Early vascular imaging and key system strategies expedite carotid revascularization after transient ischemic attack and stroke

Gocan, Sophia; Bourgoin, Aline; Shamloul, Rany; Sivakumar, Brammiya; Dowlatshahi, Dar; Stotts, Grant

doi:10.1016/j.jvs.2020.02.024

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…The Ottawa stroke prevention clinic (SPC) is a rapid access clinic located inside the Ottawa Hospital servicing the national capital region with an average of 2600 new referrals per year. 3 Acute stroke care at remote hospitals throughout the province of Ontario (population 14 million) is supported by the Ontario telestroke program (OTP). 4 Currently, there are 31 hospitals that refer to the OTP, including designated district stroke centers (primary stroke centers) and nondesignated hospitals that provide thrombolytic therapy.…”

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confidence: 99%

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

Dowlatshahi

Stotts

Bourgoin

et al. 2020

Can. J. Neurol. Sci.

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We reviewed stroke care delivery during the COVID-19 pandemic at our stroke center and provincial telestroke system. We counted referrals to our prevention clinic, code strokes, thrombolysis, endovascular thrombectomies, and activations of a provincial telestroke system from February to April of 2017–2020. In April 2020, there was 28% reduction in prevention clinic referrals, 32% reduction in code strokes, and 26% reduction in telestroke activations compared to prior years. Thrombolysis and endovascular thrombectomy rates remained constant. Fewer patients received stroke services across the spectrum from prevention, acute care to telestroke care in Ontario, Canada, during the COVID-19 pandemic.

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mentioning

confidence: 99%

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

Dowlatshahi

Stotts

Bourgoin

et al. 2020

Can. J. Neurol. Sci.

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Emergency medicine updates: Transient ischemic attack

Long,

Marcolini,

Gottlieb

2024

The American Journal of Emergency Medicine

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Multiomics unveils extracellular vesicle-driven mechanisms of endothelial communication in human carotid atherosclerosis

Raju,

Turner,

Cao

et al. 2024

Preprint

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BackgroundCarotid atherosclerosis is a multifaceted disease orchestrated by a myriad of cell-cell communication that drives progression along a clinical continuum (asymptomatic to symptomatic). Extracellular vesicles (EVs) are lipid bilayer membrane-enclosed cell-derived nanoparticles that represent a new paradigm in cellular communication. Little is known about their biological cargo, cellular origin/destination, and functional roles in human atherosclerotic plaque.MethodsEVs were enriched via size exclusion chromatography from human carotid endarterectomy samples dissected into plaque and marginal zones (n= 29 patients, paired plaque and marginal zone; symptomatic n=16, asymptomatic n=13), with further density gradient ultracentrifugation for proteomic analysis. EV cargoes were assessed via whole transcriptome miRNA sequencing and mass spectrometry-based proteomics. EV multi-omics were integrated with publicly available bulk and single cell RNA-sequencing (scRNA-seq) datasets to predict EV cellular origin and ligand-receptor interactions and multi-modal biological network integration of EV-cargo was completed. EV functional impact was assessed with endothelial angiogenesis assays.ResultsHuman carotid plaques contained greater quantities of EVs than adjacent marginal zones. EV-miRNA and protein content was different in diseased plaque versus adjacent marginal zones, with differential functions in key atherogenic pathways. EV cellular origin analysis suggested that tissue EV signatures originated from endothelial cells (EC), smooth muscle cells (SMC), and immune cells. Furthermore, EV signatures from SMCs and immune cells were most enriched in the marginal and plaque zones, respectively. Integrated tissue vesiculomics and scRNA-seq indicated complex EV-vascular cell communication strategies that changed with disease progression and plaque vulnerability (i.e., symptomatic disease). Plaques from symptomatic patients, but not asymptomatic patients, were characterized by increased involvement of endothelial pathways and more complex ligand-receptor interactions, relative to their marginal zones. Plaque-EVs were predicted to mediate communication with ECs. Pathway enrichment analysis delineated a strong endothelial signature with potential roles in angiogenesis and neovascularization – well-known indices of plaque instability. This was corroborated functionally, wherein human carotid symptomatic plaque EVs induced sprouting angiogenesis in comparison to their matched marginal zones.ConclusionOur findings indicate that EVs may drive dynamic changes in plaques through EV-vascular cell communication and effector functions that typify vulnerability to rupture, precipitating symptomatic disease. The discovery of endothelial-directed processes mediated by EVs creates new avenues for novel therapeutics in atherosclerosis.

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Early vascular imaging and key system strategies expedite carotid revascularization after transient ischemic attack and stroke

Cited by 4 publications

References 22 publications

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

Emergency medicine updates: Transient ischemic attack

Multiomics unveils extracellular vesicle-driven mechanisms of endothelial communication in human carotid atherosclerosis

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