Influence of cerebrovascular reactivity on outcome of the patients with ≥50% symptomatic unilateral middle cerebral artery stenosis.

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Abstract

Purpose/aim of the study: Cerebrovascular reactivity (CVR) reflects the vasodilatory reserve of cerebral resistance vessels, which is an important marker for assessing cerebrovascular disease. The present study is to investigate whether CVR impairment increases adverse long-term outcome risk of patients with ≥ 50% symptomatic unilateral middle cerebral artery (MCA) stenosis (ischemic stroke (IS) or transient ischemic attack (TIA)).

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Most cited references 19

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Global burden of intracranial atherosclerosis.

Lawrence Wong (2006)

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Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis.

Elizabeth Hartman, Nikesh Anumula, Hooman Kamel … (2012)

Impairments in cerebrovascular reserve (CVR) have been variably associated with increased risk of ischemic events and may stratify stroke risk in patients with high-grade internal carotid artery stenosis or occlusion. The purpose of this study is to perform a systematic review and meta-analysis to summarize the association of CVR impairment and stroke risk. We performed a literature search evaluating the association of impairments in CVR with future stroke or transient ischemic attack in patients with high-grade internal carotid artery stenosis or occlusion. We included studies with a minimum of 1-year patient follow-up with baseline CVR measures performed by any modality and primary outcome measures of stroke and/or transient ischemic attack. A meta-analysis with assessment of study heterogeneity and publication bias was performed. Results were presented in a forest plot and summarized using a random-effects model. Thirteen studies met the inclusion criteria, representing a total of 1061 independent CVR tests in 991 unique patients with a mean follow-up of 32.7 months. We found a significant positive relationship between impairment of CVR and development of stroke with a pooled random effects OR of 3.86 (95% CI, 1.99-7.48). Subset analysis showed that this association between CVR impairment and future risk of stroke/transient ischemic attack remained significant regardless of ischemic outcome measure, symptomatic or asymptomatic disease, stenosis or occlusion, or CVR testing method. CVR impairment is strongly associated with increased risk of ischemic events in carotid stenosis or occlusion and may be useful for stroke risk stratification.

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Intracranial atherosclerosis: current concepts.

Juan F. Arenillas (2010)

The most relevant ideas discussed in this article are described here. Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Its importance in whites may have been underestimated. New technical developments, such as high-resolution MRI, allow direct assessment of the intracranial atherosclerotic plaque, which may have a profound impact on ICAD diagnosis and therapy in the near future. Early detection of ICAD may allow therapeutic intervention while the disease is still asymptomatic. The Barcelonès Nord and Maresme Asymptomatic Intracranial Atherosclerosis Study is presented here. The main prognostic factors that characterize the patients who are at a higher risk for ICAD recurrence are classified and discussed. The best treatment for ICAD remains to be established. The Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study is currently ongoing to address this crucial issue. These and other topics will be discussed at the Fifth International Intracranial Atherosclerosis Conference (Valladolid, Spain, autumn 2011).

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Author and article information

Journal

Journal ID (iso-abbrev): Int. J. Neurosci.

Title: The International journal of neuroscience

Publisher: Informa UK Limited

ISSN (Electronic): 1563-5279

ISSN (Print): 0020-7454

Publication date (Electronic): Jan 2018

Volume: 128

Issue: 1

Affiliations

[1 ] a Department of Neurology, Chinese PLA Air Force General Hospital , Beijing , China.

[2 ] b Department of CT and MRI, Chinese PLA Air Force General Hospital , Beijing , China.

Article

DOI: 10.1080/00207454.2017.1357552

PubMed ID: 28724339

SO-VID: de5f7118-039c-4f44-b199-46f1df016e0e

History

Keywords: CO2 inhalation,Middle cerebral artery,cerebrovascular reactivity,ischemic stroke,perfusion computed tomography

Data availability:

Keywords: CO2 inhalation, Middle cerebral artery, cerebrovascular reactivity, ischemic stroke, perfusion computed tomography

Influence of cerebrovascular reactivity on outcome of the patients with ≥50% symptomatic unilateral middle cerebral artery stenosis.

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Abstract

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 19

Global burden of intracranial atherosclerosis.

Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis.

Intracranial atherosclerosis: current concepts.

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