Reversal of ophthalmic artery flow as a predictor of intracranial hemodynamic compromise: implication for prognosis of severe carotid stenosis

Tsai, Chien‐Sung; Lee, J.‐T.; Cheng, Chun-An; Liu, M.‐T.; Chen, C.‐Y.; Hu, Han Hwa; Peng, Giia‐Sheun

doi:10.1111/ene.12038

Cited by 28 publications

(46 citation statements)

References 26 publications

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“…Moreover, it was demonstrated that ROAF was highly associated to the combination of stenosis of the cervical and intracranial segments and less well correlated to high-grade cervical carotid stenosis/occlusion alone. Additionally, similarly to the presence of intracranial stenosis and previous stroke, ROAF was shown to be associated with a poorer functional outcome [9].…”

Section: Introductionmentioning

confidence: 93%

“…The ROAF in the setting of significant ICA (≥70%) is not infrequent, with some reports estimating an incidence of approximately 25% [8,9]. However, its role in cerebral collateralization is somewhat controversial [9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…However, its role in cerebral collateralization is somewhat controversial [9][10][11][12][13][14][15][16][17][18]. The ophthalmic artery (OA) is traditionally regarded as an important source of cerebral blood supply in patients with ICA occlusion [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Grilo¹,

Monteiro²,

Santos³

et al. 2014

IJCNMH

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Background: The assessment of ophthalmic artery flow direction by transcranial Doppler sonography has become part of the cerebrovascular routine examination in stroke patients. It provides helpful information for the investigation of collateral circulation and can evaluate the hemodynamic significance of high-grade internal carotid artery (ICA) stenosis. Our aim was to determine the value of assessing the direction of ophthalmic artery blood flow in the setting of routine color flow duplex ultrasonography examination of patients with ipsilateral carotid disease.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Grilo¹,

Monteiro²,

Santos³

et al. 2014

IJCNMH

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“…1 Because it has multifactorial causes, 2 identification of its underlying pathogenesis and risk factors is essential. 3,4 As a part of the phase I oxidizing enzyme aldehyde dehydrogenase (ALDH) superfamily, ALDH2 is responsible for both ethanol metabolism and biogenic and xenogenic aldehyde detoxification. 5,6 ALDH2 activity deficiency has been reported to increase the risk of cardiovascular disorders.…”

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confidence: 99%

Homozygous ALDH22* Is an Independent Risk Factor for Ischemic Stroke in Taiwanese Men

Sung

Lee

et al. 2016

Stroke

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Background and Purpose— The * 2 allele of the aldehyde dehydrogenase 2 gene (ALDH2 ) is the most common variant in Asian populations. The variant resulting in enzyme dysfunction was highly related to coronary artery disease. Recently, genome-wide association studies also discovered that the 12q24 locus near ALDH2 gene was associated with hypertension and ischemic stroke. This study intended to further investigate whether the above variant of ALDH2 increases the risk for ischemic stroke in Taiwanese. Methods— A case–control study was conducted on 914 patients with acute ischemic stroke and 746 nonstroke controls. Polymerase chain reaction and sequencing were used to identify the ALDH2 genotype. Vascular risk factors, stroke subtypes, vascular stenosis, and stroke outcomes were analyzed. Results— ALDH2 genotypes differed significantly between male controls (* 1/*1 versus * 1/*2 versus * 2/*2 =53.8% versus 39.9% versus 6.4%) and male patients with ischemic stroke (* 1/*1 versus * 1/*2 versus * 2/*2 =51.5% versus 37.3% versus 11.2%; P =0.048). No significant difference was found between groups for female patients ( P =0.228). Multivariate logistic regression analysis revealed that the ALDH2*2/*2 genotype was an independent risk factor for ischemic stroke in male patients (odds ratio, 1.93 [95% confidence interval, 1.07–3.46]; P =0.028). Further analysis of men with ischemic stroke demonstrated that the polymorphism of ALDH2 was not related to vascular risk factors, severity of vascular atherosclerosis, stroke subtypes, and stroke functional outcomes. Conclusions— The study demonstrated that ALDH2*2/*2 may be an independent risk factor for ischemic stroke in Taiwanese men, but not in Taiwanese women.

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“…The estimated prevalence of middle cerebral artery stenosis among asymptomatic Asian patients ranges from 7.2% to 29.6%, while Asian patients with ischemic stroke have a higher ICS incidence of 33% to 84% 4, 19. Further, concurrent atherosclerosis of intracranial and extracranial vessels is not uncommon in Asian populations13, 20, 21, 22; in fact, ≈20% to 50% of patients with ECS are reported to also have ICS 22, 23, 24. In this study, we found that 51.4% of patients with ECS had concurrent ICS.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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BackgroundIntracranial stenosis (ICS) is a major determinant of ischemic stroke in Asians. We determined the clinical significance of different risk factors and the role of ICS in Taiwanese patients with varied distributions of cervicocerebral stenosis.Methods and ResultsPresence of extracranial carotid stenosis (ECS, ≥70%) and ICS (>50%) was examined in 13 539 patients using ultrasonography and magnetic resonance angiography, respectively. Seven hundred thirty‐three patients with non‐ECS/ICS (n=372), isolated ICS (n=112), isolated ECS (n=121), or combined ECS/ICS (CEIS, n=128) were selected. Prevalence of ischemic stroke in each group was compared, and risk factors for stenosis were determined. The area under the receiver operating characteristic curve for each risk factor was calculated. Prevalence of ischemic stroke was highest in patients with CEIS (odds ratio 15.86; P<0.001), followed in decreasing order by those with isolated ICS (odds ratio 7.16; P<0.001), isolated ECS (odds ratio 1.77; P=0.011), and non‐ECS/ICS. Multivariate logistic regression analysis revealed that hypertension, coronary artery disease, and smoking were risk factors for isolated ECS; hypertension, diabetes mellitus, coronary artery disease, and smoking were risk factors for isolated ICS; and diabetes mellitus, coronary artery disease, and smoking were risk factors for CEIS. Smoking, diabetes mellitus, and coronary artery disease were the greatest contributors to CEIS, isolated ICS, and isolated ECS, respectively.ConclusionsCEIS was associated with higher odds of ischemic stroke compared with isolated ICS and isolated ECS. Smoking and diabetes mellitus, major determinants of CEIS and isolated ICS, should be targeted in therapeutic strategies to reduce the risk of ischemic stroke.

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Reversal of ophthalmic artery flow as a predictor of intracranial hemodynamic compromise: implication for prognosis of severe carotid stenosis

Abstract: ROAF may result from intracranial hemodynamic compromise. Patients with unilateral high-grade cervical carotid stenosis/occlusion in combination with intracranial stenosis appear to be a significant risk factor for poor functional outcome and increased incidence of ROAF.

Cited by 28 publications

References 26 publications

Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Homozygous ALDH22* Is an Independent Risk Factor for Ischemic Stroke in Taiwanese Men

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

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Reversal of ophthalmic artery flow as a predictor of intracranial hemodynamic compromise: implication for prognosis of severe carotid stenosis

Abstract: ROAF may result from intracranial hemodynamic compromise. Patients with unilateral high-grade cervical carotid stenosis/occlusion in combination with intracranial stenosis appear to be a significant risk factor for poor functional outcome and increased incidence of ROAF.

Cited by 28 publications

References 26 publications

Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Reversal of ophthalmic artery blood flow direction and severe ipsilateral carotid stenosis

Homozygous ALDH2*2 Is an Independent Risk Factor for Ischemic Stroke in Taiwanese Men

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

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Homozygous ALDH22* Is an Independent Risk Factor for Ischemic Stroke in Taiwanese Men