Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a study of 501 infarcts in the middle cerebral artery (MCA) territory, in 484 patients. All cases had an appropriate low-density area on computed tomography. The basal (perforators) territory was involved in half the cases and the motor pathways either in the pre-rolandic area or in the internal capsule in 90%. In all locations, except for watershed infarcts, the main cause was cardiac embolism. Atrial fibrillation accounted for 59%, the two other main causes were myocardial infarction and paradoxical embolism. Atherosclerosis accounted for less than one third of the cases. Among 102 internal carotid artery occlusions less than one half were due to atherosclerosis, cardiac embolism and dissecting aneurysms accounted for 22% each. None of 34 MCA occlusions were due to atherosclerotic thrombotic occlusion. Transient ischemic attacks were recorded in 22% of the cases. Stroke-in-progression with a mean duration of 6-8 hours in hospital, was noted in nearly half the cases. In a small group of MCA infarcts paralysis began and predominated on the lower limb, fifteen contralateral old MCA infarcts were silent. Ten of these were on the right side. The 15 patients with silent infarcts were all right-handed.
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PMID:[Infarcts in the region of the middle cerebral artery. Study of 501 cases in 484 patients]. 160 11

Atherosclerosis is often a generalized disease, affecting not only coronary circulation, but other parts of vascular system as well. Vascular diseases most commonly encountered in patients with coronary atherosclerosis are carotid disease, abdominal aortic aneurysm and obliterative atherosclerosis in aortoiliac segment. In such situation two options are available: to treat the more significant, life-threatening manifestation first and postpone the other operation--staged approach; or to perform coronary artery bypass grafting (CABG) and other vascular procedures during one single operation--synchronous surgery. The advantages of this latter approach are obvious: patient has to undergo only one operation; there is no additional risk in the waiting period for second operation; surgical treatment is greatly accelerated. From 1978 until July 1990 a total of 123 synchronous CABG and vascular procedures were carried out in our clinic. In the same period, CABG was performed in 3867 pts in the same institution; combined procedures amount to 3.5% of all coronary revascularisations performed in the same period. CABG was done together with carotid endarterectomy (CEA) in 45 pts, associated with resection of abdominal aortic aneurysm (AAA) in 31 and in 28 pts it was combined with vascular procedures in aorto-iliac or femoral segment. In 4 pts a triple procedure--CABG, CEA and peripheral vascular reconstruction--were undertaken. Thoracic aortic aneurysm and CABG were performed in 15 pts. CEA is performed immediately prior to CABG in symptomatic carotid disease, past history of transient ischemic attack, severe bilateral carotid disease and unilateral carotid obstruction with contralateral stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Simultaneous coronary and vascular surgery interventions: indications,technique and results]. 186 43

Age is the most important risk factor for ischemic stroke. The most common cause of ischemic stroke in the elderly is atherosclerosis. Patients who have had a recent transient ischemic attack (TIA) are at high risk for subsequent stroke. Thus far only aspirin and ticlopidine have proven to be effective in preventing stroke. At present, all elderly patients who have had an atherothromboembolic TIA or stroke should receive therapy as well as either aspirin or ticlopidine for control of atherosclerotic risk factors.
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PMID:Epidemiology of and stroke-preventive strategies for atherothromboembolic brain infarction in the elderly. 186 99

Intraluminal clot of the internal cervical carotid artery is commonly thought to require emergency surgery: 7 intraluminal clots specially threatening (6 of whom had a long defect--15 mm and more) are demonstrated by intraarterial digital angiography--4 patients experienced mild stroke, 3 major stroke. 3 of whom had previous recurrent T.I.A. (3 transient blindness, 1 hemispheric TIA). Carotid angiography identified 3 severe atherosclerotic stenosis, 3 ulcerated plaques and 1 dissection. One patient with coma carus died quickly. Anticoagulation therapy (6 cases) was made, 4 weeks along, without neurologic complications. Follow-up angiograms showed total resolution (4 cases), partial lysis (1 case) and mild extension (1 case). Delayed endarterectomy was made only for severe carotid atherosclerosis (5 cases). In our experience, intraluminal clot of the carotid artery may not be a surgical emergency but require anticoagulant therapy and delayed surgery if major underlying lesions.
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PMID:[Intraluminal thrombosis of the cervical internal carotid artery]. 207 76

Irradiation has been shown experimentally to cause accelerated development of atherosclerosis in exposed large arteries. However, occurrence of such an entity in carotid arteries of patients after treatment for head and neck carcinoma is unknown. Therefore, we reviewed 179 patient charts who had undergone head and neck operations with or without irradiation between 1979-1987. Of these 179 patients, 107 (59.8%) were dead at time of follow-up. Cause of death was unknown in 42 (40%) patients; in the remainder included: respiratory arrest--33; carcinoma-related--18; cardiac--6;pneumonia--7; and trauma--1. Average interval from treatment to death was 23.5 months. Of the 72 patients known to be alive, follow-up was obtained in 52 patients. Their average age was 64.9 years. Risk factors for atherosclerosis included: male gender--43; smoking--50; hypertension--9; diabetes--4; coronary artery disease--12; and peripheral vascular disease--4. Seventy-five per cent of these patients received postoperative irradiation. Average follow-up was 64.5 months. Duplex scans were performed on 34 patients. Three patients had common or internal carotid stenoses greater than 75 per cent. All of these patients had received irradiation and none of them were symptomatic. Seven patients had carotid stenoses between 50 to 75 per cent; five of these had received irradiation. Of these five patients, one had a stroke 60 months postoperatively, and one had a TIA 36 months postoperatively. The remaining 58 patients (of which 48 had irradiation) had carotid stenoses less than 50 per cent and none were symptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Carotid artery disease in patients with head and neck carcinoma. 226 6

The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.
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PMID:[Cerebral arterial ischemic complications in young adults. Etiology and prognosis]. 232 55

The long-term results of carotid endarterectomy are controversial. Here we report the late results of 44 surgically and 40 non-surgically treated patients with carotid stenosis documented by angiography in 1974-1976. The groups were similar with respect to sex-distribution, age, length of follow-up time (median 123.0 and 130.0 months in the surgical and non-surgical groups, respectively) and the occurrence of risk factors. Hypertension was more frequent (p less than 0.05) in the surgical group, as was medical treatment, mostly anticoagulants (p less than 0.06). The angiographic findings were also more severe in this group (p less than 0.001). During the follow-up period the occurrence of cerebrovascular complications (death, stroke and/or TIA) was more frequent in the nonoperated than in the operated group; however, survival of the patients was similar, as the cardiovascular deaths were an equalizing factor. The quality of life in patients alive examined for clinical and neurologic status and by neuropsychological tests and interview was similar, except that the operated patients were more satisfied. The progression of atherosclerosis in the carotid artery assessed by Duplex scanning was more frequent in the nonoperated group. Differences in medical treatment did not explain the results. Thus it is concluded that the late results were better in the operated patients with carotid stenosis than in the nonoperated ones.
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PMID:Late results of surgical and nonoperative treatment of carotid stenosis. Eighty-four patients documented by angiography in 1974-1976. 234 70

We examined the extent of extracranial carotid atherosclerosis as evaluated by a B-mode ultrasound score in four groups of hospitalized patients: hospital controls free of both cerebrovascular symptoms and coronary atherosclerosis (HC, n = 245); patients with coronary atherosclerosis but without cerebrovascular symptoms (CAD, n = 382); patients with transient ischemic attacks but asymptomatic for coronary atherosclerosis (TIA, n = 107); and patients having both transient ischemic attacks and symptomatic coronary events (TIA + CAD, n = 39). The unadjusted B-mode scores were lowest for the HC group, intermediate for the CAD group, and highest for the TIA or TIA + CAD groups (no difference between these two groups). However, after adjustment for age (or age and other risk factors), we could find no significant differences among the CAD, TIA, and TIA + CAD groups, while the HC group had significantly lower adjusted scores. These data suggest that 1) accentuated development of carotid atherosclerosis is associated with both TIA and CAD and 2) the apparent differences in extracranial carotid atherosclerosis between coronary and cerebrovascular patients are partly attributable to differences in risk factor profiles (most notably age). The potentially accentuated rate of development of extracranial atherosclerosis in patients with CAD mandates a low threshold for cerebrovascular evaluation in CAD patients.
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PMID:Extracranial carotid atherosclerosis in patients with and without transient ischemic attacks and coronary artery disease. 240 98

Pulsatile blood flow within the normal carotid sinus involves at least two distinct components. That near the flow divider is laminar and antegrade, whereas a boundary layer separation zone in the posterolateral aspect exhibits transient blood flow reversal. It is now possible to document these flow velocity components using pulsed Doppler ultrasound methods. When atherosclerosis develops, it preferentially involves the posterolateral bulb region, obliterating the normal configuration of the sinus with consequent loss of the flow separation zone. It was therefore hypothesized that if flow separation could be detected, it should be predictive of a normal angiogram. To assess this, we evaluated 20 symptomatic patients and two with only bruits found by duplex scanning to have flow separation in either one or both carotid bulbs and who also underwent cerebral angiography. Initial diagnoses were stroke in seven, reversible ischemic neurologic deficit in one, transient ischemic attack in 12, and bruit in two. Flow separation was bilateral in 13 patients (59%). There were 15 patients with symptoms in the territory of a carotid bulb exhibiting flow separation. By angiography, of the 35 bulbs with boundary layer separation, 27 (77%) were normal, with the remainder showing lesions that reduced the diameter of the vessel by 20% or less. Final diagnoses of the 15 patients with symptoms ipsilateral to a carotid sinus exhibiting flow separation were fibromuscular disease in two, lacunar stroke in three, dissection in two, subclavian steal in one, cardiogenic embolus in three, migraine in one, hyperventilation syndrome in one, kink of the mid-internal carotid artery in one, and no diagnosis in one.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic significance of flow separation in the carotid bulb. 264 91

To evaluate the association between extracranial carotid atherosclerosis, race, and transient ischemic attack, we carried out a retrospective hospital chart review and quantified the extent of noninvasively determined extracranial carotid atherosclerosis in 25 black patients greater than 45 years old with transient ischemic attacks. Two sex- and age-matched white patients with transient ischemic attacks were similarly studied for each black patient. Extent of extracranial carotid atherosclerosis (expressed as B-mode score) was similar for blacks and whites. B-mode score was only slightly less in patients with posterior- than in those with anterior-circulation transient ischemic attacks. Fifty-six patients (35 white, 21 black) had unilateral anterior-circulation transient ischemic attacks. Of the 32 patients with more extensive extracranial carotid atherosclerosis ipsilateral to the affected hemisphere, 23 (66% of 35) were white; only nine (43% of 21) were black. In the 35 white patients, the extent of disease in the ipsilateral carotid artery was significantly greater (p less than 0.03) than that in the contralateral carotid artery. When B-mode scores in the left and right carotid arteries were combined for the subgroup of patients with unilateral anterior-circulation transient ischemic attacks, blacks had slightly more atherosclerosis in the extracranial arteries than whites.
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PMID:Extracranial carotid atherosclerosis in black and white patients with transient ischemic attacks. 267 24


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