scholarly journals Intracranial Atherosclerotic Plaque Characteristics and Burden Associated With Recurrent Acute Stroke: A 3D Quantitative Vessel Wall MRI Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Beibei Sun ◽  
Lingling Wang ◽  
Xiao Li ◽  
Jin Zhang ◽  
Jianjian Zhang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Atherosclerotic Plaque ◽  
Vessel Wall ◽  
Chronic Stroke ◽  
Plaque Burden ◽  
Plaque Area ◽  
Stroke Group ◽  
First Time

Background: Intracranial atherosclerotic disease (ICAD) tends to affect multiple arterial segments, and previous studies rarely performed a comprehensive plaque analysis of the entire circle of Willis for the evaluation of recurrent stroke risk. We aimed to investigate the features of circle of Willis ICAD on 3D magnetic resonance vessel wall imaging (MR-VWI) and their relationships with recurrent acute stroke.Methods: Patients with either acute ischemic stroke (within 4 weeks after stroke) or chronic ischemic stroke (after 3 months of stroke) due to intracranial atherosclerotic plaque underwent 3D contrast-enhanced MR-VWI covering major cerebral arteries. Participants were divided into three groups: first-time acute stroke, recurrent acute stroke, and chronic stroke. Culprit plaque (defined as the only lesion or the most stenotic lesion when multiple plaques were present within the same vascular territory of the stroke) and non-culprit plaque characteristics, including total plaque number, plaque thickness, plaque area, plaque burden (calculated as plaque area divided by outer wall area), enhancement ratio (ER), eccentricity, and stenosis, were measured and compared across the three groups. Associations between plaque characteristics and recurrent acute stroke were investigated by multivariate analysis.Results: A total of 176 participants (aged 61 ± 10 years, 109 men) with 702 intracranial plaques were included in this study. There were 80 patients with first-time acute stroke, 42 patients with recurrent acute stroke, and 54 patients with chronic stroke. More intracranial plaques were found per patient in the recurrent acute stroke group than in the first-time acute stroke or chronic stroke group (5.19 ± 1.90 vs. 3.71 ± 1.96 and 3.46 ± 1.33, p < 0.001). Patients in the recurrent acute stroke group had greater culprit plaque burden (p < 0.001) and higher culprit ER (p < 0.001) than the other two groups. After adjustment of clinical demographic factors, in multivariate analysis, coronary artery disease (CAD) (odds ratio, OR = 4.61; p = 0.035), total plaque number (OR = 1.54; p = 0.003), culprit plaque ER (OR = 2.50; p = 0.036), and culprit plaque burden (OR per 10% increment = 2.44; p = 0.010) were all independently associated with recurrent acute stroke compared to the first-time acute stroke.Conclusion: Increased intracranial atherosclerotic plaque number, higher culprit plaque ER, greater culprit plaque burden, and CAD are independently associated with recurrent acute stroke.

Vascular Remodeling During Atherosclerotic Plaque Build Up Is Controlled by the Plaque Free Part of the Vessel Wall

2008 ◽  
Author(s):  
Jolanda J. Wentzel ◽  
Harald C. Groen ◽  
Rose van der Giessen ◽  
Gaston Rodriguez-Granillo ◽  
Frank J. H. Gijsen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Atherosclerotic Plaque ◽  
Vascular Remodeling ◽  
Vessel Wall ◽  
Vascular System ◽  
Control Process ◽  
Plaque Burden ◽  
Free Wall ◽  
Plaque Area ◽  
Healthy Part

Glagov et al. observed that positive, compensatory vascular remodeling during plaque build up prevents lumen narrowing until plaque burden, this is the relative plaque area to media bounded area, exceeds a threshold of 40% [1]. Until now it is not clear what mechanism controls the compensatory vascular remodeling during the atherosclerotic plaque build up and what determines absence or limits compensatory vascular remodeling. Plaque burden does not seem to reflect a parameter, which could serve as a limiting step in the known control process in the vascular system. For instance, healthy arteries control vascular remodeling by fluid flow induced shear stress via a number of endothelium dependent pathways [2]. The endothelium at the atherosclerotic plaque side is considered to be dysfunctional [2] and might thereby limit the remodeling process. Since plaques are mostly eccentric, we hypothesize that the healthy part of the artery (or plaque free wall) will respond to changes in shear stress and will determine the capacity of the arteries to remodel up till the moment of complete circumferential involvement of the disease. We investigated whether the size of the plaque free wall contributes to vascular remodeling over a 3 year period using serial intravascular ultrasound measurements by determining 1) the frequency of positive remodeling in segments with varying size of plaque free vessel wall 2) the degree of vascular remodeling for segments with varying size of plaque free vessel wall.

scholarly journals In vivo inhibition of nuclear factor of activated T-cells leads to atherosclerotic plaque regression in IGF-II/LDLR–/–ApoB100/100 mice

2018 ◽  
Vol 15 (4) ◽  
pp. 302-313 ◽  
Author(s):  
Fabiana Blanco ◽  
Suvi E Heinonen ◽  
Erika Gurzeler ◽  
Lisa M Berglund ◽  
Anna-Maria Dutius Andersson ◽  
...  
Keyword(s):  
T Cells ◽  
Atherosclerotic Plaque ◽  
Molecular Mechanisms ◽  
Density Lipoprotein ◽  
Ultrasound Biomicroscopy ◽  
Plaque Burden ◽  
Nuclear Factor ◽  
Activated T Cells ◽  
Plaque Area

Aims: Despite vast clinical experience linking diabetes and atherosclerosis, the molecular mechanisms leading to accelerated vascular damage are still unclear. Here, we investigated the effects of nuclear factor of activated T-cells inhibition on plaque burden in a novel mouse model of type 2 diabetes that better replicates human disease. Methods & Results: IGF-II/LDLR–/–ApoB100/100 mice were generated by crossbreeding low-density lipoprotein receptor–deficient mice that synthesize only apolipoprotein B100 (LDLR–/–ApoB100/100) with transgenic mice overexpressing insulin-like growth factor-II in pancreatic β cells. Mice have mild hyperglycaemia and hyperinsulinaemia and develop complex atherosclerotic lesions. In vivo treatment with the nuclear factor of activated T-cells blocker A-285222 for 4 weeks reduced atherosclerotic plaque area and degree of stenosis in the brachiocephalic artery of IGF-II/LDLR–/–ApoB100/100 mice, as assessed non-invasively using ultrasound biomicroscopy prior and after treatment, and histologically after termination. Treatment had no impact on plaque composition (i.e. muscle, collagen, macrophages). The reduced plaque area could not be explained by effects of A-285222 on plasma glucose, insulin or lipids. Inhibition of nuclear factor of activated T-cells was associated with increased expression of atheroprotective NOX4 and of the anti-oxidant enzyme catalase in aortic vascular smooth muscle cells. Conclusion: Targeting the nuclear factor of activated T-cells signalling pathway may be an attractive approach for the treatment of diabetic macrovascular complications.

scholarly journals Low Bone Mineral Density Could Predict Cognitive Impairment during the Acute and Recovery Phases of Ischemic Stroke

2020 ◽  
Author(s):  
Sang-Hwa Lee ◽  
Min Uk Jang ◽  
Yerim Kim ◽  
So Young Park ◽  
Chulho Kim ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Femoral Neck ◽  
Acute Stroke ◽  
Bone Mineral ◽  
Recovery Phase ◽  
Mineral Density

Abstract Background Little is known about the effect of osteoporosis at the acute and recovery phase of stroke on cognitive function. We evaluated the effect of osteoporosis on cognitive function in patients with ischemic stroke aged >50 years. Methods We retrospectively examined consecutive patients with acute stroke hospitalized between 2016 and 2018. Osteoporosis was defined as a T score of <-2.5 for the femoral neck or lumbar spine bone mineral density. The primary outcome was cognitive impairment measured by the Korean Mini-Mental State Examination in the acute phase and recovery phase of ischemic stroke. The association between osteoporosis and the severity of cognitive impairment was investigated using a multivariate analysis. Results Of the 260 included subjects (107 men and 153 women), 70 (26.9%) had osteoporosis. Cognitive impairment was more severe in the osteoporosis group than in the non-osteoporosis group (30.5% versus 47.1%, p=0.001). After recovery phase of stroke, the proportion of patients with cognitive impairment remained higher in the osteoporosis group. The multivariate analysis revealed a correlation between a low femoral neck bone mineral density and severe cognitive impairment in the acute and recovery phases of stroke (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.05-12.79 in the acute phase and adjusted OR 11.17, 95% CI 1.12-110.98 in the recovery phase), whereas lumbar spine osteoporosis was not associated with cognitive impairment. Conclusions Low bone mineral density is associated with poor cognitive function in patients with acute stroke. Early bone mineral density assessments during acute stroke, particularly at the femoral neck, may be a useful marker of cognitive function.

Abstract WMP44: Differential Middle Cerebral Artery Plaque Characteristics in Patients With Transient Ischemic Attack and Ischemic Stroke: A High-Resolution MR Vessel Wall Imaging Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jiayu Xiao ◽  
Matthew Padrick ◽  
Qi Yang ◽  
Tao Jiang ◽  
Shuang Xia ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Transient Ischemic Attack ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Plaque Burden ◽  
Ischemic Attack ◽  
Wall Imaging

Introduction: Intracranial atherosclerotic disease (ICAD) correlates highly with transient ischemic attack (TIA) and acute ischemic stroke (AIS). Magnetic Resonance (MR) vessel wall imaging (VWI) is an emerging non-invasive imaging modality for directly assessing ICAD lesions. Methods: We retrospectively analyzed MR-VWI from 42 TIA patients and 45 AIS patients with ICAD. All patients fulfilled the following criteria: (1) stenosis >30% of a middle cerebral artery (MCA), (2) symptoms contralateral to stenotic MCA, (3) no coexisting stenosis at other major vessels; (4) lack of compelling evidence to other etiologies of stroke/TIA. Vascular lesions were analyzed with MR-VWI with respect to the stenosis degree, vessel wall irregularity, plaque burden (PB), remodeling index (RI), plaque-wall contrast ratio (CR) and plaque enhancement grade (EG). Results: EG (OR 3.88, 95%CI 1.42-10.57, P=0.006) was a risk factor for AIS while PB (OR 0.65, 95%CI 0.27-1.54, P=0.008) was a risk factor for TIA. In patients with 30-70% degree stenosis, CR (OR 5.38, 95%CI 1.39-20.75, P=0.008) was a risk factor for stroke, while PB (OR 0.4, 95%CI 0.1-1.65, P=0.006) remained a risk factor for TIA. Conclusions: In our study, PB appeared as a risk factor for TIA but not for AIS. This suggests that unstable plaque accounting for AIS may have a wide range of PB. We further found that CR and EG are more associated with AIS than TIA. Lesions with high CR and strong enhancement may be more prone to producing the permanent ischemic injury. Further study is needed to elucidate the role of MR-VWI in differential diagnosis and management of TIA and AIS.

scholarly journals Low Bone Mineral Density Could Predict Cognitive Impairment during the Acute and Recovery Phases of Ischemic Stroke

2019 ◽  
Author(s):  
Sang-Hwa Lee ◽  
Min Uk Jang ◽  
Yerim Kim ◽  
So Young Park ◽  
Chulho Kim ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Femoral Neck ◽  
Acute Stroke ◽  
Bone Mineral ◽  
Recovery Phase ◽  
Mineral Density

Abstract Background Little is known about the effect of osteoporosis at the acute and recovery phase of stroke on cognitive function. We evaluated the effect of osteoporosis on cognitive function in patients with ischemic stroke aged >50 years. Methods We retrospectively examined consecutive patients with acute stroke hospitalized between 2016 and 2018. Osteoporosis was defined as a T score of <-2.5 for the femoral neck or lumbar spine bone mineral density. The primary outcome was cognitive impairment measured by the Korean Mini-Mental State Examination in the acute phase and recovery phase of ischemic stroke. The association between osteoporosis and the severity of cognitive impairment was investigated using a multivariate analysis. Results Of the 260 included subjects (107 men and 153 women), 70 (26.9%) had osteoporosis. Cognitive impairment was more severe in the osteoporosis group than in the non-osteoporosis group (30.5% versus 47.1%, p=0.001). After recovery phase of stroke, the proportion of patients with cognitive impairment remained higher in the osteoporosis group. The multivariate analysis revealed a correlation between a low femoral neck bone mineral density and severe cognitive impairment in the acute and recovery phases of stroke (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.05-12.79 in the acute phase and adjusted OR 11.17, 95% CI 1.12-110.98 in the recovery phase), whereas lumbar spine osteoporosis was not associated with cognitive impairment. Conclusions Low bone mineral density is associated with poor cognitive function in patients with acute stroke. Early bone mineral density assessments during acute stroke, particularly at the femoral neck, may be a useful marker of cognitive function.

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

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