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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recent reports of the risk of asymptomatic carotid stenosis have been compromised by flawed patient selection or the performance of a large number of carotid endarterectomies during follow-up. We report the natural history of a randomly selected group of asymptomatic patients (n = 188; 114 males and 74 females) with documented carotid artery disease who were prospectively followed without intervention for up to 8 years. Risk factors included ischaemic heart disease in 17%, diabetes in 10%, hypertension in 46% and 88% were smokers. The degree of internal carotid stenosis was classified by duplex scanning and a total of 259 vessels had evidence of atherosclerosis. Study end-points included TIA, CVA and death. At mean follow-up of 4 years 3% of the 96 patients with internal carotid artery stenosis of less than 50% had died and 2% suffered a stroke. Six per cent of patients with a stenosis of 50-79% had died and 4% and 2% had suffered a CVA and TIA, respectively. In the 59 patients with greater than 80% stenosis 7% had suffered a TIA and an additional 7% a CVA, while 2% had died. None of the patients suffering a stroke had an antecedent TIA. Though the incidence of ischaemic events is significantly higher in patients with greater than 80% stenosis the incidence of unheralded stroke remains low. We therefore continue to recommend a conservative approach to the management of asymptomatic carotid stenosis.
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PMID:Asymptomatic carotid stenosis: a benign lesion? 155 61

Antiphospholipid antibodies are a marker for an increased risk of thrombosis, including stroke and transient ischemic attacks. Prior studies suggest that patients with these antibodies and thrombosis may be at increased risk for recurrent thrombotic events. We prospectively evaluated 75 patients with antiphospholipid antibodies and cerebral or ocular ischemia for recurrence of thrombosis. Twenty-six patients (35%) experienced a recurrent stroke or transient ischemic attack, with a mean time to recurrence of 1.18 years. Hypertension significantly increased the risk of a recurrent transient ischemic attack. Patients with coronary artery disease were three times as likely as those without to have a recurrent stroke or transient ischemic attack. There was a trend for treatment with a combination of aspirin and dipyridamole to reduce the risk of recurrent thrombotic events after adjusting for sex and ethnicity.
Stroke 1992 Feb
PMID:Risk of recurrent thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. The Antiphospholipid Antibodies in Stroke Study Group. 156 71

A retrospective review of 42 patients (mean age 61.4 years) with surgically managed symptomatic internal carotid artery occlusion is reported. A standardized surgical protocol aimed at restoration of flow in the vessel was used. Presenting symptoms included hemispheric transient ischemic attacks in 68% of patients, new fixed neurological deficits in 28%, amaurosis fugax in 28%, and stroke-in-evolution in 9%. Twenty-four arteries were successfully reopened. A proximal remnant angioplasty (stumpectomy) was performed alone in nine patients or in combination with an external carotid endarterectomy in nine. In four patients with persisting symptoms who failed to achieve primary restoration of flow, a superficial temporal-to-middle cerebral artery bypass procedure was performed. The permanent surgical morbidity rate was 2% and the surgical mortality rate was 0%. Transient postoperative deficits were present in three patients (7%). Follow-up review at a mean of 40 months was obtained in 39 patients (93%). Following surgical intervention, five patients died of unrelated causes, two had neurological events consistent with a transient cerebral ischemic attack, and two had vertebrobasilar insufficiency. No patient suffered from stroke. Of the 24 successfully reopened vessels, follow-up ultrasound evaluations were obtained in 17 (73%) at a mean of 28 months after surgery. In 15 patients (88%) the vessels were widely patent, one (5.8%) had stenosis greater than 70%, and one (5.8%) showed asymptomatic reocclusion. Reopening occluded internal carotid arteries in selected patients is associated with low surgical morbidity and mortality rates. Further studies are necessary to determine the impact of this surgical therapy on the natural history of this condition.
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PMID:Thromboendarterectomy of the symptomatic occluded internal carotid artery. 156 37

The purpose of this study was to determine the prevalence, progression and prognosis of asymptomatic carotid artery stenosis in a population of 1198 patients with peripheral arterial disease (n = 986) or aortic aneurysm (n = 212), mean age 67.7 (S.D. = 10.0) years. Patients were recruited from 1985 to 1989 with annual assessment of carotid artery stenosis of over 50% using Doppler peak frequency analysis. Patients were followed up annually until 1990 or their first event, transient ischaemic attack (TIA), amaurosis fugax (AFx), stroke without antecedent TIA, or death (mean follow up 20 months). Life tables were used to determine risk of events in different patient groups. Only 164 (13.7%) patients had a stenosis of over 50% in either of the common or internal carotid arteries, disease was bilateral in 33 (2.8%) patients. A total of 33 patients (2.8%) had over 80% stenosis in common or internal carotid arteries. During follow up 37 (3.1%) patients developed a stenosis greater than 50%. Only 27 (2.3%) patients developed a stroke, 11 of which were fatal. A further 33 (2.8%) suffered a TIA or AFx and a total of 155 patients died during follow up. The total neurological event rate (TIA, AFx and stroke) was significantly associated with the presence of over 50% stenosis, [relative risk (RR) = 2.98, 95% confidence interval (95% C.I.) 1.68-5.29, p less than 0.001] and carotid bruit (RR = 1.16, 95% C.I. 1.23-3.81, p = 0.010). Although risk of stroke was higher in patients with a 50% stenosis, this failed to achieve statistical significance (RR = 1.78, 95% C.I. 0.66-4.80, p = 0.275).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence, progression and natural history of asymptomatic carotid stenosis: is there a place for carotid endarterectomy? 157 57

In the Swedish aspirin low dose trial (SALT) 101 patients were enrolled from the Department of Medicine, Falun. 42 patients had experienced TIA/amaurosis fugax, whereas 59 patients had suffered a minor stroke/retinal infarction. History of hypertension treated or known untreated occurred statistically more frequently in the minor stroke group at randomisation (P less than 0.01) and the mean diastolic blood pressure (DBP) was higher in the minor stroke group during the observation time (P less than 0.05; ANOVA). The minor stroke group had less favourable outcomes according to survival curves (stroke or death) during a mean observation time of 34 months in each group (P less than 0.05 at 29 months). The findings of the present trial suggest that hypertension and the higher mean DBP during the observation time might explain the better outcome of end points of stroke or death in patients with TIA.
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PMID:Differences in the outcome of patients with TIA versus minor stroke. 157 6

To evaluate the prevalence and prognostic role of silent coronary artery disease (CAD) in patients with symptomatic high-grade carotid stenosis (70 to 99%) undergoing carotid endarterectomy, and with neither history nor symptoms of CAD, 106 patients (76 men, 30 women, mean age 58.7 years [range 42 to 71]) with recent cerebral ischemia were prospectively studied. Patients were stratified as to the presence (n = 27, 25%) or absence (n = 79, 75%) of silent CAD defined by concordant abnormal exercise electrocardiographic testing and thallium-201 myocardial scintigraphy. The male sex, the severity of the symptomatic carotid lesion (greater than 90%), and the coexistence of contralateral carotid disease identified patients with higher probability of coexisting CAD. The 106 patients underwent 121 operations (bilateral in 15). In the perioperative period, no deaths or cardiac events occurred, 1 patient suffered a recurrent stroke and 3 had a transient ischemic attack. During a mean follow-up period of 5.4 years, 9 patients died (1.7%/year): fatal myocardial infarction occurred in 5 (all in the silent CAD group), cancer in 3 and vertebrobasilar stroke in 1. Nonfatal events occurred in 9 patients: myocardial infarction in 1 (without silent CAD), unstable angina in 3 (with silent CAD), and cerebral ischemic attacks in 5. After 7 years, the Kaplan-Meier estimated survival free from coronary events was 51% in patients with silent CAD, and 98% in patients without CAD (p less than 0.01). In conclusion, among patients with symptomatic high-grade carotid stenosis undergoing carotid endarterectomy, even in absence of history or symptoms of CAD, a silent CAD is detectable in one fourth of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Frequency and prognostic significance of silent coronary artery disease in patients with cerebral ischemia undergoing carotid endarterectomy. 843 Jun 60

Neurologic events following noncarotid vascular surgery (NCVS) are considered unpredictable. To test this hypothesis, we reviewed our vascular registry for a 3-year period and identified all patients with new postoperative focal neurologic events (stroke, hemispheric transient ischemic attack [TIA]) within 2 weeks of a category I or II vascular procedure as defined by the American Board of Surgery, exclusive of carotid surgery and arterial trauma. Thirteen of 1,390 NCVS procedures (0.9%) in 13 patients were associated with focal neurologic events. There were 2 TIAs, 10 anterior circulation strokes, and 1 posterior circulation stroke. Twenty-seven percent of strokes were fatal. The neurologic deficit developed in the immediate postoperative period in 31%, more than 4 hours but less than 72 hours postoperatively in 54%, and within 3 to 14 days postoperatively in 15%. Patients with anterior circulation events (group A, n = 12) were compared for variables potentially influencing postoperative stroke with case controls who were selected using a table of random numbers (group B, n = 12). Controls were derived from a pool of all category I or II NCVS procedures recorded in our vascular registry sequentially during the same time period and who were without new neurologic deficits postoperatively. Using Fisher's exact test, comparisons between groups A and B revealed that new anterior circulation neurologic events in vascular surgical patients tended to be associated with intra-abdominal procedures (p less than 0.05), perioperative hypotension (p less than 0.05), and the presence of a greater than or equal to 50% internal carotid artery stenosis ipsilateral to the neurologic event (p less than 0.001). Such information may prove useful in the management of selected patients prior to arterial reconstruction and in operated NCVS patients with postoperative neurologic events.
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PMID:Neurologic deficits following noncarotid vascular surgery. 157 15

Transient ischemic attacks (TIAs) are the most reliable warning sign of impending stroke and are highly indicative of significant coronary artery disease. The history and physical examination may suggest the pathologic mechanism, an important clue to diagnosis and prognosis. Diagnostic testing is individualized but often includes ECG and cerebral contrast angiography. Exercise testing, echocardiography, ultrasound, CT, and/or MRI are sometimes indicated. The patient with recent TIAs may be hospitalized for acute management. Long-term treatment includes stroke risk factor modification, use of antiplatelet agents, and sometimes anticoagulant therapy. Selected older patients may be candidates for carotid endarterectomy.
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PMID:Transient ischemic attacks in the elderly: diagnosis and treatment. 157 81

Clinicians should take a mechanistic approach to transient ischemic attack and stroke. Distinguishing between hemorrhagic and ischemic stroke is important and is most readily accomplished with a computed tomographic brain scan. Newer diagnostic studies are now available to help evaluate patients for a cardiogenic source of embolism. Detection of a cardiogenic source of embolism or high-grade carotid stenosis identifies stroke-prone persons in whom interventional therapy is beneficial.
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PMID:TIA and minor stroke. How to identify and treat patients at risk for recurrent cerebral ischemia. 157 27

The association between a patent foramen ovale (PFO) and thromboembolic events in young patients has been reported. Autopsy data suggest that a PFO may be present in 20 to 35% of the population. To further assess the role of a PFO in patients with possible thromboembolic events, precordial and transesophageal contrast echocardiography was performed in 104 consecutive patients (age range 16 to 84 years) presenting with a stroke, transient ischemic attack or peripheral artery embolus (group I). These patients were compared with 94 consecutive patients (age range 23 to 82 years) undergoing transesophageal echocardiography for other reasons (group II). A PFO was found in 22 patients; 9 of 35 (26%) with an event but no risk factor (group Ia), 10 of 69 (14%) with an event but a recognized risk factor (group Ib), and 3 of 94 control patients (3.2%) (group II) (group Ia vs II: relative odds 10:1, p less than 0.001; group Ib vs II: relative odds 5:1, p less than 0.01; and group Ia vs Ib: p = not significant). The detection of a PFO was not related to age. The relatively low prevalence of a PFO in this study may reflect patient selection, but other explanations include: (1) Transesophageal contrast echocardiography may be relatively insensitive for its detection; (2) the prevalence in the general population may have been overestimated; and (3) most PFOs are very small, clinically insignificant and undetectable with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk of patent foramen ovale for thromboembolic events in all age groups. 158 66


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