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Carotid stenosis, acute stroke,

Rodolfo Pini, Gianluca Faggioli, Matteo Longhi, Liborio Ferrante, Andrea Vacirca, Enrico Gallitto, Mauro Gargiulo, Andrea Stella
BACKGROUND: The influence of acute cerebral ischemic lesions (CILs) on the revascularization outcome of symptomatic carotid stenosis has been scarcely investigated in the literature. This study evaluated the effect of CILs and their volume on the results of carotid revascularization in symptomatic patients. METHODS: All patients with symptomatic carotid artery stenosis who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) between 2005 and 2014 were considered...
October 14, 2016: Journal of Vascular Surgery
Shawna Cutting, Elizabeth Regan, Vivien H Lee, Shyam Prabhakaran
BACKGROUND AND PURPOSE: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. METHODS: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h...
October 8, 2016: Cerebrovascular Diseases Extra
Salim Elyas, Angela C Shore, Hayley Kingwell, Samantha Keenan, Leigh Boxall, Jane Stewart, Martin A James, William David Strain
OBJECTIVE: Transient ischemic attacks (TIA) and minor strokes are important risk factors for recurrent strokes. Current stroke risk prediction scores such as ABCD2, although widely used, lack optimal sensitivity and specificity. Elevated urinary albumin excretion predicts cardiovascular disease, stroke, and mortality. We explored the role of microalbuminuria (using albumin creatinine ratio (ACR)) in predicting recurrence risk in patients with TIA and minor stroke. METHODS: Urinary ACR was measured on a spot sample in 150 patients attending a daily stroke clinic with TIA or minor stroke...
September 2016: Annals of Clinical and Translational Neurology
Yoko Yamamoto, Toshiyuki Okazaki, Keishi Yoda, Yoshiteru Tada, Shinji Nagahiro
Acute internal carotid artery (ICA) occlusion may result in severe disability or death. Revascularization by carotid artery stenting after treatment with intravenous (iv) recombinant tissue-type plasminogen activator (rt-PA) has been documented. However, there are few reports on emergency carotid endarterectomy (CEA) within 24 hours after the iv administration of rt-PA. We treated a 58-year-old man with right ICA occlusion with iv rt-PA. Although partial recanalization of the ICA was obtained, severe stenosis at the origin of the ICA persisted and he developed fluctuating neurological deficits...
2016: Journal of Medical Investigation: JMI
Graeme J Hankey
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis...
September 13, 2016: Lancet
Ma Serrie Platero Suministrado, Esther Wan Yee Shuang, Jing Xu, Hock Luen Teoh, Bernard Poon-Lap Chan, Narayanaswamy Venketasubramanian, Raymond Chee Seong Seet, Christopher Li-Hsian Chen, Boon Seng Wong, Vijay Kumar Sharma, YanHong Dong
BACKGROUND: Poststroke vascular cognitive impairment is highly prevalent with significant functional consequences. However, reliable biomarkers for early prediction of cognitive decline after acute ischemic stroke (AIS) are not well established. Although parenchymal imaging in patients with AIS and transient ischemic attack (TIA) may predict the resultant cognitive impairment, it may not explain the progressive deterioration after the index event. We postulated that longitudinal changes in cerebral hemodynamic parameters may influence the cognitive performance after a cerebrovascular event...
September 13, 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Yahia Z Imam, Atlantic D'Souza, Rayaz A Malik, Ashfaq Shuaib
Treatment of hypertension, diabetes, high cholesterol, smoking cessation, and healthy lifestyle have all contributed to the decline in the incidence of vascular disease over the last several decades. Patients who suffer an acute stroke are at a high risk for recurrence. Introduction of newer technologies and their wider use allows for better identification of patients in whom the risk of recurrence following an acute stroke may be very high. Traditionally, the major focus for diagnosis and management has focused on patient history, examination, imaging for carotid stenosis/occlusion, and detection of AF and paroxysmal AF (PAF) with 24-48 h cardiac monitoring...
December 2016: Translational Stroke Research
Harald Mudra, Stephan Staubach, Ralph Hein-Rothweiler, Manuela Segerer, Henning Strohm, Hannes Weber, Jakob Ledwoch
BACKGROUND: There is a lack of long-term data and data outside of controlled clinical trials in carotid artery stenting. Thus, we sought to evaluate the long-term effectiveness in stroke prevention by carotid artery stenting in a large number of patients in a real-world setting. METHODS AND RESULTS: The present work represents an all-comer registry with a strict, prospectively designed, follow-up protocol, including an independent pre- and postprocedural neurological assessment...
September 2016: Circulation. Cardiovascular Interventions
Yi Yang, Shihoko Kimura-Ohba, Jeffrey Thompson, Gary A Rosenberg
Vascular cognitive impairment dementia (VCID), which is an increasingly important cause of dementia in the elderly, lacks effective treatments. Many different types of vascular disease are included under the diagnosis of VCID, including large vessel disease with multiple strokes and small vessel disease with lacunar infarcts and white matter disease. Animal models have been developed to study the multiple forms of VCID. Because of its progressive course, small vessel disease (SVD) is thought to be the optimal form of VCID for treatment...
October 2016: Translational Stroke Research
Gordana Arandjelović Minić
BACKGROUND/AIM: Increasing evidence points to the inflammatory character of atherosclerosis and several parameters of inflammation have been proposed as cerebrovascular risk markers. The objective of the research was to examine the connection of serum inflammatory parameters and ultrasound (US) characteristics of the structure and size of carotid plaque. We assumed that the number of leukocytes (Le) was an indicator of carotid plaque instability and an increased risk of stroke. METHODS: Serum inflammatory parameters: erythrocyte sedimentation rate in the first (ESR I) and second hour (ESR II), the number of Le, high sensitivity C-reactive protein (hsCRP) and fibrinogen were measured by standard methods...
June 2016: Vojnosanitetski Pregled. Military-medical and Pharmaceutical Review
Thomas I Nathaniel, Thomas Cochran, Jose Chaves, Eric Fulmer, Crystal Sosa, Sara Yi, Megan Fredwall, Shannon Sternberg, Dawn Blackhurst, Alfred Nelson, Rodney Leacock
BACKGROUND: The objective of this study was to characterize the comorbidities in a population of patients with an acute ischaemic stroke, comparing patients that received recombinant tissue plasminogen activator (rt-PA) to those that did not receive rt-PA. METHOD: In a retrospective sample of 663 patients admitted for acute ischaemic stroke, this study analysed the effects of co-morbid conditions in the use of rt-PA. It determined non-cerebrovascular risk factors (comorbidities) that differentiate patients who received rt-PA from those who did not receive rt-PA...
2016: Brain Injury: [BI]
Oliver Matz, Omid Nikoubashman, Parajuli Rajkumar, Andreas Keuler, Martin Wiesmann, Jörg B Schulz, Arno Reich
Doppler/duplex ultrasound (DUS) and computed tomographic angiography (CTA) are frequently applied methods to assess the degree of proximal internal carotid artery (ICA) stenoses in patients with acute ischemic stroke. This study evaluated the agreement and interrater reliability (IR) of both methods using a revised DUS grading system as well as different criteria (ECST/NASCET) under real-life conditions. CTA and DUS data of 281 proximal ICA stenoses [143 patients; 65.7 % male; age (mean (years) ± SD, range) 72...
July 27, 2016: Acta Neurologica Belgica
Q Q Deng, J Tang, C Chen, H Markus, Y N Huang, H Zhao, D Ratanakorn, K S L Wong, J H Fu
BACKGROUND: Microembolic signals (MESs) are direct markers of unstable large artery atherosclerotic plaques. In a previous study, we found that the number of MESs is associated with stroke recurrence and that clopidogrel plus aspirin more effectively reduce the number of MESs than does aspirin alone. Stroke recurrence is associated with not only the number of MESs but also the size of the MES, which can theoretically be estimated by monitoring the MES intensity via transcranial doppler (TCD)...
August 15, 2016: Journal of the Neurological Sciences
Fernando Delgado, Isabel Bravo, Elvira Jiménez, Eduardo Murías, Antonio Saiz, Pedro Vega, Antonio López-Rueda, Jordi Blasco, Juan Macho, Alejandro González
BACKGROUND: Carotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy. OBJECTIVE: To evaluate the results of endovascular treatment and clinical outcomes of patients with CD. METHODS: A four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8...
July 15, 2016: Journal of Neurointerventional Surgery
Allie Massaro, Steven R Messé, Michael A Acker, Scott E Kasner, Jose Torres, Molly Fanning, Tania Giovannetti, Sarah J Ratcliffe, Michel Bilello, Wilson Y Szeto, Joseph E Bavaria, Emile R Mohler, Thomas F Floyd
BACKGROUND AND PURPOSE: Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. METHODS: We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. RESULTS: Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61%), and interrater reliability for stroke pathogenesis was high (κ=0...
August 2016: Stroke; a Journal of Cerebral Circulation
Aleksandra Yakhkind, Ryan A McTaggart, Mahesh V Jayaraman, Matthew S Siket, Brian Silver, Shadi Yaghi
A majority of patients with ischemic stroke present with mild deficits for which aggressive management is not often pursued. Comprehensive work-up and appropriate intervention for minor strokes and transient ischemic attacks (TIAs) point toward better patient outcomes, lower costs, and fewer cases of disability. Imaging is a key modality to guide treatment and predict stroke recurrence. Patients with large vessel occlusions have been found to suffer worse outcomes and could benefit from intervention. Whether intravenous thrombolytic therapy decreases disability in minor stroke patients and whether acute endovascular intervention improves functional outcomes in patients with minor stroke and known large vessel occlusion remain controversial...
2016: Frontiers in Neurology
Claudio Baracchini, Gian Paolo Anzola, Silvia Cenciarelli, Marina Diomedi, Rita Bella, Agnese Tonon, Massimiliano Braga, Maria Luisa Zedde, Carla Zanferrari, Massimo Del Sette, Pietro Caliandro, Carlo Gandolfo, Stefano Ricci, Giorgio Meneghetti
There are currently no data available on the prevalence of symptomatic intracranial atherosclerosis (ICAS) in Italy. The aim of this prospective, multicenter, hospital-based, transcranial ultrasound study was to establish the prevalence of ICAS among patients hospitalized with acute ischemic stroke. At 11 stroke centers across Italy, patients consecutively admitted for their first ever acute ischemic stroke were assessed prospectively over a 24-month period either with transcranial color-coded Doppler sonography (TCCS) or transcranial Doppler (TCD) according to validated criteria...
October 2016: Neurological Sciences
Aijun Ma, Shaonan Yang, Yuan Wang, Xia Wang, Xudong Pan
BACKGROUND: The majority of strokes are combined with the instability of atherosclerotic plaques. Microembolic signals (MES) have been considered as evidence of plaque destabilization. We found that increased CXCL16 correlated to atherosclerotic ischemic stroke. Thus, we explored whether CXCL16 correlates to MES. METHODS: The study recruited 104 controls and 118 patients with acute ischemic stroke that has an ipsilateral carotid artery stenosis of >50%. The ipsilateral middle cerebral artery of patients was insonated for 60min using Doppler device within 72h of their clinical presentation...
September 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
A V Shatravka, G Yu Sokurenko, S A Suvorov, M R Rizakhanova, I A Loginov, N V Alekseeva
Recent years have witnessed several studies concerning optimal terms of performing carotid endarterectomy after endured acute cerebral circulation disorder (ACCD). However up to now there is no common opinion regarding feasibility and safety of performing carotid endarterectomy in the acute period of ischaemic stroke. The 2013 Russian National Guidelines on surgical management of diseases of extracranial arteries point to feasibility of performing carotid endarterectomy at terms within up to 2 weeks after endured ischaemic stroke (level B evidence)...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
M N Safronova, O A Mizyurkina, A V Kovalenko, O L Barbarash
AIM: To study an effect of stenosing lesions of carotid arteries on the recovery of speech functions in acute stroke patients. MATERIAL AND METHODS: Medical histories of 253 patients (median age 58 [52,63]) with acute left hemispheric ischemic and hemorrhagic stroke and motor or sensorimotor aphasia were analyzed. The severity of atherosclerotic lesion of brachiocephalic arteries was assessed using color duplex scanning. According to the results of duplex scanning, patients were divided into 3 groups: 1 - without stenosis of extracranial arteries; 2 - with ≤50% stenosis of carotid arteries; 3 - with >50% stenosis of carotid arteries...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
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