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Symptomatic intracranial atherosclerotic disease: an ultrasound 2-year follow-up pilot study

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Abstract

Introduction

The objective of this single-center pilot study was to assess if symptomatic intracranial atherosclerotic disease (ICAD) ultrasound features change through the 2 years after acute ischemic stroke or TIA, being ICAD a relevant cause of acute ischemic stroke or TIA, linked to high rates of recurrent stroke.

Methods

We consecutively enrolled 48 patients with acute ischemic stroke or TIA with symptomatic ICAD detected by transcranial color-coded duplex sonography (TCCS) and confirmed by MR-angiography and/or CT-angiography. We set a neurosonological and clinical follow-up at 3, 6, 12, and 24 months (T0, T1, T2, T3, and T4).

Results

We observed that the hemodynamic effect of the stenosis changed during the 2-year follow-up, as revealed by the modifications of Peak Systolic Velocity (PSV) (Friedman-ANOVA test, p < 0.001). The pairwise post-hoc analysis showed a statistically significant difference between PSV at T0 and PSV at T3 (p = 0.005) and between PSV at T0 and PSV at T4 (p < 0.001) being PSV at T3 and T4 lower than PSV at T0. Seven patients had a new event in the first 12 months.

Conclusions

The high rate of recurrent stroke or death among ICAD patients seems to be independent of progressive arterial narrowing. A wide multicenter follow-up study is needed in order to identify the factors that, alongside the hemodynamic features, contribute to the high risk of recurrent stroke among patient with symptomatic ICAD.

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References

  1. Holmstedt CA, Turan TN, Chimowitz MI (2013) Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol 12:1106–1114

    Article  Google Scholar 

  2. Famakin BM, Chimowitz MI, Lynn MJ, Stern BJ, George MG, for the WASID Trial Investigators (2009) Causes and severity of ischemic stroke in patients with symptomatic intracranial arterial stenosis. Stroke 40:1999–2003

    Article  Google Scholar 

  3. Liu L, Wong KS, Leng X et al (2015) Dual antiplatelet therapy in stroke and ICAS: subgroup analysis of CHANCE. Neurology 85:1154–1662

    Article  CAS  Google Scholar 

  4. Zhao L, Barlinn K, Sharma VK, Tsivgoulis G, Cava LF, Vasdekis SN, Teoh HL, Triantafyllou N, Chan BPL, Sharma A, Voumvourakis K, Stamboulis E, Saqqur M, Harrigan MR, Albright KC, Alexandrov AV (2011) Velocity criteria for intracranial stenosis revisited: an international multicenter study of transcranial Doppler and digital subtraction angiography. Stroke 42:3429–3434

    Article  Google Scholar 

  5. Baumgartner RW, Mattle HP, Schroth G (1999) Assessment of >50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 30:87–92

    Article  CAS  Google Scholar 

  6. Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, Smith HH, Nichols F, Rogg J, Cloft HJ, Wechsler L, Saver J, Levine SR, Tegeler C, Adams R, Sloan M, The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators (2007) The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial. Neurology 68:2099–2106

    Article  CAS  Google Scholar 

  7. Liebeskind DS, Kosinski AS, Saver JL et al (2014) Computed tomography angiography in the stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) study. Interv Neurol 4:153–159

    Google Scholar 

  8. Baracchini C, Anzola GP, Cenciarelli S, Diomedi M, Bella R, Tonon A, Braga M, Zedde ML, Zanferrari C, del Sette M, Caliandro P, Gandolfo C, Ricci S, Meneghetti G (2016) Italian symptomatic intracranial atherosclerosis study (ISIDE). Neurol Sci 37:1645–1651

    Article  Google Scholar 

  9. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE (1993) Classification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial. Stroke 24:35–41

    Article  Google Scholar 

  10. Valdueza JM, Schreiber SJ, Roehl J, Klingebiel R (2008). Neurosonology and neuroimaging of stroke. Thieme, New York 76–109

  11. Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV (2001) Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke 32:89–93

    Article  CAS  Google Scholar 

  12. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall C, Johnson MD, Pride GL Jr, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ, SAMMPRIS Trial Investigators (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003

    Article  CAS  Google Scholar 

  13. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chaturvedi S, Kasner SE, Benesch CG, Sila CA, Jovin TG, Romano JG, Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316

    Article  CAS  Google Scholar 

  14. Wu F, Song H, Ma Q, Xiao J, Jiang T, Huang X, Bi X, Guo X, Li D, Yang Q, Ji X, Fan Z, on behalf of the WISP Investigators† (2018) Hyperintense plaque on intracranial vessel wall magnetic resonance imaging as a predictor of artery-to-artery embolic infarction. Stroke 49:905–911

    Article  Google Scholar 

  15. Lonn E, Yusuf S, Dzavik V, Doris C, Yi Q, Smith S, Moore-Cox A, Bosch J, Riley W, Teo K, SECURE Investigators (2001) Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Circulation 103:919–925

    Article  CAS  Google Scholar 

  16. Yusuf S, Sleight P, Pogue J et al (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 342:145–153

    Article  CAS  Google Scholar 

  17. Yamada K, Yoshimura S, Kawasaki M, Enomoto Y, Asano T, Minatoguchi S, Iwama T (2009) Effects of atorvastatin on carotid atherosclerotic plaques: a randomized trial for quantitative tissue characterization of carotid atherosclerotic plaques with integrated backscatter ultrasound. Cerebrovasc Dis 28:417–424

    Article  CAS  Google Scholar 

  18. Tsivgoulis G, Safouris A, Kim DE, Alexandrov AV (2018) Recent advances in primary and secondary prevention of atherosclerotic stroke. J Stroke 20:145–166

    Article  Google Scholar 

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Authors and Affiliations

  1. Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Rome, Italy

    Pietro Caliandro

  2. Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy

    Giuseppe Reale & Paolo Maria Rossini

  3. Hotchkiss Brain Institute, Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Canada

    Andrew M. Demchuk

  4. Division of Cardiovascular Medicine, Stroke Unit, University of Perugia, Perugia, Italy

    Valeria Caso

  5. University Clinic of Neurology, Skopje, Macedonia

    Anita Arsovska

  6. Fondazione Don Carlo Gnocchi Onlus, Milan, Italy

    Chiara Iacovelli

  7. Unità Operativa Complessa Riabilitazione 2, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Rome, Italy

    Silvia Giovannini

Authors
  1. Pietro Caliandro
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  2. Giuseppe Reale
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  3. Andrew M. Demchuk
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  4. Valeria Caso
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  5. Anita Arsovska
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  6. Chiara Iacovelli
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  7. Silvia Giovannini
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  8. Paolo Maria Rossini
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Corresponding author

Correspondence to Pietro Caliandro.

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Caliandro, P., Reale, G., Demchuk, A.M. et al. Symptomatic intracranial atherosclerotic disease: an ultrasound 2-year follow-up pilot study. Neurol Sci 39, 1955–1959 (2018). https://doi.org/10.1007/s10072-018-3484-1

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  • DOI: https://doi.org/10.1007/s10072-018-3484-1

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