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Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection
Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD. Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were rev...
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| Published in: | Journal of the neurological sciences 2018-05, Vol.388, p.23-27 |
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| creator | Matsubara, Soichiro Koga, Masatoshi Ohara, Tomoyuki Iguchi, Yasuyuki Minatoya, Kenji Tahara, Yoshio Fukuda, Tetsuya Miyazaki, Yuichi Kajimoto, Katsufumi Sakamoto, Yuki Makita, Naoki Tokuda, Naoki Nagatsuka, Kazuyuki Ando, Yukio Toyoda, Kazunori |
| description | Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD.
Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset.
Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P |
| doi_str_mv | 10.1016/j.jns.2018.02.044 |
| format | article |
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Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset.
Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P < 0.001). There was no difference between the groups regarding whether it was perforator or cortical infarct, single or multiple infarcts, unilateral or bilateral infarcts, or ischemic change extension. On the MRA imaging, the AAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47% vs. 6%, P < 0.001). After adjustment for sex, age and confounding factors, the right ACA territory infarct [odds ratio (OR), 12.2; 95% confidence interval (CI), 1.4–119.4], the MCA territory infarct (OR, 4.9; 95% CI, 1.0–25.0) and poor visualization of the right ICA (OR, 18.1; 95% CI, 4.0–101.9) were independently associated with AAD.
In emergency AIS/TIA patients, right anterior circulation infarct and poor visualization of the right ICA on cerebrovascular imaging are potential imaging markers of AAD.
•Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA).•The present study was assessed imaging characteristics on MRI in emergency AIS/TIA patients.•Right MCA infarct and poor visualization of the right ICA were independently associated with AAD.•All AAD patients with poor visualization of right ICA had the ipsilateral CCA abnormality (intimal flap or occlusion).•These imaging characteristics can be the key to detect AAD in AIS/TIA patients of candidate for IV rt-PA therapy.</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2018.02.044</identifier><identifier>PMID: 29627025</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Aneurysm, Dissecting - complications ; Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - therapy ; Aortic Aneurysm - complications ; Aortic Aneurysm - diagnostic imaging ; Aortic Aneurysm - therapy ; Aortic dissection ; Carotid Artery, Internal - diagnostic imaging ; Cerebral Angiography ; Cerebral Arteries - diagnostic imaging ; Cerebral infarction ; Clinical Trials as Topic ; Diffusion Magnetic Resonance Imaging ; Emergency Medical Services ; Female ; Humans ; Imaging ; Imaging, Three-Dimensional ; Infarction, Middle Cerebral Artery - complications ; Infarction, Middle Cerebral Artery - diagnostic imaging ; Infarction, Middle Cerebral Artery - therapy ; Ischemic Attack, Transient - complications ; Ischemic Attack, Transient - diagnostic imaging ; Ischemic Attack, Transient - therapy ; Magnetic Resonance Angiography ; Male ; MRI ; Retrospective Studies ; Stroke ; Thrombolysis</subject><ispartof>Journal of the neurological sciences, 2018-05, Vol.388, p.23-27</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c590t-d3a40440aaf6873ea2394a4e9aa5a653b7c8c78b188c51f89f29d538cd648b203</citedby><cites>FETCH-LOGICAL-c590t-d3a40440aaf6873ea2394a4e9aa5a653b7c8c78b188c51f89f29d538cd648b203</cites><orcidid>0000-0002-7905-1067 ; 0000-0001-8353-1787 ; 0000-0002-6758-4026</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29627025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matsubara, Soichiro</creatorcontrib><creatorcontrib>Koga, Masatoshi</creatorcontrib><creatorcontrib>Ohara, Tomoyuki</creatorcontrib><creatorcontrib>Iguchi, Yasuyuki</creatorcontrib><creatorcontrib>Minatoya, Kenji</creatorcontrib><creatorcontrib>Tahara, Yoshio</creatorcontrib><creatorcontrib>Fukuda, Tetsuya</creatorcontrib><creatorcontrib>Miyazaki, Yuichi</creatorcontrib><creatorcontrib>Kajimoto, Katsufumi</creatorcontrib><creatorcontrib>Sakamoto, Yuki</creatorcontrib><creatorcontrib>Makita, Naoki</creatorcontrib><creatorcontrib>Tokuda, Naoki</creatorcontrib><creatorcontrib>Nagatsuka, Kazuyuki</creatorcontrib><creatorcontrib>Ando, Yukio</creatorcontrib><creatorcontrib>Toyoda, Kazunori</creatorcontrib><title>Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD.
Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset.
Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P < 0.001). There was no difference between the groups regarding whether it was perforator or cortical infarct, single or multiple infarcts, unilateral or bilateral infarcts, or ischemic change extension. On the MRA imaging, the AAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47% vs. 6%, P < 0.001). After adjustment for sex, age and confounding factors, the right ACA territory infarct [odds ratio (OR), 12.2; 95% confidence interval (CI), 1.4–119.4], the MCA territory infarct (OR, 4.9; 95% CI, 1.0–25.0) and poor visualization of the right ICA (OR, 18.1; 95% CI, 4.0–101.9) were independently associated with AAD.
In emergency AIS/TIA patients, right anterior circulation infarct and poor visualization of the right ICA on cerebrovascular imaging are potential imaging markers of AAD.
•Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA).•The present study was assessed imaging characteristics on MRI in emergency AIS/TIA patients.•Right MCA infarct and poor visualization of the right ICA were independently associated with AAD.•All AAD patients with poor visualization of right ICA had the ipsilateral CCA abnormality (intimal flap or occlusion).•These imaging characteristics can be the key to detect AAD in AIS/TIA patients of candidate for IV rt-PA therapy.</description><subject>Aged</subject><subject>Aneurysm, Dissecting - complications</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - therapy</subject><subject>Aortic Aneurysm - complications</subject><subject>Aortic Aneurysm - diagnostic imaging</subject><subject>Aortic Aneurysm - therapy</subject><subject>Aortic dissection</subject><subject>Carotid Artery, Internal - diagnostic imaging</subject><subject>Cerebral Angiography</subject><subject>Cerebral Arteries - diagnostic imaging</subject><subject>Cerebral infarction</subject><subject>Clinical Trials as Topic</subject><subject>Diffusion Magnetic Resonance Imaging</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>Imaging, Three-Dimensional</subject><subject>Infarction, Middle Cerebral Artery - complications</subject><subject>Infarction, Middle Cerebral Artery - diagnostic imaging</subject><subject>Infarction, Middle Cerebral Artery - therapy</subject><subject>Ischemic Attack, Transient - complications</subject><subject>Ischemic Attack, Transient - diagnostic imaging</subject><subject>Ischemic Attack, Transient - therapy</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>MRI</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Thrombolysis</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kDFP7DAQhC0EgnvAD6BBLmkS1nacOKJCJ3jvSQgakOisjbMBn3LJYSdI_HsMB5RUW-zMaOZj7ERALkCU56t8NcRcgjA5yByKYocthKlMpo1Ru2wBIGWmBTwesD8xrgCgNKbeZweyLmUFUi_Y7ZICNWF8xejmHgP3a3zywxMfO-4-X9hzH90zrT1yP3B080R8etsQv-Q4hsk73voYyU1-HI7YXod9pOOve8gerq_ul_-ym7u__5eXN5nTNUxZq7BIdQGxK02lCKWqCyyoRtRYatVUzrjKNMIYp0Vn6k7WrVbGtWVhGgnqkJ1tczdhfJkpTnadSlLf40DjHK0EqQqhQagkFVupC2OMgTq7CWlkeLMC7AdGu7IJo_3AaEHa1Ct5Tr_i52ZN7Y_jm1sSXGwFlEa-ego2Ok-Do9aHRMK2o_8l_h3BKoLF</recordid><startdate>20180515</startdate><enddate>20180515</enddate><creator>Matsubara, Soichiro</creator><creator>Koga, Masatoshi</creator><creator>Ohara, Tomoyuki</creator><creator>Iguchi, Yasuyuki</creator><creator>Minatoya, Kenji</creator><creator>Tahara, Yoshio</creator><creator>Fukuda, Tetsuya</creator><creator>Miyazaki, Yuichi</creator><creator>Kajimoto, Katsufumi</creator><creator>Sakamoto, Yuki</creator><creator>Makita, Naoki</creator><creator>Tokuda, Naoki</creator><creator>Nagatsuka, Kazuyuki</creator><creator>Ando, Yukio</creator><creator>Toyoda, Kazunori</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7905-1067</orcidid><orcidid>https://orcid.org/0000-0001-8353-1787</orcidid><orcidid>https://orcid.org/0000-0002-6758-4026</orcidid></search><sort><creationdate>20180515</creationdate><title>Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection</title><author>Matsubara, Soichiro ; Koga, Masatoshi ; Ohara, Tomoyuki ; Iguchi, Yasuyuki ; Minatoya, Kenji ; Tahara, Yoshio ; Fukuda, Tetsuya ; Miyazaki, Yuichi ; Kajimoto, Katsufumi ; Sakamoto, Yuki ; Makita, Naoki ; Tokuda, Naoki ; Nagatsuka, Kazuyuki ; Ando, Yukio ; Toyoda, Kazunori</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c590t-d3a40440aaf6873ea2394a4e9aa5a653b7c8c78b188c51f89f29d538cd648b203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aneurysm, Dissecting - complications</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - therapy</topic><topic>Aortic Aneurysm - complications</topic><topic>Aortic Aneurysm - diagnostic imaging</topic><topic>Aortic Aneurysm - therapy</topic><topic>Aortic dissection</topic><topic>Carotid Artery, Internal - diagnostic imaging</topic><topic>Cerebral Angiography</topic><topic>Cerebral Arteries - diagnostic imaging</topic><topic>Cerebral infarction</topic><topic>Clinical Trials as Topic</topic><topic>Diffusion Magnetic Resonance Imaging</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging</topic><topic>Imaging, Three-Dimensional</topic><topic>Infarction, Middle Cerebral Artery - complications</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - therapy</topic><topic>Ischemic Attack, Transient - complications</topic><topic>Ischemic Attack, Transient - diagnostic imaging</topic><topic>Ischemic Attack, Transient - therapy</topic><topic>Magnetic Resonance Angiography</topic><topic>Male</topic><topic>MRI</topic><topic>Retrospective Studies</topic><topic>Stroke</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Matsubara, Soichiro</creatorcontrib><creatorcontrib>Koga, Masatoshi</creatorcontrib><creatorcontrib>Ohara, Tomoyuki</creatorcontrib><creatorcontrib>Iguchi, Yasuyuki</creatorcontrib><creatorcontrib>Minatoya, Kenji</creatorcontrib><creatorcontrib>Tahara, Yoshio</creatorcontrib><creatorcontrib>Fukuda, Tetsuya</creatorcontrib><creatorcontrib>Miyazaki, Yuichi</creatorcontrib><creatorcontrib>Kajimoto, Katsufumi</creatorcontrib><creatorcontrib>Sakamoto, Yuki</creatorcontrib><creatorcontrib>Makita, Naoki</creatorcontrib><creatorcontrib>Tokuda, Naoki</creatorcontrib><creatorcontrib>Nagatsuka, Kazuyuki</creatorcontrib><creatorcontrib>Ando, Yukio</creatorcontrib><creatorcontrib>Toyoda, Kazunori</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matsubara, Soichiro</au><au>Koga, Masatoshi</au><au>Ohara, Tomoyuki</au><au>Iguchi, Yasuyuki</au><au>Minatoya, Kenji</au><au>Tahara, Yoshio</au><au>Fukuda, Tetsuya</au><au>Miyazaki, Yuichi</au><au>Kajimoto, Katsufumi</au><au>Sakamoto, Yuki</au><au>Makita, Naoki</au><au>Tokuda, Naoki</au><au>Nagatsuka, Kazuyuki</au><au>Ando, Yukio</au><au>Toyoda, Kazunori</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2018-05-15</date><risdate>2018</risdate><volume>388</volume><spage>23</spage><epage>27</epage><pages>23-27</pages><issn>0022-510X</issn><eissn>1878-5883</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD.
Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset.
Seventeen AAD and 249 non-AAD patients were identified. Compared to non-AAD patients, AAD patients had infarcts more frequently in the right anterior cerebral artery (ACA) territory (18% vs. 2%, P = 0.007) and the right middle cerebral artery (MCA) territory (71% vs. 29%, P < 0.001). There was no difference between the groups regarding whether it was perforator or cortical infarct, single or multiple infarcts, unilateral or bilateral infarcts, or ischemic change extension. On the MRA imaging, the AAD patients more frequently had poor visualization of the right internal carotid artery (ICA) (47% vs. 6%, P < 0.001). After adjustment for sex, age and confounding factors, the right ACA territory infarct [odds ratio (OR), 12.2; 95% confidence interval (CI), 1.4–119.4], the MCA territory infarct (OR, 4.9; 95% CI, 1.0–25.0) and poor visualization of the right ICA (OR, 18.1; 95% CI, 4.0–101.9) were independently associated with AAD.
In emergency AIS/TIA patients, right anterior circulation infarct and poor visualization of the right ICA on cerebrovascular imaging are potential imaging markers of AAD.
•Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA).•The present study was assessed imaging characteristics on MRI in emergency AIS/TIA patients.•Right MCA infarct and poor visualization of the right ICA were independently associated with AAD.•All AAD patients with poor visualization of right ICA had the ipsilateral CCA abnormality (intimal flap or occlusion).•These imaging characteristics can be the key to detect AAD in AIS/TIA patients of candidate for IV rt-PA therapy.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>29627025</pmid><doi>10.1016/j.jns.2018.02.044</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-7905-1067</orcidid><orcidid>https://orcid.org/0000-0001-8353-1787</orcidid><orcidid>https://orcid.org/0000-0002-6758-4026</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aneurysm, Dissecting - complications Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - therapy Aortic Aneurysm - complications Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - therapy Aortic dissection Carotid Artery, Internal - diagnostic imaging Cerebral Angiography Cerebral Arteries - diagnostic imaging Cerebral infarction Clinical Trials as Topic Diffusion Magnetic Resonance Imaging Emergency Medical Services Female Humans Imaging Imaging, Three-Dimensional Infarction, Middle Cerebral Artery - complications Infarction, Middle Cerebral Artery - diagnostic imaging Infarction, Middle Cerebral Artery - therapy Ischemic Attack, Transient - complications Ischemic Attack, Transient - diagnostic imaging Ischemic Attack, Transient - therapy Magnetic Resonance Angiography Male MRI Retrospective Studies Stroke Thrombolysis |
| title | Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection |
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