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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of symptomatic extracranial carotid artery stenosis associated with ischemic heart disease are reported. The first case was 72-year-old male, who was admitted because of transient ischemic attack due to the stenosis of left internal carotid artery. He had a history of myocardial infarction and coronary angiography revealed three vessel disease. The second case was 74-year-old female with diabetes mellitus. She was admitted because of cerebral infarction. The carotid angiography revealed critical stenosis of bilateral internal carotid arteries. Her coronary angiography revealed three vessel disease. Her chest symptom became unstable after her admission. In both cases, simultaneous carotid endarterectomy and coronary bypass grafting were performed with successful outcome. In the patients with symptomatic extracranial carotid occlusive disease associated with severe ischemic heart diseases, we advocate simultaneous operation both for carotid and coronary artery occlusive disease.
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PMID:[Surgical results of two cases of simultaneous surgery of carotid and coronary occlusive disease]. 158 67

Multi-infarct dementia (MID) indicates a dementia disorder primarily caused by multiple cerebral infarcts. Since other pathogenetic mechanisms cause vascular dementia we evaluated clinical, CT scan and CSF neurochemical parameters of 134 MID and 67 PVD (probable vascular dementia) patients. We found no differences with regard to the presence of major risk factors. Only TIA/stroke episodes and focal neurological signs were significantly more frequent in MID than in PVD cases, an anticipable result on the basis of MID definition. CT scan findings showed a prevalence of subcortical with respect to cortical lesions in both groups, with a higher frequency in MID patients. Subjects with deep infarcts more frequently showed TIA/stroke episodes and diabetes mellitus. No differences were detectable in CSF monoamine metabolite levels. We conclude that in the majority of vascular dementias subcortical damage seems to have a major pathogenetic role.
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PMID:Is multi-infarct dementia representative of vascular dementias? A retrospective study. 169 87

We examined the baseline characteristics of patients in the Ticlopidine Aspirin Stroke Study (TASS) to determine if the effects of the two treatments in preventing stroke differed in various subgroups. Patients with the following characteristics did less well on aspirin: elevated creatinine, hypertension or diabetes requiring treatment, or treatment with anticoagulant or antiplatelet drugs prior to their qualifying TIA or stroke. Women and patients with vertebrobasilar symptoms did particularly well on ticlopidine. We performed arteriography in 1,188 patients with carotid qualifying events. The frequency of stroke in patients with abnormal arteriograms ipsilateral to their symptoms was slightly higher than in those with normal carotid arteries. Ticlopidine was more effective in patients without carotid stenosis. Ticlopidine is more effective than aspirin in preventing strokes in patients having warning TIAs. The patients who benefit most from ticlopidine may be women, those who have vertebrobasilar symptoms, those with cerebral ischemic symptoms while on aspirin or anticoagulant therapy, and patients with diffuse atherosclerotic disease rather than high-grade carotid stenosis.
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PMID:Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup. 173 90

Before 1981, the neurologic morbidity and mortality associated with carotid endarterectomy (CEA) in the Los Angeles County/USC Medical Center public teaching institution was 20 per cent, similar to results from other hospitals. In 1981, a standardized protocol was adopted in an attempt to improve surgical outcome following CEA. Between 1981 through 1990, 89 patients with a mean age of 60.9 years (range 38 to 80 yrs) had 100 consecutive CEAs. Atherosclerotic risk factors included hypertension in 57 patients (61.8%), tobacco use in 57 (64.0%), and diabetes mellitus in 28 (31.5%). Forty-nine patients had a history of ischemic heart disease. Indications for CEA were stroke in 40 cases, transient ischemic attack in 33 cases, and asymptomatic, high-grade stenosis of the internal carotid artery (greater than 85 per cent) in 19. Perioperative and surgical management are detailed in the authors' protocol. Intraluminal shunts were routinely used (99 cases) and 24 arteriotomies were patched. Completion arteriograms were performed in 99 cases, four of which were revised because of arteriographic abnormalities. Three patients sustained postoperative ipsilateral neurologic events. Ten patients had cranial nerve palsies, six of which were transient. Two patients had nonfatal postoperative myocardial infarctions. There were no deaths. The combined stroke and transient ischemic attack (TIA) mortality rate was 3 per cent. In conclusion, the audit and quality assurance process identified unacceptable results following CEA. A protocol was developed that addressed pre, intra, and postoperative details of patient selection, operative technique, and postoperative care. By adhering to the protocol, the major neurologic morbidity and mortality rate has been reduced to 3 per cent.
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PMID:A review of carotid endarterectomy at a large teaching hospital. 174 89

In order to clarify the effectiveness of extracranial- intracranial bypass in cases of vertebro-basilar occlusive disease, we investigated the operative complication, clinical course and follow-up study of 30 cases undergoing superficial temporal artery-superior cerebellar artery (STA-SCA) bypass surgery. Postoperative angiogram showed the patency of the anastomoses in all cases. No serious surgical complications were observed. The outcome on discharge was excellent, with no morbidity and one mortality which was due to cardiac infarction. In the follow-up study, there were four cases with ischemic symptoms, two with transient ischemic attack and two with completed stroke, one of which was a supratentorial infarction due to internal carotid artery occlusion and the other was a small infarction of pons. There were also two deaths due to cardiac infarction and diabetes mellitus. Favorable outcomes were obtained for the remaining cases. The present study suggests that, STA-SCA bypass, can be performed without surgical and systemic complications and used as an effective therapy for vertebrobasilar ischemia.
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PMID:Clinical analysis of STA-SCA bypass for vertebrobasilar occlusive disease. 175 11

The indication for coronary bypass surgery in the elderly has been dramatically expanded in recent years. The results, however, are often contradictory. 1,538 consecutive patients undergoing cardiac surgery were divided into two groups by their age at the time of operation: younger than 75 years (n = 1,480) and 75 years and older (n = 58). These groups were compared with regard to influencing factors of early and late mortality, morbidity, and quality of life. Preoperatively, the clinical condition of the group greater than or equal to 75 years was significantly worse than the condition of the group less than 75 years (NYHA IV: greater than or equal to 75 years: 63.8%; less than 75 years: 31.9%). Cerebrovascular diseases occurred more often in the patients greater than or equal to 75 years (stroke or transient ischemic attack: greater than or equal to 75 years: 8.6%; less than 75 years: 2.3%). The necessity of carotid reconstruction prior to coronary surgery was significantly higher in the patients greater than or equal to 75 years: (greater than or equal to 75 years: 5.2%; less than 75 years: 1.5%). Diabetes mellitus could be observed in 19.0% of the patients greater than or equal to 75 years and in 10.1% of the patients less than 75 years. The preoperative ejection fraction was similar in both groups. Cardiopulmonary bypass time and crossclamping time of the aorta did not differ significantly. Both groups received approximately the same number of distal coronary anastomoses. Rethoracotomy due to hemorrhage had been observed more often in the older group (greater than or equal to 75 years: 8.6%; less than 75 years: 4.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early and late results following coronary bypass surgery beyond the age of 75 years. 178 16

The term transient ischaemic attack (TIA) does not correspond to findings of new examination methods and is rather a matter of convention. The authors examined 19 patients with the diagnosis of TIA by CT and found in five a cerebral infarction. The dependence of cerebral infarction in TIA on age, sex, risk factors (hypertension, diabetes) and the duration of clinical symptomatology was not significant.
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PMID:[Cerebral ischemic infarct in computer tomography imaging in the diagnosis of transient ischemic attacks]. 182 68

Clinical findings and cranial CT scan identified stroke in 315 admitted patients at Taichung Veterans General Hospital from January 1, 1989 to December 31, 1989. Hemorrhage was found in 137 cases and infarction in 178 cases (thrombosis in 124 cases, embolism in 54 cases). Most cases with stroke (72.4%) were distributed in ages between 55 and 74 years. The mean age of patient with cerebral infarction was 64.8 years, which was about 3.3 years higher than those with cerebral hemorrhage (mean age 61.5 years). The control group consisted of 117 persons (matched in age and sex) who had no history of stroke. In comparison of the five risk factors (hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack, and smoking) between the patients and the controls, we found that cerebral thrombosis was significantly associated with hypertension, diabetes mellitus, and smoking; cerebral embolism with hypertension, atrial fibrillation, and transient ischemic attack; and cerebral hemorrhage with hypertension only.
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PMID:[The effects of hypertension, diabetes mellitus, atrial fibrillation, transient ischemic attack and smoking on stroke in Chinese people]. 184 32

In order to evaluate the efficacy of low dose acetylsalicylic acid (ASA) for the secondary prevention of ischemic stroke, this cooperative multicenter clinical trial was conducted on a non-blind basis. Patients having a first transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND) or completed ischemic stroke were eligible for this trial. A total of 590 patients including 47 cases of TIA, 23 cases of RIND and 520 cases of completed stroke entered this study. These patients were allocated by the time of admission to one of the following 5 trial regimens: (1) vasodilators having no known inhibitory effect on platelet function (control group), (2) dipyridamole (DP) 50 mg 3 times a day (DP group), (3) ASA 300 mg once a day (ASA 300 mg group), (4) ASA 300 mg once in combination with DP 50 mg 3 times a day (ASADP group), and (5) ASA 100 mg once a day (ASA1 group). No difference in effect between the control and DP groups was observed, nor between the ASA 300 mg and ASADP groups. Therefore, we combined the control and DP groups to make a non-ASA group, and joined the ASA 300 mg and ASADP groups to make an ASA3 group. The differences in the cumulative event-free rate appeared to be significant between the non-ASA group and the ASA3 group and also between the non-ASA group and the ASA1 group. But the frequency distribution of age, territory of stroke, diabetes mellitus, cardiac disease, hematological disease and hyperuricemia were significantly different among these 3 study groups. We thus included these covariates in the Cox's proportional hazard model to control their possible confounding effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Secondary prevention of ischemic stroke with low dose acetylsalicylic acid. 198 Dec 23

Among the 4129 patients of the Community Hospital-based Stroke Program, 30% had an unspecified stroke diagnosis. Since specific diagnosis and, perhaps, eventual treatment, derives in part from diagnostic testing, we examined the effect of clinical condition, geographic and demographic factors on the incidence of certain diagnostic tests after acute stroke. In this multivariable analysis, race, sex, history of hypertension and history of diabetes did not influence the chance of having any test, but older age strongly reduced the chances of receiving extensive evaluation. When CT scanning was available, the utilization of a CT as well as other diagnostic studies including cerebral angiography, radionuclide brain scan, EEG and EKG was increased. The odds of receiving a CT scan increased if the patient was married, and decreased with a history of previous stroke. A history of previous TIA increased the chance of having a cerebral angiogram while a history of cardiac disease decreased the chance. There were striking regional geographic differences in the use of CT, radionuclide brain scanning and cerebral angiography which may, in part, reflect differences between the availability of these technologies in urban and rural hospitals. These results indicate that evaluation of stroke patients remains heterogenous.
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PMID:The community hospital-based stroke programs in North Carolina, Oregon and New York--V. Stroke diagnosis: factors influencing the diagnostic evaluation of patients following acute stroke. 199 89


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