XVII. European Stroke Conference
Nice, France

Oral Session:

Vascular biology
Date: Wednesday 14 May 2008  
Time: 16:45 - 16:55 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

01
Association between low matrix metalloproteinases 3 plasma level and dilatative arteriopathy of the brain in stroke patients
F. PICO    J. LABREUCHE    M.P.JACOB    J.B.MICHEL    P. AMARENCO                                   
 

Versailles hospital

FRANCE

Background: Intracranial arterial dolichoectasia (IADE), also called dilatative arteriopathy of the brain, is identified in 12% of patients with brain infarction. The pathophysiology is unknown. Two ectatic arterial disorders have been associated with IADE: abdominal aortic aneurysm and ectasia of the coronary artery. Both have been associated with the matrix metalloproteinases (MMP) pathway, respectively MMP9 and 3. MMP pathway have never been investigated in IADE(+) patients with brain infarction. We investigate the matrix metalloproteinases pathway in dilatative arteriopathy of the brain Methods: Patients with BI (n=510) were consecutively recruited from 12 centers. The diagnosis of IADE was made by consensus between two neurologists based on MRI results. An independent reading of the 510 scans was made, with measurement of the diameter of the seven main intracranial arteries with a 16-diopter lens. Determination of MMP-2, MMP-3, MMP-9 levels was centralized in a single laboratory. Results: IADE was identified by consensus on brain MRI in 12% of stroke patients.We found a positive association between MMP-3 level and age, male gender, current smoking, carotid IMT and plaques. There was an higher risk of IADE with the lowest MMP3 tertile (p=0.04). The adjusted OR of IADE associated with MMP3 levels was 0.40 (95%CI, 0.19-0.85) p=0.018. In line with this resut there was a strong negative correlation between basilar artery diameter and MMP-3 level in multivariate analysis (r=-0.163, p=0.003). Discussion: IADE and basilar artery diameter were associated with low MMP3 plasm level. The latter is correlated with the 5a/5a MMP3 polymorphism which is a risk factor of ectasia of the coronary artery. This suggest that the MMP pathway could be involved in dilatative arteriopathy of the brain.

Vascular biology
Date: Wednesday 14 May 2008  
Time: 16:55 - 17:05 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

02
Endothelial Progenitor Cells in Patients with Stable and Unstable Carotid Plaques
D. Sepp    I. Ott    P. Zepper    L. Esposito    R. Feurer    K. Holzer    S.  Sadikovic    P. Heider    B. Hemmer    H. Poppert
 

Technical University of Munich

GERMANY

Background Endothelial Progenitor Cells (EPCs) play an important role in reendothelialization at sites of endothelial damage. Experimental studies have shown that EPCs promote regeneration of injured endothelial monolayer and thereby reduce the formation of atherosclerotic lesions. Cardiovascular risk factors and atherosclerosis are associated with low levels of EPC. This study investigates whether the number of EPCs differs in patients with unstable carotid plaques compared to patients with stable carotid plaques. Methods The number of EPCs positive for CD34 and CD133 was analyzed by flow cytometry in 30 patients with asymptomatic carotid artery stenosis. In order to categorize plaques patients underwent bilateral carotid MRI in a 1.5-T scanner. Carotid plaques were categorized following the modified criteria of the American Heart Association (type I-VII). Type IV-V and VI were defined as unstable plaques, type III, VII and VIII as stable plaques. Results The carotid plaques of 23 patients were classified as stable plaques, 7 patients presented unstable plaques. The number of EPCs showed no significant difference between stable carotid plaques and unstable carotid plaques (median: 0,068 cells/µl [range 0-0,81] vs. 0,097 cells/µl [range 0-0,22], p=1,00 (Mann-Whitney-U-Test)). Discussion To our knowledge this is the first study investigating the number of EPCs in different types of carotid lesions. We did not find EPC level to be predictive for the stability of carotid plaques. In order to further investigate the role of EPCs in the formation of atherosclerotic plaques we will study functional parameters of EPCs like CXCR4, which is important for recruiting EPCs into the injured endothelium.

Vascular biology
Date: Wednesday 14 May 2008  
Time: 17:05 - 17:15 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

03
GROTWH FACTORS (GF) AND NEUROLOGIC RECOVERY ON INTRACEREBRAL HAEMORRHAGE (ICH)
S. Arias    T. Sobrino    D. Brea    R. Rodríguez-González    M. Blanco    Y. Silva    J. Agulla    O. Moldes    A. Dávalos    J. Castillo
 

Clinical Neurosciences Research Lab, Hospital Clinico Universitario. Santiago de Compostela

SPAIN

Background: Currently, there is no efficient treatment for ICH. Some growth factors induce a reduction of the residual volume as stated in animal models of ICH. We explore the association of GF with the clinical evolution of ICH patients. Methods: 95 patients with primary ICH (66.3% men, 67.8 (9.8) years) of <6 h evolution. A 26.3% were included in clinical trials. We determined the ICH volume at admission, 72h and 7 (1) days. ICH growth is defined as an increment of >30% between two consecutive studies. Principal variable: percent of improvement of NIHSS during at the first 3 months, categorized as no improvement (-100% to 0%) and improvement (0% to 100%); deceased patients (28.4%) were rated with a value of -100%. We determined vascular endothelium growth factor (VEGF), Angiopoietin-1 and Granulocyte-colony stimulating factor (G-CSF) levels by ELISA in basal plasma levels as well as at 24 and 72 h. Results: GF´s levels were significantly higher at 72 h, independently of the inclusion of the patient in clinical trials. Relation between the levels of GF at 72 h and clinical improvement was positive for all of them (VEGF: Spearman coef. 0.763, p<0.0001; ANGIOPOIETIN-1 0.846, p<0.0001; G-CSF 0.778, p<0.0001). VEGF and G-CSF levels were associated, after adjustment by significant variables, with the clinical improvement (OR 5.2, CI95% 1.0 to 12.3, p<0.0001 and OR 2.6, CI95% 1.0 to 5.3, p=0.015, respectively). Association of clinical improvement was more intense and more positive for all 3 GF if the increment of the GF levels were analyzed at 72h. Conclusions: Increment of GF levels at the first 72 h after ICH is associated to a clinical improvement at 3 months.

Vascular biology
Date: Wednesday 14 May 2008  
Time: 17:15 - 17:25 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

04
Changes in functional vasomotor reactivity (fVMR) in migraine with aura
M.E.Wolf    M.G.Hennerici                                                        
 

Universitätsklinikum Mannheim, University of Heidelberg

GERMANY

Background: Migraine with aura is associated with hyper- and hypoperfusion during and after such attacks. Analysis of fVMR using transcranial Doppler (TCD) was hypothesized to identify persistent changes in VMR and hence provide quick and reliable diagnosis to separate patients from controls and those without aura as well as to monitor treatment effects. Methods: In 63 patients (47 women, age range 19-73, mean age 35.3+/-14.1 years; 16 men, age range 25-74, mean age 44.3+/-15.5 years) from our ultrasound registry and in 24 controls/patients with migraine without aura (19 women, age range 15-75, mean age 42.2+/-16.1 years; 5 men, age range 36-70, mean age 52.6+/-15.4 years) using TCD recordings from the P2-segments of both PCAs fVMR was calculated during and after visual stimulation with a moving, coloured pattern for 20 seconds (“on”-phase) followed by 20 seconds with closed eyes (“off”-phase). 10 cycles were performed and averaged. Results: A significant side difference of fVMR was observed in all patients and controls. In patients with migraine with aura the mean difference was 14.83% (SD = 12.22%; p < .001) and in controls/patients without aura mean difference was 4.48% (SD = 3.38%; p < .001). Thus the side difference was significantly higher in migraine with aura (p < .001). Conclusions: Patients with migraine with aura have a significant asymmetry of fVMR responses from bilateral TCD-PCA recordings, which reflect inter-attack persisting vasomotor changes. Functional TCD is a useful test to separate those patients from normal controls and patients without aura.

http://www.eurostroke.org/ni_graphics/g_aid522.htm
 

Vascular biology
Date: Wednesday 14 May 2008  
Time: 17:25 - 17:35 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

05
The presence of microembolic signals in patients with cervical carotid stenosis is associated with leukocyte and neutrophil counts.
N. NASR    V. LARRUE                                                        
 

Service de Neurologie Vasculaire, Hôpital Rangueil, Toulouse; INSERM U 858.

FRANCE

The presence of microembolic signals (MES) on TCD monitoring in the MCA ipsilateral to cervical carotid stenosis (CCS) is associated with an increased risk of cerebral ischemic events. Inflammation could play a role in rendering CCA atherosclerotic plaques unstable and may favour thromboembolism. In this prospective study we examined the hypothesis that peripheral leukocyte count is associated with the presence of MES in CCS. 50 consecutive patients (44 men and 6 women; median age[range]:76.5[51-89]) with CCS >or=50% who were explored for MES detection were recruited and had peripheral leukocyte count and high-sensitivity CRP measurement. CCS was symptomatic in 36 patients and asymptomatic in 14 patients. MES were detected in 12 patients. Total leukocyte and neutrophil counts were higher in patients with MES than in patients without MES (p=0.019; p=0.021; Mann-Whitney U test). Degree of stenosis, irregular contours of plaque, echo-morphology, delay from ischemic event to MES search, NIHSS, anticoagulant therapy, CRP, monocytes, lymphocytes, platelets count and treatment with statin were not associated with the presence of MES.The association between dual antiplatelet therapy using aspirin and clopidogrel and the presence of MES was marginally significant (p=0.063). Symptomatic feature was associated with the presence of MES in univariate analysis (p=0.013) but not after adjustement for leukocyte or neutrophil count (p=0.998). Leukocyte and neutrophil counts remained higher in patients with MES after adjustement for symptomatic feature and dual antiplatelet therapy (p=0.028; odds ratio: 6.6[1.23-35.44]) These results are in favour of a link between inflammation and embolization. More specifically, neutrophils may contribute to plaque disruption and thromboembolism in CCS.

Vascular biology
Date: Wednesday 14 May 2008  
Time: 17:35 - 17:45 -  Room: Erato/Uranie
Chair: J. Betlehem, Hungary and L. Hirt, Switzerland

06
Apparent stable ICA atheromatous occlusions might partially open and need endarterectomy for stroke prevention!
R. Santos    M. Carvalho    E. Azevedo                                                 
 

Hospital São João, University of Porto

PORTUGAL

Introduction: Spontaneous recanalization of extracranial internal carotid artery (ICA) atheromatous occlusion has been rarely reported. We aimed to assess the frequency of partial recanalization of these lesions using carotid ultrasound in patients presenting with ischemic stroke. Methods: Carotid ultrasound exams of patients with acute ischemic stroke due to symptomatic ICA occlusion, over a period of 3 years, were retrospectively reviewed. Selection criteria: cases with follow-up exams and proximal occlusions (velocity and morphologic ultrasound criteria). Exclusion criteria: confirmed or suspected dissection, more distal embolic occlusion, or proximal revascularization without increased velocity suggesting persistence of a more distal occlusion. Results: From 150 cases with ICA occlusion, 84 had a proximal atheromatous extracranial ICA occlusion; 36 of these had a follow-up exam, and in 5 (13.8%) there was partial recanalization with segmental stenosis and significant blood flow acceleration. Mean time of follow-up exam was 9.7 months in the 31 cases remaining occluded and 9.2 months in the 5 with partial recanalization. Two of these were treated, one with stenting and another with endarterectomy. Pathological examination of surgical specimen confirmed an atheromatous plaque. In both cases follow-up colour-coded transcranial Doppler revealed normalization of previous intracranial blood flow collateralizations. Conclusion: We confirmed spontaneous recanalization of atheromatous extracranial ICA occlusion in patients with ischemic stroke. It might be appropriate to schedule at least one follow-up exam in patients with recent ICA occlusion, since partial recanalization might indicate endovascular or surgical revascularization for secondary stroke prevention.