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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2006.00061.x Byline: Steven J. Shook (1), Rishi Gupta (1), Nirav A. Vora (1), Andrew L. Tievsky (1), Irene Katzan (1), Derk W. Krieger (1) Keywords: Brain ischemia; cerebrovascular accident; diffusion magnetic resonance imaging; hydroxymethylglutaryl (HMG)-CoA reductase inhibitors; retrospective studies; risk factors; treatment outcome Abstract: ABSTRACT Background. Studies have shown an association between HMG-CoA reductase inhibitors (statins) and improved stroke outcomes, possibly secondary to neuroprotective properties. Objective. To assess whether patients taking statins prior to ischemic stroke have smaller infarcts on magnetic resonance imaging (MRI), adjusting for other relevant clinical factors. Design. We retrospectively reviewed the Cleveland Clinic Foundation (CCF) Neurology Inpatient Database from June 2002 through June 2004. Demographics, medications, stroke subtype, diffusion-weighted imaging (DWI) infarct volume, admission NIHSS, and hours to MRI were collected. Patients with a nonlacunar middle cerebral artery (MCA) territory infarct and MRI less than 48 hours from symptom onset were included (n= 143). A multivariable linear regression model was constructed to determine independent predictors of smaller infarct volume. Results. A total of 143 patients were studied, including 38 patients taking statins at the time of their stroke. In univariate analysis, patients using statins were significantly more likely to have a history of hyperlipidemia, atrial fibrillation, and coronary artery disease and to be using coumadin, antiplatelet drugs, and angiotensin-converting enzyme inhibitors. Patients on statins had a tendency toward smaller infarcts in univariate analysis (median 25.4 cm.sup.3 vs. 15.5 cm.sup.3, P= 0.054). In multivariable linear regression analysis statin use, patient age, and TIA within the prior 4 weeks were independently associated with smaller DWI volumes; vessel occlusion on vascular imaging, and cardioembolic stroke subtype with larger infarct size. Conclusions. Statin use prior to the onset of nonlacunar MCA infarction was associated with a smaller infarct volume independent of other factors. Further studies utilizing both clinical and radiologic outcomes will be required to confirm these findings. Author Affiliation: (1)From the Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH (SS); Department of Neurology, Section of Stroke and Neurocritical Care, Cleveland, OH (NV, IK, DK); Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (NV); and Department of Radiology, Section of Neuroradiology, Cleveland, OH (AT), Department of Neurology, Division of Cerebrovasoular Diseases and Neuroendovascular Services, Michigan State University, East Lansing, MI (RG). Article History: Received March 14, 2006, and in revised form July 19, 2006. Accepted for publication July 25, 2006. Article note: Address correspondence to Derk W. Krieger, MD, PhD, Department of Neurology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, S-90, Cleveland, OH 44195. E-mail: krieged@ccf.org.

Background and Purpose: We sought to validate ultrasound as a reliable means of assessing vessel stenosis of vertebral artery origins.Methods: We reviewed 1,135 patient charts with ultrasound of the posterior circulation performed in 2008-2015 in a single hospital. Inclusion criteria for native vessels consisted of ultrasound and digital subtraction angiography (DSA) performed within 3 months. Patients with indwelling stents were analyzed separately from native vessels. Using DSA as the gold standard, we determined sensitivity and specificity of ultrasound in detecting occlusion at vertebral artery origin. All patients with nonoccluded native vertebral artery origins were evaluated for degree of stenosis on DSA, and compared to mean flow velocity (MFV), peak systolic velocity (PSV), and end-diastolic velocity (EDV) on ultrasound.Results: Among 218 vertebral artery origins in 139 patients evaluated, ultrasound showed sensitivity of 85.7% (95% confidence interval (CI): 69.7-95.2%) for occlusion and specificity of 99.5% (95%CI: 96.9-99.9%). Among 126 arteries without occlusion, <50% stenosis had average MFV (39 ± 19 cm/s), 50-69% stenosis had average MFV (68 ± 35 cm/s), and severe (70-99%) stenosis had average MFV (120 ± 93 cm/s) (P < .001). MFV cutoff value of 44 cm/s corresponded to 77% sensitivity and 70% specificity to detect vertebral artery origin stenosis >50% (C-statistic: .81). PSV value of 97 cm/s corresponded with 72% sensitivity and 70% specificity to detect >50% stenosis (C-statistic: .77). MFV cutoff value of 60 cm/s corresponded with 70% sensitivity and 82% specificity to predict 70-99% stenosis (C-statistic: .83). PSV cutoff value of 110 cm/s corresponded with 80% sensitivity and 72% specificity to predict 70-99% stenosis (C-statistic: .84).Conclusion: Ultrasound has good sensitivity and excellent specificity for detecting vertebral origin occlusion. Flow velocity can be used to screen for severe stenosis of vertebral artery at origin. [ABSTRACT FROM AUTHOR]