Jichang Luo1,2, Long Li1,2, Tao Wang1,2, Kun Yang3, Yao Feng1,2, Renjie Yang1,2, Yan Ma1,2, Peng Gao1,2,4, Bin Yang1,2, Liqun Jiao1,2,4. 1. China International Neuroscience Institute (China-INI), Beijing, China. 2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. 3. Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. 4. Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Abstract
Objective: The current study aims to analyze the risk factors of new cerebral infarctions in the distribution of basilar artery (BA) detected by diffusion-weighted imaging (DWI) after endovascular treatment in patients with severe BA stenosis. Methods: Data was collected from the electronic medical records of patients with severely atherosclerotic basilar artery stenosis (≥70%) who underwent endovascular treatment. The plaque characteristics, including the plaque distribution, plaque burden, plaque enhancement index, remodeling ratio, and stenosis degree, were evaluated qualitatively and quantitatively using high-resolution magnetic resonance imaging (HR-MRI) and digital subtraction angiography (DSA). The characteristics of the procedure, such as the type of treatment, balloon diameter, balloon length, stent diameter, and stent length, were analyzed. Results: A total of 107 patients with severe basilar artery stenosis (≥70%) who underwent endovascular treatment were enrolled. The study participants included 77 men and 30 women, with an average age of 61.6 ± 8.1 years. The rate of postoperative new cerebral infarctions was 55.1% (59/107), of which 74.6% (44/59) were caused by artery-to-artery embolism, 6.8% (4/59) due to perforator occlusion, and 18.6% (11/59) were caused by a mixed mechanism. Twelve of 59 patients had ischemic events, with nine cases of stroke and three cases of transient ischemic attacks (TIA). The plaque burden in the DWI-positive group was significantly larger than that in the DWI-negative group (3.7% vs. -8.5%, p = 0.016). Positive remodeling was more common in the DWI-positive group than in the DWI-negative group (35.6% vs. 16.7%, p = 0.028). Smoking was inversely correlated with the rate of new cerebral infarctions (odds ratio, 0.394; 95% confidence interval, 0.167-0.926; p = 0.033). Conclusion: The plaque characteristics are not associated with new cerebral infarctions in the distribution of BA, although a large plaque burden and positive remodeling are more likely to appear in patients with new cerebral infarctions after BA stenting, which warrants further studies with a larger sample size. As for smoking, the inverse correlation with new cerebral infarctions in the BA territory needs large-scale prospective randomized controlled trials to verify.
Objective: The current study aims to analyze the risk factors of new cerebral infarctions in the distribution of basilar artery (BA) detected by diffusion-weighted imaging (DWI) after endovascular treatment in patients with severe BA stenosis. Methods: Data was collected from the electronic medical records of patients with severely atherosclerotic basilar artery stenosis (≥70%) who underwent endovascular treatment. The plaque characteristics, including the plaque distribution, plaque burden, plaque enhancement index, remodeling ratio, and stenosis degree, were evaluated qualitatively and quantitatively using high-resolution magnetic resonance imaging (HR-MRI) and digital subtraction angiography (DSA). The characteristics of the procedure, such as the type of treatment, balloon diameter, balloon length, stent diameter, and stent length, were analyzed. Results: A total of 107 patients with severe basilar artery stenosis (≥70%) who underwent endovascular treatment were enrolled. The study participants included 77 men and 30 women, with an average age of 61.6 ± 8.1 years. The rate of postoperative new cerebral infarctions was 55.1% (59/107), of which 74.6% (44/59) were caused by artery-to-artery embolism, 6.8% (4/59) due to perforator occlusion, and 18.6% (11/59) were caused by a mixed mechanism. Twelve of 59 patients had ischemic events, with nine cases of stroke and three cases of transient ischemic attacks (TIA). The plaque burden in the DWI-positive group was significantly larger than that in the DWI-negative group (3.7% vs. -8.5%, p = 0.016). Positive remodeling was more common in the DWI-positive group than in the DWI-negative group (35.6% vs. 16.7%, p = 0.028). Smoking was inversely correlated with the rate of new cerebral infarctions (odds ratio, 0.394; 95% confidence interval, 0.167-0.926; p = 0.033). Conclusion: The plaque characteristics are not associated with new cerebral infarctions in the distribution of BA, although a large plaque burden and positive remodeling are more likely to appear in patients with new cerebral infarctions after BA stenting, which warrants further studies with a larger sample size. As for smoking, the inverse correlation with new cerebral infarctions in the BA territory needs large-scale prospective randomized controlled trials to verify.
Authors: Osama O Zaidat; Brian-Fred Fitzsimmons; Britton Keith Woodward; Zhigang Wang; Monika Killer-Oberpfalzer; Ajay Wakhloo; Rishi Gupta; Howard Kirshner; J Thomas Megerian; James Lesko; Pamela Pitzer; Jandira Ramos; Alicia C Castonguay; Stanley Barnwell; Wade S Smith; Daryl R Gress Journal: JAMA Date: 2015 Mar 24-31 Impact factor: 56.272
Authors: David Fiorella; Colin P Derdeyn; Michael J Lynn; Stanley L Barnwell; Brian L Hoh; Elad I Levy; Mark R Harrigan; Richard P Klucznik; Cameron G McDougall; G Lee Pride; Osama O Zaidat; Helmi L Lutsep; Michael F Waters; J Maurice Hourihane; Andrei V Alexandrov; David Chiu; Joni M Clark; Mark D Johnson; Michel T Torbey; Zoran Rumboldt; Harry J Cloft; Tanya N Turan; Bethany F Lane; L Scott Janis; Marc I Chimowitz Journal: Stroke Date: 2012-09-13 Impact factor: 7.914
Authors: D Doig; E L Turner; J Dobson; R L Featherstone; R T H Lo; P A Gaines; S Macdonald; L H Bonati; A Clifton; M M Brown Journal: Eur J Vasc Endovasc Surg Date: 2015-10-24 Impact factor: 7.069