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    Association between spontaneous internal carotid artery dissection and perivascular adipose tissue attenuation on computed tomography angiography
    (2023)
    Kevin Cheng
    ;
    Andrew Lin
    ;
    STECHER GUZMAN, XIMENA PATRICIA  
    ;
    Tomas Bernstein
    ;
    Paulo Zuñiga
    <jats:sec><jats:title>Background:</jats:title><jats:p> Spontaneous cervical artery dissection (sCAD) is a leading cause of ischemic stroke in young patients. Studies using high-resolution magnetic resonance imaging and positron emission tomography have suggested vessel wall inflammation to be a pathogenic factor in sCAD. Computed tomography (CT) attenuation of perivascular adipose tissue (PVAT) is an established non-invasive imaging biomarker of inflammation in coronary arteries, with higher attenuation values reflecting a greater degree of vascular inflammation. </jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p> We evaluate the CT attenuation of PVAT surrounding the internal carotid artery (PVAT<jats:sub>carotid</jats:sub>) with and without spontaneous dissection. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Single-center prospective observational study of 56 consecutive patients with CT-verified spontaneous dissection of the internal carotid artery (ICA). Of these patients, six underwent follow-up computed tomography angiography (CTA). Twenty-two patients who underwent CTA for acute neurological symptoms but did not have dissection formed the control group. Using semi-automated research software, PVAT<jats:sub>carotid</jats:sub> was measured as the mean Hounsfield unit (HU) attenuation of adipose tissue within a defined volume of interest surrounding the ICA. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> PVAT<jats:sub>carotid</jats:sub> was significantly higher around dissected ICA compared with non-dissected contralateral ICA in the same patients (−58.7 ± 10.2 vs −68.9 ± 8.1 HU, p &lt; 0.0001) and ICA of patients without dissection (−58.7 ± 10.2 vs −69.3 ± 9.3 HU, p &lt; 0.0001). After a median follow-up of 89 days, there was a significant reduction in PVAT<jats:sub>carotid</jats:sub> around dissected ICA (−57.5 ± 13.4 to −74.3 ± 10.5 HU, p &lt; 0.05), while no change was observed around non-dissected contralateral ICA (−71.0 ± 4.4 to −74.1 ± 4.1 HU, p = 0.19). ICA dissection was an independent predictor of PVAT<jats:sub>carotid</jats:sub> following multivariable adjustment for age and the presence of ICA occlusion. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> PVAT<jats:sub>carotid</jats:sub> is elevated in the presence of sCAD and may decrease following the acute event. </jats:p></jats:sec>
      3  1Scopus© Citations 5
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    Giant cell arteritis and its mimics: A comparison of three patient cohorts
    (2020)
    Matthew J. Koster
    ;
    Karthik Yeruva
    ;
    Cynthia S. Crowson
    ;
    Francesco Muratore
    ;
    Cristian Labarca
      1Scopus© Citations 18
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      12  1Scopus© Citations 1
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    A case report of granuloma faciale, an uncommon cutaneous vasculitis
    (2019)
    Javier Arellano
    ;
    Pablo Vargas
    ;
    Constanza Pulgar
    ;
    Gabriel Neely
    ;
    Yamile Corredoira
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    Bullous Henoch-Schonlein purpura. Case report
    (2018)
    MARIA TRINIDAD HASBUN ZEGPI
    ;
    Ximena Chaparro
    ;
    Viera Kaplan
    ;
    Felipe Cavagnaro
    ;
    CASTRO MENDEZ, ALEX  
    Scopus© Citations 8  1
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      16Scopus© Citations 13
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    Efficacy of Methotrexate in Real-world Management of Giant Cell Arteritis: A Case-control Study
    (2019)
    Matthew J. Koster
    ;
    Karthik Yeruva
    ;
    Cynthia S. Crowson
    ;
    Francesco Muratore
    ;
    Cristian Labarca
    <jats:sec><jats:title>Objective.</jats:title><jats:p>To determine the effect of methotrexate (MTX) on relapse risk and glucocorticoid (GC) use in a large single-institution cohort of patients with giant cell arteritis (GCA).</jats:p></jats:sec><jats:sec><jats:title>Methods.</jats:title><jats:p>Patients diagnosed with GCA from 1998 to 2013 with confirmed evidence of temporal artery biopsy and/or radiographic evidence of large vessel vasculitis were identified. Each patient with GCA treated with adjunct MTX (case) was matched to a similar patient with GCA treated only with GC (control). GC requirements and relapse events before and after MTX initiation (or corresponding index date) were compared using rate ratios (RR).</jats:p></jats:sec><jats:sec><jats:title>Results.</jats:title><jats:p>Eighty-three cases and 83 controls were identified and compared. No significant differences in age, demographics, laboratory variables, baseline disease characteristics, or mean initial prednisone doses were observed. Median [interquartile range (IQR)] time from GCA diagnosis to MTX initiation in cases was 39 (13–80) weeks and the median (IQR) starting dose was 13.5 (10–15) mg/week. RR comparing relapse rates before and after MTX initiation/index date were significantly reduced in both cases (RR 0.32, 95% CI 0.24–0.41) and controls (RR 0.60, 95% CI 0.43–0.86). The decrease in relapse rate was significantly greater in patients taking MTX than in those taking GC alone (p = 0.004). Rates of GC discontinuation did not differ between groups.</jats:p></jats:sec><jats:sec><jats:title>Conclusion.</jats:title><jats:p>In this large single-institution cohort, the addition of MTX to GC decreased the rate of subsequent relapse by nearly 2-fold compared to patients taking GC alone. MTX may be considered as adjunct therapy in patients with GCA to decrease the risk of further relapse events.</jats:p></jats:sec>
    Scopus© Citations 44  1