Chronic Hemodynamic Compromise and Cerebral Ischemic Events in Asymptomatic or Remote Symptomatic Large-Artery Intracranial Occlusive Disease

Introduction: Lipoprotein associated -phospholipase A2 (Lpa-A2) mass and activity can help identify high risk TIA patients. We evaluate the yield of Lpa-A2 mass and activity to differentiate acute cerebral ischemic events from non-ischemic events. Methods: From July 2007 to March 2009, 48 patients presenting to the Stanford Unversity Medical Center Emergency room with stroke or TIA symptoms were prospectively enrolled and blood samples were obtained at time of presentation, 24 hours, and 72 hours after presentation. Blood samples were analyzed for Lpa-A2 mass and activity using commercially available assays (diaDexus, Inc). Patients with final diagnosis of stroke or TIA were classified as ischemic and others as non-ischemic. The size of the ischemic lesion was measured among stroke patients on diffusion weighted imaging (DWI). Results: Twenty eight patients (58%) had a diagnosis of brain infarction [median NIHSS=7 (IQR=4-12)], 9 (19%) had a diagnosis of TIA [median ABCD2=4, (IQR=3-6)] and 11(23%) had a non ischemic event (1 peripheral vertigo, 2 infections, 3 seizures, 4 peripheral neuropathy/myopathy, 1 multiple sclerosis relapse). Among the 37 ischemic patients, stroke mechanisms were according to TOAST criteria: 6 (16%) large artery atherosclerosis, 21 (57%) cardioembolic, 1 (3%) small artery, 4 (11%) other determined and 5 (13%) undetermined. At admission, Lpa-A2 activity level was higher among patients experiencing an ischemic event (stroke or TIA) compared to non ischemic event (p=0.007). Among ischemic patients, Lpa-A2 activity measured at admission was lower than the activity measured at day 1 (p=0.006) and day 3 (p=0.002) and was stable among non ischemic patients. Among the 24 ischemic patients who underwent acute MRI and were found to have an ischemic lesion on DWI, there was no relation between Lpa-A2 activity level and infarct volume. Lipoprotein associated -phospholipase A2 mass level was not different between ischemic and non ischemic patients. The mass levels remained stable over time in each group and were not related to infarct volume. Conclusions: Lpa-A2 activity levels were higher among ischemic patients compared with non ischemic etiologies. Lpa-A2 activity levels rose during the first days after brain ischemia. This exploratory data suggests Lpa-A2 activity level could possibly help physicians discriminate cerebral ischemic from non ischemic events. Further research is warranted and ongoing.

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C-Reactive Protein Predicts Further Ischemic Events in First-Ever Transient Ischemic Attack or Stroke Patients With Intracranial Large-Artery Occlusive Disease

Stroke ◽

10.1161/01.str.0000089920.93927.a7 ◽

2003 ◽

Vol 34 (10) ◽

pp. 2463-2468 ◽

Cited By ~ 105

Author(s):

Juan F. Arenillas ◽

José Álvarez-Sabín ◽

Carlos A. Molina ◽

Pilar Chacón ◽

Joan Montaner ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Occlusive Disease ◽

Large Artery ◽

C Reactive Protein ◽

Stroke Patients ◽

Reactive Protein ◽

Ischemic Attack ◽

Ischemic Events

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Melatonin rescues cerebral ischemic events through upregulated tunneling nanotube-mediated mitochondrial transfer and downregulated mitochondrial oxidative stress in rat brain

Biomedicine & Pharmacotherapy ◽

10.1016/j.biopha.2021.111593 ◽

2021 ◽

Vol 139 ◽

pp. 111593

Author(s):

Hon-Kan Yip ◽

Navneet Kumar Dubey ◽

Kun-Chen Lin ◽

Pei-Hsun Sung ◽

John Y. Chiang ◽

...

Keyword(s):

Oxidative Stress ◽

Rat Brain ◽

Mitochondrial Oxidative Stress ◽

Mitochondrial Transfer ◽

Tunneling Nanotube ◽

Cerebral Ischemic ◽

Ischemic Events

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Clinically Silent Cerebral Ischemic Events After Cardiac Surgery: Their Incidence, Regional Vascular Occurrence, and Procedural Dependence

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.01.080 ◽

2006 ◽

Vol 81 (6) ◽

pp. 2160-2166 ◽

Cited By ~ 96

Author(s):

Thomas F. Floyd ◽

Pallav N. Shah ◽

Catherine C. Price ◽

Francis Harris ◽

Sarah J. Ratcliffe ◽

...

Keyword(s):

Cardiac Surgery ◽

Cerebral Ischemic ◽

Ischemic Events

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Further Evidence Relating Mitral-Valve Prolapse to Cerebral Ischemic Events

New England Journal of Medicine ◽

10.1056/nejm198001173020303 ◽

1980 ◽

Vol 302 (3) ◽

pp. 139-144 ◽

Cited By ~ 269

Author(s):

Henry J. M. Barnett ◽

Derek R. Boughner ◽

D. Wayne Taylor ◽

Paul E. Cooper ◽

William J. Kostuk ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Prolapse ◽

Cerebral Ischemic ◽

Ischemic Events

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Preoperative single-slab 3D time-of-flight magnetic resonance angiography predicts development of new cerebral ischemic events after carotid endarterectomy

Journal of Neurosurgery ◽

10.3171/2009.2.jns081233 ◽

2009 ◽

Vol 111 (1) ◽

pp. 141-146 ◽

Cited By ~ 5

Author(s):

Taro Suzuki ◽

Kuniaki Ogasawara ◽

Ryonoshin Hirooka ◽

Makoto Sasaki ◽

Masakazu Kobayashi ◽

...

Keyword(s):

At Risk ◽

Mr Imaging ◽

Carotid Endarterectomy ◽

Signal Intensity ◽

Mr Angiography ◽

Time Of Flight ◽

Neurological Deficits ◽

Patients At Risk ◽

Cerebral Ischemic ◽

Ischemic Events

Object Preoperative impairment of cerebral hemodynamics predicts the development of new cerebral ischemic events after carotid endarterectomy (CEA), including neurological deficits and cerebral ischemic lesions on diffusion weighted MR imaging. Furthermore, the signal intensity of the middle cerebral artery (MCA) on single-slab 3D time-of-flight MR angiography (MRA) can assess hemodynamic impairment in the cerebral hemisphere. The purpose of the present study was to determine whether, on preoperative MR angiography, the signal intensity of the MCA can be used to identify patients at risk for development of cerebral ischemic events after CEA. Methods The signal intensity of the MCA ipsilateral to CEA on preoperative MR angiography was graded according to the ability to visualize the MCA in 106 patients with unilateral internal carotid artery stenosis (≥ 70%). Diffusion weighted MR imaging was performed within 3 days of and 24 hours after surgery. The presence or absence of new postoperative neurological deficits was also evaluated. Results Cerebral ischemic events after CEA were observed in 16 patients. Reduced signal intensity of the MCA on preoperative MR angiography was the only significant independent predictor of postoperative cerebral ischemic events. When the reduced MCA signal intensity on preoperative MR angiography was defined as an impairment in cerebral hemodynamics, MR angiography grading resulted in an 88% sensitivity and 63% specificity, with a 30% positive- and a 97% negative-predictive value for the development of postoperative cerebral ischemic events. Conclusions Signal intensity of the MCA on preoperative single-slab 3D time-of-flight MR angiography is useful for identifying patients at risk for cerebral ischemic events after CEA.

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Large Artery Occlusive Disease of the Anterior Circulation

Caplan's Stroke ◽

10.1016/b978-1-4160-4721-6.50008-0 ◽

2009 ◽

pp. 221-257 ◽

Cited By ~ 1

Author(s):

Louis R. Caplan

Keyword(s):

Occlusive Disease ◽

Large Artery ◽

Anterior Circulation

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Abstract T MP26: Role of 99tc-hmpao Spect in the Assessment of Cerebral Hemodynamic Parameters After Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients With Severe Steno-Occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Stroke ◽

10.1161/str.45.suppl_1.tmp26 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Amit Batra ◽

Arvind K Sinha ◽

Leonard L Yeo ◽

Rahul Rathakrishnan ◽

Prakash Paliwal ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Occlusive Disease ◽

Hemodynamic Parameters ◽

Bypass Group ◽

Hmpao Spect ◽

Cerebral Ischemic

Background and Objective: Although superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic carotid occlusion failed to demonstrate any benefit, its role in symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated changes in hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass for impaired cerebral vasodilatory reserve (CVR). Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) evaluation and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged 99Tc-HMPAO-SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events. Results: Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR HMPAO-SPECT. Fifty (60%) of them underwent STA-MCA bypass while 34(40%) received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. TCD BHI improved from a median (IQR) of -0.05 to 1.1 (p<0.001). Compared to 98% patients with impaired CVR on pre-operative SPECT, only 20% showed abnormal results on post-operative imaging (p<0.001). During follow-up (mean 35 months; range 8 to 49months), only 6/50 (12%) patients in bypass group developed cerebral ischemic events as compared to15/34 (44%) cases on medical therapy (absolute risk reduction 32%, p=0.006). Conclusion: 99Tc-HMPAO SPECT with acetazolamide challenge is a reliable tool for the assessment of cerebral vasodilatory reserve in patients with severe steno-occlusive disease of intracranial ICA or MCA. STA-MCA bypass surgery in carefully selected patients results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

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Variations in the Presence of Carotid Intraplaque Hemorrhage Across Age Categories: What Age Groups Are Most Likely to Benefit From Plaque Imaging?

Frontiers in Neurology ◽

10.3389/fneur.2020.603055 ◽

2020 ◽

Vol 11 ◽

Author(s):

Anthony S. Larson ◽

John C. Benson ◽

Waleed Brinjikji ◽

Luis Savastano ◽

Giuseppe Lanzino ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Age Groups ◽

Intraplaque Hemorrhage ◽

Plaque Imaging ◽

Anterior Circulation ◽

The Mean ◽

Artery Disease ◽

Cerebral Ischemic ◽

Ischemic Events

Although carotid artery intraplaque hemorrhage (IPH) is a known risk-factor for cerebral ischemic events in patients of advanced age, its prevalence in younger cohorts is less certain. The purpose of this study was to assess the prevalence of carotid artery IPH across the age spectrum. A retrospective review was completed of all adult patients from our institution who underwent neck MRA with high-resolution carotid plaque imaging between 2017 and 2020. The mean ages of patients with and without IPH were calculated. The prevalence of IPH was compared between patients that were categorized into age groups. Patients with and without a cerebral ischemic event (e.g., stroke, retinal ischemia) were included. Unilateral anterior circulation ischemic events in patients without atrial fibrillation were presumed to be likely related to ipsilateral carotid artery disease. Multiple regression analysis was performed to determine independent associations with IPH. 634 patients were included (1,268 carotid arteries). Increasing age (OR: 1.04; 95% CI: 1.02–1.06; P = 0.001) was independently associated with IPH. 211 patients had unilateral anterior circulation ischemic events. The mean age of patients with carotid IPH was 71.4 years (SD = 9.9), compared to 62.8 years (SD = 15.8) of those without (P ≤ 0.0001). The prevalence of IPH increased with age in all patients (P = 0.0002). Among patients with ipsilateral anterior circulation ischemic events, each age category above 50 years had a significantly higher prevalence of IPH when compared to patients 18–50 years (P ≤ 0.05 for all comparisons). The prevalence of carotid IPH increases with age and is rare in patients under 50 years. The approximate threshold age for IPH development is likely around 50 years.

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