Intracranial Steno-Occlusive Arterial Disease and its Associations in Egyptian Ischemic Stroke Patients

Moustafa, Ramez Reda; Moneim, Amr Abdel; Salem, Haitham Hamdy; Shalash, Ali; Azmy, Hosam Ahmed

doi:10.1161/strokeaha.112.679050

Cited by 22 publications

(21 citation statements)

References 9 publications

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“…This was quite similar to the study by Radwan et al, [31] of 31 arterial segments with stenosis seen, mainly affected were the arterial territories of PCAs (n= 16). These results go with the reported findings of studies by Anneet et al, [33] and Moustafa et al [34] where the majority of strokes was found to be due to affection of the MCA territory followed by the PCA territory. This most commonly reflects the relative distribution of total blood supply of brain.…”

Section: Resultssupporting

confidence: 93%

“…The ACA usually possesses good collateral flow through its paired contralateral vessel, and thus isolated ACA infarcts are rare. [33,34] Shrier et al, [35] reported that greater than 80% of arterial steno-occlusive lesions identified by CT, CT angiography, MR imaging, or MR angiography occurred in a PCA or MCA distribution. This is consistent with the known prevalence of atheroembolic disease.…”

Section: Resultsmentioning

confidence: 99%

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Comparative Diagnostic Role of Computed Tomography Angiography (CTA) and Noncontrast Magnetic Resonance Angiography (NC-MRA) in Evaluation of Cerebrovascular Accidents

Parashar¹,

Rajul²,

Pratap³

et al. 2018

AIMDR

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Background: Cerebrovascular accidents (CVA) are a major cause of mortality and morbidity in middle and elderly agegroups. It can be ischemic or hemorrhagic and thrombotic or embolic. Digital subtraction angiography (DSA) is a gold standard investigation for evaluating patients with CVA. Due to invasive nature of DSA, computed tomography angiography (CTA) has long been used as a primary noninvasive imaging tool to evaluated patients with CVA. Angiography can also be performed with magnetic resonance imaging, both with & without contrast. Introduction: CTA serves as a primary noninvasive imaging tool in evaluation of patients with CVA as nearly half of these patients do not have treatable underlying cause. Due to increasing awareness regarding the radiation exposure, contrast-induced nephrotoxicity and iodinesensitivity, magnetic resonance angiography (MRA) is gaining more and more attention. Noncontrast MRA (NC-MRA) can be performed utilizing 3D-time of flight sequence which provides results comparable to that of CTA. Hence, we performed a study to evaluate comparable role of NC-MRA and CTA. Methods: Fifty patients with cerebrovascular accidents were evaluated with CTA & NC-MRA in tandem on the same day. The results obtained were statistically evaluated and conclusions were drawn. Results & Conclusions: Detection of aneurysm in intracranial and stenoses in intracranial as well as extracranial vessels can be detected with good accuracy by NC-MRA. The results of NC-MRA was comparable to that obtained by CTA except in very small aneurysm (<3mm) and early stenosis (20-30%) which rarely affect immediate patient management. Hence, NC-MRA can be a good substitute to CTA especially in patients where iodinated contrast is relatively or absolutely contraindicated and in combination with routine protocol for stroke imaging.

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Section: Resultssupporting

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Comparative Diagnostic Role of Computed Tomography Angiography (CTA) and Noncontrast Magnetic Resonance Angiography (NC-MRA) in Evaluation of Cerebrovascular Accidents

Parashar¹,

Rajul²,

Pratap³

et al. 2018

AIMDR

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“…Our study has shown a lower prevalence of ICAD in Egyptian patients with CAD (11.9%) than has previously been reported [13,14]. Moderate-to-severe extracranial artery stenosis and multivessel or left main CAD were the most important factors associated with ICAD.…”

Section: Discussioncontrasting

confidence: 43%

“…Moderate-to-severe extracranial artery stenosis and multivessel or left main CAD were the most important factors associated with ICAD. A recent report showed that 67% of acute ischemic stroke patients imaged by magnetic resonance angiogram within 48 h of onset had evidence of stenosis, occlusion or both in at least 1 proximal intracranial arterial segment, and symptomatic intracranial stenosis is present in at least 27% [13]. In another magnetic resonance angiogram study of 40 patients with ischemic stroke or TIA, significant ICAD (>50% luminal diameter reduction) was found in 32.5% of patients [14].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Intracranial Atherosclerosis among Patients with Coronary Artery Disease: A 1-Year Hospital-Based Study

Abd-Allah

Kassem²,

Hashad³

et al. 2014

Eur Neurol

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Background: There are limited data on the prevalence of intracranial atherosclerotic disease (ICAD) in patients with coronary artery disease (CAD) worldwide and especially among Egyptians. The purpose of the present study was to determine the prevalence and correlates of ICAD in patients with CAD. Methods: From January 1, 2012 to January 1, 2013, we recruited 118 consecutive patients who had ischemic heart disease. All patients were assessed for vascular risk factors and the existence of stroke or transient ischemic attack (TIA) and were evaluated by extracranial and transcranial color-coded sonography. All patients underwent coronary angiography. Clinical, echocardiographic and angiographic variables were tested by univariate and multivariate analysis. Results: Out of 118 consecutive patients with CAD, intracranial disease was detected in 14 patients (11.9%). Eight patients (6.8%) had stenosis >50%, while 6 patients (5.1%) had stenosis <50%. The univariate analysis showed that the strongest variables associated with ICAD were the presence of recent or old stroke or TIA, followed by moderate or severe extracranial stenosis, and multivessel or left main CAD. Conclusion: We observed low prevalence (6.8%) of high-grade ICAD among Egyptian patients with CAD. Multivessel or left main CAD and moderate-to-severe extracranial carotid stenosis were the strongest predictors for the existence of ICAD among CAD patients.

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“…Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyper lipidemia [1]. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common [4,5], But few studies have been published on the subject and none has addressed the issue of extra cranial or intracranial stenosis and other commonly found risk factors in stroke in Cameroon.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

B¹,

Jc²,

Ntone³

et al. 2016

J Vasc Med Surg

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The prevalence and incidence of cardiovascular disease have been increasing in sub Saharan Africa for the last past twenty years. One of the most common manifestations of cardiovascular disease is stroke. Very few studies have addressed the major causes of ischemic stroke in this region. The objective of this study was to determine the prevalence of significant extra cranial carotid stenosis in a population of patients with acute ischemic stroke. Patients and methods:we conducted a prospective study at the University Hospital Centre of Yaoundé from January 2013 to October 2013. We included all consenting patients with acute onset of neurological deficit with a CT scan of the head showing an ischemic stroke. We excluded all patients with hemorrhagic stroke on CT scan, or who did not have a head CT scan. The study was approved by the National ethics committee.Results: During that period, 35 patients met the criteria for acute ischemic stroke from which 51.4% were women with a sex ratio of 0.94. The mean age in this series was 66.6 years. Thirty five patients over 76 had an ischemic stroke on the CT scan, with a prevalence of 46%. Hypertension was present in 21 (60%) cases and it was a major risk factor. Only 3 patients had a carotid stenosis between 50-75%, there was no patient with a stenosis above 75%. Elevated cholesterol was found in 3.3% of patients while 30 (86%) patients had an abnormal electrocardiogram: 9 patients were found to have a tachyarrhythmia and 6 atrial fibrillation. There was no intracardiac clot even though the echocardiogram was abnormal in 26 (77%) patients. Concerning the CT scan of the head results, hypo densities were found in 26 (74.3%) patients and the CT was normal in 9 (9.9%) patients with a sudden neurological deficit. Conclusion:From this pilot study, we have found that carotid stenosis in association with hypercholesterolemia and arteriosclerosis may not be a major risk factor for ischemic stroke in our environment, while age, hypertension and arrhythmia are the most important risk factors for this disease in Cameroon. Further and larger study is needed to confirm this preliminary finding.

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Intracranial Steno-Occlusive Arterial Disease and its Associations in Egyptian Ischemic Stroke Patients

Cited by 22 publications

References 9 publications

Comparative Diagnostic Role of Computed Tomography Angiography (CTA) and Noncontrast Magnetic Resonance Angiography (NC-MRA) in Evaluation of Cerebrovascular Accidents

Comparative Diagnostic Role of Computed Tomography Angiography (CTA) and Noncontrast Magnetic Resonance Angiography (NC-MRA) in Evaluation of Cerebrovascular Accidents

Prevalence of Intracranial Atherosclerosis among Patients with Coronary Artery Disease: A 1-Year Hospital-Based Study

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

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