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Cerebrovascular intervention

Walter Pirker, Regina Katzenschlager
Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives...
October 21, 2016: Wiener Klinische Wochenschrift
Hyeon Chang Kim
Disease risk prediction models have been developed to assess the impact of multiple risk factors and to estimate an individual's absolute disease risk. Accurate disease prediction is essential for personalized prevention, because the benefits, risks, and costs of alternative strategies must be weighed to choose the best preventive strategy for individual patients. Cardiovascular disease (CVD) prediction is the earliest example of individual risk predictions. Since the Framingham study reported a CVD risk prediction method in 1976, an increasing number of risk assessment tools have been developed to CVD risk in various settings...
September 2016: Journal of Hypertension
Leroy L Cooper, Gary F Mitchell
BACKGROUND: Aortic stiffness is associated with cardiovascular and cerebrovascular events and cognitive decline. This mini-review focuses on relations of aortic stiffness with microvascular dysfunction and discusses the contribution of abnormal pulsatile hemodynamics to cerebrovascular damage and cognitive decline. We also provide a rationale for considering aortic stiffness as a putative and important contributor to memory impairment in older individuals. SUMMARY: Aging is associated with stiffening of the aorta but not the muscular arteries, which reduces wave reflection and increases the transmission of pulsatility into the periphery...
September 2016: Pulse (Basel, Switzerland)
Nuccia Morici, Laura Farioli, Laura Michelina Losappio, Giulia Colombo, Michele Nichelatti, Donatella Preziosi, Gianluigi Micarelli, Fabrizio Oliva, Cristina Giannattasio, Silvio Klugmann, Elide Anna Pastorello
OBJECTIVE: To assess the relationship between serum tryptase and the occurrence of major cardiovascular and cerebrovascular events (MACCE) at 2-year follow-up in patients admitted with acute coronary syndrome (ACS). To compare serum tryptase to other validated prognostic markers (maximum high-sensitivity troponin (hs-Tn), C reactive protein (CRP) levels at admission, Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score). METHODS: We measured serum tryptase at admission in 140 consecutive patients with ACS and in 50 healthy controls...
2016: Open Heart
Martin Möckel, Julia Searle, Henning Thomas Baberg, Peter Dirschedl, Benny Levenson, Jürgen Malzahn, Thomas Mansky, Christian Günster, Elke Jeschke
OBJECTIVES: We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy. DESIGN: Retrospective analysis of routine statutory health insurance data between 2010 and 2012. MAIN OUTCOME MEASURES: Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year...
2016: Open Heart
Amanda McIntyre, Spencer Thompson, Amer Burhan, Swati Mehta, Robert Teasell
OBJECTIVE: This study aims to perform a systematic review evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving depression resulting from cerebrovascular disease including vascular depression (VD) and poststroke depression (PSD). METHODS: A literature search of multiple scientific databases was conducted for English studies published from January 1980 to June 2016. Studies were included if the sample consisted of 50% or more adult humans with VD or PSD and had 3 or more subjects, the intervention applied was rTMS, and depression was assessed pre- and post intervention using a formal outcome measure...
October 12, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jason M Davies, Michael T Lawton
OBJECTIVE Treatment of cerebrovascular malformations has grown in complexity with the development of multimodal approaches, including microsurgery, endovascular treatments, and radiosurgery. In spite of this changing standard of care, the provision of care continues across a variety of settings. The authors sought to determine the risk of adverse outcome after treatment of patients with vascular malformations in the US. Patient, surgeon, and hospital characteristics, including volume, were tested as potential outcome predictors...
October 14, 2016: Journal of Neurosurgery
Naresh Malhotra, M K Keshan, Avinash Agarwal, R Anil Kumar, Abhijit Trailokya, Kalpesh Dalvi, Suhas Talele
BACKGROUND: Cardiovascular diseases (CVD's) are the major cause of morbidity and mortality in both developed and developing countries. Many clinical trials have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, reduces the incidence of coronary and cerebrovascular events across a broad spectrum of patients at risk. Guidelines for the management of patients at risk have been established in Europe and North America. The guidelines have advocated progressively lower LDL-C targets and more aggressive use of statin therapy...
April 2016: Journal of the Association of Physicians of India
Javier A Valle, Laura Graham, Aerin DeRussy, Kamal Itani, Mary T Hawn, Thomas M Maddox
BACKGROUND: Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown...
October 12, 2016: World Journal of Surgery
Byoung Geol Choi, Seung-Woon Rha, Taeshik Park, Se Yeon Choi, Jae Kyeong Byun, Min Suk Shim, Shaopeng Xu, Hu Li, Sang-Ho Park, Ji Young Park, Woong Gil Choi, Yun-Hyeong Cho, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
BACKGROUND AND OBJECTIVES: Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. SUBJECTS AND METHODS: A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395)...
September 2016: Korean Circulation Journal
Jose F Condado, Hanna A Jensen, Aneel Maini, Yi-An Ko, Mohammad H Rajaei, Lillian L Tsai, Chandan Devireddy, Bradley Leshnower, Kreton Mavromatis, Eric L Sarin, James Stewart, Robert A Guyton, Vasilis Babaliaros, Edward P Chen, Michael Halkos, Amy Simone, Patricia Keegan, Peter C Block, Vinod H Thourani
BACKGROUND: Screening for internal carotid artery stenosis (ICAS) with Doppler ultrasound is commonly used before cardiovascular surgery. Nevertheless, the relationship between ICAS and procedure-related stroke in isolated aortic valve replacement is unclear. METHODS: We retrospectively reviewed patients with artery stenosis who underwent ICAS screening before surgical (SAVR) or transcatheter aortic valve replacement (TAVR) between January 2007 and August 2014. Logistic regression models were used to determine the relation between post-procedure stroke and total (sum of left and right ICAS) and maximal unilateral ICAS...
October 4, 2016: Annals of Thoracic Surgery
G Colussi, C Catena, M Novello, N Bertin, L A Sechi
AIMS: To overview the effects of omega-3 polyunsaturated fatty acids (PUFA) on blood vessels and blood pressure (BP) and their relevance for cardiovascular prevention. DATA SYNTHESIS: The importance of omega-3 PUFA for the cardiovascular system has come under the spotlight during the last decades. These fatty acids are present in variable amounts in cell membranes of mammal species, and their content affects a variety of cellular functions. Evidence obtained in animal and human studies suggests that omega-3 PUFA affect many steps of the atherosclerotic process...
July 26, 2016: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
J Fluss, M Dinomais, M Kossotoroff, C Vuillerot, S Darteyre, S Chabrier
Over the last decade considerable advances have been made in the identification, understanding and management of pediatric arterial ischemic stroke. Such increasing knowledge has also brought new perspectives and interrogations in the current acute and rehabilitative care of these patients. Areas covered: In developed countries, focal cerebral arteriopathy is one of the most common causes of arterial ischemic stroke in childhood and imaging features are well characterized. However, there are ongoing debates regarding its underlying mechanisms, natural evolution and proper management...
October 12, 2016: Expert Review of Neurotherapeutics
Nefize Turan, Brandon A Miller, Robert A Heider, Maheen Nadeem, Iqbal Sayeed, Donald G Stein, Gustavo Pradilla
The most important aspect of a preclinical study seeking to develop a novel therapy for neurological diseases is whether the therapy produces any clinically relevant functional recovery. For this purpose, neurobehavioral tests are commonly used to evaluate the neuroprotective efficacy of treatments in a wide array of cerebrovascular diseases and neurotrauma. Their use, however, has been limited in experimental subarachnoid hemorrhage studies. After several randomized, double-blinded, controlled clinical trials repeatedly failed to produce a benefit in functional outcome despite some improvement in angiographic vasospasm, more rigorous methods of neurobehavioral testing became critical to provide a more comprehensive evaluation of the functional efficacy of proposed treatments...
September 27, 2016: Journal of Cerebral Blood Flow and Metabolism
Fei Song, Mengyue Yu, Jingang Yang, Haiyan Xu, Yanyan Zhao, Wei Li, Dewei Wu, Zhifang Wang, Qingsheng Wang, Xiaojin Gao, Yang Wang, Rui Fu, Yi Sun, Runlin Gao, Yuejin Yang
Animal and imaging study evidence favors early reperfusion for acute myocardial infarction. However, in clinical trials, the effect of symptom-onset-to-balloon (S2B) time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) has been inconsistent. Moreover, there are few data regarding the ischemic time in China. A total of 3,877 consecutive patients with STEMI with available S2B time undergoing pPCI from January 2013 to September 2014 at 108 hospitals that participated in the China Acute Myocardial Infarction registry were included and stratified into 3 S2B groups: <6 hours, 6 to 12 hours, >12 hours S2B time was tested in multivariate logistic regression analyses as an independent risk factor of mortality (primary outcome), major adverse cardiovascular and cerebrovascular events (MACCE), and impaired myocardial perfusion (secondary outcomes)...
August 13, 2016: American Journal of Cardiology
Philippe Charbonneau, Paule Lessard Bonaventure, Laura M Drudi, Nathalie Beaudoin, Jean-François Blair, Stéphane Elkouri
OBJECTIVE: The aim of this study was to assess time delays between first cerebrovascular symptoms and carotid endarterectomy (CEA) at a single center and to systematically evaluate causes of these delays. METHODS: Consecutive adult patients who underwent CEAs between January 2010 and September 2011 at a single university-affiliated center (Centre Hospitalier de l'Université Montréal-Hôtel-Dieu Hospital, Montreal) were identified from a clinical database and operative records...
September 20, 2016: Journal of Vascular Surgery
Leonardo Méndez Boo, Ermengol Coma, Manuel Medina, Eduardo Hermosilla, Manuel Iglesias, Carmen Olmos, Sebastian Calero Muñoz, Johanna Caro Mendivelso
BACKGROUND: To determine the effectiveness of reminders compared to no reminders in improving adherence to multiple clinical recommendations measured as the resolution of the clinical condition that motivated the reminder, in a primary care setting with a well-established feedback system. METHODS/DESIGN: A 12-month, cluster-randomized, controlled clinical trial was designed (randomized by primary care team) to evaluate the impact of computerized reminders. All study participants will continue to receive the usual feedback from the electronic health records system...
2016: SpringerPlus
Rafael Cavalcante, Yohei Sotomi, Yaping Zeng, Cheol Whan Lee, Jung-Min Ahn, Carlos Collet, Erhan Tenekecioglu, Pannipa Suwannasom, Yoshinobu Onuma, Seung-Jung Park, Patrick W Serruys
OBJECTIVE: In patients with multivessel disease and proximal left anterior descending artery (LAD) involvement, the best revascularisation strategy is still unclear. We assess outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents in a pooled analysis of individual patient-level data of the SYNTAX and BEST randomised trials. DESIGN: Proximal LAD involvement was defined by any lesion ≥ 50% diameter stenosis in the arterial segment starting from the left-main bifurcation up to (and including) the origin of the first major septal branch...
September 20, 2016: Heart: Official Journal of the British Cardiac Society
Devraj Sukul, Milan Seth, Simon R Dixon, Mark Zainea, Nicklaus K Slocum, Elizabeth J Pielsticker, Hitinder S Gurm
OBJECTIVES: We examined clinical outcomes following percutaneous coronary intervention (PCI) in patients turned down for surgical revascularization across a broad population. BACKGROUND: Prior studies suggest that surgical ineligibility is associated with increased mortality in patients with unprotected left main or multivessel coronary artery disease undergoing PCI. METHODS: This study included consecutive patients who underwent PCI in a multicenter registry in Michigan from January 2010 to December 2014...
September 21, 2016: Catheterization and Cardiovascular Interventions
Adrian Mahlmann, Norbert Weiss
Patients with aortic diseases have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Open surgery or endovascular interventions of the aorta are associated with high perioperative cardiac risk. Simple scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients, further diagnostic and therapeutic interventions are required to reduce perioperative morbidity and mortality. In contrast, low-risk patients can be identified, who may proceed to intervention without additional cardiopulmonary diagnostic testing...
September 2016: Best Practice & Research. Clinical Anaesthesiology
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