Plaque Ulceration and Lumen Thrombus Are the Main Sources of Cerebral Microemboli in High-grade Internal Carotid Artery Stenosis

Sitzer, Matthias; Müller, Wolfram; Siebler, Mario; Hort, W; Kniemeyer, H. W.; Jäncke, Lutz; Steinmetz, Helmuth

doi:10.1161/01.str.26.7.1231

Cited by 306 publications

(248 citation statements)

References 19 publications

Supporting

Mentioning

219

Contrasting

Unclassified

Order By: Relevance

“…16 -19 Falk 16 noted that Ͼ75% of major coronary thrombotic events were precipitated by atherosclerotic plaque rupture, which resulted in the exposure of thrombogenic subendothelial plaque constituents. Falk and other researchers [17][18][19] suggested that plaque disruption and erosion was the critical feature in these moderately stenotic, high-risk lesions. MRI can detect FC status (thick, thin, and ruptured) ex vivo and in vivo.…”

Section: Discussionmentioning

confidence: 90%

Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging

et al. 2002

View full text Add to dashboard Cite

Background-Recent studies demonstrated that in vivo and ex vivo MRI can characterize the components of the carotid atherosclerotic plaque, such as fibrous tissue, lipid/necrotic core, calcium, hemorrhage, and thrombus. The purpose of this study was to determine whether in vivo high-resolution multicontrast MRI could accurately classify human carotid atherosclerotic plaque according to the American Heart Association classification. Methods and Results-Sixty consecutive patients (mean age 70 years; 54 males) scheduled for carotid endarterectomy were imaged with a 1.5-T scanner after informed consent was obtained. A standardized protocol was used to obtain 4 different contrast-weighted images (time of flight and T1-, PD-, and T2-weighted) of the carotid arteries. Best voxel size was 0.25ϫ0.25ϫ1 mm 3 . Carotid plaques were removed intact and processed for histological examination. Both MR images and histological sections were independently reviewed, categorized, and compared. Overall, the classification obtained by MRI and the American Heart Association classifications showed good agreement, with Cohen's (95% CI) of 0.74 (0.67 to 0.82) and weighted of 0.79. The sensitivity and specificity, respectively, of MRI classification were as follows: type I-II lesions, 67% and 100%; type III lesions, 81% and 98%; type IV-V lesions, 84% and 90%; type VI lesions, 82% and 91%; type VII lesions, 80% and 94%; and type VIII lesions, 56% and 100%. Conclusions-In vivo high-resolution multicontrast MRI is capable of classifying intermediate to advanced atherosclerotic lesions in the human carotid artery and is also capable of distinguishing advanced lesions from early and intermediate atherosclerotic plaque.

show abstract

Section: Discussionmentioning

confidence: 90%

Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Several studies provide evidence that TCD detectable microembolic signals indicate a risk factor for cerebral ischemia. [15][16][17] Although the nature of the detected signals cannot be clearly identified, eg which aggregates of blood cells generate the signal, the method seems to be sensitive for blood inhomogeneity. The fact that after stimulation donors presented signs of hypercoagulation but no microembolism is compatible with the known clinical low incidence of ischemic morbidity.…”

Section: Discussionmentioning

confidence: 99%

Analysis of rhG-CSF-effects on platelets by in vitro bleeding test and transcranial Doppler ultrasound examination

Söhngen

Wienen

Siebler

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Experimental evidence suggests a stimulatory effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on both platelets and coagulation. RhG-CSF is increasingly used to stimulate healthy volunteer donors for blood stem cell mobilization. We therefore assessed 25 healthy donors receiving rhG-CSF for changes in in vitro bleeding test (IVBT), coagulation parameters and cerebral microembolism by transcranial Doppler (TCD) ultrasound. A significant shortening of IVBT was found on day 4 of rhG-CSF administration together with increased levels of fibrinogen and factor VIII and reduced activities of protein C and protein S. Although these changes are quite small it is possible that they may lead to a hypercoagulable state especially in donors with other risk factors for thromboembolism. However, TCD examination failed to detect any signs of microembolism. We therefore conclude that rhG-CSF leads to significant changes in coagulation parameters, but has no effect on TCD detectable microembolism as a stroke risk factor. However donors receiving rhG-CSF should be examined carefully to detect pre-existing changes in the coagulation system and we would like to suggest a routine thrombophilia screen. Keywords: in vitro bleeding test; blood coagulation; recombinant human granulocyte colony-stimulating factor; transcranial Doppler ultrasound In the context of autologous and allogeneic stem cell transplantation rhG-CSF is routinely used as a growth factor to mobilize peripheral blood stem cells. 1,2 In patients with normal bone marrow function this leads to a significant increase of peripheral leukocyte counts, so that rheological changes and disturbances of blood flow are to be anticipated. To date, we have noted thrombotic complications of central venous lines in two out of 20 patients under rhG-CSF administration. Moreover, in vitro tests demonstrated an activation of platelets and the coagulation system. 3,4 As a growing number of healthy donors receive rhG-CSF for stem cell mobilization in our institution, we were interested

show abstract

“…11,13 Plaque ulceration has been defined as "an intimal defect larger than 1000-m in width, exposing the necrotic core of the atheromatous plaque." 14 Conventional angiography has been considered the standard method for evaluating stenosis of the carotid artery, but it is not sufficiently reliable for detecting plaque ulceration 15,16 (angiography has a 46% sensitivity and a 74% specificity for detecting ulcerated plaques in large studies 17,18 ). Moreover, conventional angiography is also associated with an increased risk of thromboembolic events.…”

mentioning

confidence: 99%

CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography

Saba

Caddeo²,

Sanfilippo³

et al. 2007

American Journal of Neuroradiology

193

115

View full text Add to dashboard Cite

show abstract

Plaque Ulceration and Lumen Thrombus Are the Main Sources of Cerebral Microemboli in High-grade Internal Carotid Artery Stenosis

Cited by 306 publications

References 19 publications

Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging

Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging

Analysis of rhG-CSF-effects on platelets by in vitro bleeding test and transcranial Doppler ultrasound examination

CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography

Contact Info

Product

Resources

About