Evaluation of Intracranial and Extracranial Carotid Steno-Occlusive Diseases in Taiwan Chinese Patients With MR Angiography

Liu, Hon‐Man; Tu, Yong Kwang; Yip, Ping Keung; Su, Cheng-Tau

doi:10.1161/01.str.27.4.650

Cited by 90 publications

(91 citation statements)

References 25 publications

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“…The prevalence of carotid plaques in our data (65.4%) was higher than the findings by angiography. Previous stenosis‐based studies reported that, in Chinese stroke patients, the incidence of carotid atherosclerosis was ranging from 41.7% to 52% 16, 17, 18. In contrast, MR vessel wall imaging techniques may yield more lesion detection which may be underestimated by measuring luminal stenosis due to positive remodeling effect 19.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Dai

Cai

et al. 2018

Ann Clin Transl Neurol

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ObjectivesTo investigate the characteristics of atherosclerotic plaques in stroke‐related vascular beds and their relationship with stroke using three‐dimensional magnetic resonance (MR) vessel wall imaging.MethodsFifty‐two symptomatic patients (mean age: 56.3 ± 13.4 years; 38 males) were enrolled and underwent MR vessel wall imaging for stroke‐related vascular beds including intracranial and extracranial carotid arteries and aortic arch and routine MR imaging for brain. The maximum wall thickness (Max WT) and luminal stenosis of each plaque were measured. The presence/absence of atherosclerotic plaque, intraplaque hemorrhage (IPH), and severe stenosis (stenosis >50%) at each vascular bed and acute ischemic lesion (AIL) were determined. The correlation between Max WT of each vascular bed and AIL was analyzed.ResultsOf 52 patients, 24 (46.2%) had AILs, and 30 (57.7%), 34 (65.4%), and 11 (21.2%) had plaques in intracranial artery, extracranial carotid artery, and aortic arch, respectively. The prevalence of IPH and severe stenosis was 25% and 26.9% for intracranial arteries, 13.5% and 9.6% for extracranial carotid artery, and 3.8% and 0% for aortic arch, respectively. In discriminating AIL, Max WT of intracranial artery had the highest area‐under‐the‐curve (AUC = 0.84), followed by extracranial carotid artery (AUC = 0.83) and aortic arch (AUC = 0.78) after adjusted for confounding factors. The AUC of Max WT combined three stroked‐related vascular beds reached 0.87.ConclusionExtracranial carotid arteries have the highest prevalence of plaques and intraplaque hemorrhage and severe stenosis are most frequently seen in intracranial arteries in Asian symptomatic patients. The Max WT combined three stroke‐related vascular beds show stronger predictive value for AIL than each vascular bed alone.

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Section: Discussionmentioning

confidence: 99%

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Dai

Cai

et al. 2018

Ann Clin Transl Neurol

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“…The estimated prevalence of middle cerebral artery stenosis among asymptomatic Asian patients ranges from 7.2% to 29.6%, while Asian patients with ischemic stroke have a higher ICS incidence of 33% to 84% 4, 19. Further, concurrent atherosclerosis of intracranial and extracranial vessels is not uncommon in Asian populations13, 20, 21, 22; in fact, ≈20% to 50% of patients with ECS are reported to also have ICS 22, 23, 24. In this study, we found that 51.4% of patients with ECS had concurrent ICS.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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BackgroundIntracranial stenosis (ICS) is a major determinant of ischemic stroke in Asians. We determined the clinical significance of different risk factors and the role of ICS in Taiwanese patients with varied distributions of cervicocerebral stenosis.Methods and ResultsPresence of extracranial carotid stenosis (ECS, ≥70%) and ICS (>50%) was examined in 13 539 patients using ultrasonography and magnetic resonance angiography, respectively. Seven hundred thirty‐three patients with non‐ECS/ICS (n=372), isolated ICS (n=112), isolated ECS (n=121), or combined ECS/ICS (CEIS, n=128) were selected. Prevalence of ischemic stroke in each group was compared, and risk factors for stenosis were determined. The area under the receiver operating characteristic curve for each risk factor was calculated. Prevalence of ischemic stroke was highest in patients with CEIS (odds ratio 15.86; P<0.001), followed in decreasing order by those with isolated ICS (odds ratio 7.16; P<0.001), isolated ECS (odds ratio 1.77; P=0.011), and non‐ECS/ICS. Multivariate logistic regression analysis revealed that hypertension, coronary artery disease, and smoking were risk factors for isolated ECS; hypertension, diabetes mellitus, coronary artery disease, and smoking were risk factors for isolated ICS; and diabetes mellitus, coronary artery disease, and smoking were risk factors for CEIS. Smoking, diabetes mellitus, and coronary artery disease were the greatest contributors to CEIS, isolated ICS, and isolated ECS, respectively.ConclusionsCEIS was associated with higher odds of ischemic stroke compared with isolated ICS and isolated ECS. Smoking and diabetes mellitus, major determinants of CEIS and isolated ICS, should be targeted in therapeutic strategies to reduce the risk of ischemic stroke.

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“…13 Estimates of the responsibility of intracranial stenosis in causing stroke are 33%-50% in China. 9,21,22 Asymptomatic patients with vascular risk factors also frequently have significant degrees of intracranial stenosis. TCD sonography identified MCA stenosis in 12.6% of at-risk individuals in a study conducted in Hong Kong.…”

Section: Epidemiologymentioning

confidence: 99%

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

Degnan

Gallagher

Zhang

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Intracranial atherosclerotic disease may constitute the most common cause of ischemic stroke worldwide; yet, in the developed world, imaging research has largely focused on extracranial atherosclerosis. Many studies in populations of Asian, African, and Hispanic descent demonstrate the preponderance of intracranial stenosis compared with carotid stenosis. This review examines the clinical presentations of MCA atherosclerosis and stenosis and the use of noninvasive MR imaging in the assessment of intracranial vasculature. MRA is a well-validated technique that offers great advantage over traditional angiography. Advances in high-resolution MR imaging of MCA stenosis have the potential to yield excellent visualization of plaque. Future developments in high-resolution MR imaging to depict intracranial atherosclerosis are explored in this review; these advances will guide endovascular therapy and the comparison of novel interventions.ABBREVIATIONS: TOF ϭ time-of-flight; TCD ϭ transcranial Doppler S troke is a common cause of morbidity and mortality, with cerebrovascular disease constituting the second most frequent cause of death worldwide.1 While the burden of cerebrovascular disease in the developing world is receiving greater attention, its importance is underestimated.2 Intracranial atherosclerotic disease is reaching greater clinical prominence as potentially the greatest contributor to the burden of cerebrovascular disease worldwide.3 Previously, atherosclerotic disease within intracranial vessels was not well-appreciated clinically, perhaps due to the inability to visualize the MCA noninvasively or the greater emphasis on the more easily imaged carotid arteries. In an early study of MCA syndromes, Lhermitte et al 4 alleged that "atherosclerotic thrombosis of MCA is probably a rare event and the primary cause . . . lies in the proximal ICA . . . for an almost inaccessible artery appears to be of little significance." Thus, early investigations established a precedent of emphasizing extracranial atherosclerosis at the expense of investigation of other manifestations of cerebrovascular disease.In examining only extracranial disease, investigators may be detecting only advanced atherosclerosis. Some argue that MCA disease may precede extracranial atherosclerosis; this sequence is suggested by the lack of substantial carotid stenosis in a group of patients with intracranial atherosclerosis, while nearly all those with extracranial stenosis also had concomitant intracranial stenosis.5 Therefore, detecting intracranial atherosclerosis may enable clinicians to intervene earlier.There is much controversy about the degree of MCA stenosis responsible for stroke, with some groups arguing that MCA stenosis is not important in the white population on the basis of a small TCD sonography study.6 Yet a host of postmortem and imaging studies implicate MCA atherosclerosis as a likely cause of stroke.7-9 Further investigation is necessary to evaluate the prevalence and importance of MCA disease as an etiology of ischemic...

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Evaluation of Intracranial and Extracranial Carotid Steno-Occlusive Diseases in Taiwan Chinese Patients With MR Angiography

Cited by 90 publications

References 25 publications

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

MR Angiography and Imaging for the Evaluation of Middle Cerebral Artery Atherosclerotic Disease

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