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 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carotid artery atherosclerosis, age, family history, smoking, arterial hypertension, diabetes mellitus, and dyslipidemia represent risk factors of cerebrovascular events (stroke and transient ischemic attack). Hence, preventive treatment is vital for patients presenting these factors. Seven hundred and sixty-six patients (348 men and 418 women; age range 30-80 years) who were asymptomatic and attending a vascular unit for routine ultrasound (US) screening of the carotid arteries and with risk factors, intima-media thickness (IMT) of carotid artery > 1.3 mm, IMT associated with findings of atherosclerotic plaque creating stenosis > 20%, < or = 50%, and carotid plaque creating stenosis > 50% were considered. For patients with diabetes and hyperlipemia (35.8%)--or with hypertension, diabetes, and hyperlipemia (34.8%)--a higher prevalence of IMT > 1.3 mm was found. Higher prevalence of atherosclerotic plaque > 50% varied between 14.2% (in cases with diabetes mellitus and dyslipidemia) and 29.6% (in cases presenting 4 concomitant risk factors). Direct correlation was found between different risk factors and US findings. Our US findings revealed both a high incidence of carotid atherosclerosis, and that single and multiple correlation between US diagnosis of vascular damage and risk factors further enhanced risk. The study results confirmed the significance of vascular risk factors in patients with carotid artery atherosclerosis, and underlined the diagnostic validity of US.
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PMID:Ultrasound diagnosis of carotid artery lesions in a population of asymptomatic subjects presenting atherosclerosis risk factors. 1790 57

Survivors of ischemic stroke are at significant risk for recurrent stroke. Appropriate therapy for stroke prevention is needed given the significant morbidity and mortality associated with stroke, the high financial costs, and the neurologic disability associated with treatment failure. A treatment strategy based on assessed risk represents an appropriate use of medical resources and results in improved outcomes. This approach requires evaluation of major risk factors, the most serious of which is a history of ischemic stroke or transient ischemic attack. The annual risk for recurrent stroke is 6% during the first 5 years after an initial stroke. Non-modifiable risk factors include age, race, ethnicity, gender, family history, and geography. The most important modifiable risk factor is hypertension. Diabetes mellitus, hyperlipidemia, left ventricular hypertrophy, atrial fibrillation, and lifestyle factors such as smoking, alcohol abuse, and obesity contribute to stroke risk. Antihypertensive, lipid-lowering, and antiplatelet therapies have been successful in reducing the incidence of secondary stroke. Clinical trials validate the benefits of statin therapy in reducing the risk for secondary stroke. Studies of antiplatelet agents, including aspirin, clopidogrel, and aspirin combined with extended-release dipyridamole, have evaluated the risk reduction in recurrent stroke and have been concerned particularly with the risk for hemorrhage. Therapy for stroke prevention based on risk stratification can identify patients who are appropriate targets for aggressive intervention.
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PMID:Secondary prevention of ischemic stroke: evolution from a stepwise to a risk stratification approach to care. 1796 Oct 80

Patients with neurologic symptoms who undergo carotid endarterectomy (CEA) have a higher incidence of stroke and death in the perioperative period than those with asymptomatic carotid disease. This study examines the outcomes of symptomatic and asymptomatic patients undergoing carotid stenting (CAS). From 2002 to 2006, 201 CAS procedures were performed in 193 patients (117 men, mean age 73 +/- 10 years), of whom 142 were for asymptomatic (AS) and 59 for symptomatic (S) disease. Preoperative neurologic symptoms included recent ipsilateral cerebrovascular accident (CVA, 29%), transient ischemic attack (50%), and amaurosis fugax (22%). There were 201 carotid stents placed (107 Acculink, 43 Wallstent, 23 Precise, 21 NexStent, 3 Exponent, 3 Xact, 1 Herculink) and 198 protection devices used (79 Accunet, 53 EPI Filterwire, 43 PercuSurge, 20 Angiogard, 3 EmboShield). Mean follow-up was 41 weeks. The groups were matched in terms of demographics and comorbidities (carotid artery disease, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, smoking, and chronic obstructive pulmonary disease; p = nonsignificant [NS]). There was no significant difference in anatomic risk factors (neck irradiation, S 3%, AS 6%; prior CEA, S 14%, AS 14%; bovine arch, S 22%, AS 16%; p = NS), and the types of embolic protection devices and stents used were similar between groups. The mean percentages of preintervention carotid stenosis were equal (S 88%, AS 88%), and the technical success rate was 99%. Incidence rates of CVA (S 3.4%, AS 1.4%), myocardial infarction (S 1.7%, AS 1.4%), and death (S 0, AS 0.7%) were equivalent between groups (p = NS). CAS with cerebral protection can be performed safely in both symptomatic and asymptomatic patients. The presence of preoperative neurologic symptoms does not significantly increase the risk of adverse events in the perioperative period in this study.
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PMID:Periprocedural complication rates are equivalent between symptomatic and asymptomatic patients undergoing carotid angioplasty and stenting. 1834 78

Stroke in young adults is more common in India and Sri Lanka and the reasons for this are not well understood. The current study was conducted to elucidate the risk factors and radiologic features in young people (age < 45 years) with ischemic stroke. Sociodemographic data, stroke risk factor information, and laboratory investigations were recorded in 41 cases with first-ever ischemic stroke. Most common risk factors for stroke in the 15- to 45-year-old age group were: hypertension, 8 (21%); family history of stroke, 7 (18%); transient ischemic attack, 6 (16%); hyperlipidemia, 3 (8.0%); and diabetes, two (5%). Age group younger than 15 years included 3 girls and one had a mass attached to the posterior mitral valve leaflet. Our observations underscore the importance of the presence of hypertension, family history of stroke, and transient ischemic attack in young adults and thus to adopt preventative strategies.
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PMID:Young strokes in Sri Lanka: an unsolved problem. 1956 Jun 86

Recurrent stroke is a major public health concern, occurring in approximately one third of stroke survivors within 5 years. Besides, the overall aging of the developed countries population and the improved survival of patients with stroke have created a large population of older adults in need of secondary stroke prevention. Thus, at present, more than 5% of individuals 65 to 74 years old and more than 10% of those 75 and older have had a prior stroke. An age bias exists in the prescription of important secondary-preventive therapies in the elderly. Knowledge of the evidence behind the secondary prevention strategies could be useful to practicing physicians caring for stroke elderly patients. Effective strategies for the secondary prevention of stroke include treatment of hypertension and hyperlipidaemia. Our review presents the most recent evidence on hypertension and lipid lowering therapy for stroke prevention in elderly patients with previous stroke or TIA. Basis for evidence (or the lack thereof), areas of controversy, and avenues of future focus for these treatments are also discussed in this paper.
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PMID:Secondary stroke prevention in the elderly: new evidence in hypertension and hyperlipidemia. 1978 18

We aimed to present our experience with carotid angioplasty and stenting (CAS) and to document how the technique evolved over the last decade (1997-2007). A retrospective study of 333 patients (259 men; median age, 69 years) who underwent 336 CAS procedures. Of these, 118 (35%) patients were symptomatic and 164 (49%) lesions involved the left carotid bifurcation. The first 163 patients received a balloon-expandable stent, whereas the remaining 173 received a self-expandable one. Cerebral protection devices were used in the last 84 (25%) procedures. Access was via the femoral artery in all but six cases, in which direct puncture of the common carotid was necessary. The left common carotid originated from the innominate artery in 18 cases (5%). Conversion to open endarterectomy was necessary in two patients due to inability to remove the filter. Perioperative neurological events included stroke in 6 patients (1.8%), transient ischemic attack in 15 (4.5%), and hyperperfusion syndrome in 10 (3.0%). Three patients died during the first 30 days. As a result, the mortality and the combined stroke/death rate were 0.9 and 2.4%, respectively, with no differences between symptomatic and asymptomatic patients. Bradycardia was noted in 48 patients (14%), and hypotension in 45 (13%). Univariate analysis identified hypertension (P = 0.03), hyperlipidemia (P = 0.02), and current or ex-smoking (P = 0.02) as significant risk factors for death/stroke. On multivariate analysis using logistic regression, only hyperlipidemia [odds ratio (OR), 53.90; 95% confidence interval (CI), 4.19-693.47; P = 0.002] and current or ex-smoking (OR, 63.84; 95% CI,: 4.80-848.68; P = 0.001) remained statistically significant. In conclusion, CAS can be performed safely and effectively, with acceptable mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection devices), perioperative pharmacological management, and increasing experience are all clinically significant factors influencing the short-term results, none appeared to be statistically significant in this patient sample.
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PMID:Thirty-day outcome following carotid artery stenting: a 10-year experience from a single center. 1990 86

A 63-year-old white woman with a history of hypertension, hyperlipidemia, hypothyroidism, and transient ischemic attack, on Premarin, presented with a 2-week history of worsening edema and pain on the left side of the lower extremity associated with purplish discoloration and decreased temperature after a prolonged car travel. Physical examination revealed 2+ edema from the midthigh to the toes associated with purpuric discoloration. All arterial pulses were 4+. Ultrasound examination demonstrated an acute deep vein thrombus extending from the external iliac veins down throughout the visualized veins of the left calf. The patient was started on intravenous heparin and underwent venogram with subsequent thrombolysis. After 48 hours of alteplase infusion, balloon angioplasty was performed and 2 stents were placed in the left common and external iliac veins. Premarin was discontinued and she remains on oral anticoagulation with Coumadin. The patient did well clinically and a second ultrasound showed interval improvement. There is significant family history but no personal history of thrombotic events; however, thrombophilia evaluation is unremarkable.
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PMID:Acute deep vein thrombus due to May-Thurner syndrome. 2015 6

Abnormalities in diffusion-weighted and perfusion-weighted magnetic resonance images not only occur in stroke patients but also in transient ischemic attack patients. We found magnetic resonance images were abnormal in 28 patients (68%): 15 had diffusion-weighted imaging abnormalities, 7 had both diffusion-weighted imaging and perfusion-weighted imaging defects and 6 had an isolated perfusion-weighted imaging abnormality. Patients with shorter onset to magnetic resonance imaging, large artery atherothrombosis, coronary artery disease, hyperlipidemia and hemiparesis were more likely to show perfusion-weighted imaging abnormalities. Compared with patients who had a good prognosis, in poor prognosis patients, the relative cerebral blood flow and relative cerebral blood volume was significantly higher. The data suggest that transient ischemic attack patients are more likely to have a poor prognosis when white matter of the symptomatic side shows hyperperfusion within 24 h of symptom onset; however, patients are more likely to have a good prognosis when white matter of the symptomatic side shows hypoperfusion.
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PMID:Combined diffusion- and perfusion-weighted imaging: a new way for the assessment of hemispheric transient ischemic attack patients. 2086 35

Statin agents have proven effective in primary and secondary prevention of cardiovascular disease. Approximately 10-15 percent of patients on statin agents discontinue these agents because of myalgia. We report a patient with a remote history of a transient ischemic attack, significant hyperlipidemia and a positive family history of vascular disease and intolerance to multiple lipid lowering agents, including several statin agents. The patient was started on 5 mg rosuvastatin every other day with no adverse symptoms. The dose was increased to 20 mg rosuvastatin every other day over approximately four months resulting in a 39-percent decrease in LDL levels and a 14-percent improvement in HDL levels with excellent tolerability. The long half-life of rosuvastatin along with its high potency make it a good candidate for alternate-day administration. While few studies have evaluated the efficacy of the described alternate-day statin therapy, the failure to address significant hyperlipidemia is associated with adverse health outcomes and costs. Alternate-day statin agent use remains an underutilized option in patients intolerant of daily statin administration. While significant cost benefits also may occur with an alternate-day regimen, prospective studies are needed to confirm the long-term safety and efficacy of this mode of administration.
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PMID:Alternate day rosuvastatin, an underutilized option in statin intolerant hyperlipidemic patients: a case report and literature review. 2138 99

The National Stroke Registry (NSR) was established in 2009 under National Neurology Registry (NNeuR) . The main objectives of NSR were to describe the demographic and disease pattern of stroke patients in Malaysia, to examine the risk factors and evaluate the specified treatment and outcomes. This prospective observational study was carried out from August 2009 until December 2010 using a standardized case report form which involved two participating hospital, namely Hospital Sultanah Nur Zahirah, Kuala Terengganu and Hospital Seberang Jaya, Pulau Pinang. There were 1018 patients registered. Ischemic stroke accounted for the majority of cases (73.3%). The most common risk factor was hypertension (75.5 %), followed by diabetes mellitus, previous stroke or Transient Ischemic Attack (TIA), hyperlipidemia and active smoker: 45.6%, 25.1%, 22.4%, and 19.4%, respectively. Overall, our stroke management, based on nine stroke key performance indicators (KPI) still needs to be improved. There was a total of 121 mortality cases with the main contributing factor was massive cerebral bleed (21.6%). In conclusion, the findings highlight the important of primary and secondary stroke management. Further and continuous observation with more site date provider (SDP) involvement is needed to get a more comprehensive data on stroke in Malaysia.
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PMID:National Stroke Registry (NSR): Terengganu and Seberang Jaya experience. 2308 22


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