Retrograde aortic blood flow as a mechanism of stroke: MR evaluation of the prevalence in a population-based study

Harloff, Andreas; Hagenlocher, Paul; Lodemann, Thomas; Hennemuth, Anja; Weiller, Cornelius; Hennig, Jürgen; Vach, Werner

doi:10.1007/s00330-019-06104-z

Cited by 15 publications

(17 citation statements)

References 21 publications

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“…[9][10][11][12] The unique ability of 4D flow MRI to measure advanced metrics such as flow energetics and wall shear stress (WSS) has given newer insights into disease pathophysiology that could not be obtained through other existing imaging modalities. [13][14][15][16][17] However, these benefits come at the expense of long scan times associated with multi-dimensional imaging, hindering the adoption of 4D flow MRI into routine clinical imaging. In cardiothoracic applications, the scan times are further increased by the need for respiratory motion compensation, where typically a respiratory navigator follows the movement of the diaphragm, and only accepts data acquired in end-expiration.…”

Section: Introductionmentioning

confidence: 99%

“…When used in cardiovascular imaging, 4D flow MRI helps in the evaluation and characterization of various congenital 1‐4 and adult heart diseases, 5‐8 particularly several aortic diseases 9‐12 . The unique ability of 4D flow MRI to measure advanced metrics such as flow energetics and wall shear stress (WSS) has given newer insights into disease pathophysiology that could not be obtained through other existing imaging modalities 13‐17 . However, these benefits come at the expense of long scan times associated with multi‐dimensional imaging, hindering the adoption of 4D flow MRI into routine clinical imaging.…”

Section: Introductionmentioning

confidence: 99%

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Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease

Pathrose

Berhane

et al. 2020

Magnetic Resonance in Med

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Purpose: To systematically assess the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors (R) for the quantification of aortic flow dynamics and wall shear stress (WSS) in patients with aortic disease. Methods: Twenty patients with aortic disease (58 ± 15 y old; 19 M) underwent four 4D flow scans: one conventional (GRAPPA, R = 2) and three CS 4D flows with R = 5.7, 7.7, and 10.2. All scans were acquired with otherwise equivalent imaging parameters on a 1.5T scanner. Peak-systolic velocity (V max), peak flow (Q max), and net flow (Q net) were quantified at the ascending aorta (AAo), arch, and descending aorta (DAo). WSS was calculated at six regions within the AAo and arch. Results: Mean scan times for the conventional and CS 4D flows with R =

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease

Pathrose

Berhane

et al. 2020

Magnetic Resonance in Med

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“…Retrograde flow in the descending aorta could in theory allow emboli from plaques distal to the supra-aortic arteries to travel to the cranial circulation. 5,25,29 However, causality has yet to be proven and the most appropriate management in this setting remains undetermined. Previous studies on patients with aortic plaque indicated no added benefit in Significant carotid artery stenosis z 6 (9%) 5 (15%) 1 (3%) Carotid artery occlusion 1 (1%) 1 (3%) 0 (0%) Carotid artery near occlusion x 1 (1%) 0 (0%) 1 (3%) Cranial CTA Intracranial large vessel occlusion 3 (4%) 0 (0%) 3 (9%) ECG À Electrocardiogram; CT À Computed Tomography; CTA À CT Angiography; TIA À Transient ischaemic attack.…”

Section: Discussionmentioning

confidence: 99%

CT Angiography of the Heart and Aorta in TIA and Ischaemic Stroke: Cardioembolic Risk Sources and Clinical Implications

Holswilder

Wermer

Holman

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Background: Cardiac emboli are important causes of (recurrent) ischaemic stroke. Aorta atherosclerosis might also be associated with an increased risk of stroke recurrence. This study aimed to evaluate the yield and clinical implications of CTangiography (CTA) of the heart and aorta in the diagnostic workup of transient ischaemic attack (TIA) or ischaemic stroke. Methods: CTA of the heart and aortic arch was performed in TIA/ischaemic stroke patients, in addition to routine diagnostic workup. Occurrence of cardioembolic (CE) risk sources and complex aortic plaques were assessed. Implications of cardiac CTA for therapeutic management were evaluated Results: Sixty-seven patients were included (TIA n = 33, ischaemic stroke n = 34) with a mean age of 68 years (range 51À89) and median NIHSS of 0 (interquartile range 0À2). CE risk sources were detected in 29 (43%) patients. An intracardiac thrombus was present in 2 patients (3%; TIA 0%; ischaemic stroke 6%). Medium/low-risk CE sources included mitral annular calcification (9%), aortic valve calcification (18%) and patent foramen ovale (18%). Complex aortic plaque was identified in 16 patients (24%). In two patients with an intracardiac thrombus, therapeutic management changed from antiplatelet to oral anticoagulation. Conclusions: CTA of the heart and aorta has a high yield for detection of embolic risk sources in TIA/ ischaemic stroke, with clinical consequences for 6% of ischaemic stroke patients. Implementation of CTA of the heart and aorta in the acute stroke setting seems valuable, but cost-effectiveness of this approach remains to be determined.

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“…The asymmetry of ischemic patterns in patients with high‐risk atherosclerotic plaques in the DAo support this mechanism: the predominance of left‐sided lesions most likely originates from embolism via the left carotid or left vertebral arteries, closer to the DAo 6‐8 . In addition, 4D flow magnetic resonance imaging (MRI) studies provide evidence that diastolic flow reversal in the DAo is frequent in patients with aortic plaques and is a possible risk factor of retrograde embolism in cryptogenic stroke patients 9‐11 . Notably, blood flow reversal in the thoracic aorta is a common phenomenon, occurring even without aortic valve regurgitation 12 .…”

mentioning

confidence: 96%

“…[6][7][8] In addition, 4D flow magnetic resonance imaging (MRI) studies provide evidence that diastolic flow reversal in the DAo is frequent in patients with aortic plaques and is a possible risk factor of retrograde embolism in cryptogenic stroke patients. [9][10][11] Notably, blood flow reversal in the thoracic aorta is a common phenomenon, occurring even without aortic valve regurgitation. 12 Previous work suggests that aortic geometry, aortic stiffness, and impedance mismatch are major determinants of aortic flow reversal.…”

mentioning

confidence: 99%

Renin Angiotensin System Inhibitors Reduce Aortic Stiffness and Flow Reversal After a Cryptogenic Stroke

Soulat

Jarvis

Pathrose

et al. 2020

Magnetic Resonance Imaging

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Background: Blood flow reversal is a possible mechanism for retrograde embolism in the setting of high-risk atherosclerotic plaques in the descending aorta (DAo). Evidence suggests that pulse wave velocity (PWV) is a determinant of blood flow reversal and can be reduced by the destiffening effect of renin-angiotensin system inhibitors (RASI). Purpose: To evaluate the impact of antihypertensive therapy on in vivo changes in PWV and flow reversal in patients with cryptogenic stroke. Study Type: Prospective. Population: Sixteen patients (69 AE 9 years; 10 males) included after cryptogenic stroke. Field Strength/Sequence: 3T. 4D flow sequence (temporal resolution = 19.6 msec) Assessment: Patients underwent aortic MRI at baseline and at 6-month follow-up. Patients received standard-of-care antihypertensive therapy that were classified as RASI vs. non-RASI medications (ie, destiffening vs. nondestiffening).We compared aortic PWV, flow reversal fraction (FRF), aortic measurements, cardiac function, and other aortic and cardiac measurements in the antihypertensive therapy groups. Statistical Tests: Two-tailed paired or unpaired Student's t-tests (normal distributions) or Wilcoxon tests (nonnormal distribution). Univariate correlations using Pearson correlation coefficients. Results: There was a significant decrease in PWV in the RASI (n = 10) group (9.4 AE 1.6 m/s vs. 8.3 AE 1.9 m/s; P < 0.05), as well as FRF (18.6% AE 4.1% vs. 16.3% AE 4.0%; P < 0.05) between baseline and the 6-month MRI studies. There were no changes in PWV or FRF in the non-RASI (n = 6) group (P = 0.146 and P = 0.32). A decrease in FRF was significantly correlated with a decrease in PWV (r = 0.53; P < 0.05). Data Conclusion: The findings of our study suggest that RASI therapy after cryptogenic stroke resulted in a decrease of blood flow reversal and aortic stiffness. Evidence Level: 1 Technical Efficacy Stage: 4

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Retrograde aortic blood flow as a mechanism of stroke: MR evaluation of the prevalence in a population-based study

Cited by 15 publications

References 21 publications

Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease

Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease

CT Angiography of the Heart and Aorta in TIA and Ischaemic Stroke: Cardioembolic Risk Sources and Clinical Implications

Renin Angiotensin System Inhibitors Reduce Aortic Stiffness and Flow Reversal After a Cryptogenic Stroke

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