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Background: Hypertension, hyperlipidemia, and diabetes mellitus (DM) are common cardiovascular disease (CVD) comorbidities and well-known major determinants of atherosclerosis. However, their combined effects and relative contributions have not been well explored. This study aimed to characterize the characteristics of carotid atherosclerosis and dissect the relative effects of these common CVD comorbidities on the presence and severity of carotid atherosclerosis in community-dwelling elderly individuals. Methods: We enrolled 817 elders from communities in northern Taiwan. We evaluated their cardiovascular risk profiles and scanned their extracranial carotid arteries using high-resolution ultrasonography systems. Results: The prevalence rates for hypertension, hyperlipidemia, and DM were 45.4%, 37.1%, and 16.8%, respectively. Sixty-two (7.6%) and 188 (23.0%) elderly had all three and two of these common CVD comorbidities, respectively. The prevalent rates of carotid plaque and moderate-to-severe atherosclerosis were 62.9% and 35.5%, respectively. The percentages of one or more common CVD comorbidities in elders with carotid plaque and moderate-to-severe atherosclerosis were 78.2% and 83.1%, respectively. Multivariate analyses showed that the number of common CVD comorbidities was the most predictive determinant. Multivariable-adjusted odds ratios (ORs) per comorbidity for the presence of carotid plaque and advanced carotid atherosclerosis were 1.52 (95% CI, 1.28-1.81) and 1.57 (95% CI, 1.28-1.93), respectively. Models containing hypertension and DM were the second most predictive. Combinatory analyses showed distinct relationship patterns between carotid atherosclerosis and hypertension, hyperlipidemia, and DM. Hypertension was significantly correlated with higher ORs for the presence of carotid plaque and advanced carotid atherosclerosis but not for hyperlipidemia. Conclusion: Carotid plaques are highly prevalent in community-dwelling elders. The number of common CVD comorbidities was the most predictive determinant of carotid plaques and advanced carotid atherosclerosis. Our results indicate that to reduce the impact of atherosclerotic diseases, blood pressure controls precede the control of blood lipids and glucose in the community-dwelling elders. [ABSTRACT FROM AUTHOR]

Objectives: The evidence of intra-arterial thrombectomy (IAT) in acute ischemic stroke with internal carotid artery (ICA) occlusion was less solid than with middle cerebral artery occlusion. In this study, we aimed to investigate the predictors of good functional outcome of acute ischemic stroke with ICA occlusion after IAT in order to identify which characteristics were more associated with good functional outcome. Methods: From June 2016 to November 2018, all subjects who received IAT for acute stroke in three hospitals were enrolled. Those who had angiographic evidence of arterial occlusion not at ICA were excluded. Presence of tandem lesions was also excluded. After review of images, subjects without available non-enhanced CT or multiphase CTA were also excluded. The modified Rankin Scale (mRS) was used to separate all subjects into good outcome (mRS: 0-2) and poor outcome (mRS: 3-6) groups. Statistical analysis was used to find between group differences, including epidemiological data, clinical characters, imaging results, and IAT results. Results: The final enrolled subjects were 32 cases. The median and interquartile range of age was 74.5 [16.5] years old and there were 15 men. As compared with the poor outcome group, significant differences in the good outcome group included younger age (p = 0.038), higher percentage of usage of antithrombotic agents (p = 0.019), higher percentage of good or intermediate collateral (p = 0.018), and good reperfusion result (p = 0.018). Conclusion: The benefit of IAT in acute ICA occlusion was stronger in patients with better collateral and the success of IAT was also a key to good clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether the age-related change occurs in the arterial segments of the circle of Willis (CoW). Materials and Methods: Patients (n = 100) who underwent time-of-flight MR angiography (TOF-MRA) were grouped according to age, 10-20 years old (n = 50) or 50-60 years old (n = 50). MRA images were retrospectively analyzed and the diameters of segments of the CoWweremeasured, and the patency of the CoW and the half circles was estimated. The CoW patterns according to the patency of each vessel segment were recorded. Results: Most segments of the CoW in adult group revealed significant decrease in vessel diameter except for bilateral posterior communicating arteries. The number of vascular patterns of the CoW in the adult groupwas higher than in the adolescent group. Therewas significant decrease in the patency rate of the posterior, left, and right half-circles. Conclusion: The CoW showed age-related change, resulting in markedly decreased vessel diameters in most segments. [ABSTRACT FROM AUTHOR]

Background: Patients with acute cerebral large-vessel occlusion (LVO) are candidates for thrombectomy. Early detection of LVO by emergent triage according to clinical symptoms is difficult. We aimed to investigate the usefulness of evaluation using the Glasgow Coma Scale (GCS) in acute stroke patients to predict possible LVO. Methods: We retrospectively evaluated our stroke registry data from Jan. to Dec. 2015. Patients diagnosed with acute stroke in our emergency room (ER) within 6 hours of stroke onset were included. All LVO patientswere documented on magnetic resonance imaging or computed tomography angiography after admission. We analyzed the relationship between GCS and LVO. Results: Altogether, 319 acute stroke patients presenting to the ER within 6 hours of stroke onset were included and analyzed. Eighty-two (25.7%) patients had LVO and were possible candidates for thrombectomy. Patients in the LVO group were significantly older (73 ± 12 years, p < 0.05) and showed a greater incidence of atrial fibrillation (45% vs. 13%, p < 0.001) and dense artery sign on non-contrast computed tomography (61% vs. 1%, p < 0.001). The non-LVO group had a greater proportion of male patients (64% vs. 48%). GCS showed fair sensitivity (94%) and specificity (90%) in predicting LVO stroke. The positive predictive valuewas 77% and the negative predictive valuewas 98%. The odds ratio for LVO with GCS score < 15 was 60.39 (95% confidence interval: 13.32-273.83). Conclusion: GCS evaluation at triage can help in early detection of patients with LVO stroke and may hasten the protocol of intra-arterial thrombectomy. [ABSTRACT FROM AUTHOR]