Hirokuni Sakima

Correlation between the Degree of Left Subclavian Artery Stenosis and the Left Vertebral Artery Waveform by Pulse Doppler Ultrasonography

Background:Development of retrograde blood flow may be observed in the vertebral artery and is associated with progressive ipsilateral proximal subclavian or innominate artery stenosis. The subclavian steal phenomenon is more prevalent in the left subclavian artery (LSA). The purpose of this study was to analyze the correlation between the degree of LSA stenosis and pulse Doppler waveforms of the left vertebral artery (LVA). Methods:A retrospective analysis of LVA waveforms was performed in 22 cases with LSA proximal stenosis before the origin of the LVA in conventional angiograms. The degree of LSA stenosis was classified into 5 groups (<50, 50–59, 60–69, 70–89, 90–100%). Pulse Doppler waveforms of the LVA were also classified into 5 subtypes depending on the depth of the mid-systolic notch representing retrograde blood flow (normal, mid-systolic notch, retrograde flow smaller than antegrade flow, retrograde flow larger than antegrade flow, retrograde flow without antegrade flow). Results:A statistically significant correlation (R2 = 0.646, p < 0.0001) was found between the degree of LSA stenosis and the LVA waveform. Conclusions:The pattern analysis of LVA pulse Doppler waveforms seems to be useful in determining the degree of LSA stenosis.

Association between the intima-media thickness of the brachiocephalic trunk and white matter hyperintensity in brain MRI

The intima-media thickness (IMT) of the brachiocephalic trunk (BCT) can be measured using duplex carotid ultrasonography, which is used for imaging the common carotid artery (CCA). However, the clinical significance of the BCT-IMT has not been studied. We reviewed 1109 stroke-free participants in the registry of the Okinawa General Health Maintenance Association. We compared the association between the BCT-IMT or the CCA-IMT with deep and subcortical white matter hyperintensity (DSWMH). The BCT-IMT was correlated with the CCA-IMT, and like CCA-IMT, it increased with advancing age. The increase in both the BCT-IMT and the CCA-IMT quartiles was correlated with the development of DSWMH. The multivariate logistic regression analysis indicated that, as observed for the CCA-IMT, the increase in the BCT-IMT was associated with a higher prevalence of significant DSWMH (Fazekas grade 2 or 3 per 0.1 mm increase in IMT; OR 1.02, 95% confidence interval 1–1.04; P=0.04). The increase in quartiles of the BCT-IMT was only associated with a higher prevalence of significant DSWMH in subjects with lower CCA-IMT (1st and 2nd quartiles, R2=0.18, P<0.05) but not in subjects with higher CCA-IMT (3rd and 4th quartiles). Combinations of the CCA-IMT and BCT-IMT quartiles failed to have an additive effect on the prevalence of significant DSWMH. The BCT-IMT has a similar clinical profile to the CCA-IMT in terms of its association with DSWMH. However, the CCA-IMT and the BCT-IMT did not predict DSWMH in an additive manner, and distinct mechanisms might underlie the observed thickening of the IMT in the CCA and BCT.

High glycated hemoglobin levels and intracranial artery stenosis are predictive factors for early motor worsening events in patients with penetrating artery infarction.

Background: The purpose of this study was to identify typical clinical characteristics to predict early motor worsening (EMW) of patients with penetrating artery infarction. Methods: We reviewed 65 consecutive patients with pure motor hemiparesis, sensorimotor stroke, and ataxic hemiparesis. EMW was defined as deterioration by ≥1 point on the National Institutes of Health Stroke Scale for motor function within 5 days of admission. Results: EMW was observed in 22 patients (34%). HbA1c levels were higher in patients with EMW than in those without EMW (7.9 ± 2.6 vs. 6.3 ± 1.6%; p < 0.01). The percentage of EMW patients with intracranial artery stenosis (ICAS) was greater than that of non-EMW patients with ICAS (13/22 patients, 59% vs. 8/43 patients, 19%; p < 0.01). Multivariate logistic regression analysis indicated that HbA1c levels ≥7.0% (OR 3.0, 95% CI 1.5–6.8; p < 0.005) or ICAS (OR 2.3, 95% CI 1.2–4.8; p < 0.05) increased the risk of EMW, and the combination of these factors increased the risk in an additive manner (OR 7.6, 95% CI 2.5–40; p < 0.005). Conclusion: HbA1c levels ≥7.0% and/or ICAS in patients with penetrating artery infarction are associated with EMW.

Transoral Carotid Ultrasonography Using A Micro Convex Probe with B-flow Imaging for Extracranial Internal Carotid Artery Dissection

We report on transoral carotid ultrasonography using a micro convex probe with B-flow imaging for determining spontaneous extracranial internal carotid artery dissection just below the petrous portion. A 49-year-old man suffered cortical and subcortical infarction in the region of the right middle cerebral artery. Magnetic resonance angiography on the third day of admission revealed spontaneous recanalization of the right internal carotid artery associated with an intimal flap-like structure at the petrous portion. Transoral carotid ultrasonography using a micro convex probe revealed right extracranial internal carotid artery dissection, showing an increased diameter of the right extracranial internal carotid artery with double lumen formation, stenosis of the true lumen, and a mobile intimal flap in B-flow imaging. Transoral carotid ultrasonography using a micro convex probe was helpful to attempt a self-expanding stent for recanalizing right extracranial internal carotid artery dissection. The patient recovered and was discharged ambulatory. The size of the micro convex probe was optimum for transoral carotid ultrasonography in our patient. Micro convex probe is more commonly used than the standard transoral carotid ultrasonography probe, which lacks versatility. We consider that transoral carotid ultrasonography using a micro convex probe could be routinely used for ultrasonographic evaluation of extracranial internal carotid artery dissection.

A questionnaire survey to assess lower urinary tract symptoms in patients with chronic stroke

In this study, we evaluated the prevalence of lower urinary tract symptoms and the associated clinical features in patients with chronic stroke.

357 RELATIONSHIP BETWEEN SERUM URIC ACID AND SILENT BRAIN ISCHEMIA IN MEN: A CROSS-SECTIONAL STUDY

Background: Although serum uric acid (SUA) level as well as silent brain ischemia is known to a risk factor for cardiovascular events, association between SUA and silent brain ischemia has not been fully elucidated. Methods: We evaluated the association between SUA level and deep and subcortical white matter hyperintensity (DSWMH, Fazekas grade) in 1109 stroke free participants (male 56%, age 24 - 85 years) in the registry of Okinawa general health maintenance association. Results: DSWMH was found in 34% of participants (grade 1, 10%; 2, 21%; 3, 3%, respectively). The SUA level was significantly higher in men than in women (6.5 ± 1.2 vs. 4.8 ± 1.1 mg/dl, P < 0.0001). The prevalence of DSWMH (grade 2 - 3) decreased with increasing quartiles of SUA level (1st, 27%, 2nd, 20%, 3rd, 18%, 4th, 18%; P = 0.1) in men, but increased slightly (1st, 28%, 2nd, 29%, 3rd, 32%, 4th, 32%; P = 0.8) in women. We also found negative association between SUA level and Fazekas grade (no DSWMH, 6.6 ± 1.2; grade 2, 6.3 ± 1.3; grade 3, 6.0 ± 1.2 mg/dl, P < 0.05) in men, but not in women. Conclusion: Gender difference about the relationship between SUA levels and silent brain ischemia was observed. Thus SUA may have a beneficial effect of brain ischemia in men but not in women. The prospective study to elucidate association between SUA level and brain ischemia will be needed in the future.