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

Sonographic patterns for the Doppler ophthalmic test (DOT) were determined by reviewing the type of graphic record obtained from 25 patients who had undergone angiography. Three principal patterns were identified, depending upon whether there was augmentation (Type 1), diminution (Type 2) or no change (Type 3) in the character of the supraorbital Doppler signal upon temporal artery compression. Type 1 records were seen in 28 of 33 instances where the carotid arteries remained patent. Type 2 records occurred in 10 of 14 instances where there was significant carotid stenoses or tortuosity and in two instances in a patient with a subclavian steal syndrome. A "false-positive" test was recorded in one instance in a patient with vascular headaches. There were three Type 3 records.
Stroke
PMID:Doppler sonography diagnosis of cerebrovascular disease. 96 Jan 65

Percutaneous transluminal angioplasty (PTA) was performed in 45 patients with a manifest subclavian steal syndrome. Thirty-five of those patients were subjected to follow up examinations over a period of 6 to 18 months. Five patients suffered from severe restenosis and were treated again. Two thirds of the patients benefited from the treatment. PTA of the proximal vertebral artery was performed in 15 patients with bilateral occlusive lesions of the extracranial vertebral arteries. In 13 of these cases the neurological and the vascular states of the patients were regularly reexamined, 8 showed a marked improvement. During the 2 to 25 month observation period (average 15 months post-PTA) reocclusion was observed in only two cases. These showed no recurrent neurological sequelae. Forty-three consecutive patients with acute vertebro-basilar or basilar occlusion received intraarterial fibrinolytic therapy with streptokinase or urokinase. Twenty-three of these had presented severe deficits at the beginning of therapy (e.g. complete tetraplegia, comatous state for more than 6 hours). None of this group survived. By contrast the 20 other patients in this group presented with incomplete fluctuating or progressive motor deficits. None was comatous for more than 6 hours. Fourteen patients (33% in this group) survived. Local intraarterial fibrinolytic therapy is the only therapy successful in the treatment of progressive stroke from vertebro-basilar thrombosis.
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PMID:Vascular recanalizing techniques in the hind brain circulation. 297 Nov 45

Vascular recanalizing techniques only recently became methods of some clinical importance. Angioplasty of the subclavian artery in cases with subclavian steal syndrome has now been performed in so many instances that it can be judged safe. Angioplasty at the origin of the vertebral artery has not yet been performed in as many cases. However, even there this method is obviously less hazardous than surgery. Local intraarterial fibrinolytic therapy is the only therapy providing some success in progressive stroke from vertebrobasilar thrombosis. In contrast to the vertebrobasilar territory local fibrinolytic therapy within the carotid territory has to be strictly limited to some special indications.
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PMID:Vascular recanalizing techniques in interventional neuroradiology. 315 15

Eighty-two patients presenting with subclavian steal syndrome (36 men, 46 women; median age, 66.5 years) were studied. All patients underwent clinical and noninvasive evaluation. Diagnosis was based on both a 20 mmHg difference in blood pressure between arms and reversed blood flow in the vertebral artery. Twenty-one patients (25.6%) had a transient ischemic attack or cerebrovascular accident before the study. In 16 patients (19.5%), the anterior circulation was involved and the vertebrobasilar circulation was effected in 5 patients (4.8%). Fifty-five patients were followed for one to six years (mean 4.1 years). During this period three patients died. Noninvasive studies showed that 39 patients (70.9%) had progression of disease in the carotid arteries and that 10 of these 39 (12.1%) exhibited a transient ischemic attack or cerebrovascular accident, and eight patients (9.7%) required carotid endarterectomy. No patient had a stroke involving the vertebrobasilar circulation, but four patients (4.8%) had a transient ischemic attack. Three other patients had revascularization procedures performed for arm ischemia. Patients with subclavian steal syndrome are more likely to experience a transient ischemic attack or cerebrovascular accident involving the carotid circulation than the vertebrobasilar circulation. Noninvasive evaluation of the carotid arteries and the posterior circulation should be included in the long-term follow-up of these patients.
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PMID:Natural history of subclavian steal syndrome. 318 98

Continuous-wave Doppler ultrasonography and clinical examination were used over a 2-year period to monitor the natural history of subclavian stenoses and occlusions in 67 patients. Thirty-nine presented with subclavian steal and 28 without. We also studied an additional group of 29 patients who had undergone surgery for subclavian steal syndrome and vertebrobasilar transient ischemic attacks. The results, in terms of both ultrasonographic and clinical criteria, demonstrate the benign nature of the subclavian steal syndrome: all neurologic signs and symptoms were of a transient character. Spontaneous remission of vertebrobasilar transient ischemic attacks occurred in approximately 50% of the initially symptomatic patients, and only 15% of the initially asymptomatic patients experienced vertebrobasilar transient ischemic attacks during follow-up. Doppler ultrasonography revealed progression during follow-up in only 17% of the subclavian stenoses, and in 13% a stenosis was no longer detectable. Still-ongoing brainstem transient ischemic attacks were reported in 24% of the operated patients. The most important factor for the lack of improvement was the occlusion of the bypass. Continuation of transient neurologic symptoms could be observed in only 14% of the patients with intact carotid-subclavian bypass. In conclusion, indications for surgical treatment of the subclavian steal syndrome should be restricted to cases in whom vertebrobasilar transient ischemic attacks occur frequently and are either debilitating or greatly frighten the patient.
Stroke 1988 Apr
PMID:Ultrasonographic follow-up of subclavian stenosis and occlusion: natural history and surgical treatment. 328 16

A case of left subclavian steal syndrome with transient ischemic attacks of left carotid artery distribution is presented. An attempt to explain this uncommon symptomatology is based on a rare patent cervical arterial network, stealing blood from the left common carotid artery and supplying the distal portion of the obstructed left subclavian artery.
Stroke
PMID:Unusual clinical signs in left subclavian artery occlusion: clinical and angiographic correlation. 665 8

Patients who have undergone a Blalock-Taussig anastomosis for treatment of congenital heart disease may have the vascular anatomy of the subclavian steal syndrome. Cerebral ischemia has been reported in such patients, but not when total surgical correction has eliminated other predisposing factors. We report a patient who developed vertebrobasilar insufficiency 31 years after Blalock-Taussig anastomosis and 4 years after total intracardiac repair of tetralogy of Fallot. He had angiographically proven subclavian steal and no other known predisposing factor for cerebral ischemia. This case suggests that symptomatic subclavian steal may be a late risk of surgical treatment of congenital heart disease that leaves the vascular anatomy of subclavian steal intact. Vascular reconstructive surgery can be effective treatment for these patients and may be indicated prophylactically at the time of intracardiac repair if subclavian steal syndrome becomes a more frequently recognized sequela of prior Blalock-Taussig anastomosis.
Stroke
PMID:Vertebrobasilar ischemia after total repair of tetralogy of Fallot: significance of subclavian steal created by Blalock-Taussig anastomosis. Vertebrobasilar ischemia after correction of tetralogy of Fallot. 670 43

Transcranial Doppler sonography can be used to evaluate a spectrum of intracranial and extracranial vascular abnormalities. It is of proved value in the detection and follow-up of vasoconstriction caused by subarachnoid hemorrhage and can be used to demonstrate significant stenosis or occlusion of basal intracranial arteries and coexisting routes of collateral circulation. Transcranial Doppler sonography can play an important role in the determination of brain death and can be used to identify the nidus of an arteriovenous malformation, along with its major routes of supply and drainage. The technique may provide insights into cerebral hemodynamics following trauma, stroke, or migraine. Use of transcranial Doppler sonography enables a rapid, noninvasive diagnosis of the subclavian steal syndrome, and it is a valuable adjunct to duplex carotid sonography for determining the effect of atherosclerotic lesions of the internal carotid artery on cerebral hemodynamics. In the operating room or angiographic suite, transcranial Doppler sonography can be used to monitor patients undergoing surgical, interventional, or diagnostic procedures for the development of cerebrovascular complications.
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PMID:Transcranial Doppler sonography. Part 2. Evaluation of intracranial and extracranial abnormalities and procedural monitoring. 789 97

Reversed vertebral blood flow distal to a subclavian obstruction is not uncommon and rarely leads to stroke. A small subgroup of these patients have obstruction in other portions of the extracranial or intracranial circulation, however, and cerebrovascular symptoms are induced by arm exercise, which may decrease regional cerebral blood flow--at times to critical levels--indicating a true "steal" syndrome. We evaluated six patients with symptomatic subclavian steal syndrome using stable xenon with computed tomography cerebral blood flow mapping. A decrease in flow from 13% to 90% in one or more regional vascular territories was found after arm exercise. Patients with a true "steal" syndrome may be at higher risk for stroke. Measuring regional cerebral blood flow may be a means of detecting patients who have a critical loss of flow reserves and who will be symptomatically improved by cerebral revascularization.
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PMID:The effect of arm exercise on regional cerebral blood flow in the subclavian steal syndrome. 805 33

Proximal subclavian or brachiocephalic artery obstruction may present with a variety of symptoms. Surgery has been considered by many to be the corrective procedure of choice, but percutaneous alternatives are becoming increasingly popular. Little work has been done to compare the outcomes of the two techniques. Presenting symptoms in this condition often include angina secondary to coronary-subclavian steal, subclavian steal syndrome, arm ischemia, and axillo-femoral graft inflow obstruction. A systematic review of the surgical literature has been performed and has included analysis of the incidence of technical success, overall complications, stroke, death, and subsequent patency. However, despite comparison of these data to the published series of stenting, there are no head-to-head trials of one technique versus another. Review and analysis of the contemporary literature suggests a high patency and low complications in stent series, and is in contrast to similar midterm patency but a higher incidence of stroke and death in the surgical literature. A variety of techniques can be used for successful stent-based revascularization, and a blending of skills from the traditional "coronary" and "peripheral" venues may be helpful. Comparison with the published surgical experience suggests that the effectiveness of percutaneous revascularization is at least equivalent and that these techniques may be associated with fewer procedure-related serious complications. Percutaneous stenting should be considered a first-line therapy in treating subclavian or brachiocephalic obstruction.
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PMID:Subclavian and Innominate Revascularization: Surgical Therapy Versus Catheter-Based Intervention. 1109 57


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