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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of trials that study patients with defined lesions (atrial fibrillation without valvular heart disease, various severities of carotid artery stenosis in the neck, intracranial artery stenosis) are very helpful for clinicians caring for patients with those conditions. On the other hand, trials that group all patients with brain ischemia together are not very helpful. Modern technology now makes it possible to define quickly and safely: (1) the location, nature, and severity of causative cerebrovascular, cardiac, and aortic lesions; (2) blood constituents and coagulability; and, (3) the presence, location, and severity of ischemic brain damage. As in all medicine, treatment should be aimed at the cause of disease, not the time course and severity of present damage. Clearly, more trials are needed in patients who have been studied thoroughly using modern technology. Until then, clinicians must understand the context of the trial data to determine if the results are applicable to Mr. or Ms. Jones, and the patients sitting before them in the office or in the hospital bed.
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PMID:Evidence-based treatment of patients with ischemic cerebrovascular disease. 1147 69

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) confirmed that carotid endarterectomy (CEA) can significantly cut the risk of stroke in patients with moderate and severe blockage. The standard today is that patients who have internal carotid artery stenosis > 70% with associated symptoms and who are appropriate surgical candidates should be offered CEA. Aneurysmal disease, a growing public health concern, poses the threat of death from rupture, and lower extremity arterial occlusive disease poses a significant risk of critical leg ischemia and limb loss. Both conditions involve surgical options. In treating their patients, primary care physicians should become familiar with the benefits and risks of vascular surgery to manage the various aspects of peripheral arterial disease.
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PMID:Vascular surgery for peripheral arterial disease. 1242 83

Based on clinical and neurophysiological investigations, triplex scanning of the carotid arteries the authors make a conclusion that early clinical forms of the ischemic diseases of the brain (IDB) in hemodynamically significant atherostenosis of the carotid arteries are characterized by certain neuropsychological and neurological complexes of symptoms dependent on the impairments of blood flow at the main and regional levels. The leading role of hypoperfusion was shown in the development of early forms of the cerebral blood flow impairments in patients with IDB. A significantly increased number of atherosclerotic plaques was shown with the increasing degree of carotid artery stenosis. Specific alterations of the central hemodynamics were determined in early impairments of the cerebral circulation against the background of atherosclerotic stenosing lesion of BCA. A complex comparative investigation of these parameters at the pre- and postoperative stages (after carotid endarterectomy) has shown a practically complete regress of hemodynamic impairments and clinical manifestations of ischemia of brain structures. According to the investigations performed, the timely correction of hemodynamically significant atherostenoses of carotid arteries during revascularization of the brain in such patients allows to carry out primary prophylactics of acute impairments of cerebral blood flow and to increase effectiveness of the treatment.
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PMID:[Clinical and pathologic aspects of the impairment of cerebral blood flow in atherosclerotic carotid stenosis]. 1270 85

The ocular ischemic syndrome represents a serious blinding condition due to retinal ischemia secondary to hemodynamically significant carotid artery stenosis. However, this condition has received little attention in the neurological literature and is likely underdiagnosed. We here describe a patient with bilateral severe carotid stenosis and progressive visual loss due to ocular ischemia. The best management for this condition remains controversial and should be established by including these patients into randomized trials of carotid surgery.
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PMID:The ocular ischemic syndrome. 1464 21

Screening for carotid artery disease in patients with systemic manifestations of atherosclerosis (e.g., peripheral vascular disease or coronary artery disease) has been recommended. We have been anecdotally impressed by what appears to be a unique atherosclerotic disease pattern in the Hispanic patient population of South Texas. To determine the prevalence of significant carotid artery disease in Hispanic patients with diabetes presenting with limb-threatening ischemia and to identify factors predictive of occurrence, we conducted a year-long prospective study of 92 consecutive patients undergoing infrainguinal bypass for limb salvage at The University of Texas Health Science Center in San Antonio. Peak systolic and end diastolic velocities in both internal carotid arteries were recorded by perioperative color duplex scanning. We found that the presence of a carotid artery stenosis did not correlate with any variables other than advanced age and presence of a bruit. Only 2 patients had a greater than 80% stenosis. We concluded that screening for carotid artery disease in diabetic Hispanics with critical lower extremity ischemia cannot be justified in younger patients. Even in patients older than 60 years, the presence of high-grade stenosis and, therefore, the need for carotid endarterectomy, is unlikely. However, screening in older patients is recommended to identify persons with moderate stenosis (peak systolic velocity greater than 175 cm/sec) whose disease is more likely to progress.
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PMID:Duplex screening for asymptomatic carotid artery disease in Hispanic diabetic patients undergoing lower extremity revascularization: is it a worthwhile endeavor? 1498 81

Hemorheological disturbances may occur in more than 40% of patients with ischemic cerebrovascular diseases. In this study the changes of rheological factors--hematocrit, plasma fibrinogen concentration, whole blood and plasma viscosity, red blood cell aggregation and deformability were investigated in 297 patients (173 males, 124 females, mean age 60 +/- 11 years) with transient ischemic attack or chronic phase (> 3 months after onset) ischemic stroke, and in 73 healthy volunteers (35 males, 38 females, mean age 38 +/- 7 years). Hematocrit, plasma and whole blood viscosity were significantly (p < 0.0001) elevated in cerebrovascular patients compared to controls. Plasma fibrinogen concentration (p < 0.001), red blood cell aggregation (p < 0.05) and deformability (p < 0.01) were also impaired in stroke patients. Hemorheological disturbances were dominant in stroke patients with diabetes, hyperlipidemia and smoking habits. Hematocrit, plasma viscosity and red blood cell aggregation showed a significant (p < 0.025-0.001) correlation with the severity of carotid artery stenosis. We could not find any characteristic distribution of rheological parameters among the three subtypes of brain ischemia. Our results show that all of the measured rheological parameters are significantly impaired in chronic ischemic cerebrovascular disorders, especially in diabetic, smoking and alcoholic patients. They correlate with the severity of the carotid artery stenosis, but there is no association with the type of ischemic stroke.
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PMID:Hemorheological disturbances in patients with chronic cerebrovascular diseases. 1527 48

Atherosclerotic disease accounts for approximately 25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patients with risk factors for atherosclerosis, including hypertension, diabetes, smoking and hypercholesterolemia. Stroke can be prevented in patients with established atherosclerotic disease by identification and management of patients with carotid artery stenosis by non-invasive testing. Particular attention must be paid to patients with transient symptoms of brain ischemia.
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PMID:Diagnosis and prevention of atherosclerotic cerebral infarction. 1615 12

Even in the absence of symptoms, peripheral arterial disease carries with it a significant risk of morbidity and mortality; thus, screening with the use of the ankle-brachial index is important in identifying patients at risk. Endovascular therapy in the lower extremities is continually evolving for treatment of patients with claudication symptoms or limb-threatening ischemia. Alternative treatments such as cryotherapy and the use of laser-assisted angioplasty hold much promise but need further investigation. In the case of renal artery stenosis and resulting hypertension, supportive clinical evidence is limited for renal revascularization despite the rationale for reducing cardiovascular risk. The current standard of care for significant carotid artery stenosis can include carotid stenting and carotid endarterectomy, but medical therapy may have a role also.
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PMID:Peripheral arterial disease: an overview of endovascular therapies and contemporary treatment strategies. 1691 24

Clinical investigations designed to contrast the efficacy of carotid endarterectomy (CEA) versus best medical therapy and CEA versus carotid artery stenting (CAS) in patients with carotid artery stenosis have been based on the traditional endpoints of stroke, myocardial infarction, and death. Cognitive function is being increasingly recognized as an important outcome measure that affects patient well-being and functional status. However, it has not been evaluated systematically in the context of carotid revascularization. A decline in cognitive function could occur from microembolic ischemia during surgical dissection (CEA) or intravascular instrumentation (CAS). It could also occur from hypoperfusion during clamping (CEA) or balloon dilation (CAS). Conversely, restoring perfusion could improve cognitive dysfunction that might have occurred from a state of chronic hypoperfusion. It is still unclear whether these complex interactions ultimately result in a net improvement or a deterioration of cognitive function. Furthermore, it is not known whether the 2 methods of carotid revascularization have a differential effect on cognitive outcomes. It is becoming increasingly clear, though, that there is a positive relationship between improvement in cognition and improvement in functional outcome of patients. Vascular surgeons will be well served to remain informed and even actively engaged in the development of this field if they wish to continue providing the high-quality, well-informed care they have traditionally offered to patients with carotid stenosis.
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PMID:Cognitive function after carotid artery revascularization. 1727 37

Patients with extracranial carotid atherosclerosis, either symptomatic or asymptomatic, demonstrate altered cerebral perfusion. Carotid revascularization procedures, such as carotid endarterectomy or stenting, aim mainly at stroke prevention from thromboembolic events, whereas their effects on cerebral perfusion, particularly those seen after carotid stenting, have not been extensively examined. Moreover, ischemia and reperfusion injury have been recognized as devastating complications of these procedures. The present work is a literature review of cerebral perfusion patterns in normal individuals and in patients with carotid artery stenosis prior to and after carotid stenting.
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PMID:Cerebral perfusion patterns in patients with extracranial carotid atherosclerosis and the impact of carotid stenting. A review. 1866 13


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