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  • Hwang, Jaechun  (8)
  • Lee, Kwang Ho  (8)
  • 1
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    Abstract WP280: Caveolin-1, Ring Finger Protein 213, and Endothelial Function in Moyamoya Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease of unknown etiology. Ring finger protein 213 (RNF213) was identified as a susceptibility gene for MMD in East Asian. However, the pathogenesis of MMD is still unclear. Methods: We prospectively analyzed clinical data for 139 patients with MMD (108 definite MMD, 31 probable MMD) and 61 patients with intracranial atherosclerotic stroke (ICAS), and 68 healthy subjects. We compared the genetic (RNF213 variant) and protein biomarkers for caveolae (caveolin-1), angiogenesis (vascular endothelial growth factor [VEGF] and receptor [VEGFR2] , and antagonizing cytokine [endostatin]) and endothelial dysfunction (asymmetric dimethylarginine [ADMA] , nitric oxide and its metabolites [nitrite and nitrate]), between patients with MMD and ICAS. We then performed the path analysis to evaluate whether a certain protein biomarker mediates the association the genetic and MMD. Results: Caveolin-1 level was decreased in patients with MMD and this level was markedly decreased in RNF213 variant carriers. Circulating factor such as VEGF and receptor were not different among the groups. Markers for endothelial dysfunction were significantly higher in patients with ICAS, but normal in MMD. The path analysis showed that the presence of the RNF213 variant was associated with caveolin-1 level that led to MMD. The level of combined marker of MMD (caveolin-1) and ICAS (ADMA, marker for endothelial dysfunction) predicted MMD with a good sensitivity and specificity. Conclusions: Our results indicate that MMD is primarily caveolae disorder, dysregulation of endothelial vesicular trafficking and signal transduction, but not related to endothelial dysfunction or dysregulation of circulating cytokines.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp280
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Abstract TP123: RNF213 Polymorphisms as a Susceptible Gene for Intracranial Atherosclerosis: A High-Resolution MRI and Conventional Angiography Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Both intracranial atherosclerotic stenosis (ICAS) and moyamoya disease (MMD) are prevalent in Asians. We hypothesized that Ring Finger 213 (RNF213 p.Arg4810Lys) polymorphism, a susceptibility locus for MMD in East Asian, is a susceptible gene for ICAS confirmed by conventional angiography (absence of basal collaterals) and high-resolution MRI (HR-MRI, presence of plaque). Method: We analyzed 532 consecutive patients with ischemic events within the MCA distribution and relevant stenotic lesion on distal ICA or proximal MCA, but no demonstrable carotid or cardiac embolism sources. Additional angiography was performed in 370 (69.5%) patients, and HR-MRI in 283 (53.2%). Results: Based on angiographic and HR-MRI findings, 234 patients were diagnosed as ICAS, and 288 as MMD. The RNF213 variant was observed in 50 (21.4%) ICAS patients as well as 119 (69.1%) MMD patients. The RNF213 variant was observed in 25.2% (33 of 131) of patients with HR-MRI confirmed ICAS. Similarly, 15.8% (6 of 38) of ICAS patients in whom MMD was excluded by angiography had this variant. Among ICAS patients, RNF213 variant carriers were younger and more likely to have family history of MMD than non-carrier. Multivariate testing showed that age of ICAS onset was independent associated with RNF213 variant (odds ratio, 0.97; 95% CI, 0.944-0.99). Other clinical characteristics including vascular risk factors and HR-MRI findings were not different between them. Conclusions: RNF213 is susceptible gene not only for MMD but also for ICAS in East Asians. Further studies are needed on non-p.Arg4810Lys RNF213 variants in ICAS patients outside East Asian populations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp123
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Ischemic Stroke in Takayasu's Arteritis: Lesion Patterns and Possible Mechanisms
    XMLink ; 2012
    In:  Journal of Clinical Neurology Vol. 8, No. 2 ( 2012), p. 109-
    Details
    In: Journal of Clinical Neurology, XMLink, Vol. 8, No. 2 ( 2012), p. 109-
    Type of Medium: Online Resource
    ISSN: 1738-6586 , 2005-5013
    URL: Article
    DOI: 10.3988/jcn.2012.8.2.109
    Language: English
    Publisher: XMLink
    Publication Date: 2012
    detail.hit.zdb_id: 2500489-X
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  • 4
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    Implications of CHA〈sub〉2〈/sub〉DS〈sub〉2〈/sub〉-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients
    S. Karger AG ; 2017
    In:  European Neurology Vol. 77, No. 5-6 ( 2017), p. 307-315
    Details
    In: European Neurology, S. Karger AG, Vol. 77, No. 5-6 ( 2017), p. 307-315
    Abstract: 〈 b 〉 〈 i 〉 Background and Aims: 〈 /i 〉 〈 /b 〉 The aim of this study was to investigate the stroke mechanisms and associated conditions influencing the decision regarding stroke thromboprophylaxis in patients with atrial fibrillation (AF) plus ischemic stroke, according to the CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We evaluated 938 consecutive patients with a diagnosis of AF plus transient ischemic attack/ischemic stroke. Based on the CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores, patients were stratified as score 0 or 1 ( 〈 i 〉 n 〈 /i 〉 = 151), score 2 ( 〈 i 〉 n 〈 /i 〉 = 146), score 3 ( 〈 i 〉 n 〈 /i 〉 = 213), score 4 ( 〈 i 〉 n 〈 /i 〉 = 185), or score ≥5 ( 〈 i 〉 n 〈 /i 〉 = 243). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Patients with a higher CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score were more likely to have noncardioembolic stroke mechanism ( 〈 i 〉 p 〈 /i 〉 = 0.001). Large-artery atherosclerosis causing stenosis 〉 50% was more frequently observed in the high CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc group ( 〈 i 〉 p 〈 /i 〉 〈 0.001). Coronary artery disease and the use of antiplatelet agents were more prevalent in the higher group ( 〈 i 〉 p 〈 /i 〉 〈 0.001). A high CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score was associated with a higher frequency of cerebral microbleeds and a higher Fazekas grade for leukoaraiosis ( 〈 i 〉 p 〈 /i 〉 〈 0.001). The HAS-BLED score was correlated with the CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score ( & #x03B3; = 0.650; 〈 i 〉 p 〈 /i 〉 〈 0.001). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 A higher CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score is associated with noncardioembolic mechanisms of stroke and with a higher risk of bleeding. Strategies to treat macro/microangiopathy such as use of statin for plaque stabilization, as well as oral anticoagulants with a lower bleeding risk, are needed in these patients.
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    URL: Article
    DOI: 10.1159/000475495
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 209426-5
    detail.hit.zdb_id: 1482237-4
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  • 5
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    NIHSS sub-item scores predict collateral flow in acute middle cerebral artery infarction
    SAGE Publications ; 2018
    In:  Interventional Neuroradiology Vol. 24, No. 6 ( 2018-12), p. 678-683
    Details
    In: Interventional Neuroradiology, SAGE Publications, Vol. 24, No. 6 ( 2018-12), p. 678-683
    Abstract: The status of collateral vessels has important clinical implications in acute ischemic stroke. To evaluate which components of ischemic symptoms were predictive of pretreatment collateral status, we tested the hypothesis that sub-item scores from the National Institutes of Health Stroke Scale (NIHSS) are associated with leptomeningeal collateral status in acute ischemic stroke with middle cerebral artery (MCA) occlusion. Methods This study included consecutive patients with acute M1 occlusion who underwent revascularization treatment for acute MCA infarction. We evaluated clinical factors and the NIHSS score according to the collateral status assessed by multiphase perfusion computed tomography. Results Eighty-six patients were included (48 good collateral status, 38 poor collateral status). The patients with poor collateral status were more likely to have a higher total NIHSS score (18 versus 11, p  〈  0.001) and atrial fibrillation (65.8% versus 41.7%, p = 0.026) than patients with good collateral flow. In a multiple logistic regression, the NIHSS sub-items such as profound “facial palsy” (score 2 versus 0–1) and “visual field defect” (score 2 versus 0–1) were independently associated with poor collateral status. Conclusion Among the NIHSS sub-items, severe facial palsy and visual field defect were associated with poor collateral status in acute MCA stroke with M1 occlusion. Decision on whether to treat these patients endovascularly should be made more cautiously due to the possibility of a poor outcome.
    Type of Medium: Online Resource
    ISSN: 1591-0199 , 2385-2011
    URL: Article
    DOI: 10.1177/1591019918788056
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 1354913-3
    detail.hit.zdb_id: 2571161-1
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  • 6
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    Selective Application of High‐Resolution 3 T MRI in the Evaluation of Intracranial Vertebral Artery Dissection
    Wiley ; 2017
    In:  Journal of Neuroimaging Vol. 27, No. 1 ( 2017-01), p. 71-77
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 27, No. 1 ( 2017-01), p. 71-77
    Abstract: Although high‐resolution magnetic resonance imaging (HR‐MRI) is considered optimal for the diagnosis of intracranial vertebral artery dissection (IVAD), it is not readily available for all patients with suspected IVAD. The purpose of our study was to determine the factor related to IVAD lesions that are not definitively diagnosed by conventional MRI. METHODS This study included IVAD lesions that were evaluated with both of 3 T conventional MRI and HR‐MRI. Definitive dissection was defined as the presence of one or more pathognomonic radiological findings including crescentic intramural hematoma, intimal flap, and double lumen. A total of 30 IVAD lesions definitively diagnosed by HR‐MRI were included and grouped into a conventional MRI true‐positive group ( n = 17) or false‐negative group ( n = 13) based on the presence of definitive findings on conventional MRI. RESULTS Clinical characteristics did not differ between the two groups. The absence of vertebral artery aneurysmal dilatation was more common in the conventional MRI false‐negative group (84.6% vs. 35.3%; P = .010). Ipsilesional vertebral hypoplasia was observed more frequently in the conventional MRI false‐negative IVAD group (53.8% vs. 17.6%; P = .056). In logistic regression, absence of vertebral artery aneurysmal dilatation was independently associated with conventional MRI false‐negative IVAD (OR, 16.37; 95% CI, 1.39‐192.30; P = .026). Ipsilesional vertebral artery hypoplasia showed only a trend as a predictor of conventional MRI false‐negative IVAD (OR, 7.24; 95% CI, .73‐71.51; P = 0.090). CONCLUSIONS HR‐MRI may be useful for diagnosing IVAD without aneurysmal dilatation or with ipsilesional vertebral hypoplasia.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.2017.27.issue-1
    DOI: 10.1111/jon.12368
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1071724-9
    detail.hit.zdb_id: 2035400-9
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  • 7
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    Microembolic Signals in Acute Posterior Circulation Cerebral Ischemia : Sources and Consequences
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 3 ( 2012-03), p. 747-752
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 3 ( 2012-03), p. 747-752
    Abstract: The clinical significance of microembolic signals (MES) in the posterior circulation remains unclear. The aim of this study was to investigate the sources and consequences of MES in acute posterior circulation cerebral ischemia. Methods— We evaluated a total of 140 consecutive patients (93 males, mean age 62.9 years) who had acute posterior circulation cerebral ischemia. The MES monitoring was conducted at the basilar artery through the suboccipital window for a 30-minute period. Results— MES were detected in 18 (12.9%) of the 140 patients. Clinical characteristics and laboratory data did not differ between the MES-positive and MES-negative groups. Intracranial vertebrobasilar artery (VBA) stenosis was independently associated with the presence of MES (odds ratio, 9.85; 95% confidence interval, 1.22–79.48; P =0.032), whereas the patients with vertebral artery stenosis that was limited to the extracranial portion did not show an association. Microembolic signals occurred significantly more frequently in patients with severe degree of VBA stenosis compared to those with nonsignificant stenosis (odds ratio, 9.88; 95% confidence interval, 1.23–79.07; P =0.031). In a subgroup analysis of the 79 patients who had lesions on diffusion-weighted images and relevant VBA stenosis, the MES-positive group showed more frequent embolic infarction ( P =0.010) and multiple lesion patterns ( P =0.007) than single perforating infarctions. Conclusions— In acute posterior circulation cerebral ischemia, intracranial and severe VBA stenosis is associated with MES and may be its root causes. The presence of MES in VBA stenosis suggests that multiple and embolic type infarctions are the mechanisms of stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.633438
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Abstract WP23: Clot Burden and Collateral Flow on Multiphase CT: Predictor of Outcomes After Recanalization Therapy in Acute Middle Cerebral Artery Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction and Hypothesis: We evaluated the ability of mixed grading system based on thrombus burden and collateral status assessed by multiphase computed tomography (MPCT) as a predictor of outcome after recanalization therapy. Methods: Eighty-six consecutive patients who underwent MPCT for acute M1 middle cerebral artery occlusion within 6 hours of symptom onset were included. Collateral status to the occluded MCA territory was classified as follows: grade 1, no collaterals; grade 2, slow collaterals with persistence of defect; Grade 3, slow but complete collateral; grade 4, rapid complete collateral. A grade of 1-2 was designated as poor, 3-4 as good collateral flow. Short clot segment was defined as contrast filling defect length on MPCT 〈 1 centimeter. We divided patients into 3 groups based on collateral status and clot segment length: good collateral with short clot segment (N=29), good collateral with long clot segment (N=34), poor collateral (N=23). Results: Clinical characteristics were not different between 3 groups. Good functional outcome (3 months modified Rankin scale scores ≤ 2) and major neurologic improvement (1 day NIHSS score improved to 0 or 1 point or 〉 8 points decrease from baseline) were more frequent for short clot segment group and good collateral group than poor collateral group. In logistic regression, after adjusting other variables, good collateral and short clot segment were independent predictors for good functional outcome compared poor collateral (good collateral: OR 12.117, p=0.013; short clot segment with good collateral: OR 44.418, p=0.003). Similarly, the major neurologic improvement was significantly related with good collateral and short segment group. (good collateral: OR 8.903, p=0.41; short clot segment with good collateral: OR 40.430, p=0.006) Conclusions: Short clot segment and good collateral flow assessed with MPCT were useful additional markers predicting clinical outcomes after recanalization therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp23
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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