No abstract available.
Intracranial Arteriosclerosis*

BACKGROUND: The ankle brachial index (ABI) is a useful screening tool for peripheral arterial disease. It has been documented that the cerebral atherosclerosis is more frequent in stroke patients with abnormal ABI than in those with normal ABI. The present study compared the different calculation methods of ABI for coexistent intracranial and extracranial arterial stenosis (IECAS) in ischemic stroke. METHODS: We reviewed the data of patients admitted for acute ischemic stroke or transient ischemic attack. The following four distinct ABIs were calculated: the ratio of the higher (ABI-H), lower (ABI-L), or either of the systolic blood pressures (SBPs) of the posterior tibial (ABI-PT) and dorsalis pedis (ABI-DP) arteries relative to the higher of the brachial SBP. We compared the values of these four ABI measures relative to the presence of any IECAS using receiver operating characteristic (ROC) curve analysis. RESULTS: ABI-H, ABI-L, ABI-PT, and ABI-DP were abnormal (≤ 0.9) in 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%) of 145 patients, respectively. The area under the ROC curve was significantly larger for ABI-H, ABI-L, and ABI-DP than for ABI-PT for any type of IECAS. The extracranial stenosis was more frequent when any of the four ABIs was abnormal, while intracranial stenosis was not correlated with the four ABIs. The IECAS was more frequent for abnormal ABI-H and ABI-DP than for normal ABIs. CONCLUSIONS: Our studies suggested that ABIs based on a higher SBP of the PT or DP (i.e., ABI-H) are more strongly associated with the presence of IECAS than are those using the SBP of the PT (ABI-PT). Extracranial artery stenosis seems to be more strongly associated with ABI than is intracranial stenosis.
Ankle Brachial Index* ; Ankle* ; Arteries* ; Atherosclerosis ; Constriction, Pathologic* ; Humans ; Intracranial Arteriosclerosis ; Ischemic Attack, Transient ; Mass Screening ; Methods* ; Peripheral Arterial Disease ; ROC Curve ; Stroke*

No abstract available.
Arteries ; Intracranial Arteriosclerosis

PURPOSE: To determine differences in angiographic variations of the circle of Willis between atherosclerosis and normal groups. MATERIALS AND METHODS: In 289 patients we reviewed complete cerebral angiograms obtained using biplane digital subtraction angiography. Atherosclerosis was diagnosed in 189 patients, while 100 were normal. Patients were divided into four subgroups according to the relative size of each segment and the presence of cross-filling of opposite-sided vessels. When the circle was completely present, we determined whether or not it was balanced, and statistically compared variation patterns between the two groups. RESULTS: In the atherosclerosis group, the anterior half of the circle was complete in 74% of cases(139/189), and the posterior half in 38% (72/189). In the normal group, the anterior half was complete in 90% of cases, and the posterior half in 63%. An incomplete circle was more common in the atherosclerosis group than among normal subjects (26% vs 10%, p<.05; 62% vs 37%, p<.001). In the atherosclerosis group with incomplete circle, agenesis was found in the anterior communicating artery in 19% of cases (36/189), the A1 segment in 7% (14/189), the posterior communicating artery in 58% (109/189), and the P1 segment in 7% (14/189). In the normal group with incomplete circle, agenesis was seen in the anterior communicating artery in 9% of cases, in the A1 segment in 1%, in the posterior communicating artery in 36%, and in the P1 segment in 3%. Agenesis of the anterior communicating artery (19% vs 9%, p<.05), the A1 segment (7% vs 1%, p<.05), or the posterior communicating artery (58% vs 36%, p<.001) was more common in the atherosclerosis group than in the normal group. Unbalanced type with a size discrepancy between A1 segments was also more common in the atherosclerosis group (19% vs 8%, p<.05). There was no significant difference between the two groups regarding posterior communicating arteries equal to or larger than the P1 segment (42% vs 27%, p>.05) and agenesis of the P1 segment (7% vs 3%, p>.05). CONCLUSION: An incomplete and unbalanced circle of Willis was more common in the atherosclerosis group than in the normal group. Agenesis of the anterior communicating artery, the A1 segment, or the posterior communicating artery was common in the atherosclerosis group, as was size discrepancy between A1 segments.
Angiography, Digital Subtraction ; Arteries ; Atherosclerosis* ; Circle of Willis* ; Humans ; Intracranial Arteriosclerosis

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.
Angiography ; Arteries ; Arteriosclerosis ; Atherosclerosis ; Cause of Death ; Coronary Angiography* ; Coronary Artery Bypass ; Diabetes Mellitus ; Extremities ; Heart ; Heart Diseases ; Hospitalization ; Humans ; Hypercholesterolemia ; Hypertension ; Lower Extremity* ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Peripheral Vascular Diseases ; Risk Factors ; Smoke ; Smoking

Atherosclerosis is a systemic and multifactorial disease, its incidence is raised recently. Cerebral and coronary atherosclerosis have some similar pathogenesis, but their relationship and mechanisms are still remain unclear. Intimal neovascularization in the atherosclerotic plaque was focused with respect to its pathological roles, intimal thickening and atherosclerotic progression. Ang-2, which is an angiogenesis regulating factor, provides a destabilizing signal for endothelial cells, leading to vessel regression or sprouting. However the role and distribution of Ang-2 in atherosclerotic coronary and cerebral arteries are still not well known. Thus, we analyzed 1) atherosclerotic lesion progression 2) relationship of atherosclerosis to Ang-2 expression in human middle cerebral and coronary artery. Paraffin sections from 25 human coronary (COA) and 36 middle cerebral arteries (MCA) were characterized according to AHA classification. In the same person, the score of atherosclerosis progression in COA was higher than that of MCA. In the two kinds of arteries having same atherosclerotic progression, the degree of intimal proliferation and luminal stenosis in COA was higher than that of MCA. Expression of Ang-2 was not shown in normal artery but localized in lumen-lining endothelium, macrophage in preatheroma, atheroma and complicated lesion. Ang-2 expression and infiltration of macrophages were rich in COA than MCA. Our result indicated that cerebral atherosclerosis has some different pathogenic mechanisms with coronary atherosclerosis according to difference of progression and angiogenic factor Ang-2 expression. Thus this is a fundamental study for understanding the progression of atherosclerosis in different vascular beds.
Angiogenesis Inducing Agents ; Angiopoietin-2* ; Arteries ; Atherosclerosis* ; Cerebral Arteries ; Classification ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels* ; Endothelial Cells ; Endothelium ; Humans ; Incidence ; Intracranial Arteriosclerosis ; Macrophages ; Middle Cerebral Artery ; Paraffin ; Phenobarbital ; Plaque, Atherosclerotic

Preoperative evaluation of precise aneurysmal geometry is important for the treatment of intracranial aneurysms. We present two cases of unclippable side wall aneurysms due to their extremely low dome height, which appeared as saccular in the preoperative image because of a comparatively narrow atherosclerotic parent arterial lumen. In both cases, a calcified vessel wall was noted preoperatively. Lack of a definitive neck and abrupt discrepancy between the fragile aneurysmal wall and the atherosclerotic parent arterial wall was confirmed intraoperatively in both cases. This study describes an illustrative mechanism for the finding with emphasis on the importance of its preoperative diagnosis. Intracranial atherosclerosis associated with small side walled aneurysms may lead to overestimation of aneurysm height on preoperative imaging of the intravascular compartment.
Aneurysm* ; Angiography* ; Arteries* ; Atherosclerosis ; Diagnosis ; Humans ; Intracranial Aneurysm ; Intracranial Arteriosclerosis ; Neck ; Parents*

BACKGROUND: The patients with familial hypercholesterolemia (FH) suffer from early onset atherosclerotic vascular disease due to high level of cholesterol and subsequent vascular inflammation, especially in the form of coronary artery disease. We investigated the clinical characteristics of FH associated cerebral infarction and its possible mechanism. METHODS: Between January 2014 and May 2017, acute cerebral infarction patients who admitted to Chung-Ang University Hospital were reviewed from stroke registry and the diagnosis of FH was made based on the Dutch Lipid Clinic Network Diagnostic Criteria for FH. We reviewed their initial laboratory and brain imaging information, prescribed medication and followed lipid profile after discharge. Stroke mechanism was determined based on Trial of ORG 10172 in Acute Stroke Treatment classification. RESULTS: Among 1,401 acute cerebral infarction or transient ischemic attack patients, one probable and three possible FH stroke patients were detected. All the patients denied of previous coronary artery disease history and initial lipid panel revealed high levels of total cholesterol (378±75 mg/dL) and low-density lipoprotein-cholesterol (238±56 mg/dL). Stroke mechanisms were heterogeneous, including one atherosclerotic, two vertebral artery dissection cases and one coagulation disorder. All the patients were combined with noticeable degree of intracranial atherosclerosis and were maintained with statin treatment. CONCLUSIONS: This study illustrates diverse stroke mechanism among stroke patients with FH. Further research is required to disclose exact incidence of FH among stroke population and effective treatment strategy.
Atherosclerosis ; Cerebral Infarction ; Cholesterol ; Classification ; Coronary Artery Disease ; Diagnosis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperlipoproteinemia Type II ; Incidence ; Inflammation ; Intracranial Arteriosclerosis ; Ischemic Attack, Transient ; Neuroimaging ; Stroke ; Vascular Diseases ; Vertebral Artery Dissection

Intracranial large artery disease (ILAD) is the major cause of stroke worldwide. With the application of recently introduced diagnostic techniques, the prevalence of non-atherosclerotic ILAD is expected to increase. Herein, we reviewed recent reports and summarized progress in the diagnosis and clinical impact of differentiation between ILAD of atherosclerotic and non-atherosclerotic origin. Our review of the literature suggests that more careful consideration of non-atherosclerotic causes and the application of appropriate diagnostic techniques in patients with ILAD may not only provide better results in the treatment of patients, but it may also lead to more successful clinical trials for the treatment of intracranial atherosclerosis.
Arteries* ; Atherosclerosis ; Constriction, Pathologic ; Diagnosis ; Humans ; Intracranial Arteriosclerosis ; Magnetic Resonance Imaging ; Prevalence ; Stroke