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.

Current perspectives and future directions of the treatment for non acute intracranial artery occlusion / 中国综合临床

Non-acute intracranial artery total occlusion can lead to severe neurological defect and high recurrence rate of stroke.At present, there is no effective treatment recommended by the guidelines.Traditional treatment methods include medical therapy, extracranial-intracranial bypass surgery and minimally invasive endovascular recanalization therapy.In recent years, with the development of microsurgical vascular anastomosis technique and neurosurgical intervention, and the development of interventional materials, the treatment of non-acute intracranial artery total occlusion has become a hot spots.In this paper, the concept of non on-acute intracranial artery total occlusion, medical therapy, extracranial-intracranial bypass surgery and endovascular interventional therapy are reviewed.

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.

High-Resolution Magnetic Resonance Imaging Using Compressed Sensing for Intracranial and Extracranial Arteries: Comparison with Conventional Parallel Imaging

OBJECTIVE: To compare conventional sensitivity encoding (SENSE) to compressed sensing plus SENSE (CS) for high-resolution magnetic resonance imaging (HR-MRI) of intracranial and extracranial arteries. MATERIALS AND METHODS: HR-MRI was performed in 14 healthy volunteers. Three-dimensional T1-weighted imaging (T1WI) and proton density-weighted imaging (PD) were acquired using CS or SENSE under the same total acceleration factors (AF(t))-5.5, 6.8, and 9.7 for T1WI and 3.2, 4.0, and 5.8 for PD-to achieve reduced scanning times in comparison with the original imaging sequence (SENSE T1WI, AF(t) 3.5; SENSE PD, AF(t) 2.0) using the 3-tesla system. Two neuroradiologists measured signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and used visual scoring systems to assess image quality. Acceptable imaging was defined as a visual score ≥ 2. Repeated measures analysis of variance and Cochran's Q test were performed. RESULTS: CS yielded better image quality and vessel delineation than SENSE in T1WI with AF(t) of 5.5, 6.8, and 9.7, and in PD with AF(t) of 5.8 (p 0.05). SNR and CNR in CS were higher than they were in SENSE, but lower than they were in the original images (p < 0.05). CS yielded higher proportions of acceptable imaging than SENSE (CS T1WI with AF(t) of 6.8 and PD with AF(t) of 5.8; p < 0.0167). CONCLUSION: CS is superior to SENSE, and may be a reliable acceleration method for vessel HR-MRI using AF(t) of 5.5 for T1WI, and 3.2 and 4.0 for PD.

Fatigue Strength for Intracranial Artery Stents / 医用生物力学

Objective To analyze the relationship between fatigue strength and connector length of intracranial artery stents, so as to investigate the exact location of fatigue fracture for the stent. Methods The fatigue life for 3 kinds of artery stents were analyzed by finite element analysis method of fatigue fracture, and distribution map of dangerous points was drawn by means of Goodman curve. Based on F2477-07 standard from American Society for Testing and Materials (ASTM), the fatigue life for 3 kinds of stents was tested. Results If the length of the support connector was longer, the maximum equivalent stress and the average stress in dangerous points of the stent would be larger. If the distribution of dangerous points was more close to the curve of fatigue limit, and fatigue fracture was more likely to occur in the stent. Goodman curves indicated that 3 kinds of stents was safe to be used in the body for ten years. Finite element analysis and experimental result showed that fatigue life near the stent junction was relatively lower, and dangerous points of the stent was located at the arc junction. Conclusions It is reasonable to study stents by finite element analysis, whose results are basically coincided with the experimental data. Fatigue life can be extended by reducing connector’s length for the design of stent structure.

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.

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.

Comparison of impacts on efficiency and safety between two types of microwires during mechanical thrombectomy for stroke / 上海交通大学学报（医学版）

Objective· To compare the impacts on clinical efficiency and safety between 0.014 inch Synchro microwire and Transend microwire used during mechanical thrombectomy for acute ischemic stroke (AIS) caused by large artery occlusion.Methods· Forty-six patients undergoing mechanical thrombectomy with stent retrievers between October 2012 and January 2016 were included,who were classified into Synchro group (21cases) and Transend group (25 cases).The clinical outcome,procedure time,and safety were analyzed and compared between two groups.Results· The recanalization rates were similar between two groups (P=0.600),but time from puncture to vascular recanalization of Synchro group was much shorter than that of Transend goup (48.88 min vs 82.33 min,P=0.001).The rates of functional independence (modified Rankin scale score ≤ 2) were similar between two groups (P=1.000).There was no significant difference of the rates of post-procedure subarachnoid hemorrhage (PSAH) between two groups (P=1.000).However,there were two cases that had fatal subarachnoid hemorrhage with intracranial hematoma in Transend group,while there was only one case of mild subarachnoid hemorrhage who recovered well in Synchro group.Conclusion· Compared with Transend microwire,Synchro microwire can significantly shorten the procedure time of mechanical thrombectomy,and the risk of fatal subarachnoid hemorrhage is rather small.

Application value of high-resolution magnetic resonance imaging in the etiological diagnosis of head and neck artery occlusion / 中国脑血管病杂志

Objective To discuss the value of high-resolution magnetic resonance imaging (HR-MRI) in the etiological diagnosis of patients with head and neck artery occlusion.Methods From December 2015 to February 2017,25 consecutive patients with acute head and neck artery occlusion in Xuanwu Hospital,Capital Medical University were enrolled prospectively.The 32-channel head-neck combined coils were used to conduct head-neck integrated HR-MRI.The characteristics of proximal vascular wall of the occluded vascular segments and the signal features of thrombi in the middle and distal segments of occlusion were analyzed.The evaluation of the occlusive etiology was performed by two neurologists according to the clinical history,laboratory examinations,and imaging examinations of the patients,and the accuracy of conventional lumen imaging and conventional lumen imaging combined with HR-MRI in etiological classification were compared.Results Twenty-five patients with acute head and neck artery occlusion completed HR-MRI examinations.A total of 31 segments of the occluded vessels were diagnosed,and 21 of these were diagnosed with the conventional luminal imaging,30 were diagnosed with the conventional luminal imaging+HR-MRI,including 24 segments of atherosclerotic occlusion (n=19),4 segments of arterial dissecting occlusion (n=4),and 3 segments of arteritis occlusion (n=2).(2) In patients with atherosclerotic occlusion,the eccentric thickening was observed in the proximal wall of occlusive segment;the typical double-lumen or crescent-shaped hyperintense hematoma were observed in occlusive arterial dissection;long-segment annular thickening and enhancement were observed in the segment of arteritis occlusion.(3) The accuracy of the cause classification diagnosis of conventional luminal imaging and conventional luminal imaging+HR-MRI were 67.7% (21/31) and 96.8% (30/31) respectively (P<0.01).Conclusions Compared with the luminal imaging,the head and neck combined HR-MRI can reveal the arterial wall characteristics of the initial segment of occlusion.It has certain advantages in the interpretation of the causes,such as atherosclerosis,arterial dissection and arteritis.

Analysis of feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery / 中国脑血管病杂志

Objective To investigate the feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery.Methods From January 2009 to January 2017,the clinical and imaging data of 15 patients with chronic occlusion of large intracranial artery admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University for endovascular recanalization were analyzed retrospectively.Twelve patients were V4 segment occlusion of vertebral artery and 3 were internal carotid artery occlusion.Preoperative whole brain digital subtraction angiography (DSA) was used to assess the occlusion length and location.High-resolution magnetic resonance imaging (MRI) was used to evaluate the nature of occlusion and the feasibility of recanalization.The intraoperative bilateral femoral artery sheath placement was conducted in 13 cases,one side was used for recanalization and stenting,and the other side was compensated by filling the distal occlusion of the artery through collateral circulation as the reference path map,and increased the feasibility of recanalization.According to the thrombolysis in cerebral infarction (TICI) grades after procedure,the forward flow after recanalization was systematically evaluated,and grade ≥2b was defined as the success of recanalization.Results The median time between the first onset of symptoms and recanalization was 50 (range,18-365) days.The occluded recanalization sites included intracranial segment of vertebral artery in 12 cases and intracranial segment of internal carotid artery in 3 cases.Recanalization was successful in 13 cases and recanalization failure of the intracranial segment of vertebral artery was in 2 cases.Recanalization was successful in 13 cases,and intracranial vertebral artery recanalization failed in 2 cases.Of the 13 patients of successful recanalization,the forward flow of angiography returned to grade TICI 3 in 12 cases after recanalization,and returned to TICI 2b in 1 case;the symptoms of 7 cases were improved,the symptoms of 4 cases did not have any change,and the symptoms of 2 patients aggravated after procedure and developed transient ischemic attack or stroke.After 11 patients were followed up for a median of 39 (3-89) months,the median mRS score was 1 (0-2).Conclusion For recanalization of chronic large intracranial artery occlusion,using preoperative high-resolution magnetic resonance imaging evaluation and intraoperative bilateral sheath placement technique may increase the patency rate and reduce the perioperative complications.

Enfermedad de moyamoya: a propósito de un caso / Moyamoya disease: a case report

Resumen La enfermedad de moyamoya (EMM) es una patología crónica caracterizada por la oclusión progresiva de la vasculatura cerebral y no aterosclerótica, generando un patrón angiográfico conocido como moyamoya, que en japonés hace alusión a la apariencia en "bocanada de humo", trae como consecuencia eventos cerebrovasculares isquémicos o hemorrágicos. Tiene dos picos de presentación, uno entre los 5 y 9 años y otro entre los 45 y 49 años, con un ligero predominio en mujeres, suele ser más frecuente en individuos de origen asiático, y menos en personas de origen hispano. El tratamiento de elección es el procedimiento quirúrgico precoz y su pronóstico no es totalmente predecible. Reporte de caso: mujer de 44 años que ingresó por presentar movimiento tónico-clónicos y requirió IOT, con tomografía axial computarizada cerebral simple que mostró hematoma intraparenquimatoso izquierdo y arteriografía con patrón moyamoya. Se manejó en la unidad de Cuidados Intensivos, donde finalmente falleció.

Summary Moyamoya disease (EMM) is a chronic disease characterized by progressive occlusion of the cerebral vasculature and nonatherosclerotic, generating an angiographic pattern known as moyamoya, which in Japanese refers to the appearance "puff of smoke", results in cerebrovascular ischemic or hemorrhagic events. Presentation has two peaks, one between 5 and 9 years and another between 45 and 49 years, with a slight predominance in women over men, usually more common in individuals of Asian origin, and less in people of Hispanic origin. The treatment of choice is early surgical procedure and prognosis is not entirely predictable. Case report: 44-year-old woman presenting income tonic-clonic movement and required IOT, single computed tomography showed left cerebral intracerebral hematoma and arteriography with Moyamoya pattern. It was handled in Intensive Care Unit, where he eventually died.

Application of rotational DSA dual volume technology in the displaying of intracranial artery stent and its effective analysis / 实用放射学杂志

Objective To investigate the implementation and application of rotational DSA dual volume technology in displaying the intracranial artery stent.Methods Firstly,the “stent opacity”single volume technology was used to display 5 types of stent which were released in 7 cases of pure intracranial artery stenting and 12 cases of stent-assisted aneurysm embolization.Then we applied “vessel translucent”and “vessel opacity”single volume technology to display corresponding vessel segments.Finally,by coalescing the single volume imaging of stent and vessel,the “vessel opacity + stent opacity”dual volume image and “vessel translucent+ stent opacity”dual volume image were performed.We compared the effects of two kinds of dual volume imaging and assessed the imaging characteristics and influencing factors of each method.Results (1)On the “stent opacity”single volume display mode,in 7 cases of pure intracranial artery stenting,the display effect of two Pipeline stents and three Apollo stents belongs to level 1,the display effect of two Enterprise stents belongs to level 2;In 12 cases of stent-assisted aneurysm embolization,in the stent segments which weren’t influenced by artifacts,the display effect of two LEVIS stents belongs to level 1,the display effects of 5 Enterprise stents and 2 Solitaire AB stents belongs to level 2;While in the stent segments which were influenced by the artifact of spring coil and bone,the display effect significantly reduced, three pieces of Enterprise stents were even unable to identify.(2)On the “vessel opacity”single volume display mode,1 9 cases of vessel segment at the stent completed opacity display.The surface structure of vessel was very clear,but the structure under the surface was completely being covered.On the “vessel translucent”single volume display mode,the surface structure of 19 cases of vessel segment at the stent displayed clear at the tangential position.The vessel lumen also presented transparent state.(3)On the “stent opacity+vessels opacity”double volume display mode,the start-stop location and the adherence of stents in blood vessels in 1 6 cases were displayed clearly. When using the “stent opacity+ vascular opacity”double volume imaging,except 3 cases which used ball expansion Apollo stents could display comprehensive relationship between the blood vessels,in the other 13 cases,the relationship between stent and vascular could not be fully displayed.Conclusion On the condition that the single volume display technology shows stent well,the “stent opaque+vessels translucent”double volume display technology can well present the stent condition in the vessels.

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.

Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries / 대한뇌졸중학회지

Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography).

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.