Evaluation of three-dimensional high-resolution magnetic resonance imaging in the diagnosis of intracranial atherosclerotic stenosis / Evaluación de resonancia magnética tridimensional de alta resolución en el diagnóstico de la estenosis aterosclerótica intracraneal

SUMMARY: Intracranial artery stenosis (ICAS) was one of the main causes of ischemic stroke onset and recurrence. About 30 % of strokes were caused by intracranial artery stenosis. Intracranial artery stenosis had a high incidence in China and faced a high risk of recurrence for a long time. It affected patient safety and quality of life seriously. At the same time, it caused a heavy financial burden for the patient´s family. Therefore, early detection and accuracy of intracranial artery stenosis evaluation were extremely important. High-resolution magnetic resonance imaging (HR-MRI) had been widely used in clinical examinations, making up for the shortcomings of traditional vascular imaging methods that could only show the degree of luminal stenosis, making it possible to perform lumens, tube wall and plaque features of atherosclerotic intracranial arteries at the same time. There were still some controversies about the credibility of this technique in assessing the intracranial artery lumen stenosis. This article reviewed the application efficacy of HR-MRI technology in evaluating the degree of intracranial atherosclerotic stenosis.

RESUMEN: La estenosis de arterias intracraneales (ICAS) es una de las principales causas del ictus isquémico, como así también de su recurrencia. Alrededor del 30 % de los ataques cerebrovasculares son causados por estenosis de la arteria intracraneal. La estenosis de arterias intracraneales tiene una alta incidencia en China y enfrenta un alto riesgo de recurrencia, afectando gravemente la seguridad y la calidad de vida de los pacientes. Al mismo tiempo, supone una importante carga financiera para la familia de los pacientes. Por lo tanto, la detección temprana y la precisión de la evaluación de la estenosis de arterias intracraneales es extremadamente importante. La resonancia magnética de alta resolución (HR-MRI, por sus siglas en inglés) es utilizada ampliamente en los exámenes clínicos, compensando las deficiencias de los métodos tradicionales de imágenes vasculares que solo pueden mostrar el grado de estenosis luminal, haciendo posible el estudio de las características del lumen, pared vascular y la placa ateroesclerótica, de las arterias intracraneales afectadas, al mismo tiempo. Aún existen algunas controversias sobre la credibilidad de esta técnica en la evaluación de la estenosis del lumen de arterias intracraneales. En este artículo se revisó la eficacia de la aplicación de la tecnología HR-MRI para evaluar el grado de estenosis aterosclerótica intracraneal.

Hybrid operation for symptomatic intracranial artery stenosis with proximal vascular tortuosity: report of two cases / 中国脑血管病杂志

Patient 1 was a 73-year-old female who was diagnosed as symptomatic severe stenosis of • left middle cerebral artery with left internal carotid artery tortuosity. Hersymptoms persisted despite the optimal medical therapy. Reconstruction of the left internal carotid artery was successfully performed by truncating the redundant segment and following end-to-end anastomosis, then intracranial steht was deployed via a new available approach. Patient's symptoms alleviated after operation and never reoccured in 12-month follow-up. Patient 2 was a 70-year-old male who had basilar artery severe stenosis with left vertebral artery. Tortuosity and contralateral one slendemess. He suffered from recurrent posterior circulation ischemia even with optimal medical therapy. During the hybrid operation, the left vertebral artery was exposed and cut open so that an available approach for endovascular procedure was created. No recurrence of symptoms in follow- up after operation with for 9 months. Relevant literature was reviewed. We concluded that for treatment of symptomatic severe intracranial artery stenosis with proximal vascular tortuosity, hybrid operation can be safe and effective.

Correlation between smoking and occurrence of intracranial artery stenosis by ultrasonography:an analysis of multi-center research results / 中国脑血管病杂志

Objective To analyze the correlation between smoking and occurrence of intracranial artery stenosis.Methods From June 2015 to May 2016,a total of 10 711 inpatients with transient ischemic attack (TIA) or ischemic stroke from 20 basel hospitals of nationwide were enrolled using a cross-sectional study,76 patients with unknown smoking and smoking cessation years were excluded.Finally,a total of 10 635 patients were enrolled.Transcranial color coded sonography and/or transcranial Doppler were used evaluate the intracranial artery stenosis lesions.The basic risk factors for cerebrovascular disease (age,sex,smoking and smoking years,whether smoking cessation and years,hypertension,diabetes,hyperlipidemia,atrial fibrillation,and family history of stroke) were recorded.According to the different smoking years,the smoking years were divided into five groups:non-smoking,smoking time ≤10-year,11 to 20-year,21 to 30-year,and >30-year groups for trend chi square test.According to the different smoking cessation years in the smokers,the smoking cessation years were divided into four groups:non-cessation,cessation time 1 to 10-year,11 to 20-year,and >20-year groups for trend chi square test.The effects of different smoking years and different smoking cessation years on the occurrence of intracranial arterial stenosis were analyzed.Results The incidence of intracranial artery stenosis in the smokers (40.4%[1 433/3 547]) was significantly higher than that in the non-smoking patients (29.4%[2 085/7 088]).There was significant difference (χ2=128.850,P<0.01),and the incidence of cerebral infarction in the smokers (91.6%[3 250/3 547]) was significantly higher than the non-smokers (85.0%[6 027/7 088]).There was significant difference (χ2=92.328,P<0.01).Smoking was an independent risk factor for intracranial artery stenosis (OR,1.603;95%CI 1.456-1.765;P<0.01).With the increase of smoking years,the detection rate of intracranial arterial stenosis increased gradually (trend χ2=115.437,P<0.01).Whether giving up smoking had no significant effect on the incidence of intracranial artery stenosis in patients with ≥20 years of smoking (trend χ2=1.043,P=0.307).Conclusions Smoking is an independent risk factor for affecting intracranial artery stenosis;the risk of disease increases with the number of smoking years.Long-term smokers (≥20 years) cannot reduce the effect on intracranial artery stenosis,even if they give up smoking.

Study on the correlation between intracranial and extracranial artery stenosis in patients with ischemic stroke / 中国综合临床

Objective To determine whether there is correlation between intracranial and extracranial arterial stenosis in patients with ischemic stroke,and to understand the difference of the main risk factors between them.Methods One hundred and sixty-eight patients with symptomatic ischemic stroke were selected in order to analyze the correlation and risk factors of intracranial arterial stenosis and extracranial arterial stenosis.Results In the 168 cases,123 patients(73.2%)were with abnormal artery(include intimal thickening)and 100 patients(59.5%)were diagnosed with artery stenosis,including 33 cases of intracranial artery stenosis,48 cases of extracranial artery stenosis and 19 cases of intracranial and extracranial stenosis.The rate of extracranial artery stenosis(39.9%)was higher than that of intracranial artery stenosis(31.0%),but there was no significant difference between them(χ2 =2.93,P=0.11).There was no definite correlation between them(χ2 =0.35,P=0.61)and there were statistically significant differences in age and arterial pressure between patients with intracranial and mean extracranial artery stenosis(t=1.98,P=0.05;t=5.42,P<0.001),but the gender,blood pressure,blood glucose and dyslipidemia rate showed no significant difference (χ2 =1.15,3.41,0.43,0.81,P>0.05).Conclusion Extracranial arterial stenosis may not predict the possibility of intracranial arterial stenosis,and extracranial arterial stenosis may be more likely to cause ischemic stroke.

Perioperative complications of stenting with symptomatic intracranial artery stenosis / 实用医学杂志

Objective To investigate the perioperative complications of stenting with symptomatic intracra-nial artery stenosis and study the mechanism and prevention of complications. Methods 63 patients were collect-ed from Stroke Center of Guangxi. They were proved intracranial artery stenosis and performed intracranial stents. Patients′ age,with hypertension,diabetes and hyperlipidemia or not,smoking or not,types and occurrence time of complications were registered. Results 63 patients were registered and 2 patients terminated operation due to blood vessels circuity or serious vessel spasm. Operation success rate reached 96.83％. 5 patients had complications among 63 cases,with complication incidence of 8.20％. 3 patients experienced cerebral hemorrhage and two cere-bral infarction in peri-operation period. 2 patients died of complications and mortality rate was 3.28％. Conclu-sions The incidence rate of complications of intracranial stenting with symptomatic intracranial artery stenosis is relatively high and it can be reduced by preoperative sufficient assessment and prudent selection ,careful operation and strict management after operation.

Study on the correlation between intracranial and extracranial artery stenosis in patients with ischemic stroke / 中国综合临床

Objective To determine whether there is correlation between intracranial and extracranial arterial stenosis in patients with ischemic stroke,and to understand the difference of the main risk factors between them.Methods One hundred and sixty-eight patients with symptomatic ischemic stroke were selected in order to analyze the correlation and risk factors of intracranial arterial stenosis and extracranial arterial stenosis.Results In the 168 cases,123 patients(73.2%)were with abnormal artery(include intimal thickening)and 100 patients(59.5%)were diagnosed with artery stenosis,including 33 cases of intracranial artery stenosis,48 cases of extracranial artery stenosis and 19 cases of intracranial and extracranial stenosis.The rate of extracranial artery stenosis(39.9%)was higher than that of intracranial artery stenosis(31.0%),but there was no significant difference between them(χ2 =2.93,P=0.11).There was no definite correlation between them(χ2 =0.35,P=0.61)and there were statistically significant differences in age and arterial pressure between patients with intracranial and mean extracranial artery stenosis(t=1.98,P=0.05;t=5.42,P<0.001),but the gender,blood pressure,blood glucose and dyslipidemia rate showed no significant difference (χ2 =1.15,3.41,0.43,0.81,P>0.05).Conclusion Extracranial arterial stenosis may not predict the possibility of intracranial arterial stenosis,and extracranial arterial stenosis may be more likely to cause ischemic stroke.

Perioperative complications of stenting with symptomatic intracranial artery stenosis / 实用医学杂志

Objective To investigate the perioperative complications of stenting with symptomatic intracra-nial artery stenosis and study the mechanism and prevention of complications. Methods 63 patients were collect-ed from Stroke Center of Guangxi. They were proved intracranial artery stenosis and performed intracranial stents. Patients′ age,with hypertension,diabetes and hyperlipidemia or not,smoking or not,types and occurrence time of complications were registered. Results 63 patients were registered and 2 patients terminated operation due to blood vessels circuity or serious vessel spasm. Operation success rate reached 96.83％. 5 patients had complications among 63 cases,with complication incidence of 8.20％. 3 patients experienced cerebral hemorrhage and two cere-bral infarction in peri-operation period. 2 patients died of complications and mortality rate was 3.28％. Conclu-sions The incidence rate of complications of intracranial stenting with symptomatic intracranial artery stenosis is relatively high and it can be reduced by preoperative sufficient assessment and prudent selection ,careful operation and strict management after operation.

The clinical value of TCD on the measurement of cerebral arterio-venous pulse wave time / 实用医学杂志

Objective To evaluate the clinical value of transcranial Doppler (TCD) on the measurement of cerebral arterio-venous pulse wave time (CAV-PWT). Methods 86 patients with ischemic cerebrovascular disease (ICD) were received by TCD and digital subtraction angiography (DSA). The relationship of CAV-PWT and the stenosis degree of intracerebral arteries (IA) was evaluated by linear correlation analysis. Follow-up was made for half year, and the cases of cerebral stroke were recorded. The risk of CAV-PWT and cerebral stroke was evaluated by multivariate Logistic regression analysis. Results There were no difference on the stenosis rate of intracervical artery system and vertebrobasilar artery system by DSA or TCD, which were 52.33% vs 47.86%(P = 0.056) and 61.63% vs 56.98%(P = 0.059). The positive relationship of CAV-PWT and mean arterial pressure to the stenosis degree of IA was confirmed by linear correlation analysis (r = 0.832,P = 0.025 and r =0.625,P = 0.040). The CAV-PWT was the independent risk factor in the occurrence of cerebral stroke by multivariate Logistic regression analysis (OR = 1.527). Conclusion The CAV-PWT detected by TCD can evaluate the stenosis degree of IA and also has perfect clinical value to patients′ prognosis.

Analysis of the risk factors between anterior and posterior intracranial artery stenosis in acute stroke patients / 中国综合临床

Objective To investigate the association between vascular risk factors and the location of intracranial artery stenosis (anterior versus posterior).Methods Magnetic resonance angiography(MRA) were examined in 374 acute stroke patients.It was divided into two groups (anterior and posterior intracranial artery stenosis group).Analyzed possible risk factors.Results Univariate analysis showed there were differences between anterior and posterior intracranial artery stenosis in systolic blood pressure,history of smoking,drinking and stroke status,and national institutes of health stroke scale (NIHSS) score at discharge,short-term prognosis,serum creatinine,triglyceride,low density lipoprotein cholesterol (LDL-C) (P ＜ 0.05).In multivariate logistic regression analysis,high blood sugar (OR =1.135,95％ CI:1.003-1.284),history of stroke(OR =1.133,95％ CI:1.007-1.276),good short-term prognosis (OR =5.987,95％ CI:1.441-24.873) were preferentially related to anterior intracranial artery stenosis,whereas history of smoking (OR =0.003,95 ％ CI:0.000-0.376),high serum creatinine values (OR =0.509,95 ％ CI:0.328-0.790),high triglyceride values (OR =0.054,95％ CI:0.004-0.645) and high LDL-C values (OR =0.096,95％ CI:0.015-0.608) were preferentially related to posterior intracranial artery stenosis.Conclusion Vascular risk factors appeared to exert different effects of risk for anterior and posterior intracranial artery stenosis.

Effect of Gateway-Wingspan system for treatment of intracranial arterial stenosis: A follow-up observation / 中国脑血管病杂志

Objective: To evaluate the safety and efficacy of Gateway-Wingspan system for treatment of symptomatic intracranial arterial stenosis. Methods: The clinical data of 31 patients with symptomatic intracranial arterial stenosis in the Department of Neurosurgery, Peking University First Hospital were analyzed retrospectively from June 2008 to June 2011. The stenotie rate was all >50%. According to Mori's classification, 7 patients were type A and 24 were type B. The patients were treated by using Gateway-Wingspan system and were followed up and evaluated. The perioperative and postoperative complications were observed. Results: Circled digit oneOf the 31 patients, the average stenosis rate in Mori type A patients before procedure was 72.2 ± 4.5% and after Wingspan stenting was 21.6 ± 2.1%. In Mori type B patients, the average preoperative stenosis rate was 75.1 ± 7.0% and after stenting was 24.2 ± 3.8%, the success rate of Wingspan stenting was 96.8%. One patient had perioperative complications; he had unilateral limb weakness and lethargy. Head CT and MRI did not reveal significant infarction and hematoma. Circled digit twoOf the 31 patients, 2 were lost follow-up observation, and the remaining patients were followed up for 5 to 41 months. None of them had cerebral infarction on the stent side within 1 month after procedure. Of the 16 patients whom followed-up with DSA, no restenosis (0/5) was found in the Mori type A patients after procedure. In the 11 Mori type B patients, 4 had restenosis (4/11, P = 0.245) and 2 of them occurred ischemic events after stenting but no mortality. Conclusion: Gateway-Wingspan system in the treatment of symptomatic intracranial stenosis is safe and efficient through rigorous screening of patients. Its long-term efficacy and how to prevent the postoperative restenosis warrant further investigation.

Ischemic Stroke in Takayasu's Arteritis: Lesion Patterns and Possible Mechanisms

BACKGROUND AND PURPOSE: The purpose of the present study was to use brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to identify the mechanism of stroke in patients with Takayasu's arteritis (TA). METHODS: Among a retrospective cohort of 190 TA patients, 21 (3 males and 18 females) with a mean age of 39.9 years (range 15-68 years) who had acute cerebral infarctions were included in lesion pattern analyses. The patients' characteristics were reviewed, and infarction patterns and the degree of cerebral artery stenosis were evaluated. Ischemic lesions were categorized into five subgroups: cortical border-zone, internal border-zone, large lobar, large deep, and small subcortical infarctions. RESULTS: In total, 21 ischemic stroke events with relevant ischemic lesions on MRI were observed. The frequencies of the lesion types were as follows: large lobar (n=7, 33.3%), cortical border zone (n=6, 28.6%), internal border zone (n=1, 4.8%), small cortical (n=0, 0%), and large deep (n=7, 33.3%). MRA revealed that 11 patients had intracranial artery stenosis. CONCLUSIONS: Hemodynamic compromise in large-artery stenosis and thromboembolic mechanisms play significant roles in ischemic stroke associated with TA.

Prevalence of asymptomatic intracranial artery stenosis in middle-aged and elderly population in the community of Foshan city, Guangdong province: a cross-sectional study / 中华流行病学杂志

Objective To investigate the prevalence and risk factors of asymptomatic intracranial artery stenosis in middle-aged and elderly population in the community of Foshan city,Guangdong province. Methods Subjects from residential communities were chosen through Cluster sampling method. Physical data and history were collected. Serum fasting glucose, total cholesterol and triglycerides concentrations were tested with venous blood samples. Intracranial artery stenosis was diagnosed by transcranial Doppler(TCD). Data was analyzed by the software SPSS 18.0.Results 1405 subjects met the inclusive criteria, among which 163(11.6%)were found one(7.4%)or more(4.2%)stenotic arteries, and the standardized rate was 10.3%. 9.89% of the SICA, and 3.05%, 2.29%, 1.59%, 1.38%, 0.89% of basilar artery, middle cerebral artery, anterior lerebral artery,vertebral artery, posterior cerebral artery were found stenotic respectively. Data from the age-stratified analysis showed that the prevalence in these above 70(27.8%)was significantly higher than that under age 70(7.5%)(P=0.000). Single factor and logistic regression analysis demonstrated the history of diabetes mellitus and elevated systolic pressure present were significantly different between stenofic group and the non-stenotic group(P=0.000, P=0.000), which were the independent risk factors of asymptomatic stenosis of intracranial arteries(OR= 2.362,95%CI:1.194-4.674; OR= 1.024,95%CI:1.016-1.031). Conclusion Comparatively high prevalence of asymptomatic intracranial artery stenosis in middle-aged and aged community population was found in the Southern part of China,especially among the age group above 70. History of diabetes and elevated systolic pressure seemed to be the independent risk factors of asymptomatic stenosis of intracranial arteries.

Relationship between Ankler-brachial Index and Extent of Intracranial Artery Stenosis / 中国康复理论与实践

@# ObjectiveTo evaluate the significance of ankler-brachial index (ABI) to predict the extent of intracranial artery stenosis in ischemic stroke patients. Methods243 ischemic stroke patients were enrolled, brain angiography were examined and all of the ABI and basic data were collected. ResultsABI≤0.9 was associated with a specificity of 84.6% and a sensitivity of 16.8% for predicting the presence of severe stenosis in intracranial artery. The area under receiver operating characteristic curve was (0.591±0.046) (P<0.05). ConclusionABI≤0.9 has a relative specificity and sensitivity for predicting the presence of severe stenosis of intracranial artery.

Early cerebral ischemic lesions ly after stenting for symptomatic intracranial artery stenosis: a clinical study / 介入放射学杂志

Objective To analyze the clinical manifestations of early cerebral ischemic lesions after stenting with WingSpan system for symptomatic intracranial artery stenosis, and to evaluate the early effects and safety of the stenting therapy. Methods Twenty-nine consecutive patients with symptomatic intracranial stenosis underwent diffusion weighted imaging (DWI) before and after stenting (within 72 hours). The clinical data, including patients' general condition, stenting procedures and newly-developed cerebral ischemic lesions, were recorded. Neurological defect was estimated with NIHSS, the safety and early outcome of stenting were evaluated. Results The degree of stenosis was reduced from a mean baseline of (72.3 ± 10.7)% to (31.9 ± 13.6)% immediately after stenting. The technical success rate was 100%. The total eomplicatiom nate was 17.2%. And among them, z were symptomatic (6.9%). Sixty-three ischemic lesions were demonstrated on DWI in 13 patients (44.8%). Among them, 11 (84.6%) were asymptomatic. Fifty-five newly-developed lesions on DWI (87.3%) were located in the region of stented vessels and 3.2% were situated in the region of branch vessels of stented artery. Conclusion DWI is of great value in assessing the safety of intracranial stenting procedures. The treatment of symptomatic intracranial artery stenosis by using WingSpan system is safe and effective. Newly-developed ischemic lesions can be well detected on DWI and should receive physician's attention, although most ischemic lesions are asymptomatic. Long-term outcome of this treatment needs to be further observed.