilar artery. RESULTS: Recanalization with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 74.5 %. Intermediate catheters were used in 13 cases. The mean length of the procedures was significantly shorter when intermediate catheters were used (44.8 ± 27.6 vs. 70.7 ± 41.4 min, P = .043). There were no significant differences in the number of passes or in the final mTICI scores. CONCLUSIONS: The use of intermediate catheters significantly reduces the length of mechanical thrombectomy procedures in acute basilar artery occlusions.


Assuntos
Cateteres/estatística & dados numéricos , Angiografia Cerebral/estatística & dados numéricos , Trombólise Mecânica/estatística & dados numéricos , Duração da Cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Idoso , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Trombólise Mecânica/instrumentação , Trombólise Mecânica/métodos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Vertebrobasilar/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA