Luminal and Wall Changes in Intracranial Arterial Lesions for Predicting Stroke Occurrence
| Autor: | Gyeong-Moon Kim, Woo-Keun Seo, Ye Sel Kim, Jong-Won Chung, Eun-Hyeok Choi, Hyung Jun Kim, Oh Young Bang, Jae-Hwan Kim |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Stroke recurrence 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans In patient Prospective Studies Stroke Advanced and Specialized Nursing business.industry Asia Eastern Gold standard (test) Middle Aged medicine.disease Magnetic Resonance Imaging Stenosis Embolism Carotid artery.internal Cardiology Female Neurology (clinical) Endothelium Vascular Intracranial Arterial Diseases Moyamoya Disease Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Stroke. 51(8) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose: Luminal imaging (degree of stenosis) currently serves as the gold standard to predict stroke recurrence and guide therapeutic strategies in patients with intracranial large artery diseases (ILADs). We comparatively evaluated the importance of vessel wall and luminal changes in predicting stroke occurrence. Methods: Consecutive patients with ILAD in the proximal middle cerebral artery or distal internal carotid artery without proximal sources of embolism from the carotid and heart underwent time-of-flight magnetic resonance angiography, high-resolution magnetic resonance imaging, and the ring finger protein 213 ( RNF213 ) gene variant test. Patients were followed up for >3 months. Results: Of the 675 patients, 241 (35.7%) had atherosclerotic ILAD and 434 (64.3%) showed nonatherosclerotic ILAD (315 [46.7%] moyamoya disease cases and 119 [17.6%] dissection cases). The RNF213 variant was detected in 74.9%, 33.6%, and 3.4% patients with moyamoya disease, atherosclerosis, and dissection, respectively. Three hundred (44.4%) patients had asymptomatic ILAD, whereas 375 (55.6%) patients had symptomatic ILAD. Multivariate analysis showed that vessel enhancement and etiological subtypes, not degree of stenosis, determined by high-resolution magnetic resonance imaging and RNF213 gene variant analysis were independently associated with symptomatic ILAD. The presence of the RNF213 variant was also independently associated with recurrent cerebrovascular events. Conclusions: This study demonstrates the prevalence of nonatherosclerotic ILAD in East Asian patients with ILAD. Unlike luminal changes, wall changes determined by high-resolution magnetic resonance imaging and presence of the RNF213 variant could predict stroke occurrence in patients with ILADs. |
| Databáze: | OpenAIRE |
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