Vascular Retinal, Neuroimaging and Ultrasonographic Markers of Lacunar Infarcts

Rodriguez, I. Martinez; Lema, M; Blanco, Miguel; Rodríguez‐Yáñez, Manuel; Leira, Rogelio; Castillo, José

doi:10.1111/j.1747-4949.2010.00462.x

Cited by 13 publications

(10 citation statements)

References 38 publications

(57 reference statements)

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“…Neuroimaging and ultrasonographic evaluation was done at admission. A detailed description of the neurological examination protocol was published elsewhere . In summary, LI was diagnosed when the patient had one of the clinical lacunar syndromes lasting > 24 hours, no evidence of cortical dysfunction, and a normal or deep focal infarction with a diameter ≤15 mm in an appropriate location visualized by CT/MRI.…”

Section: Methodsmentioning

confidence: 99%

“…A detailed description of the neurological examination protocol was published elsewhere. 24,31 In summary, LI was diagnosed when the patient had one of the clinical lacunar syndromes lasting > 24 hours, no evidence of cortical dysfunction, and a normal or deep focal infarction with a diameter ≤15 mm in an appropriate location visualized by CT/MRI. The presence of an LI in the baseline CT in which the topography did not correspond with the present clinical syndrome was considered a silent infarct (i.e., asymptomatic brain infarcts).…”

Section: Neurological Examinationmentioning

confidence: 99%

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Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct

Leira

Rodríguez‐Yáñez

Arias

et al. 2018

Journal of Periodontology

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Background Periodontitis has been associated with lacunar infarct (LI), a type of cerebral small vessel disease. The objective of this study was to ascertain whether periodontitis is associated with increased circulating levels of systemic inflammation and endothelial dysfunction biomarkers in patients with LI. Methods One hundred twenty patients with LI and 120 healthy controls underwent a full‐mouth periodontal examination. The periodontal inflamed surface area (PISA) was calculated for each participant. Demographic, medical, and neurological information were recorded from all of them. In addition, blood samples were collected in order to investigate differences in terms of interleukin (IL)‐6, IL‐10, pentraxin (PTX) 3, soluble fragment of tumor necrosis factor‐like weak inducer of apoptosis (sTWEAK) and amyloid‐beta (Aβ) peptides (i.e., Aβ1‐40, and Aβ1‐42) measured in serum. Results Periodontitis was independently associated with increased levels of IL‐6 (R2 = 0.656, P < 0.001), PTX3 (R2 = 0.115, P < 0.001), sTWEAK (R2 = 0.527, P < 0.001), and Aβ1‐40 (R2 = 0.467, P < 0.001) in patients with LI. Within patients with poor outcome, PISA positively correlated with IL‐6 (r = 0.738, P < 0.001), PTX3 (r = 0.468, P = 0.008), sTWEAK (r = 0.771, P < 0.001), and Aβ1‐40 (r = 0.745, P < 0.001). Conclusions Our data suggest a link between periodontitis, systemic inflammatory response, and disruption of the vascular endothelial function in patients with LI. Experimental studies are needed to elucidate possible pathways through which periodontitis could lead to this systemic inflammatory state with impairment of the endothelial function in LI. Further longitudinal studies with large samples are warranted to confirm our findings.

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Section: Methodsmentioning

confidence: 99%

Section: Neurological Examinationmentioning

confidence: 99%

Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct

Leira

Rodríguez‐Yáñez

Arias

et al. 2018

Journal of Periodontology

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“…An increase in PI is associated with white matter hyperintensities and lacunar infarction, especially in diabetic patients. A strong relationship between retinal microangiopathy and PI with neuroimaging markers of brain small vessel disease was demonstrated in a previous study [18]. It has been speculated that the thickened fibrotic wall of small vessel microangiopathy loses its elastic properties and becomes rigid.…”

Section: Discussionmentioning

confidence: 93%

“…Recently, it has also been suggested that an increased plasma total homocysteine level was independently associated with increased PIs of intracranial arteries [17]. Several previous studies have demonstrated that the PI is an index of the presence and severity of diffuse small vessel disease [8,9,18]. An increase in PI is associated with white matter hyperintensities and lacunar infarction, especially in diabetic patients.…”

Section: Discussionmentioning

confidence: 98%

Increased Pulsatility Index Is Associated with Intracranial Arterial Calcification

et al. 2012

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Background/Aims: An increase in the pulsatility index (PI) has been suggested to reflect distal vascular resistance. The purpose of the present study was to investigate the association between intracranial arterial calcification and intracranial PIs. Methods: Consecutive patients with acute ischemic stroke or transient ischemic attack were included. The PIs of both middle cerebral arteries (MCAs) were measured by transcranial Doppler ultrasonography. Intracranial carotid artery calcification (ICAC) was assessed on computed tomography angiography, and then compared with the mean PI of both MCAs. Patients with internal carotid artery steno-occlusion were excluded from this study. Results: A total of 156 patients were finally enrolled. The prevalence of diabetes increased as the PI value increased (p for trends; p = 0.025). PI was correlated with ICAC score (r = 0.413, p < 0.001) and age (r = 0.507, p < 0.001). Multiple linear regression analysis indicated that aging and ICAC were independent determinants of the PI of MCA after adjusting for sex, systolic blood pressure, smoking, and the presence of diabetes. Conclusions: This study shows that an increase in PI was correlated with the severity of ICAC, which suggests calcification-related vascular resistance might have a role in the elevation of PI.

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“…The same explorer (SA), blinded to clinical data, performed the ultrasonographic study using high‐resolution B‐mode ultrasound (Aplio 50 [Toshiba aplio 50, MCM1754TSA, Rome, Italy] Toshiba SSA‐700 [Toshiba Medical Systems Corporation, Otawara‐SHI, Japan]) with a 7.5 MHz, linear‐array transducer (Linear array transducer PLT‐704AT, Toshiba, Tochigi, Japan; Phased array transducer PST‐20CT, Toshiba, Tochigi, Japan) (Rodríguez et al., ). In brief, the image was focused on the posterior (far) wall of the left carotid artery.…”

Section: Methodsmentioning

confidence: 99%

Periodontitis as a risk indicator and predictor of poor outcome for lacunar infarct

Leira

Rodríguez‐Yáñez

Arias

et al. 2018

J Clinic Periodontology

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Aim To investigate the association between periodontitis (PD) and lacunar infarct (LI) as well as to analyse whether PD could be a predictor of poor functional prognosis in patients with LI. Material and Methods Full‐mouth periodontal examination was done in 120 cases (patients with LI) and 157 healthy controls. Demographic, clinical, medical and neurological information were collected from all of them. In addition, a measure of periodontal inflammation and disease activity, namely the periodontal inflamed surface area (PISA), was also calculated for each patient. Poor functional outcome was considered as a modified Rankin Scale >2 at 3 months. Results PD was independently associated with the presence of LI (OR = 3.3, p < 0.001). Poor outcome was observed in 31 patients with LI (25.8%), of which 90.3% had PD. A PISA value ≥727 mm2 was an independent predictor of poor prognosis, after adjusting for clinical confounders (OR = 6.5, p = 0.001). Conclusions PD and LI were associated. Active moderate to severe PD predicted poor prognosis in patients with LI. Further evidence is warranted to confirm our results and investigate potential mechanisms behind this association.

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Vascular Retinal, Neuroimaging and Ultrasonographic Markers of Lacunar Infarcts

Abstract: The association of retinal microangiopathy (but not vascular retinopathy) and leukoaraiosis is linked to small-vessel disease and may be a useful marker of lacunar infarcts not secondary to a macrovascular lesion.

Cited by 13 publications

References 38 publications

Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct

Periodontitis is associated with systemic inflammation and vascular endothelial dysfunction in patients with lacunar infarct

Increased Pulsatility Index Is Associated with Intracranial Arterial Calcification

Periodontitis as a risk indicator and predictor of poor outcome for lacunar infarct

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