Biomedical subjects

H H Schild

Publications and source records attributed to H H Schild.

At least 19 recordsLinked to original sources

PubMed2007

Double inversion recovery brain imaging at 3T: diagnostic value in the detection of multiple sclerosis lesions.

BACKGROUND AND PURPOSE: To prospectively determine the sensitivity in the detection of multiple sclerosis (MS) lesions by using double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR), and T2-weighted turbo spin-echo (T2 TSE) MR imaging at 3T. METHODS: Seventeen patients presenting with a clinically isolated syndrome (CIS) suggestive of MS, 9 patients with definite MS, and 6 healthy control subjects were included. Imaging was performed on a 3T MR system using DIR, FLAIR, and T2 TSE sequences. Lesions were counted and classified according to 5 anatomic regions: infratentorial, periventricular, deep white matter, juxtacortical, and mixed white matter-gray matter. The sensitivity at DIR was compared with the corresponding sensitivity at FLAIR and T2 TSE sequence. The contrast between lesions and normal-appearing gray matter, normal-appearing white matter, and CSF was determined for all sequences. RESULTS: Because of higher lesion-white matter contrast, the DIR showed a higher number of lesions compared with the FLAIR (7% gain, P = 0.04) and the T2 TSE (15% gain, P = 0.01). The higher sensitivity was also significant for the infratentorial region compared with the FLAIR (56% gain, P = 0.02) and the T2 TSE (44% gain, P = 0.02). Compared with the FLAIR, no significant changes of the lesion load measurements were observed in the supratentorial brain: slightly higher numbers of periventricular and mixed gray matter-white matter lesions on the DIR were counterbalanced by a slightly reduced sensitivity regarding juxtacortical lesions. CONCLUSION: DIR brain imaging at 3T provides the highest sensitivity in the detection of MS lesions especially in the infratentorial region.

Adult↗

PubMed2006

Mutations in the gene encoding the Wnt-signaling component R-spondin 4 (RSPO4) cause autosomal recessive anonychia.

Anonychia is an autosomal recessive disorder characterized by the congenital absence of finger- and toenails. In a large German nonconsanguineous family with four affected and five unaffected siblings with isolated total congenital anonychia, we performed genomewide mapping and showed linkage to 20p13. Analysis of the RSPO4 gene within this interval revealed a frameshift and a nonconservative missense mutation in exon 2 affecting the highly conserved first furin-like cysteine-rich domain. Both mutations were not present among controls and were shown to segregate with the disease phenotype. RSPO4 is a member of the recently described R-spondin family of secreted proteins that play a major role in activating the Wnt/ beta -catenin signaling pathway. Wnt signaling is evolutionarily conserved and plays a pivotal role in embryonic development, growth regulation of multiple tissues, and cancer development. Our findings add to the increasing body of evidence indicating that mesenchymal-epithelial interactions are crucial in nail development and put anonychia on the growing list of congenital malformation syndromes caused by Wnt-signaling-pathway defects. To the best of our knowledge, this is the first gene known to be responsible for an isolated, nonsyndromic nail disorder.

Adult↗

PubMed2006

Initial experience with lung-MRI at 3.0T: Comparison with CT and clinical data in the evaluation of interstitial lung disease activity.

OBJECTIVES: We evaluated the feasibility of highfield lung-MRI at 3.0T. A comparison with Computed Tomography (CT) and clinical data regarding the assessment of inflammatory activity in patients with diffuse lung disease was performed. MATERIAL AND METHODS: Prospective evaluation of 21 patients (15 males, 6 females, 43-80 y) with diffuse lung diseases who underwent clinical work-up inclusive laboratory tests, lung-function tests and transbronchial biopsy. After routine helical CT (additional 12 HRCT) a lung-MRI (3.0 Intera, Philips Medical Systems, Best, The Netherlands) using a T2-weighted, cardiac and respiratory triggered Fast-Spinecho-Sequence (TE/TR=80/1500-2500 ms, 22 transverse slices, 7/2mm slice-thickness/-gap) was performed. A pneumologist classified the cases into two groups: A=temporary acute interstitial disease or chronic interstitial lung disease with acute episode or superimposed infection/B=burned out interstitial lung disease without activity. Two blinded CT-radiologists graded the cases in active/inactive disease on the basis of nine morphological criteria each. A third radiologist rated the MRI-cases as active/inactive, depending on the signal-intensities of lung tissues. RESULTS: The pneumologist classified 14 patients into group A and 7 patients into group B. Using CT, 6 cases were classified as active, 15 cases as inactive disease. With MRI 12 cases were classified as active and 9 cases as inactive. In the complete group of 21 patients MRI decisions and CT decisions respectively were false positive/false negative/correct in 2/4/15 respectively 0/8/13 cases. Correct diagnoses were obtained in 72% (MRI) respectively 62% (CT). In the subgroup of 12 cases including HRCT, MRI respectively CT were false positive/false negative/correct in 2/1/9 respectively 0/5/7 cases. Correct diagnoses were obtained in 75% (MRI) respectively 58% (CT). CONCLUSION: Highfield MRI of the lung is feasible and performed slightly better compared to CT in the determination of activity in patients with interstitial lung diseases.

Adult↗

PubMed2006

Treatment monitoring and response prediction with proton MR spectroscopy in AD.

In this proton magnetic resonance spectroscopy ((1)H-MRS) study, the authors correlated cognitive improvement after 3 months of treatment with donepezil with changes of N-acetylaspartate (NAA) level and NAA/Creatine (Cr) ratio in the medial temporal and parietal lobe of 17 patients with Alzheimer disease. Treatment response was associated with an increase of NAA and NAA/Cr in the parietal lobe. Low baseline NAA/Cr in the parietal lobe predicted positive treatment outcome.

Aged↗

PubMed2006

Magnetic resonance (MR) imaging and MR angiography for evaluation and follow-up of hepatic artery banding in patients with hepatic involvement of hereditary hemorrhagic telangiectasia.

BACKGROUND: We describe findings obtained by magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) for evaluation and follow-up after hepatic artery banding in patients with hepatic involvement of hereditary hemorrhagic telangiectasia (HHT). METHODS: Abdominal MRA and liver MRI were performed in three patients with HHT as clinically defined by Curacao criteria. One patient underwent MRA and MRI twice for preinterventional evaluation and follow-up, one patient for preinterventional evaluation, and one patient for postinterventional evaluation. Hepatic vascular involvement of the disease and postinterventional vascular anatomy were evaluated by two radiologists by consensus. RESULTS: Hepatic vascular involvement with perfusion disorders and arteriosystemic shunts was found in all three patients. MRA and MRI allowed diagnostic characterization of hepatic vascular disease (three of three), preinterventional evaluation of complex vascular anatomy and variants (two of two), and postinterventional follow-up of hepatic artery banding (two of two). CONCLUSION: In preinterventional evaluation and postinterventional follow-up, MRA and MRI allows characterization of complex hepatic vascular alterations of HHT and, hence, is an alternative to other imaging modalities in the diagnosis, clinical decision making, and follow-up of HHT.

Aged↗

PubMed2006

[MR techniques for noninvasive diagnosis of prostate cancer].

The diagnosis of prostate cancer is suggested on the basis of an elevated PSA level, abnormal digital exam, and abnormal transrectal ultrasound. US-guided biopsy is used to confirm the diagnosis, but up to 30% of prostate cancer may be missed with this approach. Meanwhile MR imaging and proton MR spectroscopy have emerged as the most sensitive additional tools for the noninvasive evaluation of prostate cancer. This article reviews the clinical indications for MRI of the prostate and summarizes new techniques such as high field strength (3 tesla) and dynamic contrast-enhanced MRI.

Biomarkers, Tumor↗

PubMed2006

Does high-field MR imaging have an influence on the classification of patients with clinically isolated syndromes according to current diagnostic mr imaging criteria for multiple sclerosis?

BACKGROUND AND PURPOSE: Current MR imaging criteria for multiple sclerosis (MS) do not specify the magnetic field strength. The aim of this study was to investigate whether different MR imaging field strengths, specifically high-field MR imaging, have an impact on the classification of patients with clinically isolated syndromes suggestive of MS, according to MR imaging and diagnostic criteria. METHODS: In a prospective intraindividual comparative study, we examined 40 patients with clinically isolated syndromes (CIS) consecutively with a 1.5 T and 3T MR imaging system, including axial sections of T2 turbo spin-echo, fluid-attenuated inversion recovery, and T1 spin-echo, before and after injection of gadolinium-diethylene-triaminepentaacetic acid. Constant resolution parameters were used for both field strengths. High-signal-intensity white matter lesions with a size of >3 mm were counted and categorized according to their anatomic location in infratentorial, callosal, juxtacortical, periventricular, and other white matter areas. Assessment of the fulfilled Barkhof MR imaging and McDonald diagnostic criteria was made separately for both field strengths in every patient. RESULTS: Eleven patients fulfilled more MR imaging criteria at 3T. Two of these patients fulfilled the criterion of dissemination in space (DIS) according to the first definition of McDonald criteria, which is based on imaging criteria alone. Another patient had DIS only at 3T, according to the second definition of the McDonald criteria including CSF parameters. CONCLUSION: MR field strength, specifically high-field MR imaging, has a substantial influence on the classification of patients with CIS according to imaging and a mild influence on the classification according diagnostic criteria for MS, leading to consequences for prognostic classification, imaging guidelines, and clinical trials.

Adolescent↗

PubMed2005

A recombinant anti-carcinoembryonic antigen immunoreceptor with combined CD3zeta-CD28 signalling targets T cells from colorectal cancer patients against their tumour cells.

BACKGROUND AND AIMS: The prognosis of metastatic colorectal cancer is still poor, raising the need for alternative therapeutic approaches, particularly by manipulating the antitumour immune response. Advanced tumour stages, however, are frequently accompanied by functional T cell defects which may be critical for a T cell based anticancer immunotherapy. The aim of this study was to address whether T cells from colorectal cancer patients with advanced tumour stages can be specifically antigen activated against their autologous tumour cells. METHODS: T cells were isolated from colorectal cancer patients and retrovirally transduced to express a recombinant immunoreceptor that has an extracellular binding domain for carcinoembryonic antigen (CEA) and an intracellular CD3zeta signalling domain with and without CD28 costimulation for T cell activation. RESULTS: Peripheral blood T cells from colorectal cancer patients were successfully engineered to express the anti-CEA immunoreceptor on the cell surface. On coincubation with autologous CEA(+) tumour cells, T cells with anti-CEA immunoreceptor are specifically activated to secrete interferon gamma (IFN-gamma) and to lyse autologous tumour cells whereas T cells without immunoreceptor are not. T cells equipped with combined CD3zeta-CD28 signalling receptor are more efficiently activated to secrete IFN-gamma compared with T cells with CD3zeta signalling receptor. Induction of interleukin 2 secretion on targeting towards autologous tumour cells requires triggering of T cells by the CD3zeta-CD28 costimulatory receptor. CONCLUSIONS: T cells from advanced colorectal cancer patients can be tumour specifically activated with high efficiency by engraftment with a combined CD3zeta-CD28 immunoreceptor to break tolerance against autologous tumour cells.

Aged↗

PubMed2005

An enhanced expression of ABC 1 transporter in circulating leukocytes as a potential molecular marker for the diagnostics of glaucoma.

OBJECTIVE: Glaucoma is a neurodegenerative disease. Since vascular dysregulation is supposed to be a risk factor for the development of glaucomatous damage, the preventive treatment might slow down the disease development. The efficiency of the therapeutic treatment depends particularly on a drug efflux pump regulated by ABC transporters. ABC 1 is also known to participate on the vascular regulation. This study was focused on the comparative analysis of ABC 1 expression levels in circulating leukocytes of non-glaucomatous individuals and glaucoma patients. RESULTS AND CONCLUSIONS: The expression rates of ABC 1 were significantly increased in leukocytes of glaucoma patients compared to non-glaucomatous individuals. The expression level of ABC 1 was, furthermore, highly homogeneous in glaucoma patients. In contrast, these expression levels in non-glaucomatous individuals were extremely heterogeneous. This transporter acts as the energy-dependent unidirectional transmembrane cholesterol efflux pump and can export a wide range of hydrophobic drugs. Additionally an observed enhanced ABC 1 expression in circulating leukocytes may be implicated in the vascular regulation mechanisms of glaucoma. We proposed the enhanced expression of ABC 1 in leukocytes as a potential marker for the diagnostics and ex vivo molecular monitoring of glaucoma.

ATP-Binding Cassette Transporters↗

PubMed2005

Combined analysis of biochemical parameters in serum and differential gene expression in circulating leukocytes may serve as an ex vivo monitoring system to estimate risk factors for complications in Diabetes mellitus.

OBJECTIVE: Oxidative stress plays a crucial role in the development of complications in Diabetes mellitus (DM). Individual sensitivity against stress, however, varies among DM-patients and results, therefore, in differential severity of consequent complications. To allow more complex interpretation of a delicate antioxidant/free radicals balance and its effect on cellular functions in individual DM-patients, we analysed a correlation between total antioxidant status (TAS), antioxidant gap (AtxGap), level of free radicals (FR), routine clinical biochemical parameters in blood and differential gene expression in circulating leukocytes of DM-patients versus non-diabetic individuals. RESULTS AND CONCLUSIONS: Positive correlation was found between TAS and creatinine (p=0.05), AtxGap and iron (p=0.025), and between AtxGap and anti-streptolysin O (p=0.025). Whereas no correlation was found between FR and any of the routine clinical parameters tested, a negative correlation was observed between AtxGap and glucose content (p=0.025) and between AtxGap and gamma-glutamyltransferase (p=0.05). An increased content of FR was shown to influence significantly an expression of selected stress responsible genes in leukocytes. Transcription levels of NF-kappaB, XRCC1 and 90-kDa heat-shock protein A were increased in all DM-patients compared to non-diabetic individuals. In contrast, an expression of XIAP and cytochrome P450 reductase was up-regulated in patients with decreased levels of both FR and TAS and increased body mass index. This differential expression of the stress responsible genes might be further considered as a potential risk factor for diverse DM-complications helping also in reliable monitoring of supplemental antioxidant therapy and more complex interpretation of delicate antioxidant/free radicals balance.

Adult↗

PubMed2005

Molecular imaging system for possible prediction of active retinopathy in patients with Diabetes mellitus.

OBJECTIVE: The deposition of advanced glycation end products is enhanced in Diabetes mellitus (DM) and has been linked to diabetic complications such as a microvascular disease. Glycated proteins have receptors on mononuclear blood cells (MBCs) and have been shown to generate reactive oxygen species altering gene expression and modifying cellular targets, such as endothelial cells. Retinal angiopathy is a frequently observed microvascular complication in DM-patients. Because of the central role of activated MBCs, we hypothesised a functional link between specific alterations in gene expression of MBCs, an increased activity of matrix proteases in serum, and the extent of retinal angiopathy in DM. MATERIAL AND METHODS: An appearance and proliferation index of diabetic retinopathy was evaluated in 38 DM-patients using fluorescein angiography. Alterations of gene transcription levels in MBCs were investigated using hybridisation of individual mRNA-pools to Atlas Array with a concomitant quantification of specific cDNAs by "Real-Time"-PCR. The activity of matrix metalloproteinases MMP-2 and MMP-9 in individual serum samples was measured by zymography combined with densitometric imaging system. RESULTS AND CONCLUSIONS: Hybridisation to Atlas Array of mRNA-pools isolated from MBCs revealed an enhanced expression of recoverin in DM-patients compared to the control group. "Real-Time"-PCR showed the highest recoverin levels in the DM-subgroup with a high proliferation index. MMP-2 activity was highly increased in 36% of all patients, and in 44, 44, and 19% of patients with proliferative retinopathy, advanced proliferative retinopathy, and no detectable proliferation respectively. In those 3 groups MMP-9 activity was highly increased in 56, 67, and 31% of patients respectively, and in 44% of all DM-patients. In contrast to patients with active proliferation, the simultaneous high activation of all three genes was not observed in patients without active proliferation. The ex vivo molecular imaging system developed in this work may be helpful for the prediction of active proliferative retinopathy in DM.

Diabetes Mellitus↗

PubMed2005

Increased DNA breaks and up-regulation of both G(1) and G(2) checkpoint genes p21(WAF1/CIP1) and 14-3-3 sigma in circulating leukocytes of glaucoma patients and vasospastic individuals.

OBJECTIVE: Vascular disorder leading to local ischemia/reperfusion has been shown to play an important role in the glaucomatous damage. A decreased expression level of XPGC-gene has been found in circulating leukocytes of normal-tension glaucoma patients. Although decreased activity of XPGC-gene leads to insufficient DNA-repair, no leukopenia has been observed in glaucoma. Molecular mechanisms ensuring cell survival have not been elucidated yet for glaucoma with vascular disorder. MATERIAL AND METHODS: Using the ex vivo optical imaging method of alkaline "comet assay" comparative quantification of DNA breaks was performed in circulating leukocytes of non-glaucomatous non-vasospastic and vasospastic individuals as well as both normal-tension and high-tension glaucoma patients. Relative expression levels of the anti-apoptotic factors P21(WAF1/CIP1) and 14-3-3 sigma were investigated in all groups tested. RESULTS AND CONCLUSIONS: The quantification of P21(WAF1/CIP1) showed the highest expression rates in high-tension glaucoma patients which were significantly higher than those in all other groups tested. The highest expression rates of 14-3-3 sigma were found in both groups of glaucoma patients. These expression levels correlated well with DNA breaks measured. Since the expression of P21(WAF1/CIP1) in leukocytes was shown to be crucial for their survival under stress conditions, we suppose further that the up-regulation of this gene is the key event in the survival mechanisms of leukocytes in glaucoma accompanied with vascular disorder. The p21(WAF1/CIP1) gene should be further taken into consideration as a potential marker, the up-regulation of which in circulating leukocytes of vasospastic individuals may indicate an increased risk for the developing glaucoma.

14-3-3 Proteins↗

PubMed2004

3.0-T high-field magnetic resonance imaging of the female pelvis: preliminary experiences.

The purpose of this study was to evaluate if 3.0 T allows for clinically useful pelvic magnetic resonance imaging, i.e. if familiar image quality and tissue contrast can be achieved at 3.0 T as compared with at 1.5 T. Adapting a 1.5-T protocol to the 3.0-T environment is subject to a variety of factors. In order to reduce the number of potential variables, we chose two cornerstones: the 3.0-T sequence should have similar spatial resolution and acquisition time; furthermore, the contrast parameters repetition time (TR) and echo time (TE) were kept identical. Based on this modified 3.0-T T2-weighted turbo spin-echo sequence (TR/TE 2,705/80 ms; 0.7x1.04x4 mm measured voxel size; field of view 360 mm; 4.03-min scan time) we performed an intraindividual study on 19 patients with the 1.5-T sequence as the standard of reference. Two radiologists analyzed the examinations in consensus with regard to tissue contrast (visualization of zonal anatomy of the uterus and/or delineation of pathologic findings) rated on a three-point scale (3 is 3.0 T better; 2 is 3.0 T equal; 1 is 3.0 T worse than 1.5 T). In addition, the signal difference between muscle and bone marrow was measured as a marker for tissue contrast. The analysis of the image quality comprised the level of the artifacts (rated on a five-point scale: 1 is no artifacts; 5 is nondiagnostic study), the visual signal-to-noise ratio (rated on a three-point scale) and detail delineation. Only minor artifacts were observed at both 1.5 and 3.0 T; the difference was not statistically significant. The visual signal-to-noise ratio and the delineation of image details were rated equal for 1.5 and 3.0 T. With regard to image contrast, both qualitative analysis as well as quantitative analysis revealed comparable image contrast for the 1.5- and 3.0-T protocols. Pathological findings were seen equally well with both field strengths. Clinically diagnostic pelvic studies of high image quality can be obtained using a 3.0-T scanner with our modified examination protocol. To fully exploit the capability of the high-field technique, and to point out potential advantages, further intraindividual studies are needed, with the adjustment of other imaging parameters to the high-field environment.

Adult↗

PubMed2004

Sensitivity encoding (SENSE) for high spatial resolution time-of-flight MR angiography of the intracranial arteries at 3.0 T.

PURPOSE: 1) To evaluate feasibility of sensitivity encoding (SENSE) for high spatial resolution intracranial 3D time-of-flight (TOF) MR angiography at 3.0 T using a 1024 imaging matrix and 2) to compare image quality and diagnostic yield with 3.0 T TOF MRA without SENSE. METHODS: In a prospective study TOF MR angiography of the circle of Willis was performed with SENSE in 24 patients on a clinical whole body 3.0 T MR system (Intera, Philips Medical Systems, NL). In the SENSE protocol (S-MRA), a SENSE factor of 2.5 was used to shorten acquisition time and to increase the anatomic coverage (5:12 min.; 150 slices). A matrix of 832 x 572 was acquired and reconstructed to 1024 yielding a non-zerofilled voxel size of 0.30 x 0.44 x 1.00 mm(3) (0.13 mm(3)). Two readers were asked to review the images regarding the presence of vascular disease, and to rate, in consensus, the quality of the angiograms on a 5-point scale (5 = excellent through 1 = non-diagnostic). Results were compared with the results in 15 subjects who underwent intracranial TOF MRA at 3.0 T without SENSE (NS-MRA: acquisition time, 7:57 min.; 100 slices). Digital subtraction angiography (DSA) served as standard of reference in the 4/24 patients in whom vascular disease was identified. RESULTS: S-MRA at 3.0 T was judged to provide image quality that was adequate for diagnosis or better in 24/24. Median score of image quality of S-MRA and NS-MRA were 5 and 5, respectively. In the 4 patients with DSA correlation, a total of 8 pathologic findings (7 steno-occlusive diseases, 1 aneurysm) were correctly identified on S-MRA. CONCLUSION: The use of SENSE for intracranial TOF MRA at very high imaging matrix is feasible at 3.0 T. Compared to the imaging technique without SENSE, it allows TOF MRA with substantially reduced acquisition time, and with substantially increased anatomic coverage while maintaining image quality of NS-MRA.

Adolescent↗

PubMed2004

[Diagnostic imaging of vascular leiomyosarcomas].

Primary vascular leiomyosarcomas are very rare tumors, with the venous variety most often arising from the inferior caval vein and the arterial variety from the pulmonary artery. The tumors show either an exclusive intra- or extravascular pattern or a mixed growth pattern. The clinical symptoms depend on tumor location, with intraluminal tumors of the inferior caval vein causing edema or a Budd-Chiari syndrome. Leiomyosarcomas of the pulmonary artery can mimic chronic central or recurrent peripheral pulmonary embolism. Contrast enhanced spiral CT with multiplanar reconstruction is the diagnostic method of choice when a vascular leiomyosarcoma is suspected. MRI with MR-angiography can be added. If a tumor of undetermined origin shows a broad contact with a vessel and/or an intraluminal component, possible primary vascular leiomyosarcoma should be included in the differential diagnosis.

Budd-Chiari Syndrome↗

PubMed2004

Etiopathogenetic mechanisms in long-term course of schizophrenia.

Schizophrenia is a severe mental disorder with a relapsing long-term course in 80 % of the sufferers. The underlying neurobiological principles of the long-term course are widely unknown. Therefore an attempt is made to evaluate data from structural imaging and neuropsychology to shed some light on these mechanisms. Interestingly there was a significant correlation between length of illness and volume reduction in the prefrontal grey matter in schizophrenia. There was a lack of such a correlation for the whole brain volume, white matter volume or the grey matter volume outside the prefrontal lobe. Furthermore none of the neuropsychological measures correlated with length of illness. Both findings are supported by data from prospective studies up to five years demonstrating a significant loss of frontal grey matter volume, but no change of cognitive dysfunction in the course of time. The attempt is made to connect prefrontal grey matter loss with post-mortem findings of reduced neuropil but preserved cytoarchitecture leading to recently described candidate genes and their function.

Brain↗

PubMed2003

[Cystic renal lesions].

Cystic renal lesions are most often simple or complicated cysts, which can be seen solitary or as part of cystic renal disease. The minority of these lesions are benign or malignant cystic tumors. The classification of cystic renal masses by Bosniak (category l - IV) based on specific ultrasound and CT features is very useful for the characterization of the lesion and for the therapeutic decision. The main objective of this classification is to differentiate nonsurgical (category II) from surgical cystic masses (category III/IV). Ultrasound is the first modality of choice in the diagnostic work-up of cystic renal masses, because an accurate and economically reasonable diagnosis of the frequent simple cyst can be made by maintaining rigid ultrasound criteria of the Bosniak classification. If a complicated cyst or a cystic tumor is suspected a three phasic contrast-enhanced CT of the kidneys should be performed. MRI is superior to CT in the characterization of complex cystic masses.

Cost-Benefit Analysis↗

PubMed2002

Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type?

Little is known about whether recanalization of carotid territory occlusions by local intra-arterial thrombolysis (LIT) depends on the type of the occluding thromboembolus. We retrospectively analysed the records of 62 patients with thromboembolic occlusions of the intracranial internal carotid artery (ICA) bifurcation or the middle cerebral artery who were undergoing LIT with urokinase within 6 h of symptom onset. We determined the influence of thromboembolus type (according to the TOAST criteria), thromboembolus location, leptomeningeal collaterals, time interval from onset of symptoms to onset of thrombolysis, and patient's age on recanalization. The thromboembolus type was atherosclerotic in six patients, cardioembolic in 29, of other determined etiology in four, and of undetermined etiology in 23 patients. Thirty-three (53%) thromboembolic occlusions were recanalized. The thromboembolus location but not the TOAST stroke type nor other parameters affected recanalization. In the TOAST group of patients with cardioembolic occlusions recanalization occurred significantly less frequently when transoesophageal echocardiography showed cardiac thrombus. The present study underlines the thromboembolus location as being the most important parameter affecting recanalization. The fact that thromboembolic occlusions originating from cardiac thrombi had a lower likelihood of being resolved by thrombolysis indicates the thromboembolus type as another parameter affecting recanalization.

Carotid Artery Thrombosis↗