Cortical vessel sign on susceptibility weighted imaging reveals clinically relevant hypoperfusion in internal carotid artery stenosis

Mundiyanapurath, Sibu; Ringleb, Peter A.; Diatschuk, Sascha; Burth, Sina; Möhlenbruch, Markus; Floca, Ralf; Wick, Wolfgang; Bendszus, Martin; Radbruch, Alexander

doi:10.1016/j.ejrad.2015.12.020

Cited by 23 publications

(29 citation statements)

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“…Hypoperfusion finding is not surprising since this is a well observed finding in patients with long standing artery stenosis [25]. So When we investigated the presence of a relative cerebellar and brainstem hypoperfusion in the non-VAD and BAC cohort with UIV patients, the exclusion and inclusion of VAS, VA occlusion (VAO), BA stenosis (BAS) would be discussed respectively.…”

Section: Methodsmentioning

confidence: 99%

Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo

Feng

et al. 2016

Journal of the Neurological Sciences

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PurposeTo determine the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo (UIV) patients using 320-detector row computed tomography (CT).MethodsA total of 150 patients who underwent CT angiography (CTA) and CT perfusion (CTP) imaging were divided into UIV group and benign paroxysmal positional vertigo (BPPV) group. Sixty individuals with sex- and age-matched without vertigo and cerebral diseases served as the control. The morphological changes of intracranial arteries, perfusion parameters and vascular risk factors (VRFs) were analyzed, calculated and compared.ResultsIn UIV patients, hypertension (HT), hyperlipidemia and number of VRFs ≥ 3 occurred more commonly (P < 0.0125, respectively). The incidence of vertebral artery dominance (VAD), vertebral artery stenosis (VAS) and basilar artery curvature (BAC) were significantly higher (P < 0.0125, respectively). HT was an independent risk predictor of non-VAD (OR: 5.411, 95%CI: 1.401; 20.900, P = 0.014). HT and VAD associated with BAC served as risk predictors (OR: 4.081, 95%CI: 1.056;15.775, P = 0.041 and OR: 6.284, 95%CI: 1.848; 21.365, P = 0.003, respectively). The absolute difference in relative values of CTP parameters from cerebellum and brainstem were significantly different (P < 0.05), and hypoperfusion was found in the territories of the non-VAD side and the BAC cohort (P < 0.05, respectively).ConclusionsOn the basis of multiple VRFs, morphological changes of vertebrobasilar artery (VBA) and the unilateral hypoperfusion of the cerebellum and brainstem, that acts as a herald for IV occurrence, which should be paid cautious attention to UIV patients.

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Section: Methodsmentioning

confidence: 99%

Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo

Feng

et al. 2016

Journal of the Neurological Sciences

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“…There are several reasons for that. First, in a previous report prominent and partially enlarged cortical veins were found in areas of hypoperfusion. This sign can be detected on SWI for increased deoxyhemoglobin in these vessels.…”

Section: Discussionmentioning

confidence: 99%

“…The following inclusion criteria were used: 1) patients with acute or subacute cerebral infarction caused by occlusion of ipsilateral MCA; 2) MR inspection sequences included DWI, SWI, and time‐of‐flight MR angiography (TOF‐MRA); 3) a 3‐month clinical follow‐up, evaluated with a modified Rankin Scale scoring (mRS) ; 4) if there was a history of previous ischemic attacks, no sequelae left over, or mRS <3 and the fluctuation of mRS ≤1; 5) no contraindication for MR examination. The exclusion criterion were: 1) patients with bilateral acute or subacute infarction foci; 2) severe steno‐occlusion of vessels of posterior circulation or other cerebral arteries of anterior circulation; 3) patients with hemorrhagic transformation; 4) patients without SWI‐DWI mismatch area; 5) patients without sufficient MR and clinical data; or 6) onset to admission time >2 weeks.…”

Section: Methodsmentioning

confidence: 99%

Fewer peripheral asymmetrical cortical veins is a predictor of favorable outcome in MCA infarctions with SWI‐DWI mismatch

Tao

Ren

Guanmin

et al. 2018

Magnetic Resonance Imaging

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“…21 In addition, hypoperfusion caused by carotid stenosis can increase stroke risk and can be assessed by Doppler sonography, computed tomography (CT) or MR-perfusion and positron-emission tomography (PET). [22][23][24] Burning questions, without recent evidence from randomised trials, are: whether CAS or CEA are still superior to a modern optimal medical therapy (OMT) in the primary prevention of ischaemic stroke in patients with a severe asymptomatic carotid stenosis; and whether CAS is at least non-inferior to CEA in terms of safety and efficacy. To gain data on this topic the investigator-initiated multicentre controlled design (updated protocol).…”

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confidence: 99%

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confidence: 99%

Update on Extracranial Carotid Stenosis

Reiff¹,

Gumbinger²,

Mundiyanapurath³

et al. 2016

European Neurological Review

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Carotid stenosis is a risk factor of ischaemic stroke and has an increasing prevalence with age. Stroke risk under optimised medical therapy, as well as recommendations of carotid artery endarterectomy/stenting, as therapy in high risk carotid stenosis, are discussed in consideration of recent research results. KeywordsCarotid artery stenosis, carotid endarterectomy, angioplasty and stenting, optimal medical treatment, stroke prevention.Disclosure: Tilman Reiff, Christoph Gumbinger and Sibu Mundiyanapurath have nothing to disclose in relation to this paper. Peter A Ringleb is a member of the steering committee of SPACE-2. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received for the publication of this article.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. 1,2 The prevalence of atherosclerotic carotid disease increases with age. Epidemiological data show a prevalence of 3.1% for men and 0.9% for women in individuals with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria carotid stenosis who were 80 years or older. For ≥50% carotid stenosis, prevalence is 7.5% for men and 5.0% for women.3 A pooled analysis of the general population indicates a prevalence of ≥70% carotid stenosis of 1.7% (95% confidence interval [CI] 0.7-3.9%).4 Due to improvements in medical therapy, the annual ipsilateral stroke risk of asymptomatic carotid stenosis ≥50% has decreased within the last decades from about 2% to 0.5-1.0%. [5][6][7] Data are inconsistent as to whether the grade of stenosis (>70-99%) increases stroke risk.8-10 Risk of recurrent stroke in recently symptomatic carotid stenosis is reported with 6% in the first month and about 20% within the first year.11 Other data show a higher risk (21% in the first two weeks and 32% within 12 weeks).12 More recent studies indicate a high risk (6-21%) of recurrent stroke in the first 72 hours after initial stroke symptoms, but a lower risk of 11.5% at 14 days, and 18.8% at 90 days. 10,13,14 Quite low rates of recurrent stroke were seen under aggressive medical therapy with acetylsalicylic acid, clopidogrel and simvastatin (2.5% within 90 days). 15Carotid atherosclerosis is also a marker for high risk of myocardial infarction and vascular death.16 Considering all these facts, patients with carotid stenosis should receive intensive medical therapy with statins and antiplatelets; treatment of hypertension and diabetes; they should follow a healthy diet, and perform lifestyle modifications. [17][18] Discussions about invasive treatment of asymptomatic carotid stenosis are currently controversial. The recently published Asymptomatic Carotid Surgery Trial-1 (ACT-1) study confirmed that carotid artery stenting (CAS) was non-inferior to carotid endarterectomy (CEA) in a cohort of 1,453 patien...

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Cortical vessel sign on susceptibility weighted imaging reveals clinically relevant hypoperfusion in internal carotid artery stenosis

Cited by 23 publications

References 32 publications

Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo

Evaluating the morphological changes of intracranial arteries and whole-brain perfusion in undetermined isolated vertigo

Fewer peripheral asymmetrical cortical veins is a predictor of favorable outcome in MCA infarctions with SWI‐DWI mismatch

Update on Extracranial Carotid Stenosis

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