Estimation of critical closing pressure using intravascular blood pressure of the common carotid artery.

PURPOSE: Radial artery, femoral artery, and aortic arterial blood pressures (ABPs) can be used to estimate cerebral critical closing pressure (CrCP) and resistance-area product (RAP). However, the use of the common carotid artery (CCA) intravascular blood pressure to estimate CrCP is unclear. Thus, using continuous ABP monitoring, we compared the CrCP and RAP estimated from CCA measurements with the corresponding values acquired from the radial artery. METHODS: In this retrospective cross-sectional study, we analyzed CrCP and RAP estimations from 21 patients with normal cerebral blood vessels between July 23, 2010, and February 9, 2011, using linear regression of the cerebral blood flow velocity-ABP relationship. RESULTS: Bland-Altman analysis showed that the average differences (95% limits of agreement) between the radial artery and the left CCA were -6.3 (-53.1 - 40.6) mmHg and -0.08 (-0.41 - 0.25) mmHg s cm-1 for CrCP and RAP, respectively. CONCLUSIONS: The CrCP and RAP estimated from the CCA measurements are consistent with the corresponding values obtained from the radial artery.

Association Between Carotid-Cerebral Pulse Wave Velocity and Acute Ischemic Stroke: Clinical Trial Protocol.

BACKGROUND: Pulse wave velocity is commonly regarded as the most effective and noninvasive indicator for evaluating arterial stiffness, while increased arterial stiffness is known to be related to atherosclerosis, which has been proved to play a significant role on the onset of acute ischemic stroke. However, it is still only used in the assessment of central and peripheral arteries. Our previous studies have found that carotid-cerebral pulse wave velocity measured using transcranial Doppler may be a promising method for the assessment of human cerebral arterial stiffness. This trial was designed to examine the association between carotid-cerebral pulse wave velocity and acute ischemic stroke. METHODS: In a single-center, single-arm, prospective clinical trial, patients with acute ischemic stroke who had anterior circulation infarcts confirmed by magnetic resonance imaging are eligible to receive measurement of carotid-cerebral pulse wave velocity, which is measured in the supine position with transcranial Doppler that using 2-MHz and 4-MHz ultrasound probes by 2 experienced operators. Subjects will be received follow-up for 1 year. Vascular and nonvascular death at follow-up will be assessed as primary outcomes. Secondary outcomes include intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack, recurrence or aggravation of ischemic stroke. CONCLUSION: This trial will be the first to evaluate carotid-cerebral pulse wave velocity in patients with acute ischemic stroke using transcranial Doppler. The results may provide more valuable theoretical basis for the prevention, treatment, and prognosis of acute ischemic stroke.

Association between Cerebral Arterial Stiffness and Large Artery Atherosclerosis in Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Carotid-cerebral pulse wave velocity (ccPWV) reflects the segment (C-M segment) stiffness between common carotid artery and ipsilateral middle cerebral artery. The C-M segment atherosclerosis (CMSA) is regarded as a most frequent cause of anterior circulation ischemic stroke. We therefore, attempted to investigate the relationship between cerebral arterial stiffness and CMSA, and provide reliable data for the early diagnosis of CMSA. METHODS: Between June 2012 and August 2016, 81 acute ischemic stroke (AIS) patients with 154 C-M segments successfully evaluated with digital subtraction angiography and ccPWV were enrolled into this study. Patient demographics and clinical data were retrieved from our AIS databases. RESULTS: Multivariate analyses showed that ccPWV was independently associated with CMSA (ß = 39.6, P = .009) and Systolic blood pressure (ß = 7.1, P < .001) in AIS patients. The values of ccPWV had a trend to be higher in the groups with more lesions (F = 45.9, P < .01) and severer stenosis (F = 102.6, P = .000), and was positively correlated with the number of lesions (r = .662, P = .000), and degree of stenosis (r = .858, P = .000) of CMSA. The fractional polynomial plots with 95% CIs also describe the close relationship between ccPWV and the number of lesions and degree of stenosis in CMSA. CONCLUSIONS: Cerebral arterial stiffness is independently associated with the presence of CMSA, closely related to the vascular damage of C-M segment and reflects the vascular structure change of C-M segment in AIS patients. It may have the potential for assessment of CMSA in its initial stage.

Metabolic syndrome and stroke: A meta-analysis of prospective cohort studies.

BACKGROUND AND AIM: The relationships between metabolic syndrome (MetS) and risk of incident stroke are inconsistent. We summarized the evidence by a meta-analysis of prospective cohort studies. METHODS AND RESULTS: We searched the PubMed, EMBASE, and Google Scholar databases from their inception until June 2016 for prospective cohort studies investigating this research question, relevant information was extracted by two independent investigators, and then aggregated using the fixed-effects models. We identified 16 studies, including 116,496 participants who were initially free of cardiovascular diseases. Comparing the persons without MetS, those with MetS have a significantly higher risk of incident stroke, and the pooled relative risk (RR) was 1.70 (95% confidence interval (CI): 1.49-1.95). Subgroup analyses suggested that women were more sensitive to this effect (with an RR of 1.83, 95% CI: 1.31-2.56) than men (RR=1.47 (95% CI: 1.22-1.78). And those with MetS have a significantly higher risk of ischemic stroke (RR=2.12, 95% CI: 1.46-3.08) than hemorrhagic stroke (RR=1.48, 95% CI: 0.98-2.24). CONCLUSIONS: This meta-analysis suggests that metabolic syndrome might be an important risk factor of stroke, particularly among women and those with ischemic stroke.