Diffusion weighted MRI imaging and MES detection in the assessment of stroke origin

Droste, Dirk W.; Knapp, Jan; Freund, M.; Nágy, Ildikó; Schulte, Volker; Schomacher, Guido; Csiba, László; Ringelstein, E. Bernd

doi:10.1179/016164107x164120

Cited by 5 publications

(4 citation statements)

References 12 publications

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“… 18 An investigation into the relationship between posterior circulation brain infarction and diabetes that used MRI, 19 showed that diabetes was associated with an increased frequency of brain stem infarction. The present study used diffusion-weighted MRI, considered to be a precise method, 20 to determine the stroke type. Due to the existence of the posterior communicating artery, the distal region of the posterior communicating artery P1 segment may receive blood from the anterior circulation.…”

Section: Discussionmentioning

confidence: 99%

Association between patency of the circle of Willis and diabetes mellitus in patients with cerebral ischaemic stroke

Chen

2017

J Int Med Res

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ObjectiveTo examine patency of the cerebral anterior and posterior communicating arteries in patients with ischaemic stroke with or without diabetes mellitus.MethodsThis retrospective study included patients with acute ischaemic stroke treated between July 2011 and May 2016. Cerebral infarction was evaluated by magnetic resonance imaging. Anterior and posterior communicating-artery patency was determined using magnetic resonance angiography. Vessels were defined as patent or occluded.ResultsOut of 1 406 patients, incidence of vertebral basilar artery brain infarction and posterior cerebral artery brain infarction were significantly higher in patients with diabetes versus those without diabetes (35.5% versus 22.3% and 11.7% versus 6.8%, respectively). Among patients with posterior cerebral artery brain infarction, anterior and posterior communicating-artery patency rates were higher in patients with diabetes versus those without diabetes (66.7 versus 23.5% and 33.3% versus 5.9% [bilateral], respectively). Among patients with vertebral basilar artery infarction and posterior cerebral artery P1 segment infarction, patency rate of the anterior communicating artery was higher in patients with diabetes versus those without diabetes (55.7% versus 45.9%).ConclusionAmong patients with ischaemic stroke, patency rate of the circle of Willis may be higher in patients with diabetes than those without diabetes.

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Section: Discussionmentioning

confidence: 99%

Association between patency of the circle of Willis and diabetes mellitus in patients with cerebral ischaemic stroke

Chen

2017

J Int Med Res

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“…The mechanisms by which ERILs develop are not clear, but repetitive distal embolism from acutely activated chronic atheroma, stimulated inflammation and thrombi caused by increased hypercoagulability have been postulated [12,15,19]. Previous studies showed that microembolic signals seen on transcranial duplex sonography were associated with ERILs [20,21]. Another report indicated that a combination of aspirin and clopidogrel was superior to aspirin monotherapy in terms of reducing microembolic signals [22].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Aspirin Resistance and Recurrent Lesions in Patients with Acute Ischemic Stroke

et al. 2010

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Background: The effect of biochemical aspirin resistance (BAR) on ischemic stroke has not been well established. Early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging (DWI) are proposed as potential surrogate markers of clinically recurrent stroke. Methods: We included 117 consecutive patients who (1) were admitted within 24 h of symptom onset; (2) had an ischemic stroke confirmed by DWI; (3) underwent follow-up DWI within seven days after onset, and (4) received aspirin treatment. BAR was measured using the VerifyNow® Aspirin Assay. We analyzed the associations between BAR and any ERILs (overall ERILs), and between BAR and ERILs occurring outside the vascular territories of index stroke (distant ERILs). Results: BAR was observed in 16 (13.7%) patients. Overall ERILs were detected in 34 (29.1%), and distant ERILs in 10 (8.5%) patients. Patients with BAR were more likely to develop ERILs, but the association was not significant (OR 2.13; 95% CI 0.72–6.29; p = 0.234). However, BAR was independently related to distant ERILs by logistic regression analysis (OR 6.01; 95% CI 1.29–28.09; p = 0.023). Conclusions: BAR was associated with distant ERILs but not with overall ERILs during the first week after ischemic stroke.

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“…Among the included studies, 8 studies were prospective/retrospective cohort, 2 were case series, and one was a cross-sectional study. The studies included in our systematic review and meta-analysis from distinct countries are as follows: 2 studies were from Germany [11,12], USA [13,14], and multicentric [15,16], and one study each from Brazil [17], Japan [18], France [19], Portugal [20], and Spain [21]. The publication year of the included studies ranged from 1996 to 2020.…”

Section: Study Characteristicsmentioning

confidence: 99%

Micro-Embolic Signals and Dissection: Association or Causation for Stroke? A Systematic Review and Meta-Analysis

Sudheer¹,

Vibha²

2021

Cerebrovasc Dis

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Background and Objective: Although the mechanism of stroke in cervical artery dissection (CAD) has been hypothesized to be embolization rather than hemodynamic compromise, there are a limited number of studies supporting this hypothesis. Detection of micro-embolic signals (MESs) using transcranial Doppler (TCD) helps in understanding the mechanism in these patients. A systematic review and meta-analysis were performed to estimate the prevalence of MES and its association with stroke outcomes in patients with acute stroke/TIA secondary to dissection. Methods: A comprehensive literature search was conducted for studies before January 26, 2021, in PubMed, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov. Studies were identified that used TCD to detect MES in stroke/TIA patients secondary to CAD. Pooled prevalence was calculated. Entire statistical analysis was conducted in R version 3.6.2. Results: Eleven studies involving 112 patients (50 MES+, 62 MES−) were included in our meta-analysis. The pooled prevalence of MES among acute stroke/TIA patients secondary to dissection was 46.0% (95% CI 26.0–67.0%). The presence of MES was associated with an increased risk of early ischemic recurrence in patients with CAD. We could not estimate the functional outcome and mortality associated with the presence of MES due to the scarcity of data. Conclusions: Our meta-analysis showed 46% prevalence of MES in the studies which looked at acute stroke/TIA secondary to CAD using TCD. This finding supports the assumption that embolism may be a major cause of stroke in patients with dissection although this could be determined only in a small population.

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Diffusion weighted MRI imaging and MES detection in the assessment of stroke origin

Abstract: There is a contribution of both techniques to the understanding of stroke etiology. The impact of DWI is, however, superior to that of MES detection. Longer TCD recording times may diminish this discrepancy.

Cited by 5 publications

References 12 publications

Association between patency of the circle of Willis and diabetes mellitus in patients with cerebral ischaemic stroke

Association between patency of the circle of Willis and diabetes mellitus in patients with cerebral ischaemic stroke

Biochemical Aspirin Resistance and Recurrent Lesions in Patients with Acute Ischemic Stroke

Micro-Embolic Signals and Dissection: Association or Causation for Stroke? A Systematic Review and Meta-Analysis

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