Significant Contribution of Aortogenic Mechanism in Ischemic Stroke

Higuchi, Yoshiharu; Hirayama, Atsushi; Hamanaka, Yuma; Kobayashi, Tomoaki; Sotomi, Yohei; Komatsu, Sei; Yutani, Chikao

doi:10.1016/j.jacasi.2022.07.009

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Higuchi, et al reported on the relationship of aortic plaques and ischemic stroke using angioscopy. 22) They reported asymptomatic ischemic stroke was strongly associated with the presence of spontaneously ruptured aortic plaque in the ascending aorta-aortic arch. This report of angioscopy is supportive for our opinion that the cause of the ACI may be thrombus or atheromatous materials in the aorta.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization

Yamaji,

Iwanaga,

Kakehi

et al. 2024

Int. Heart J.

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Recent studies have showed that asymptomatic cerebral infarction (ACI) developed in a reasonable number of patients after cardiac catheterization. However, no study has investigated the long-term prognostic impact of ACI after cardiac catheterization. We investigated whether ACI after cardiac catheterization affects long-term mortality and subsequent cardiovascular events.We retrospectively enrolled patients who underwent cardiac catheterization before cardiac surgery and cerebral diffusion-weighted magnetic resonance imaging (DWI). The incidence and clinical features of ACI were investigated. The long-term prognosis, including all-cause mortality and subsequent major cardiovascular events (MACE; all-cause mortality, stroke, acute myocardial infarction, fatal arrhythmia, and hospitalized heart failure), was also assessed.A total of 203 patients were enrolled. Of these, 10.3% had ACI diagnosed by DWI. There were no differences in baseline characteristics between patients with and without ACI, except more frequent history of symptomatic stroke in patients with ACI. In the Kaplan-Meier analysis during a median follow-up of 1009 days, the patients with ACI showed worse mortality and a slightly higher occurrence of MACE compared with those without ACI (P = 0.01 and P = 0.08, respectively). In addition, ACI was a prognostic marker independent of age, surgery type, and history of stroke.ACI after cardiac catheterization frequently developed and was also associated with long-term prognosis. It may be an independent prognostic marker in high-risk patients who underwent subsequent cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization

Yamaji,

Iwanaga,

Kakehi

et al. 2024

Int. Heart J.

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“…In the current study, patients with protruding aortic plaque, compared with those without, were older and more frequently had hypertension, chronic kidney disease, and prior myocardial infarction, which is in line with previous reports. 17 , 18 , 19 , 28 Furthermore, patients with protruding aortic plaque had higher levels of high‐sensitivity C‐reactive protein and NT‐proBNP, more coronary plaque vulnerability, and experienced more major adverse cardiac and cerebrovascular events. A previous study reported that BNP was strongly associated with pan‐vascular inflammation and atherosclerosis, even in the absence of heart failure.…”

Section: Discussionmentioning

confidence: 99%

Protruding Aortic Plaque and Coronary Plaque Vulnerability

Yuki,

Isselbacher,

Niida

et al. 2024

JAHA

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Background Protruding aortic plaque is known to be associated with an increased risk for future cardiac and cerebrovascular events. However, the relationship between protruding aortic plaque and coronary plaque characteristics has not been systematically investigated. Methods and Results A total of 615 patients who underwent computed tomography angiography, and preintervention optical coherence tomography imaging were included. Coronary plaque characteristics were compared to evaluate coronary plaque vulnerability in patients with protruding aortic plaque on computed tomography angiography. 615 patients, the 186 (30.2%) patients with protruding aortic plaque were older and had more comorbidities such as hypertension, chronic kidney disease, and a prior myocardial infarction than those without. They also had a higher prevalence of coronary plaques with vulnerable features such as thin‐cap fibroatheroma (85 [45.7%] versus 120 [28.0%], P <0.001), lipid‐rich plaque (165 [88.7%] versus 346 [80.7%], P =0.014), macrophages (147 [79.0%] versus 294 [68.5%], P =0.008), layered plaque (117 [62.9%] versus 213 [49.7%], P =0.002), and plaque rupture (96 [51.6%] versus 111 [25.9%], P <0.001). Patients with protruding aortic plaque experienced more major adverse cardiac and cerebrovascular events, including all‐cause mortality, nonfatal acute coronary syndromes, and stroke (27 [14.7%] versus 21 [4.9%], P <0.001; 8 [4.3%] versus 1 [0.2%], P <0.001; 5 [2.7%] versus 3 [0.7%], P =0.030; and 5 [2.7%] versus 2 [0.5%], P =0.013, respectively). Conclusions The current study demonstrates that patients with protruding aortic plaque have more features of coronary plaque vulnerability and are at increased risk of future adverse events.

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“…The number of aortic plaques detected using NOGA is associated with cardiovascular events [ 6 ]. The frequency and number of SRAPs are associated with ischemic stroke [ 7 ]. There are two kinds of scattering-type SRAPs [ 4 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Different Characteristics and Interleukin-6 Ratios of Scattering-Type Aortic Plaques

Komatsu,

Yutani,

Takahashi

et al. 2024

Cureus

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Background Cholesterol crystals (CCs) are related to innate inflammation in spontaneously ruptured aortic plaques (SRAPs), and variability exists in the CCs and interleukin (IL)-6 ratio in SRAPs. Methods The prevalence of scattering-type ruptures that glittered against the light of angioscopic fibers (puff-chandelier ruptures) and those that did not (puff ruptures) was analyzed in 848 patients with suspected coronary artery disease. Overall, 177 puff-chandelier ruptures and 105 puff ruptures were sampled using nonobstructive general angioscopy (NOGA). The sampled plaques were analyzed by direct detection of CCs with polarized light microscopy. The characteristics of the plaque fragments from puff and puff-chandelier ruptures were compared. The Interleukin-6 (IL-6) ratios were calculated for 100 puff-chandelier ruptures and 100 puff ruptures. Results CCs were detected in 54% of puff-chandelier ruptures and 20% of puff ruptures. The longer and shorter dimensions of the puff ruptures were smaller than those of the puff-chandelier ruptures. CCs were more prevalent in puff chandeliers than in puff ruptures (54% vs. 20%, respectively; p<0.0001). The number of CCs was higher in puff chandeliers than in puff ruptures with CCs (median 12,727 (interquartile range (IQR) 3,636-25,909)/10 mL vs. median 3,182 ( IQR 909-9,318)/10 mL) in CC-positive samples (p=0.0120). The IL-6 ratio of puff-chandelier ruptures was higher than that of puff ruptures (p=0.0014). Conclusions Examination of plaque fragments from puff-chandelier and puff ruptures revealed a higher prevalence of CCs in puff-chandelier ruptures compared to puff ruptures. Puff chandeliers exhibited a significantly greater number of CCs, suggesting a potential correlation with inflammatory levels. The IL-6 ratio was also higher in puff-chandelier ruptures. Direct detection of CCs and hematoxylin and eosin staining for SRAPs demonstrated variations in CC degree and dimensions between puff-chandelier and puff ruptures. Puff-chandelier ruptures exhibited more CCs associated with innate inflammation and larger fragments than puff ruptures. NOGA proved effective in detecting diverse characteristics and inflammation levels, as indicated by IL-6, in scattering-type SRAPs.

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Significant Contribution of Aortogenic Mechanism in Ischemic Stroke

Cited by 9 publications

References 28 publications

Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization

Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization

Protruding Aortic Plaque and Coronary Plaque Vulnerability

Different Characteristics and Interleukin-6 Ratios of Scattering-Type Aortic Plaques

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