scholarly journals Atherosclerotic Plaque Locations may be Related to Different Ischemic Lesion Patterns

2020 ◽  
Author(s):  
Ho Geol Woo ◽  
Sung Hyuk Heo ◽  
Eui Jong Kim ◽  
Dae-il Chang ◽  
Tae Jin Song ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Disease ◽  
Ischemic Lesion ◽  
Large Lesion ◽  
Lesion Pattern ◽  
Artery Embolism ◽  
The Common ◽  
Stroke Mechanism ◽  
Major Stroke

Abstract Background: Atherosclerosis of the internal carotid artery (ICA) are an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. We hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with the lesion pattern in acute ischemic stroke.Methods: Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured; moreover, ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern (dichotomized by size) were investigated.Results: A total of 93 patients (31 high-apical plaques and 62 low-body plaques) were investigated. In patients with low-body plaques, hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (162.3 ± 9.8° vs. 167.7 ± 10.4°, p = 0.019). Low-body plaques more frequently appeared as small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques more frequently appeared as a large lesion with additional lesions (38.7% vs. 11.3%, p = 0.002). Low-body plaques (odds ratio 3.106, 95% confidence interval 1.105–8.728, p = 0.032) was independently associated with the small lesions only pattern.Conclusions: Low-body plaques more frequently present small-scattered lesions, whereas high-apical plaques more frequently present a large lesion with additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.

scholarly journals Atherosclerotic plaque locations may be related to different ischemic lesion patterns

2020 ◽  
Author(s):  
Ho Geol Woo ◽  
Sung Hyuk Heo ◽  
Eui Jong Kim ◽  
Dae-il Chang ◽  
Tae Jin Song ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Small Lesion ◽  
Stroke Patients ◽  
Ischemic Lesion ◽  
Lesion Pattern ◽  
Artery Embolism ◽  
The Common ◽  
Stroke Mechanism ◽  
Major Stroke

Abstract Background: Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke.Methods: Ischemic stroke patients with symptomatic proximal ICA disease (>50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated.Results: Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7 ± 10.4° vs 162.3 ± 9.8°, p = 0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p = 0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105–8.728, p = 0.032) was independently associated with the small lesion-only pattern.Conclusions: Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.

scholarly journals Atherosclerotic plaque locations may be related to different ischemic lesion patterns

2020 ◽  
Author(s):  
Ho Geol Woo ◽  
Sung Hyuk Heo ◽  
Eui Jong Kim ◽  
Dae-il Chang ◽  
Tae Jin Song ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Small Lesion ◽  
Stroke Patients ◽  
Ischemic Lesion ◽  
Lesion Pattern ◽  
Artery Embolism ◽  
Stroke Mechanism ◽  
Major Stroke

Abstract Background: Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke.Methods: Ischemic stroke patients with symptomatic proximal ICA disease (>50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated.Results: Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7 ± 10.4° vs 162.3 ± 9.8°, p = 0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p = 0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105–8.728, p = 0.032) was independently associated with the small lesion-only pattern.Conclusions: Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.

Carotid artery webs in embolic stroke of undetermined source with large intracranial vessel occlusion

2020 ◽  
pp. 174749302092994
Author(s):  
Marc-Antoine Labeyrie ◽  
Fabiola Serrano ◽  
Vittorio Civelli ◽  
Clément Jourdaine ◽  
Peggy Reiner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Confidence Interval ◽  
Statistical Significance ◽  
Embolic Stroke ◽  
Wall Thickening ◽  
Intracranial Artery ◽  
Vessel Occlusion ◽  
Potential Source ◽  
Artery Embolism

Background Whether carotid artery web can be considered as a potential source of arterial thromboembolism in ischemic stroke remains uncertain. Aims In a large sample of individuals with large intracranial artery occlusion, we compared the prevalence of carotid artery webs between patients with and without embolic stroke of undetermined source. Methods In a single-center study of consecutive patients with anterior circulation ischemic stroke referred for mechanical thrombectomy, the presence of carotid artery web was systematically assessed by two independent readers. Thereafter, its prevalence was compared between patients with and without embolic stroke of undetermined source. Results Among 466 patients of whom 12% were considered to have had an embolic stroke of undetermined source, ipsilateral carotid artery web was detected in 1.9% (confidence interval 95% = 0.7–3.1). Ipsilateral carotid artery web was more frequent in embolic stroke of undetermined source than in the rest of the sample (10.7% (confidence interval 95% = 2.7–18.7] vs. 0.7% (0–1.5), P < 0.001). This difference remains significant after adjustment for sex, age, and vascular risk factor (odds ratio: 12.5 (2.1–72), P = 0.005) or after exclusion of patients with any other bulb wall thickening ( P = 0.025). In contrast, the difference of prevalence of contralateral carotid artery web between the two groups did not reach statistical significance (2.4% vs. 1.9%, P = 0.6). Conclusions Our results suggest that the presence of a carotid artery web might be considered as a potential source of large intracranial artery embolism. Longitudinal studies are needed to assess the exact risk of recurrence associated with these lesions.

scholarly journals A case of left middle cerebral artery embolism due to Takayasu’s arteritis in the common carotid artery

Nosotchu ◽  
2014 ◽  
Vol 36 (4) ◽  
pp. 271-274
Author(s):  
Ryu Ubagai ◽  
Takehiro Suyama ◽  
Shin Yamashita ◽  
Rin Shimozato ◽  
Masahiro Murakami ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Common Carotid Artery ◽  
Takayasu’S Arteritis ◽  
Left Middle Cerebral Artery ◽  
Takayasu's Arteritis ◽  
Artery Embolism ◽  
The Common ◽  
Left Middle

Abstract WP257: Therapeutic Anti Coagulation and Ischemic Stroke Mechanism in Atrial Fibrillation Exploring Risk Factors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ayman Al-Salaimeh ◽  
Bruce Bradley ◽  
Vedant Gupta ◽  
Michael Dobbs ◽  
Nils Henninger ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Stepwise Logistic Regression ◽  
Carotid Disease ◽  
Adequate Treatment ◽  
History Of ◽  
Stroke Mechanism

Background: Ischemic stroke occurs in setting of AF despite adequate treatment because of both cardiac and non-cardiac causes. We hypothesized that certain clinical , and cardiac characteristics would increase the likelihood of cardio -embolic stroke(CES) in therapeutically anticoagulated patients with AF Methods: We reviewed the records of all adults who were adequately anticoagulated with warfarin or a DOAC(if information was available), and admitted to either the University of Kentucky or University of Massachusetts medical School with a diagnosis of ischemic stroke or transient ischemic attack between 01/01/2011 -06/30/2016. Stroke mechanism (CES vs non CES) using ASCOD criteria was determined by a vascular neurologist masked to the echocardiographic results. Categorical variables were analyzed with Chi square or Fisher exact test as appropriate. Continuous variables were analyzed using t test. P value <.05 was considered significant. Stepwise logistic regression was used to identify variable independently associated with CES Results: 110 patients (68 patients with CES and 42 with non- CES ) were identified. In univariable analyses, CHF was more common in CES group (45% vs 23.8%, p=0.026) , EF was lower in CES group (49% vs 60% , p .00008) , history of PAD or Carotid disease were more common in non CES group (78% vs 50%, p .01) , also total cholesterol on admission was higher in the non CES group (158.5 vs 132.3 mg/dl, p .002) .other variables did not reach statistical significance ( see table) on multiple logistic regression only EF , total cholesterol and history of PAD/Carotid disease maintained statistical significance (.043, 0.013, and 0.022, respectively). Conclusion: Patients with CES despite therapeutic anticoagulation had lower EF, were less likely to have extensive atherosclerotic disease , and had lower total cholesterol compared to those with non- CES. Larger prospective studies are required to confirm these findings

scholarly journals Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign

2018 ◽  
Vol 128 (5) ◽  
pp. 1280-1288 ◽  
Author(s):  
Nobuhiko Ichinose ◽  
Seiji Hama ◽  
Toshio Tsuji ◽  
Zu Soh ◽  
Hideaki Hayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Ldl Cholesterol ◽  
Linear Regression Analysis ◽  
Gaussian Mixture ◽  
Ischemic Lesion ◽  
Increased Risk ◽  
Pls Analysis

OBJECTIVECarotid artery stenting (CAS) has been considered to prevent ischemic strokes caused by stenosis of the cervical carotid artery. The most common complication of CAS is new cerebral infarction. The authors have previously reported that the jellyfish sign—the rise and fall of the mobile component of the carotid plaque surface detected by carotid ultrasonography—suggests thinning and rupture of the fibrous cap over the unstable plaque content, such as the lipid-rich necrotic core or internal plaque hemorrhage. The authors’ aim in the present study was to evaluate the risk of a new ischemic lesion after CAS by using many risk factors including calcification (size and location) and the jellyfish sign.METHODSEighty-six lesions (77 patients) were treated with CAS. The presence of ischemic stroke was determined using diffusion-weighted imaging (DWI). Risk factors included calcification of the plaque (classified into 5 groups for size and 3 groups for location) and the jellyfish sign, among others. Multiple linear regression analysis (stepwise analysis and partial least squares [PLS] analysis) was conducted, followed by a machine learning analysis using an artificial neural network (ANN) based on the log-linearized gaussian mixture network (LLGMN). The additive effects of the jellyfish sign and calcification on ischemic stroke after CAS were examined using the Kruskal-Wallis test, followed by the Steel-Dwass test.RESULTSThe stepwise analysis selected the jellyfish sign, proximal calcification (proximal Ca), low-density lipoprotein (LDL) cholesterol, and patient age for the prediction model to predict new DWI lesions. The PLS analysis revealed the same top 3 variables (jellyfish sign, proximal Ca, and LDL cholesterol) according to the variable importance in projection scores. The ANN was then used, showing that these 3 variables remained. The accuracy of the ANN improved; areas under the receiver operating characteristic curves of the stepwise analysis, the PLS analysis, and the ANN were 0.719, 0.727, and 0.768, respectively. The combination of the jellyfish sign and proximal Ca indicates a significantly increased risk for ischemic stroke after CAS.CONCLUSIONSThe jellyfish sign, proximal Ca, and LDL cholesterol were considered to be important predictors for new DWI lesions after CAS. These 3 factors can be easily determined during a standard clinical visit. Thus, these 3 variables—especially the jellyfish sign and proximal Ca—may be useful for reducing the ischemic stroke risk in patients with stenosis of the cervical carotid artery.

Cortical Ischemic Lesion Burden Measured by DIR Is Related to Carotid Artery Disease Severity

2014 ◽  
Vol 39 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Doriana Landi ◽  
Paola Maggio ◽  
Domenico Lupoi ◽  
Paola Palazzo ◽  
Claudia Altamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Disease Severity ◽  
Carotid Artery Disease ◽  
Carotid Disease ◽  
Ischemic Lesion ◽  
Cerebrovascular Risk ◽  
Artery Disease ◽  
The Impact

Background: Over time, exposure to cerebrovascular risk factors and carotid artery disease may cause multiple asymptomatic brain cortical and subcortical microinfarcts, which are commonly found at brain autopsy. So far, lack of convenient neuroimaging tools limited the investigation of grey matter ischemic damage in vivo. We applied the Double Inversion Recovery (DIR) sequence to explore the impact of carotid artery disease on intracortical ischemic lesion load in vivo, taking into account the impact of demographic characteristics and vascular risk factors. Methods: DIR was acquired in 62 patients with common cerebrovascular risk factors stratified in three groups according to carotid artery disease severity. Intracortical lesions scored on DIR (DIRlns) were classified by vascular territory, lobe and hemisphere. White matter hyperintensities (WMHs) volume was also quantified on Fluid Attenuated Inversion Recovery sequence (FLAIR). Results: Among demographic characteristics and cerebrovascular risk variables explored, General Linear Model indicated that age and carotid artery disease were significantly associated to DIRlns. After correcting for age, DIRlns load was found to be significantly dependent on carotid artery stenosis severity (F(2, 58) = 5.56, p = 0.006). A linear positive correlation between DIRlns and WMHs was found after correcting for age (p = 0.003). Conclusions: Carotid disease severity is associated with DIRlns accrual. Microembolism and impaired cerebral hemodynamics may act as physiopathological mechanisms underlying cortical ischemic damage. The role of other factors, such as small vessel disease and the possible interaction with carotid disease, remains to be further explored.

scholarly journals Duplex Study of Carotid Artery in Patients with Ischemic Stroke

2013 ◽  
Vol 28 (2) ◽  
pp. 67-73
Author(s):  
Nasreen Sultana ◽  
AKM Faslul Bari ◽  
Touhidul Karim Majumder ◽  
Md Rafiqul Islam ◽  
Ferdous Ara Hossain
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Total Occlusion ◽  
Ischemic Lesion ◽  
Significant Stenosis

Objective: To determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients. Method: It was cross-sectional observational study which was carried out in neurology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of January 2010 to December 2011 and one hundred patients admitted with acute ischemic stroke were included in the study. Doppler ultrasound was performed during hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS - 14. Results: Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% ( n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found to have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion and 19% (n=11) had stenosis on the contralateral side. Out of significant stenosis ,mild (50% stenosis) in 12% (n=7) patients, moderate ( 51-69% ) stenosis in 50%( n= 30 ) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Conclusion: Carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke.DOI: http://dx.doi.org/10.3329/bjn.v28i2.17172 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 67-73

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