Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke

Hy, Choi; Jung, Yong Wook; Nam, Chung Mo; Yang, Jing; Hj, Cho; Nam, HS; Lee, Ki Young; Heo, Ji Hoe

doi:10.1111/j.1468-1331.2009.02690.x

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…1,4,8,23 Cross-sectional associations of WSS with CI have not, to our knowledge, been demonstrated before. Still, 1 study reported a lower mean WSS in the common carotid artery ipsilateral to unilateral ischemic stroke, accompanied by more evident atherosclerotic plaques at the same side.…”

Section: Discussionmentioning

confidence: 92%

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

Mutsaerts

Palm-Meinders

Craen

et al. 2011

Stroke

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on behalf of the PROSPER Study GroupBackground and Purpose-Low wall shear stress (WSS) is an early marker in the development of vascular lesions. The present study aims to assess the relationship between diastolic and systolic WSS in the internal carotid artery and periventricular (PWML), deep white matter lesions, and cerebral infarcts (CI). Methods-Early, mid, and late diastolic and peak systolic WSS were derived from shear rate obtained by gradient echo phase contrast magnetic resonance sequences multiplied by individually modeled viscosity. PWML, deep white matter lesions, and CI were derived from proton density (PD), T2, and fluid attenuated inversion recovery (FLAIR) MRI in 329 participants (70 -82 years; PROSPER baseline

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Section: Discussionmentioning

confidence: 92%

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

Mutsaerts

Palm-Meinders

Craen

et al. 2011

Stroke

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“…Patients with cardioembolism were excluded when we analyzed the frequency of cerebral artery atherosclerosis and relationships with CAD because nonatherosclerotic steno-occlusive lesions of the cerebral artery by embolism from the heart are occasionally indistinguishable from those of atherosclerosis [26]. The SAS statistics package (version 9.2; SAS Institute Inc., Cary, N.C., USA) was used for statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

The Frequency and Risk of Preclinical Coronary Artery Disease Detected Using Multichannel Cardiac Computed Tomography in Patients with Ischemic Stroke

Yoo

Yang

Choi³

et al. 2012

Cerebrovasc Dis

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Background: Atherosclerosis is a systemic disease. Many ischemic stroke patients may have concomitant coronary artery disease (CAD). Detection and treatment of preclinical CAD in stroke patients may improve long-term outcome and survival because CAD is a major cause of death during follow-up in stroke patients. However, association between coronary and cerebral artery atherosclerosis in stroke patients has not fully been investigated. This study aimed at examining the frequency and high-risk groups of CAD in ischemic stroke patients. Methods: Consecutive patients who were admitted due to acute ischemic stroke between July 2006 and June 2010 were prospectively enrolled in this study. A total of 1,304 patients who underwent MSCT coronary angiography and cerebral angiography were included in this study. By using 64-multislice computed tomography coronary angiography, we investigated the frequency of CAD and association between coronary and cerebral artery atherosclerosis in terms of location and burden (severity and extent) in stroke patients. We also sought to identify high-risk groups for CAD among stroke patients. Results: The frequency of significant (≧50%) CAD was 32.3% and the frequency of any degree of CAD was 70.1%. Diabetes mellitus, serum levels of total cholesterol, high-density lipoprotein cholesterol and triglyceride, and significant stenosis of the extracranial carotid, intracranial vertebral and basilar arteries were independently associated with CAD. However, no association was found between CAD and significant stenosis of the anterior, middle and posterior cerebral arteries. The association between CAD and cerebral atherosclerosis was stronger with increased severity and extent of cerebral atherosclerosis. When compared to patients with <2 risk factors and without significant cerebral atherosclerosis, those with multiple (≧2) risk factors and atherosclerosis in both the carotid and the vertebrobasilar arteries had very high risks of CAD [odds ratio (OR) 8.36; 95% confidence interval (CI) 4.15–16.87]. The risk was also high in patients with multiple risk factors and atherosclerosis in either the carotid or the vertebrobasilar artery (OR 4.13; 95% CI 2.62–6.51), and in those with <2 risk factors but atherosclerosis in both the carotid and the vertebrobasilar arteries (OR 3.40; 95% CI 1.22–9.47). Conclusions: A substantial portion of stroke patients had preclinical CAD, and there was a clear relationship between coronary and cerebral artery atherosclerosis in terms of location and burden. The risk of CAD was particularly high in stroke patients with multiple risk factors and atherosclerosis of the carotid and/or vertebrobasilar arteries.

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“…Endovascular treatment also was offered for lesions that were discovered during the pretreatment angiography during the endovascular treatment of a symptomatic intra- or extracranial stenotic lesion. The above mentioned lesions are considered to carry an increased risk of subsequent cerebral ischemia [9, 10]. Failure of previous medical therapy was not a compulsory indication criterion for the endovascular treatment.…”

Section: Methodsmentioning

confidence: 99%

Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

Vajda

Güthe

Pérez

et al. 2012

Cardiovasc Intervent Radiol

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PurposeStenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions.MethodsFifty-two patients (median age: 71 years; range: 54–86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed.ResultsAngioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion.ConclusionAngioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

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Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke

Abstract: Atherosclerosis in cerebral arteries may develop and progress in a mirror pattern. In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination.

Cited by 8 publications

References 27 publications

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

Diastolic Carotid Artery Wall Shear Stress Is Associated With Cerebral Infarcts and Periventricular White Matter Lesions

The Frequency and Risk of Preclinical Coronary Artery Disease Detected Using Multichannel Cardiac Computed Tomography in Patients with Ischemic Stroke

Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

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