Joon Hwa Lee

Comprehensive evaluation of coronary artery disease and aortic atherosclerosis in acute ischemic stroke patients: usefulness based on Framingham risk score and stroke subtype.

Background: Evaluation of coronary artery disease (CAD) and aortic atherosclerosis has been performed in patients with acute ischemic stroke. We investigated the usefulness of a dual-source CT (DSCT) protocol enabling the comprehensive evaluation of CAD and aortic atherosclerosis. The clinical characteristics of those patients who would benefit more from this protocol were investigated based on vascular risk factors, Framingham Risk Score (FRS), and stroke subtype. Methods: Of 469 patients with acute ischemic stroke, the 274 who had no history of CAD and had undergone DSCT were analyzed. Predictors of CAD (≧50% stenosis) or complicated aortic plaque (CAP) were evaluated based on vascular risk factors, FRS and stroke subtype. Results: Of the 274 patients analyzed, asymptomatic CAD (≧50% stenosis) was found in 61 (22.3%) and CAP in 58 (21.2%). Furthermore, the severity of CAD or aortic atherosclerosis was correlated with FRS (CAD, r = 0.291, p < 0.001 and aortic atherosclerosis, r = 0.297, p < 0.001). Additionally, severe CAD and aortic atherosclerosis were independent predictors of each other: CAP for the presence of CAD (≧50% stenosis) [odds ratio (OR), 5.71; 95% confidence interval (CI), 1.94–16.87]; CAD (≧50% stenosis) for the presence of CAP (OR, 4.20; 95% CI, 1.82–9.72). Specific stroke subtypes as well as large-artery atherosclerosis (OR, 5.25; 95% CI, 2.24–12.31) and cardioembolism (OR, 5.22; 95% CI, 1.75–15.60) were associated with the presence of CAP. Conclusions: A comprehensive evaluation protocol for CAD and aortic atherosclerosis may be useful in acute ischemic stroke patients, especially in those with higher FRS or specific stroke subtypes.

Acute simultaneous multiple lacunar infarcts: a severe disease entity in small artery disease.

Background: We hypothesized that acute simultaneous multiple lacunar infarcts (sMLI) may have different clinico-radiological characteristics compared to acute single lacunar infarcts (SLI). Methods: We retrospectively reviewed stroke patients with sMLI or SLI in a consecutively collected stroke registry with a predefined long-term clinical follow-up. Clinical characteristics, including vascular risk factors, rheological profiles, premorbid functional status, and clinical outcome were evaluated. In addition, radiological characteristics, including white matter ischemic changes, previous lacunes, microbleeds, and concomitant intra- or extracranial arterial stenosis were evaluated. Results: Of the 548 acute ischemic stroke patients, sMLI was found in 23 (13.5%) and SLI in 148 (86.5%). There was no difference in vascular risk factors and rheological profiles between the two groups, except for advanced age and more frequent previous history of stroke in the sMLI group. The sMLI group also showed more previous lacunes (p < 0.001) and microbleeds (p < 0.001). A cardioembolic or atherothrombotic stroke mechanism was rare in both groups. Recurrent strokes were more frequent in the sMLI group. Conclusions: The main pathophysiology of sMLI may be small artery disease. However, clinico-radiological characteristics suggest that sMLI may be a more severe entity of small artery disease compared to SLI.

Multimodal CT: Favorable Outcome Factors in Acute Middle Cerebral Artery Stroke with Large Artery Occlusion

Background: We investigated which parameters of multimodal computed tomography (CT) or their combinations might be useful as additional imaging predictors for favorable outcomes in acute stroke patients with large artery occlusion. Methods: The parameters of multimodal CT, including non-enhanced CT, CT angiography, perfusion CT parameters, CT angiography source image (CTA-SI), and collateral flow, were analyzed in 66 consecutive patients with acute middle cerebral artery stroke with large artery occlusion. For favorable outcomes at the 3-month follow-up, odds ratios of multimodal CT parameters with an optimum predictive cut-off Alberta Stroke Program Early CT Score (ASPECTS) were assessed. Results: Cerebral blood volume (CBV) ASPECTS ≥6, CTA-SI ASPECTS ≥7, and good collateral flow were associated with a favorable outcome. The combination of those parameters had better predictive validity compared to a single parameter only: CBV (p = 0.039), CTA-SI (p = 0.038), and collateral flow (p < 0.001). Conclusion: Among the various parameters of multimodal CT, CBV ASPECTS ≥6, CTA-SI ASPECTS ≥7, and good collateral flow might be the most reliable predictors for favorable outcomes in acute stroke patients with large artery occlusion. Moreover, considering these parameters simultaneously might improve the predictive validity of multimodal CT for functional outcome.

Post-carotid stenting reperfusion injury with blood-brain barrier disruption on gadolinium-enhanced FLAIR MRI.

BackgroundFollowing carotid revascularization, an abrupt increase in cerebral blood flow may disrupt the blood-brain barrier, resulting in reperfusion injury. This damage to the blood-brain barrier may be reflected by subarachnoid enhancement on FLAIR MRI after gadolinium injection.Case presentationThe authors present two cases of post-carotid stenting reperfusion injury that showed hyperintensity in the subarachnoid spaces on FLAIR MRI after gadolinium injection.ConclusionThese MRI findings may represent a marker for reperfusion injury after carotid revascularization.

Intravenous thrombolysis in a patient with acute ischemic stroke attributable to intracranial dissection.

Ischemic stroke attributable to intracranial dissection is a rare condition. We present a case of intravenous thrombolysis therapy in a patient with acute ischemic stroke after a dissection of the middle cerebral artery. Safety and outcome of intravenous thrombolysis therapy was favorable and the dissection regressed over 3 months with anticoagulation therapy.