Stroke Mechanisms

Wong, Kin Sun; Caplan, Louis R.; Kim, Jong Seung

doi:10.1002/9781444300673.ch5

Cited by 13 publications

(17 citation statements)

References 50 publications

(57 reference statements)

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“…Even though atherosclerosis within intracranial arteries possesses distinct features by virtue of unique anatomy and hemodynamics in the intracranial vascular system, the course of atherogenesis may be based on the general mechanism (D'Armiento et al, ; Elkind, ; Kiechl & Willeit, ). Normally, atherogenesis in intracranial arteries engages with a series of systemic and local lipid‐driven inflammatory activities (Wong, Caplan, & Kim, ; Wu, Li, Hou, & Chu, ). Chronic systemic inflammation may exacerbate the progression of ICAS via the activation of endothelial injury and inflammatory cells within cerebral arteries (Chen & Fisher, ; Wong et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Normally, atherogenesis in intracranial arteries engages with a series of systemic and local lipid‐driven inflammatory activities (Wong, Caplan, & Kim, ; Wu, Li, Hou, & Chu, ). Chronic systemic inflammation may exacerbate the progression of ICAS via the activation of endothelial injury and inflammatory cells within cerebral arteries (Chen & Fisher, ; Wong et al, ). Additionally, local inflammatory infiltration evolving a fate of macrophages may increase the vulnerability of atherosclerotic plaques, which results in the rupture of plaques and subsequent thrombotic events (Hilgendorf, Swirski, & Robbins, ; Moore, Sheedy, & Fisher, ; Wong et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Inflammation‐regulatory microRNAs: Valuable targets for intracranial atherosclerosis

Chen

2019

J of Neuroscience Research

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Intracranial atherosclerosis (ICAS) is the most common etiology of ischemic stroke with the highest rate of stroke recurrence. Little is currently known of the association of circulating inflammation-regulatory microRNAs (miRNAs) with ICAS. In this review, we briefly discuss that ICAS is characterized as a dynamic and unstable inflammatory process within intracranial arteries. Then, as a topic of discussion, we mainly concentrate on the following crucial miRNAs (miR-155, miR-27a/b, miR-342-5p, miR-21, miR-124, and miR-223) by virtue of their multiple roles in regulating the progression of atherosclerosis involved with systemic and local inflammatory activities in cerebral arteries. Clinical perspectives of other miRNAs (miR-146a, miR-181b, miR-126, miR-143, and let-7b) in ICAS are also mentioned. In relevance to the inflammatory mechanisms of ICAS, the in-depth knowledge of miRNAs engaged in the progression of intracranial atherosclerotic plaques may provide an approach to a more precise exploration of diagnostic and therapeutic targets for ICAS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inflammation‐regulatory microRNAs: Valuable targets for intracranial atherosclerosis

Chen

2019

J of Neuroscience Research

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“…3 Patients with thrombotic atherosclerotic plaques may develop progressive occlusion, and this may result in hypoperfusion and regional artery-to-artery embolism within the vascular territory. 4 Neurological status in such patients is usually dependent on both the degree of collateral blood supply to the occluded vascular territory and the amount of potentially salvageable ischemic brain tissue, ie, the ischemic penumbra. The amount can be judged clinically by a mismatch in diffusion-perfusion or diffusion-symptom in the ischemic tissue and appears to identify patients with stroke who are more likely to respond to delayed intra-arterial recanalization, that is, recanalization performed beyond the currently recommended 6-hour time limit.…”

mentioning

confidence: 99%

Intracranial Stenting of Subacute Symptomatic Atherosclerotic Occlusion Versus Stenosis

Lü

Park²,

Park³

et al. 2011

Stroke

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Background and Purpose-Limited data are available concerning the outcome of angioplasty/stenting for subacute atherosclerotic intracranial artery occlusion, which is often associated with progressive symptom development in the salvageable brain under ischemic threat due to poor collateral blood supply. Methods-Among 177 patients who underwent angioplasty and/or stenting for severe symptomatic intracranial stenoocclusion, 26 had subacute atherosclerotic intracranial artery occlusion. Outcome after stenting (Nϭ22) was assessed according to procedural success (return of antegrade flow and residual stenosis Ͻ50%), adverse event (any stroke or death) rate, and restenosis (Ͼ50%) using weighted Cox proportional hazards regression in the overall cohort and in separate subgroups. Results-Successful recanalization was achieved in 95%. Three adverse events (13.6%) occurred among patients undergoing stenting for occlusion, including 2 major strokes and 1 nonprocedure-related death. Good outcome (modified Rankin Scale Յ2) was achieved in 73%. In the overall cohort, no significant difference was observed between the occlusion and stenosis groups in terms of the risk of adverse events (hazard ratio for the occlusion group, 1.055; 95% CI, 0.29 -3.90) or the risk of restenosis (hazard ratio for the occlusion group, 1.2; 95% CI, 0.19 -7.72). A trend toward a higher rate of adverse events was observed in older age (Ͼ65 years), progressive worsening, balloon-expandable stent, and no history of a preprocedural P2Y12 assay. Conclusions-In a cohort of patients undergoing angioplasty/stenting for subacute atherosclerotic intracranial artery occlusion, no significant difference in the rates of adverse events was observed. However, several factors, including age, tended to be associated with a higher event rate. (Stroke. 2011;42:3470-3476.)

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“…In addition, patients with MCA occlusion may have disabling cognitive impairment, especially for those with bilateral diseases. 5 For our two patients, the etiology of their recurrent TIAs was likely to be hemodynamic impairment from total MCA occlusion, arising from atherosclerotic stenosis and superimposed thrombosis based on angiographic findings. The optimal management of them was controversial.…”

Section: Discussionmentioning

confidence: 87%

Endovascular recanalization for chronic symptomatic middle cerebral artery total occlusion

Gao

et al. 2012

J NeuroIntervent Surg

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The optimal treatment of chronic middle cerebral artery (MCA) occlusion is unclear. Angioplasty and stenting may be an alternative treatment for patients with recurrent ischemic symptoms despite medical therapy. Two patients with chronic right MCA occlusion successfully treated with stenting are reported, together with their long term follow-up to illustrate the feasibility of endovascular recanalization. One patient remained asymptomatic at the 29-month follow-up. Another patient developed symptomatic in-stent restenosis at 12 months which resolved after repeat angioplasty. Further larger scale pilot studies are needed to determine the efficacy and long term outcome of this treatment.

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Stroke Mechanisms

Cited by 13 publications

References 50 publications

Inflammation‐regulatory microRNAs: Valuable targets for intracranial atherosclerosis

Inflammation‐regulatory microRNAs: Valuable targets for intracranial atherosclerosis

Intracranial Stenting of Subacute Symptomatic Atherosclerotic Occlusion Versus Stenosis

Endovascular recanalization for chronic symptomatic middle cerebral artery total occlusion

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