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2. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes

Author

Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 5, Team Medisch, Circulatory Health, Neurologen, Brain, Zorgeenheid Vaatchirurgie Medisch, Regenerative Medicine and Stem Cells, MS Interne Geneeskunde, Sharif, Shahnam, Van der Graaf, Y, Cramer, M J, Kapelle, L J, de Borst, G J, Visseren, Frank L J, Westerink, Jan, SMART Study Group, Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 5, Team Medisch, Circulatory Health, Neurologen, Brain, Zorgeenheid Vaatchirurgie Medisch, Regenerative Medicine and Stem Cells, MS Interne Geneeskunde, Sharif, Shahnam, Van der Graaf, Y, Cramer, M J, Kapelle, L J, de Borst, G J, Visseren, Frank L J, Westerink, Jan, and SMART Study Group

Published
2021

3. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes.

Author

Sharif, Shahnam, Van der Graaf, Y., Cramer, M. J., Kapelle, L. J., de Borst, G. J., Visseren, Frank L. J., Westerink, Jan, the SMART study group, van Petersen, R., Dinther, B. G. F., Algra, A., Grobbee, D. E., Rutten, G. E. H. M., Visseren, F. L. J., Kappelle, L. J., Leiner, T., and Nathoe, H. M.

Subjects
TYPE 2 diabetes, MORTALITY, CARDIOVASCULAR diseases, CARDIOVASCULAR diseases risk factors, PROPORTIONAL hazards models, INSULIN resistance
Abstract

Background: Type 2 diabetes is a condition associated with a state of low-grade inflammation caused by adipose tissue dysfunction and insulin resistance. High sensitive-CRP (hs-CRP) is a marker for systemic low-grade inflammation and higher plasma levels have been associated with cardiovascular events in various populations. The aim of the current study is to evaluate the relation between hs-CRP and incident cardiovascular events and all-cause mortality in high-risk type 2 diabetes patients. Methods: Prospective cohort study of 1679 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART). Cox proportional hazard models were used to evaluate the risk of hs-CRP on cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality. Hs-CRP was log-transformed for continuous analyses. Findings were adjusted for age, sex, BMI, current smoking and alcohol use, non-HDL-cholesterol and micro-albuminuria. Results: 307 new cardiovascular events and 343 deaths occurred during a median follow-up of 7.8 years (IQR 4.2–11.1). A one unit increase in log(hs-CRP) was related to an increased vascular- and all-cause mortality risk (HR 1.21, 95% CI 1.01–1.46 and HR 1.26, 95% CI 1.10–1.45 respectively). No relation was found between log(hs-CRP) and myocardial infarction or stroke. The relations were similar in patients with and without previous vascular disease. Conclusion: Low grade inflammation, as measured by hs-CRP, is an independent risk factor for vascular- and all-cause mortality but not for cardiovascular events in high-risk type 2 diabetes patients. Chronic low-grade inflammation may be a treatment target to lower residual cardiovascular risk in type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Published
2021
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4. Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: Results of a nationwide Dutch clinical audit

Author

Kuhrij, Laurien S., Marang-van de Mheen, Perla J., van den Berg-Vos, Renske M., de Leeuw, Frank-Erik, Nederkoorn, Paul J., Lingsma, H. F., de Borst, G. J., van Norden, A. G. W., Eysink Smeets, M. M., Aerden, L. A. M., Alblas, C. L., de Beer, F., Bienfait, H. P., Boon, A. E., Bor, S., Boreas, A. M. H. P., Bronner, I., Brouns, R., Brouwers, P. J. A. M., Brugman, F., Dane, M. L., Fransen, P. S. S., van Gemert, H. M. A., van Golde, A. E. L., de Graaf, M. T., Hani, L., van der Heijden, A. M. H. G., Hilkens, P. H., ten Holter, J. B. M., de Jong, S. W., Kapelle, L. J., Keizer, K., Keunen, R., Kloppenborg, R. P., Kok, A. J. M., Koops, L., Kruyt, N. D., de Leeuw, F. E., Lövenich, H., Luijckx, G. J., Maasland, E., Miedema, I., Nederkoorn, P. J., Persoon, S., Peters, E. W., van der Ree, T. C., Rozeman, A. D., Saxena, R., van Schaik, S., de Schryver, E. L. L. M., Schuiling, W. J., Schut, E. S., Staals, J. E. A., Stalpers, X., Tjeerdsma, H., van Tuijl, J. H., Vermeer, S. E., Visser, M. C., van den Wijngaard, I., van Zagten, M. S. G., Zylicz, S. A., Graduate School, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, RS: Carim - B05 Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), and RS: CARIM - R3.03 - Cerebral small vessel disease

Subjects
Clinical audit, Male, medicine.medical_specialty, Percentile, Neurology, medicine.medical_treatment, 030204 cardiovascular system & hematology, Logistic regression, lcsh:RC346-429, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Neurochemistry, Thrombolytic Therapy, Quality improvement, Stroke, lcsh:Neurology. Diseases of the nervous system, Aged, Netherlands, Aged, 80 and over, business.industry, General Medicine, Thrombolysis, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Female, Neurology (clinical), Neurosurgery, INTRAVENOUS THROMBOLYSIS, business, 030217 neurology & neurosurgery, Research Article
Abstract

Background Intravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT. Methods Patients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT. Results Included were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98). Conclusions Even though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.

Published
2019

5. Tijdelijke stoornissen van het zien met één oog

Author

Volkers, E J, Donders, R C J M, Algra, A, and Kapelle, L J

Subjects
genetic structures, sense organs, eye diseases
Abstract

Transient monocular vision loss (TMVL) caused by temporary disturbance of blood flow to the retina is a harbinger of future vascular complications. The diagnosis may be difficult, not only because it is solely dependent on history taking, but also because the range of monocular visual symptoms a patient may experience is wide. The classic pattern of a sudden black or grey visual field, or a curtain that is drooping in front of one eye, easily fits in the diagnosis of TMVL; however, coloured vision or flashes should not always be considered as benign. The distinction between visual symptoms of one or both eyes should receive attention during history taking. It is the professional expertise of the neurologist and ophthalmologist which should make it possible to establish the correct diagnosis. A patient suspected of a retinal TIA should be evaluated and treated with the same urgency as someone with a cerebral TIA.

Published
2017

7. Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation

Author

Zorgeenheid Vaatchirurgie Medisch, Researchgr. Neuroradiologie, Brain, Circulatory Health, Arts-assistenten Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Huibers, A, Hendrikse, J, Brown, M M, Pegge, S A, Arnold, M, Moll, F L, Kapelle, L J, de Borst, G J, Zorgeenheid Vaatchirurgie Medisch, Researchgr. Neuroradiologie, Brain, Circulatory Health, Arts-assistenten Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Huibers, A, Hendrikse, J, Brown, M M, Pegge, S A, Arnold, M, Moll, F L, Kapelle, L J, and de Borst, G J

Published
2017

8. Tijdelijke stoornissen van het zien met één oog

Author

ZL Cerebrovasculaire Ziekten Medisch, Brain, Cardiovasculaire Epi Team 6, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Volkers, E J, Donders, R C J M, Algra, A, Kapelle, L J, ZL Cerebrovasculaire Ziekten Medisch, Brain, Cardiovasculaire Epi Team 6, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Volkers, E J, Donders, R C J M, Algra, A, and Kapelle, L J

Published
2017

9. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

Author

Ederle, J., Dobson, J., Featherstone, R. L., Bonati, L. H., Worp, H. B., Borst, G. J., Lo, T. H., Gaines, P., Dorman, P. J., Macdonald, S., Lyrer, P. A., Hendriks, J. M., Mccollum, C., Nederkoorn, P. J., Brown, M. M., Algra, A., Bamford, J., Beard, J., Bland, M., Bradbury, A. W., Clifton, A., Hacke, W., Halliday, A., Malik, I., Mas, J. L., Mcguire, A. J., Sidhu, P., Venables, G., Bradbury, A., Collins, R., Molynewc, A., Naylor, R., Warlow, C., Ferro, J. M., Thomas, D., Coward, L., Featherstone, R. F., Tindall, H., Mccabe, D. J. H., Wallis, A., Brooks, M., Chambers, B., Chan, A., Chu, P., Clark, D., Dewey, H., Donnan, G., Fell, G., Hoare, M., Molan, M., Roberts, A., Roberts, N., Beiles, B., Bladin, C., Clifford, C., Grigg, M., New, G., Bell, R., Bower, S., Chong, W., Holt, M., Saunder, A., Than, P. G., Gett, S., Leggett, D., Mcgahan, T., Quinn, J., Ray, M., Wong, A., Woodruff, P., Foreman, R., Schultz, D., Scroop, R., Stanley, B., Allard, B., Atkinson, N., Cambell, W., Davies, S., Field, P., Milne, P., Mitchell, P., Tress, B., Yan, B., Beasley, A., Dunbabin, D., Stary, D., Walker, S., Cras, P., D Archambeau, O., Hendriks, J. M. H., Schil, P., Bosiers, M., Deloose, K., Buggenhout, E., Letter, J., Devos, V., Ghekiere, J., Vanhooren, G., Astarci, P., Hammer, F., Lacroix, V., Peters, A., Verhelst, R., Dejaegher, L., Peeters, A., Verbist, J., Blair, J. F., Caron, J. L., Daneault, M., Giroux, M. F., Guilbert, F., Lanthier, S., Lebrun, L. H., Oliva, V., Raymond, J., Roy, D., Soulez, G., Weill, A., Hill, M., Hu, W., Hudion, M., Morrish, W., Sutherland, G., Wong, J., Alback, A., Harno, H., Ijas, P., Kaste, M., Lepantalo, M., Mustanoja, S., Paananen, T., Porras, M., Puutala, J., Railo, M., Sairanen, T., Soinne, L., Vehmas, A., Vikatmaa, P., Goertler, M., Halloul, Z., Skalej, M., Brennan, P., Kelly, C., Leahy, A., Moroney, J., Thornton, J., Koelemay, M. J. W., Reekers, J. A. A., Roos, Y. B. W. E. M., Koudstaal, P. J., Pattynama, P. M. T., Lugt, A., Dijk, L. C., Sambeek, L. R. H. M., Urk, H., Verhargen, H. J. M., Bruininckx, C. M. A., Bruijn, S. F., Keunen, R., Knippenberg, B., Mosch, A., Treurniet, F., Dijk, L., Overhagen, H., Wever, J., Beer, F. C., Den Berg, J. S. P., Hasselt, B. A. A. M., Zeilstra, D. J., Boiten, J., Otterloo, J. C. A. D., Vries, A. C., Nieholt, G. J. L. A., Kallen, B. F. W., Blankensteijn, J. D., Leeuw, F. E., Kool, L. J. S., Vliet, J. A., Kort, G. A. P., Kapelle, L. J., Mali, W. P. T. M., Moll, F., Verhagen, H., Barber, P. A., Bourchier, R., Hill, A., Holden, A., Stewart, J., Bakke, S. J., Krohg-Sorensen, K., Skjelland, M., Tennoe, B., Bialek, P., Biejat, Z., Czepiel, W., Czlonkowska, A., Dowzenko, A., Jedrzejewska, J., Kobayashi, A., Lelek, M., Polanski, J., Kirbis, J., Milosevic, Z., Zvan, B., Vasco, J., Blasco, J., Chamorro, A., Macho, J., Obach, V., Riambau, V., San Roman, L., Branera, J., Canovas, D., Estela, J., Gaibar, A. G., Perendreu, J., Bjorses, K., Gottsater, A., Ivancev, K., Maetzsch, T., Sonesson, B., Berg, B., Delle, M., Formgren, J., Gillgren, P., Kall, T. B., Konrad, P., Nyman, N., Takolander, R., Andersson, T., Malmstedt, A., Soderman, M., Wahlgren, C., Wahlgren, N., Binaghi, S., Hirt, L., Michel, P., Ruchat, P., Engelter, S. T., Fluri, F., Guerke, L., Jacob, A. L., Kirsch, E., Radue, E. W., Stierli, P., Wasner, M., Wetznel, S., Bonvin, C., Kalangos, A., Lovblad, K., Murith, N., Ruefenacht, D., Sztajzel, R., Higgins, N., Kirkpatrick, P. J., Martin, P., Adam, D., Bell, J., Crowe, P., Gannon, M., Henderson, M. J., Sandler, D., Shinton, R. A., Scriven, J. M., Wilmink, T., D Souza, S., Egun, A., Guta, R., Punekar, S., Seriki, D. M., Thomson, G., Brennan, A., Enevoldson, T. P., Gilling-Smith, G., Gould, D. A., Harris, P. L., Mcwilliams, R. G., Nasser, H. C., White, R., Prakash, K. G., Serracino-Inglott, F., Subramanian, G., Smyth, J. V., Walker, M. G., Clarke, M., Davis, M., Dixit, S. A., Dolman, P., Dyker, A., Ford, G., Golkar, A., Jackson, R., Jayakrishnan, V., Lambert, D., Lees, T., Louw, S., Mendelow, A. D., Rodgers, H., Rose, J., Stansby, G., Wyatt, M., Baker, T., Baldwin, N., Jones, L., Mitchell, D., Munro, E., Thornton, M., Baker, D., Davis, N., Hamilton, G., Mccabe, D., Platts, A., Tibballs, J., Cleveland, T., Dodd, D., Lonsdale, R., Nair, R., Nassef, A., Nawaz, S., Belli, A., Cloud, G., Markus, H., Mcfarland, R., Morgan, R., Pereira, A., Thompson, A., Chataway, J., Cheshire, N., Gibbs, R., Hammady, M., Jenkins, M., Wolfe, J., Adiseshiah, M., Bishop, C., Brew, S., Brookes, J., Jager, R., Kitchen, N., Ashleigh, R., Butterfield, S., Gamble, G. E., Nasim, A., O Neill, P., Edwards, R. D., Lees, K. R., Mackay, A. J., Moss, J., Rogers, P., Developmental Genetics, International Carotid Stenting Study, ACS - Amsterdam Cardiovascular Sciences, Neurology, Surgery, Radiology and Nuclear Medicine, and ANS - Amsterdam Neuroscience

Subjects
Male, medicine.medical_specialty, SURGERY, medicine.medical_treatment, Carotid endarterectomy, 030204 cardiovascular system & hematology, Neuroinformatics [DCN 3], 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Angioplasty, medicine, Humans, Carotid Stenosis, cardiovascular diseases, ANGIOPLASTY, Stroke, Endarterectomy, Aged, Endarterectomy, Carotid, Intention-to-treat analysis, Cardiovascular diseases [NCEBP 14], business.industry, Stent, General Medicine, Interim analysis, medicine.disease, 3. Good health, Surgery, Female, Stents, Human medicine, Carotid stenting, business, 030217 neurology & neurosurgery, Angioplasty, Balloon
Abstract

Contains fulltext : 88112.pdf (Publisher’s version ) (Closed access) BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. FINDINGS: The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006). Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). INTERPRETATION: Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery. FUNDING: Medical Research Council, the Stroke Association, Sanofi-Synthelabo, European Union.

Published
2010
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10. Cerebral metabolism of patients with stenosis of the internal carotid artery before and after endarterectomy

Author

van der Grond, J., Balm, R., Klijn, C. J., Kapelle, L. J., Eikelboom, B. C., Mali, W. P., and Other departments

Abstract

Occlusion or severe stenosis, with a reduction in the diameter of more than 70% of the extracranial arteries may lead to hpoperfusion of the brain with an increased risk of cerebral infarction. The aim of this study was to investigate whether endarterectomy of stenosed internal carotid arteries leads to alternations in cerebral metabolism in regions in which no infarcts were visible with magnetic resonance imaging (MRI). We studied 10 healthy control subjects and 20 patients with transient or nondisabling cerebral ischemia with MRI and 1H magnetic resonance spectroscopic imaging. All patients underwent carotid endarterectomy. Patients were examined 1 week before and 3-6 months after carotid endarterectomy. The N-acetyl aspartate (NAA)/choline ratio in the symptomatic hemisphere before endarterectomy (2.29 +/- 0.42) was significantly (p

Published
1996

11. Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation.

Author

Huibers A, Hendrikse J, Brown MM, Pegge SA, Arnold M, Moll FL, Kapelle LJ, and de Borst GJ

Subjects
Brachiocephalic Trunk diagnostic imaging, Carotid Stenosis complications, Carotid Stenosis diagnostic imaging, Carotid Stenosis physiopathology, Cerebrovascular Circulation, Cerebrovascular Disorders diagnosis, Cerebrovascular Disorders etiology, Cerebrovascular Disorders physiopathology, Computed Tomography Angiography, Humans, Magnetic Resonance Angiography, Netherlands, Randomized Controlled Trials as Topic, Retrospective Studies, Risk Factors, Stents, Subclavian Steal Syndrome complications, Subclavian Steal Syndrome diagnostic imaging, Time Factors, Treatment Outcome, Blood Pressure, Brachiocephalic Trunk physiopathology, Carotid Stenosis therapy, Endarterectomy, Carotid adverse effects, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Subclavian Steal Syndrome physiopathology, Upper Extremity blood supply
Abstract

Introduction: Blood pressure (BP) regulation is important in patients with carotid artery atherosclerotic disease. Concomitant subclavian artery stenosis (SAS) might lead to an underestimation of the true systemic BP in the monitoring of these patients. This study aimed to assess the prevalence of the inter-arm BP difference in patients undergoing carotid intervention and its association with ipsilateral significant subclavian stenosis and clinical outcome., Methods: Bilateral BP measurements and vascular imaging (CTA and MRA) of both subclavian arteries and the innominate artery were assessed in 182 symptomatic patients with carotid artery stenosis undergoing revascularisation in the International Carotid Stenting Study (ICSS). Data were separately analysed according to previously described cutoff values for systolic BP (SBP) differences of ≥10 and <15 mmHg, ≥15 and <20 mmHg, or ≥20 mmHg. Significant SAS was defined as a >50% diameter reduction., Results: Of the 182 patients, 39 (21%) showed an inter-arm difference in SBP >15 mmHg. The mean inter-arm SBP difference associated with ipsilateral SAS was 14 mmHg. SAS was present in 21/182 (12%) patients. Only two patients (1%) had bilateral stenotic disease. An inter-arm SBP difference of ≥20 mmHg was associated with unilateral SAS (RR 11.8; 95% CI 3.2-43.1) with a sensitivity of 23% and a specificity of 98%. Patients were followed up for a median of 4.0 years (IQR 3.0-6.0; maximum 7.5). Risk of stroke or death during follow-up was 20.0% (95% CI 11.1-28.9) in patients with, and 15.1% (95% CI 12.3-17.9) in patients without SAS (p = .561). The hospital stay was longer in patients with significant SAS (5.0 days, SD 4.9 vs. 2.7 days, SD 4.3, p = .035)., Conclusion: The present study is the first to affirm the clinical need for the measurement of inter-arm BP differences in patients undergoing carotid revascularisation, especially in the post-operative phase in the prevention of cerebral hyperperfusion., (Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Published
2017
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12. [Transient monocular vision loss].

Author

Volkers EJ, Donders RCJM, Algra A, and Kapelle LJ

Subjects
Humans, Retina, Retinal Vessels pathology, Stroke complications, Vision Disorders etiology, Vision Disorders diagnosis, Vision, Monocular
Abstract

Transient monocular vision loss (TMVL) caused by temporary disturbance of blood flow to the retina is a harbinger of future vascular complications. The diagnosis may be difficult, not only because it is solely dependent on history taking, but also because the range of monocular visual symptoms a patient may experience is wide. The classic pattern of a sudden black or grey visual field, or a curtain that is drooping in front of one eye, easily fits in the diagnosis of TMVL; however, coloured vision or flashes should not always be considered as benign. The distinction between visual symptoms of one or both eyes should receive attention during history taking. It is the professional expertise of the neurologist and ophthalmologist which should make it possible to establish the correct diagnosis. A patient suspected of a retinal TIA should be evaluated and treated with the same urgency as someone with a cerebral TIA.

Published
2017

13. Arterial spin-labeling MR imaging measurements of timing parameters in patients with a carotid artery occlusion.

Author

Bokkers RP, van Laar PJ, van de Ven KC, Kapelle LJ, Klijn CJ, and Hendrikse J

Subjects
Aged, Blood Flow Velocity physiology, Collateral Circulation physiology, Dominance, Cerebral physiology, Female, Frontal Lobe blood supply, Humans, Male, Middle Aged, Occipital Lobe blood supply, Parietal Lobe blood supply, Regional Blood Flow physiology, Sensitivity and Specificity, Angiography, Digital Subtraction, Brain blood supply, Carotid Artery, Internal, Carotid Stenosis diagnosis, Hemodynamics physiology, Image Processing, Computer-Assisted methods, Magnetic Resonance Angiography, Magnetic Resonance Imaging methods, Spin Labels
Abstract

Background and Purpose: Arterial spin-labeling (ASL) with image acquisition at multiple delay times can be exploited in perfusion MR imaging to visualize and quantify the temporal dynamics of arterial blood inflow. In this study, we investigated the consequences of an internal carotid artery (ICA) occlusion and collateral blood flow on regional timing parameters., Materials and Methods: Seventeen functionally independent patients with a symptomatic ICA occlusion (15 men, 2 women; mean age, 57 years) and 29 sex- and age-matched control subjects were investigated. ASL at multiple delay times was used to quantify regional cerebral blood flow (CBF) and the transit and trailing edge times (arterial timing parameters) reflecting, respectively, the beginning and end of the labeled bolus. Intra-arterial digital subtraction angiography and MR angiography were used to grade collaterals., Results: In the hemisphere ipsilateral to the ICA occlusion, the CBF was lower in the anterior frontal (31 +/- 4 versus 47 +/- 3 mL/min/100 g, P < .01), posterior frontal (39 +/- 4 versus 55 +/- 2 mL/min/100 g, P < .01), and frontal parietal region (49 +/- 3 versus 61 +/- 3 mL/min/100 g, P = .04) than that in control subjects. The trailing edge of the frontal-parietal region was longer in the hemisphere ipsilateral to the ICA occlusion compared with that in control subjects (2225 +/- 167 versus 1593 +/- 35 ms, P < .01). In patients with leptomeningeal collateral flow, the trailing edge was longer in the anterior frontal region (2436 +/- 275 versus 1648 +/- 201 ms, P = .03) and shorter in the occipital region (1815 +/- 128 versus 2388 +/- 203 ms, P = .04), compared with patients without leptomeningeal collaterals., Conclusion: Regional assessment of timing parameters with ASL may provide valuable information on the cerebral hemodynamic status. In patients with leptomeningeal collaterals, the most impaired territory was found in the frontal lobe.

Published
2008
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14. Cerebral metabolism of patients with stenosis of the internal carotid artery before and after endarterectomy.

Author

van der Grond J, Balm R, Klijn CJ, Kapelle LJ, Eikelboom BC, and Mali WP

Subjects
Aged, Aspartic Acid analogs & derivatives, Aspartic Acid metabolism, Carotid Stenosis surgery, Choline metabolism, Female, Humans, Lactates metabolism, Lactic Acid, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Male, Middle Aged, Brain metabolism, Carotid Artery, Internal, Carotid Stenosis metabolism, Endarterectomy
Abstract

Occlusion or severe stenosis, with a reduction in the diameter of more than 70% of the extracranial arteries may lead to hpoperfusion of the brain with an increased risk of cerebral infarction. The aim of this study was to investigate whether endarterectomy of stenosed internal carotid arteries leads to alternations in cerebral metabolism in regions in which no infarcts were visible with magnetic resonance imaging (MRI). We studied 10 healthy control subjects and 20 patients with transient or nondisabling cerebral ischemia with MRI and 1H magnetic resonance spectroscopic imaging. All patients underwent carotid endarterectomy. Patients were examined 1 week before and 3-6 months after carotid endarterectomy. The N-acetyl aspartate (NAA)/choline ratio in the symptomatic hemisphere before endarterectomy (2.29 +/- 0.42) was significantly (p < 0.001) lower than for control subjects (3.18 +/- 0.32). In five of the patients lactate was detected preoperatively in regions that were not infarcted. The NAA/choline ratio in the symptomatic hemisphere of these five patients did not increase significantly after endarterectomy (1.99 +/- 0.22 vs. 2.23 +/- 0.48). The NAA/choline ratio in patients without lactate preoperatively increased significantly (p < 0.01) after endarterectomy to a normal level (from 2.39 +/- 0.42 to 2.92 +/- 0.52). These results indicate that the presence of cerebral lactate may predict whether the NAA/choline ratio increases after carotid endarterectomy.

Published
1996
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