Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis

Kasner, Scott E.; Chimowitz, Marc I.; Lynn, Michael; Howlett-Smith, Harriet; Stern, Barney J.; Hertzberg, Vicki; Frankel, Michael; Levine, Steven R.; Chaturvedi, Seemant; Benesch, Curtis; Sila, Cathy A.; Jovin, Tudor G; Romano, José G.; Cloft, Harry J.

doi:10.1161/circulationaha.105.578229

Cited by 669 publications

(517 citation statements)

References 30 publications

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“…10,31 DSA was performed and the resulting images were analyzed by a single experienced neuroradiologist who was blinded to all sonographic data. Obstructive ICA lesions were classified as follows: 0%-29% (mild stenosis), 30%-49% (moderate stenosis), 50%-69% (higher grade stenosis), 70%-89% (severe stenosis), 90%-99% (subtotal stenosis), and 100% (occlusion).…”

Section: Dsamentioning

confidence: 99%

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Valaikienė¹,

Schuierer²,

Ziemus³

et al. 2008

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the "gold standard," digital subtraction angiography (DSA).

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Section: Dsamentioning

confidence: 99%

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Valaikienė¹,

Schuierer²,

Ziemus³

et al. 2008

American Journal of Neuroradiology

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“…The risk of stroke recurrence depends on the severity of the IAS. Patients with≥70 % luminal narrowing have a 35 % risk of stroke recurrence in the first year; this risk decreases to 18 % with antithrombotic therapy [3]. Current therapy available to patients with symptomatic IAS includes medication with or without endovascular intervention [4].…”

Section: Introductionmentioning

confidence: 99%

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

et al. 2015

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Symptomatic intracranial arterial stenosis (SIAS) is very common in octo-and nonagenarians, especially in the Chinese population, and is likely the most common cause of stroke recurrence worldwide. Clinical trials demonstrate that endovascular treatment, such as stenting, may not be suitable for octogenarians with systemic diseases. Hence, less invasive methods for the octogenarian patients are urgently needed. Our previous study (unique identifier: NCT01321749) showed that repetitive bilateral arm ischemic preconditioning (BAIPC) reduced the incidence of stroke recurrence by improving cerebral perfusion (confirmed by single photon emission computed tomography and transcranial Doppler sonography) in patients younger than 80 years of age; however, the safety and effectiveness of BAIPC on stroke prevention in octo-and nonagenarians with SIAS are still unclear. The objective of this study was to evaluate the safety and effectiveness of BAIPC in reducing stroke recurrence in octo-and nonagenarian patients with SIAS. Fifty-eight patients with SIAS were enrolled in this randomized controlled prospective study for 180 consecutive days. All patients enrolled in the study received standard medical management. Patients in the BAIPC group (n=30) underwent 5 cycles consisting of bilateral arm ischemia followed by reperfusion for 5 min each twice daily. Those in the control group (n=28) underwent sham-BAIPC twice daily. Blood pressure, heart rate, local skin status, plasma myoglobin, and plasma levels of thrombotic and inflammatory markers were documented in both groups before beginning the study and for the first 30 days. Finally, the incidences of stroke recurrence and magnetic resonance imaging during the 180 days of treatment were compared. Compared with the control, BAIPC had no adverse effects on blood pressure, heart rate, local skin integrity, or plasma myoglobin, and did not induce cerebral hemorrhage in the studied cohort. BAIPC reduced plasma high sensitive C-reactive protein, interleukin-6, plasminogen activator inhibitor-1, leukocyte count, and platelet aggregation rate and elevated plasma tissue plasminogen activator (all p<0.01). In 180 days, 2 infarctions and 7 transient ischemic attacks were observed in the BAIPC group compared with 8 infarctions and 11 transient ischemic attacks in the sham BAIPC group (p<0.05). BAIPC may safely inhibit stroke recurrence, protect against brain ischemia, and ameliorate plasma biomarkers of inflammation and coagulation in octo-and nonagenarians with SIAS. A multicenter trial is ongoing.Clinical Trial Registration: www.clinicaltrials.gov, unique identifier: NCT01570231.

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“…The risk of recurrent stroke in the territory of symptomatic stenotic artery s as high as 23% during the first year in patients with severe stenosis (defined as 70% or more luminal narrowing), while the annual risk of moderate stenosis (50%–69%) is approximately 10% (Kasner et al., 2006). …”

Section: Introductionmentioning

confidence: 99%

Cerebral blood flow evaluation of intensive rosuvastatin therapy in stroke/transient ischemic attack patients with intracranial arterial atherosclerotic stenosis study: Rationale and design

et al. 2017

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IntroductionThe risk of recurrent stroke is high in patients with intracranial atherosclerotic stenosis (ICAS). Statin use has been demonstrated to decrease the incidence of stroke by reducing atherosclerotic plaque burden. However, its effect on the hemodynamic situation and cerebral perfusion status has not yet been validated. With the use of computed tomography perfusion (CTP), we aim to evaluate the impact of Rosuvastatin on cerebral hemodynamic changes, as well as the downstream perfusion.MethodCerebral bood flow evaluation of intensive rosuvastatin therapy in patients with intracranial arterial atherosclerotic stenosis (CEIRIS) is a single‐center, prospective, randomized, parallel‐group, and open‐label trial, and it will include 50 participants as estimated. Patients with moderate to severe (50%–99%) ICAS are randomized 1:1 to 10 mg/day or 20 mg/day Rosuvastatin and followed every 13 weeks until 52 weeks. The primary outcome for the trial is the change in the relative regional cerebral blood flow evaluated by CTP after 52 weeks of Rosuvastatin treatment. The secondary outcomes are cerebral blood volume, change in the degree of stenosis of the target vessel and lipid parameters.ConclusionThe CEIRIS trial about the effects of statin on the temporal hemodynamic progression of ICAS may extend our understanding of the basic pathophysiology and mechanisms of stroke in ICAS patients.

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Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis

Abstract: Among patients with symptomatic intracranial stenosis, the risk of subsequent stroke in the territory of the stenotic artery is greatest with stenosis > or =70%, after recent symptoms, and in women.

Cited by 669 publications

References 30 publications

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

Ischemic Conditioning Is Safe and Effective for Octo- and Nonagenarians in Stroke Prevention and Treatment

Cerebral blood flow evaluation of intensive rosuvastatin therapy in stroke/transient ischemic attack patients with intracranial arterial atherosclerotic stenosis study: Rationale and design

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