scholarly journals Familial Presentation of Intracranial Occlusive Arteriopathy and Ischemic Stroke in Patients with Graves’ Hyperthyroidism

2015 ◽  
Vol 11 (02) ◽  
pp. 89
Author(s):  
Priyank Khandelwal ◽  
Nirav Shah ◽  
Tannvi Prakash ◽  
Gustavo Ortiz ◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Stenosis ◽  
Graves Disease ◽  
Intracranial Arterial Stenosis ◽  
Ischemic Event ◽  
First Report ◽  
Mother And Daughter ◽  
Occlusive Arteriopathy

Background:The comorbidity of intracranial occlusive arteriopathy and Graves’ disease (GD) is increasingly being reported.Methods:We describe two patients (mother and daughter) with GD, intracranial occlusive arteriopathy, and ischemic strokes.Results:Both patients were thyrotoxic at the time of the ischemic event, and the intracranial arterial stenosis was progressive while in thyrotoxic state. In one of the cases, there was no further progression of the disease after 1 year of follow up, once hyperthyroidism was well controlled.Conclusion:To the best of our knowledge, this is the first report of familial presentation of moyamoya-like vasculopathy in patients with GD in Latin population.

scholarly journals Instantaneous Wave-Free Ratio Measurement During Intracranial Submaximal Angioplasty: Case Series and 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. 422-428
Author(s):  
Kunal Vakharia ◽  
Muhammad Waqas ◽  
Najya Fayyaz ◽  
Amanda Young ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Case Series ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Ratio Measurement ◽  
Pressure Wire ◽  
Before And After ◽  
Stenosis Severity

Abstract BACKGROUND Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively. OBJECTIVE To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty. METHODS We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty. RESULTS A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients. CONCLUSION iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.

scholarly journals Association between homocysteine and white matter hyperintensities in asymptomatic intracranial arterial stenosis: results from a population-based study

2019 ◽  
Author(s):  
Hao Yin ◽  
Xiang Wang ◽  
Yuan-yuan Zhao ◽  
Xiao-kang Ji ◽  
Shao-wei Sang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Hyperintensities ◽  
Population Based ◽  
Arterial Stenosis ◽  
Chinese People ◽  
Intracranial Arterial Stenosis ◽  
Population Based Study

Abstract Background: Although homocysteine (Hcy) and white matter hyperintensities (WMH) have been proven to be correlated with increased risks of ischemic stroke, there have been few studies addressing the association between serum Hcy and WMH in a population with asymptomatic intracranial arterial stenosis (aICAS). Thus, the aim of the present study is to describe the association between Hcy and WMH in rural-dwelling Chinese people with aICAS. Methods: In this study, 150 participants diagnosed as aICAS by magnetic resonance angiography were recruited from the Kongcun Town Study, which was a population-based study aimed to investigate the prevalence of aICAS in general population aged 40 to 90 years old, free of ischemic stroke history, and living in the Kongcun town, Pingyin county, Shandong, China. Data on demographics, risk factors, and serum Hcy levels were collected via interview, clinical examination, and laboratory tests. The WMH volumes were calculated through the lesion segmentation tool system for the Statistical Parametric Mapping package based on magnetic resonance imaging. The association between Hcy and WMH volume was analyzed using both linear and logistic regression analysis. Results: After adjusting for all confounders, high Hcy (HHcy) (serum Hcy ≥15umol/L) was significantly associated with severe WMH (the highest quartile in WMH volume) (OR: 2.972, 95%CI: 1.017-7.979, P <0.05). However, with changing of WMH volumes, only trends towards association with HHcy were observed in all 3 models (P values only slightly exceeded 0.05). After being stratified by age, sex, or ever smoking, the association between HHcy and WMH became more significant in participants who were ≥60 years old, male, or ever smoker. Conclusions: HHcy is associated with severe WMH in rural-dwelling Chinese people with aICAS, especially in participants ≥60 years old, male participants, or ever smokers, indicating these may be risk factors that contribute to the association between HHcy and severe WMH.

Abstract 2634: A Prospective Study Of Asymptomatic Intracranial Arterial Stenosis In Japanese Healthy Subjects

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ryukichi Matsui ◽  
Hiroaki Oguro ◽  
Nagai Atsushi ◽  
Hirokazu Bokura ◽  
Keiichi Onoda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Healthy Subjects ◽  
Significant Risk ◽  
Stroke Onset ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
A Prospective Study ◽  
Age And Sex

Background and purpose: Atherosclerotic stenosis of major intracranial arteries accounts for 5 to 10% of all causes of stroke. The Warfarin versus Aspirin Symptomatic Intracranial Disease (WASID) Study has demonstrated stroke onset in 5 among 100 patients with asymptomatic intracranial arterial stenosis (AIAS) during the follow-up period of 1.8 years. However, there are no prospective studies of intracranial stenosis in healthy subjects with a longer follow-up period. We conducted a 7-years longitudinal study in healthy subjects with AIAS to examine its risk factors and prognosis. Methods: We performed a prospective study on 3,155 neurologically normal subjects without history of stroke (1724 men, 1431 woman, mean age of 59). They were followed up with the mean interval of 83 months to obtain information about their stroke event with a questionnaire by mail or telephone interview and inquiry to the relevant medical facilities. AIAS were assessed on MRA at the time of first visit for all subjects. Result: AIAS was detected in 323 subjects (10.2%; AIAS group) at the initial examination. Significant risk factors for AIAS were older age, female, hypertension, high values of fasting blood glucose and HbA1c. During the follow-up stroke occurred in 77 subjects (2.7%) from the no-AIAS group and 14 subjects (4.3%) from the AIAS group (p = 0.07). Age and sex affected the stroke onset. The Cox's proportional-Hazards regression model after adjustment of age and sex revealed the significant contribution of AIAS on stroke onset (OR 1.9; 95% CI 1.03-3.4, p = 0.039). The stroke types were 11 ischemic and 3 hemorrhagic in the AIAS group. Conclusions: AIAS is a significant risk factor for future stroke even in healthy subjects. Intense management of blood pressure and glucose level might be crucial for preventing asymptomatic intracranial atherosclerotic disease.

Abstract TP422: Comparison of Natural History and Effect of Intracranial Stent Placement Between Patients With Intra-Dural and Those With Sub-Arachnoid Intracranial Arterial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sargun S Walia ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
Brandi R French ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Stent Placement ◽  
Cerebral Hemorrhage ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stent ◽  
Subarachnoid Spaces

Background: Intracranial stenosis can be located in intradural or subarachnoid space. It is unclear whether there are any differences in ipsilateral ischemic stroke risk, cerebral hemorrhage and death in response to stent placement in these two locations. Methods: We analyzed Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) data. We divided the patients based on location of arterial stenosis: intradural [petrous internal carotid artery (ICA), pre-cavernous ICA, cavernous ICA or pre-posterior inferior cerebellar artery (PICA) vertebral artery] and subarachnoid [post-cavernous ICA, middle cerebral artery, vertebral artery at the level of or distal to origin of PICA, or basilar artery]. Cox proportional hazards analyses were used to determine the effect of intradural versus subarachnoid location on risk of ipsilateral ischemic stroke, cerebral hemorrhage or death during the follow-up period. Results: A total of 451 patients with stenosis located in intradural (n=74, 16.4%) or subarachnoid (n=377, 83.5 %) spaces were followed for a mean (SD) period of 29.06 (15.22) months after randomization. The rate of ischemic stroke seen in intradural and subarachnoid spaces was 11.86% and 14.58%, respectively. The rate of cerebral hemorrhage in the intradural and subarachnoid spaces was 1.35% and 2.92 %, respectively. The rate of death in the intradural and subarachnoid spaces was 10.81% and 1.59%, respectively. In Cox proportional hazards analyses, the risk of ipsilateral ischemic stroke (HR 1.08, P = 0.46), cerebral hemorrhage (HR 1.05, P = 0.59) and death (HR 0.9, P = 0.9) was not significantly different between patients with intradural arterial stenosis and those with subarachnoid arterial stenosis. The interaction between location of stenosis and treatment (intracranial stent versus best medical treatment) was not significant for the either ipsilateral ischemic stroke (p= 0.21), cerebral hemorrhage (p= 0.18) or death (p=0.15). Conclusion: We did not find any evidence to suggest that there was any difference in natural history or response to intracranial stent placement in patients with intradural location of stenosis compared with those with subarachnoid location.

Long-term natural history of intracranial arterial stenosis: An MRA follow-up study

2013 ◽  
Vol 333 ◽  
pp. e225
Author(s):  
Y. Kim ◽  
W.S. Ryu ◽  
S.S. Park ◽  
Y.S. Kim ◽  
S.H. Lee ◽  
...  
Keyword(s):  
Natural History ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Follow Up Study ◽  
History Of

Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

2020 ◽  
Vol 49 (6) ◽  
pp. 619-624
Author(s):  
Keisuke Tokunaga ◽  
Masatoshi Koga ◽  
Sohei Yoshimura ◽  
Yasushi Okada ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Left Atrial ◽  
Nonvalvular Atrial Fibrillation ◽  
Ischemic Event ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Ischemic Events

<b><i>Background:</i></b> The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). <b><i>Methods:</i></b> Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. <b><i>Results:</i></b> A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). <b><i>Conclusion:</i></b> Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

scholarly journals Undersized angioplasty and stenting of symptomatic intracranial tight stenosis with Enterprise: Evaluation of clinical and vascular outcome

2015 ◽  
Vol 22 (2) ◽  
pp. 187-195 ◽  
Author(s):  
Kun-Yu Lee ◽  
David Yen-Ting Chen ◽  
Hui-Ling Hsu ◽  
Chi-Jen Chen ◽  
Ying-Chi Tseng
Keyword(s):  
Medical Therapy ◽  
Arterial Stenosis ◽  
Modified Rankin Scale ◽  
Intracranial Arterial Stenosis ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Stent Restenosis ◽  
Intracranial Atherosclerotic Disease ◽  
Stenotic Lesions

Background Severe intracranial arterial stenosis results in more than 10% incidence of stroke and transient ischemic attack. Using undersized angioplasty with off-label closed-cell Enterprise stent may be a feasible alternative option for treating patients with intracranial atherosclerotic disease who fail dual-antiplatelet medical therapy. The results of the authors’ study are presented in this paper. Materials and methods Between January 2013 and July 2014, 24 symptomatic patients with a total of 30 intracranial arterial stenotic lesions refractory to medical therapy, who underwent undersized angioplasty and Enterprise stenting, were retrospectively reviewed in the authors’ institution. The results evaluated include technical success rate, clinical outcome measured as modified Rankin Scale at presentation and follow-up, peri-procedural morbidity within 30 days and 1 year, and follow-up vessel patency. Results Stent deployment was successfully achieved in all stenotic lesions (30/30). Mean pre-stent and post-stent diameter residual stenosis was 81% and 18%, respectively. The peri-procedural complication rate during 30 days after stenting was 10% per lesion (3/30), including intracranial hemorrhage, in-stent thrombosis and ischemic stroke. No further thromboembolic event or complication occurred in any patient more than 30 days after stenting. Modified Rankin scale ≤ 2 was observed in 64% and 83% of patients at initial presentation and follow-up (mean 15.8 months), respectively. Imaging follow-up was available in 17 of 24 patients (70.8%) and 20 of 30 treated lesions (66.6%) with a mean follow-up period of 15.4 months. Only one asymptomatic in-stent restenosis occurred in 20 available lesions (5.0%). Conclusion This preliminary study suggests that using undersized angioplasty and Enterprise stenting may effectively treat high-degree symptomatic intracranial arterial stenosis with favorable clinical and angiographic outcome.

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