Carotid stenting in acute ischemic stroke patients with intraluminal thrombus

Introduction  

Carotid stenosis with intraluminal thrombus is associated with a high risk of early recurrent stroke. We evaluated the feasibility and outcome of carotid stenting in acute ischemic stroke patients with carotid stenosis and intraluminal thrombus.     

Carotid artery calcification on CT may independently predict stroke risk

OBJECTIVE: The purpose of our study was to quantitatively evaluate calcified atherosclerotic burden in the cervical carotid arteries using MDCT to determine the relationship of scores with luminal stenosis and symptomatology. MATERIALS AND METHODS: Calcium plaque volume was measured in 106 cervical carotid arteries (53 patients) using MDCT angiography. The study group included 32 asymptomatic patients (mean age, 70.2 +/- 8.7 [SD] years; 15 women, 17 men) and 21 patients with ischemic neurologic symptoms (69.6 +/- 12.9 years; eight women, 13 men). By vessel, there were 43 high-grade stenotic (> or = 60% by North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria), 15 moderate-grade stenotic (30-59%), and 44 mild-grade stenotic or normal (0-29%) vessels, with four excluded for prior carotid endarterectomy. Volume scores were calculated by summing the area of calcium in the common and extracranial internal carotid arteries on axial slices and multiplying by the slice increment. RESULTS: Controlling for cardiovascular risk factors and luminal stenosis, we found that scores were significantly related to the occurrence of symptoms (p = 0.003). Even with patient age as a covariant, patients with high-grade stenosis had significantly higher scores than those without high-grade disease (p = 0.004). Moreover, quantitative burden was associated with luminal stenosis on adjusted multivariate analysis (p = 0.034). The specificity and positive predictive value for high-grade luminal narrowing were notably lower on individual vessel analysis than on total score analysis, likely secondary to variability in vascular remodeling. CONCLUSION: Calcium scores in the cervical carotid arteries may represent an independent marker for luminal stenosis and ischemic symptoms. A prospective longitudinal study examining calcium levels and morbidity may be warranted to examine whether burden has a role in risk stratification.     

Carotid web and ischemic stroke: a CT angiography study

ObjectivesWe sought to explore the prevalence, demographics, clinical and imaging features of the Carotid web (CaW) on CT angiography (CTA) in patients with cryptogenic and non-cryptogenic stroke through a large-scale retrospective study.Materials and methodsA total of 1662 patients with ischemic stroke and had a neck CTA were retrospectively reviewed. An extensive clinical workup was performed to identify patients with cryptogenic stroke. All neck CTA studies were reconstructed and independently evaluated by two experienced radiologists for presence or absence of CaW on the ipsilateral and contralateral to the stroke side.ResultsThirty-three cases of CaW were eventually diagnosed in patients with ischemic stroke, with a prevalence of 2.2% (33/1489) in a hospital-based series. Twenty-six (26/33, 78.8%) cases of CaW were ipsilateral to the stroke side. There are 18 ipsilateral CaWs (18/285, 6.3%) in cryptogenic stroke patients, and eight ipsilateral CaWs (8/1204, 0.7%) in non-cryptogenic stroke, yielding an odds ratio of 10.1. Cryptogenic stroke patients with ipsilateral CaW were relatively young with a higher prevalence of women. The interrater and intrarater agreement on the CTA based diagnosis of CaW were substantial.ConclusionsOur results demonstrate a strong correlation between the CaW and cryptogenic stroke in large Asian study population. CTA is the imaging modality of choice for detecting CaW.     

症状性缺血性脑卒中颈动脉斑块成分的 高分辨MRI分析

目的应用高分辨MRI(HRMRI)探讨颈动脉斑块不同成分在症状性缺血性脑卒中病人中的危险性。方法选取2016年1月—2017年6月于我院行超声检查发现存在颈动脉斑块的病人50例,其中女21例,男29例,年龄43~77岁,平均(61.62±7.96)岁。依据病人近3个月来是否发生过与患侧颈动脉相关的缺血性脑卒中临床症状分为有症状组(22例,存在斑块血管40支)及无症状组(28例,50支),所有病人行3.0 T HRMRI以评估颈动脉血管及斑块内成分。采用χ~2检验或t检验对2组病人的临床资料、斑块成分及血管管腔狭窄程度进行比较,采用logistic回归分析缺血性脑卒中病人症状的独立危险因素。结果检出存在斑块纤维帽破溃(FCR)的血管,症状组15支,检出率为37.5%,无症状组8支,检出率为16.0%,症状组FCR的检出率高于无症状组(P0.05)。检出斑块内出血(IPH)的血管,症状组21支,检出率为52.5%,无症状组15支,检出率为30.0%,症状组IPH的检出率高于无症状组(P0.05)。检出存在斑块钙化(CA)的血管,症状组15支,检出率为37.5%,无症状组13支,检出率为26.0%,2组间检出率差异无统计学意义(P0.05)。症状组管腔狭窄程度为57.64%±13.36%,无症状组为53.86%±11.19%,2组间管腔狭窄程度差异无统计学意义(t=1.460,P=0.148)。FCR在症状性缺血性脑卒中危险性最高(OR=3.012),IPH危险性次之(OR=2.478)。结论 HRMRI可以分析斑块内成分,而这些成分是缺血性脑卒中临床症状发生的危险因素,是斑块易损性的表现。     

青年脑梗死危险因素和临床特点分析

目的分析青年脑梗死危险因素和临床特点。方法将我院收治的63例青年脑梗死和同时期324例老年脑梗死患者临床资料进行对比,并作统计学分析。结果青年组男性性别构成明显高于中老年组（P〈0.05）;青年组吸烟、饮酒、高血压发病率高于中老年组（均为P〈0.05）;青年组较中老年组糖尿病、肥胖、血脂异常差异无统计学意义。结论男性、高血压、吸烟、饮酒是青年脑梗死的主要危险因素,因此,对青年人开展健康宣传教育,进行早期干预,能有效减少脑梗死的发生。     

Metastatic choriocarcinoma: a rare cause of stroke in the young adult

A 20-year old woman presented with acute right hemiplegia 10 weeks after intrauterine fetal death at 34-weeks gestation (G1P0). A brain MRI showed a typical acute infarct in the left middle cerebral artery territory. A CT pulmonary angiography carried out 1 week later for sudden cardiopulmonary deterioration showed disseminated pulmonary metastases. The CT was extended to the abdomen and pelvis, which showed a uterine mass with bilateral theca lutein cysts. The radiological diagnosis of metastatic choriocarcinoma was made and was subsequently confirmed with the markedly increased serum beta-human chorionic gonadotrophin. A serum beta-human chorionic gonadotrophin is therefore considered worthwhile in any young female adult who presents with stroke.     

The gait profile score characterises walking performance impairments in young stroke survivors

BackgroundThe Gait Profile Score (GPS) provides a composite measure of the quality of joint movement during walking, but the relationship between this measure and metabolic cost, temporal (e.g. walking speed) and spatial (e.g. stride length) parameters in stroke survivors has not been reported.Research Question: The aims of this study were to compare the GPS (paretic, non-paretic, and overall score) of young stroke survivors to the healthy able-bodied control and determine the relationship between the GPS and metabolic cost, temporal (walking speed, stance time asymmetry) and spatial (stride length, stride width, step length asymmetry) parameters in young stroke survivors to understand whether the quality of walking affects walking performance in stroke survivors.MethodsThirty-nine young stroke survivors aged between 18 and 65years and 15 healthy age-matched able-bodied controls were recruited from six hospital sites in Wales, UK. Joint range of motion at the pelvis, hip, knee and ankle, and temporal and spatial parameters were measured during walking on level ground at self-selected speed with calculation of the Gait Variable Score and then the GPS.ResultsGPS for the paretic leg (9.40° (8.60–10.21) p < 0.001), non-paretic leg (11.42° (10.20–12.63) p < 0.001) and overall score (11.18° (10.26–12.09) p < 0.001)) for stroke survivors were significantly higher than the control (4.25° (3.40–5.10), 5.92° (5.11 (6.73)). All parameters with the exception of step length symmetry ratio correlated moderate to highly with the GPS for the paretic, non-paretic, and/or overall score (ρ = <−0.732 (p < 0.001)).SignificanceThe quality of joint movement during walking measured via the GPS is directly related to the speed and efficiency of walking, temporal (stance time symmetry) and spatial (stride length, stride width) parameters in young stroke survivors.     

青年卒中患者心理健康状况及其影响因素研究

目的调查青年卒中患者心理健康状况及其影响因素,为制定预防保健措施提供科学依据。方法采用随机抽样的方法,利用一般资料表、症状自评量表、社会支持量表以及家庭功能量表对120例青年卒中患者进行问卷调查。结果青年卒中患者心理异常阳性检出率为49.17%（59例）;与1986年、2006年全国常模比较,青年卒中患者症状自评量表总分及各因子得分均较高（P＜0.05）;多元逐步回归分析显示,文化程度、家庭功能、社会支持3个变量是青年卒中患者心理健康主要影响因素。结论青年卒中患者心理健康状况较差,医护人员应当及时采取有效干预措施,改善患者心理健康水平。     

MRI在中青年缺血性脑卒中rt-PA静脉溶栓治疗中的价值

目的:探讨MRI在中青年缺血性脑卒中静脉溶栓治疗前后的价值.方法:83例中青年缺血性脑卒中患者均在MRI指导下行rt-PA静脉溶栓治疗,记录患者治疗前后颅内动脉狭窄评分、神经功能缺损评分(NIHSS评分)、生活质量评分(BI评分)及功能恢复评分(mRS评分),并进行统计学分析.结果:83例患者治疗后颅内动脉狭窄评分、NIHSS评分、BI评分及mRS评分均较治疗前明显好转,溶栓治疗前后差异有统计学意义(P<0.05);发病在12h内不同时间段(≤4.5h和>4.5h)的脑梗死患者行静脉溶栓治疗前后NIHSS评分差异无统计学意义(P>0.05).结论:MRI指导的中青年脑梗死静脉溶栓治疗安全有效,≤4.5h和4.5~12.0h脑梗死患者在MRI界定下具有相同的组织窗时疗效差异无统计学意义.准确而及时的MRI评估在缺血性脑卒中患者治疗中起着重要的指导作用.     

Anomalous External Carotid Artery-Internal Carotid Artery Anastomosis in Two Patients with Proximal Internal Carotid Arterial Remnants

Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.     

Antiphospholipid antibodies, ischemic stroke in young adults, and calcium supplementation: a hypothesis

The proper treatment of younger patients who have suffered ischemic stroke and who have no stroke risk factors other than antiphospholipid antibodies is unsettled. We propose a rationale to support adding dietary supplementation with calcium and vitamin D to the present standard regimen of anticoagulant therapy for these patients. We expect that the benefits from this additional therapy will prove additive. Proving this hypothesis will require large numbers of patients unlikely to present to any one center. The military health care system is well suited to such a study.     

Carotid dissections

In younger patients, the clinical symptoms of sudden unilateral headache and facial pain, often combined with Horner syndrome and the cerebrovascular symptoms of TIAs or stroke, should indicate the diagnosis of spontaneous carotid dissection. Angiographic findings can verify this diagnosis, showing various signs of eccentric, narrowing stenosis, false lumen, pseudoaneurysms, or complete occlusion. An addition to noninvasive Doppler ultrasonography, B-mode and Duplex investigations, although more or less nonspecific, give some indications of the diagnosis; modern imaging techniques, especially MRI, can image the intramural hematoma directly. As the hematoma is the source of the intracranial emboli, the therapy of choice in this rarely diagnosed disease should be anticoagulation.     

Carotid ultrasound

This article provides an overview of basic diagnostic carotid ultrasound applications, and emphasizes practical aspects of this examination. Areas currently being investigated include carotid plaque characterization and applications relative to IMT measurements. Contrast-enhanced ultrasound imaging also offers promise to improve plaque characterization, which in turn may link these evaluations to outcome studies.     

Carotid plaque assessment using inversion recovery T1 weighted-3 dimensions variable refocus flip angle turbo spin echo sampling perfection with application optimized contrast using different angle evolutions black blood imaging

Vulnerable plaque can be attributed to induction of ischemic symptoms and magnetic resonance imaging of carotid artery is valuable to detect the plaque. Magnetization prepared rapid acquisition with gradient echo (MPRAGE) method could detect hemorrhagic vulnerable plaque as high intensity signal; however, blood flow is not sufficiently masked by this method. The contrast for plaque in T1 weighted image (T1WI) could not be obtained sufficiently with black blood image (BBI) by sampling perfection with application optimized contrast using different angle evolutions (SPACE) method as turbo spin echo (TSE). In addition, an appearance of artifact by slow flow is a problem. Considering these controversial situations in plaque imaging, we examined the modified BBI inversion recovery (IR)-SPACE in which IR was added for SPACE method so that the contrast for plaque in T1WI was optimized. We investigated the application of this method in plaque imaging. As a result of phantom imaging, the contrast for plaque in T1WI was definitely obtained by choosing an appropriate inversion time (TI) for the corresponding repetition time. In clinical cases, blood flow was sufficiently masked by IR-SPACE method and the plaque imaging was clearly obtained in clinical cases to the same extent as MPRAGE method. Since BBI with IR-SPACE method was derived from both IR pulse and flow void effect, this method could obtain the blood flow masking effect definitely. The present study suggested that SPACE method might be applicable to estimate properties of carotid artery plaque.