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

We reviewed 1,669 patients who survived coronary artery bypass graft surgery between 1969 and 1981. A total of 75 cerebral complications were identified, including (1) altered mental state, (2) stroke, and (3) seizure in 64 patients (3.8%). Altered mental state (delirium, hypoxic-metabolic encephalopathy) occurred in 57 (3.4%). Postoperative arrhythmias were associated with an increased risk of altered mental state. Cerebral infarction occurred in 13 (0.8%). Patients who suffered stroke had a higher occurrence of carotid bruits and history of peripheral vascular disease. Seizures occurred in five patients (0.3%). Mortality in patients with a neurologic complication was 29%.
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PMID:Natural history of cerebral complications of coronary artery bypass graft surgery. 660 94

Scanning 3000 cases admitted for rehabilitation after cerebrovascular accident over a 20 year period produced a sample of 1369 subjects, without age restrictions, admitted within six months of a first stroke of thrombotic etiology. In this sample, survival rates showed no significant difference between men and women. Age at onset, however, clearly influenced survival changes; the expected mean survival was 6 years at 40 and 2 at age 80; average loss of life was 14 years for the whole sample, meaning a vital prognosis two to three times worse than that of the general population. At least 86% of the sample presented one or more of five etiological antecedents to stroke: hypertensive heart disease, peripheral vascular disease, diabetes mellitus, myocardial infarction and atrial fibrillation. In 87% of those, HHD and/or PVD were present. Presence of hypertension significantly lowered life expectancy and so did PVD; their influence is felt from the earliest stages. In contrast, diabetes mellitus, the next most common factor, has a late influence, starting about the fifth year after stroke. MI and AF were present in relatively fewer patients, but they contributed towards a considerable decrease in life expectancy, evident from the first stages, the more drastic reduction being observed in the AF group.
Stroke
PMID:Hemiplegics after a first stroke: late survival and risk factors. 665 53

This paper is the second devoted to the controlled trial "A.I.C.L.A." comparing aspirin, aspirin + dipyridamole and placebo in the secondary prevention of athero-thrombotic cerebral ischaemic events. It presents the description and distribution of baseline characteristics at entry. Six hundred and four patients (men: 70 p. 100, mean age : 63) were entered. Risk factors were distributed as follows: arterial hypertension: 63 p. 100, Diabetes: 24 p. 100, High blood lipids: 26 p. 100, high uric acid: 20 p. 100, hematocrit greater than 46 p. 100: 34 p. 100, cigarette smoking: 64 p. 100, angina pectoris and myocardial infarction: 15 p. 100, peripheral vascular disease: 7 p. 100, 37 p. 100 of patients had a stroke prior to entry. The ischemic event at entry occurred not more than one year prior to randomization and less than 3 months in 77 p. 100. It was much more often a completed stroke (84 p. 100) than a transient ischaemic attack (16 p. 100) and was referrable either to the carotid (46 p. 100) or the vertebrobasilar circulation (50 p. 100). On the whole patients are older and strokes more severe than in other similar studies. Randomization produced remarkably comparable treatment groups since almost no significant difference was observed between the 3 groups.
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PMID:[Controlled cooperative trial. Secondary prevention of atherosclerosis-related cerebral ischemic accidents by aspirin dipyridamole. 2: Description of subjects at the beginning of the trial]. 704 82

The hemodynamic effects of dopamine (DPM) and dobutamine (DBM) were compared in 13 patients with acute cardiogenic circulatory collapse. All patients presented with acute pump failure and inadequate systemic perfusion, and most were hypotensive. Nine patients had an acute myocardial infarction (AMI); the other four patients had an acute decompensation of a previously stable ischemic cardiomyopathy, and presented with a low-output syndrome in the absence of documented AMI. Patients were studied with a randomized single crossover design using each patient as his own control. Both drugs were given at doses of 2.5, 5, and 10 micrograms/kg/min for periods of 10 minutes at each dose while hemodynamics were monitored. No other vasoactive drugs were used during the study. Because of advanced age or severe peripheral vascular disease, no patient was considered suitable for intra-aortic balloon counterpulsation. There were no significant differences between the two drugs with regard to heart rate, mean-arterial pressure, systemic vascular resistance, stroke work index, or mean right atrial pressure. DBM improved stroke index and cardiac index significantly (p less than 0.05) more than DPM at doses of 5 micrograms/kg/min. DPM increased left ventricular filling pressure (LVFP) more than DMB at 5 micrograms/kg/min (p less than 0.001) and at 10 micrograms/kg/min (p less than 0.05). Although both DPM and DBM are useful in acute cardiogenic circulatory collapse, there appear to be important differences in their effect on LVFP and in the mechanisms whereby they increase blood pressure.
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PMID:Comparative hemodynamic effects of dopamine and dobutamine in patients with acute cardiogenic circulatory collapse. 708 Oct 40

Investigations of the incidence and the extent of the asymptomatic early stages of extracranial arterial disease (EAD) have been restricted for methodical reasons. Direct Continuous Wave-Doppler examination has given highly accurate results in the location and correct estimation of the degree of EAD both for the carotid (97%) and the vertebral arteries (90%), as shown from a detailed comparison with carotid (n = 604) and vertebral (n = 426) angiograms. Compared with this degree of reliability, the validity of normal auscultation for the diagnosis of EAD is shown to be poor: if bruits are taken as the only signs of associated EAD in patients with systemic atherosclerosis, only 27.6% in a group of 123 patients would have been correctly diagnosed. This parallels the number of false-positives (22.6%) in patients with normal results. The frequency and degree of EAD was studied by the use of direct Doppler examination in 2009 neurologically asymptomatic patients admitted either with severe vascular (n = 375) or coronary atherosclerosis (n = 262) or with high-risk factors (n = 1370). The frequency was significantly higher (32.8%) in patients with peripheral vascular disease than in those with coronary artery disease (6.8%) and in risk-factor patients (5.9%). The combination and degree of vessel involvement are presented in detail and their possible prognostic significance discussed.
Stroke
PMID:Incidence of asymptomatic extracranial arterial disease. 730 64

This prospective study used non-invasive techniques to screen for asymptomatic carotid occlusive disease in 314 patients who were to have coronary or peripheral arterial reconstruction. Hemodynamically significant carotid obstruction (greater than or equal to 50% stenosis or occlusion) was present in 54 arteries of 41 patients (13.1%), but only one-third of these lesions were accompanied by a cervical bruit. Among 48 carotid arteries where a bruit was heard, only 18 (37.5%) were associated with significant obstruction demonstrated by non-invasive screening. No prophylactic carotid endarterectomies were performed. There was only one perioperative TIA and one non-fatal stroke, neither of which was related to detectable carotid obstruction. In patients with peripheral vascular disease and detectable carotid obstruction or bruit, the perioperative mortality was higher than in patients without carotid obstruction or bruit (15.0% and 18.2 vs 3.1% and 2.1%, respectively). The deaths were primarily due to myocardial infarction. This study suggests that asymptomatic carotid occlusive disease, while common in patients with other cardiovascular disease, does not necessarily predispose to perioperative stroke and thus does not necessitate prophylactic carotid endarterectomy prior to indicated coronary or peripheral vascular reconstruction.
Stroke
PMID:Asymptomatic carotid disease in the cardiovascular surgical patient: is prophylactic endarterectomy necessary? 731 72

The postoperative stroke rate in 330 patients requiring coronary artery (170) or peripheral vascular (160) surgery was compared with the presence of carotid bruits and the results of noninvasive screening (Doppler imaging and spectral analysis of flow) to determine prevalence and significance of carotid lesions) and their relationship to perioperative stroke. Carotid lesions were suspected because of bruits in 70 patients with peripheral vascular disease (PVD) and in 28 patients with coronary artery disease (CAD). Noninvasive tests showed high grade stenosis or occlusion in 62 patients with PVD and in 14 with CAD. Forty-four patients with PVD and 101 patients with CAD had normal Doppler studies. The rest in both groups had plaquing without major stenosis. Noninvasive tests uncovered severe, occult lesions in only 13 patients (9 PVD, 4 CAD). Postoperative neurologic complications occurred in 16 patients (13 strokes: 5 PVD, 8 CAD and 3 TIAs: 2 PVD, 1 CAD). Thirteen neurologic complications occurred in patients having nonstenotic plaques or normal carotids without bruits. Only three of the strokes and 1 TIA occurred in patients with bruits and detectable carotid stenosis. Few of the postoperative strokes or TIAs were focal (2 PVD, 1 CAD), and the rest were nonfocal. None of the postoperative strokes or TIAs were associated with postoperative carotid occlusion. Physical examination is not an accurate method of determining severity of carotid disease. Severe carotid stenosis is more common in PVD patients than in CAD patients, but there is no significant difference in postoperative stroke rate. No direct relationship has been found between a bruit, severity of disease, and incidence of perioperative stroke.
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PMID:Postoperative stroke in cardiac and peripheral vascular disease. 741 31

Increased pressures on health-care budgets mean that governments require good value for money from the resources devoted to health care. In many countries, measures have been introduced to increase efficiency or to contain health-care costs. These include price controls, limitations on reimbursement of health technologies, budgetary reform in health-care institutions, and the encouragement of competition. Given this changing environment, it is important that drugs and other health technologies be shown to give good value for money. The methods of economic evaluation, such as cost-benefit and cost-effectiveness analysis, can be used to assess the value of drugs and other health technologies. They have been widely applied. The economic evaluation of drugs in peripheral vascular disease and stroke would compare the cost of adding the drug with its benefits. These would include improvements in length and quality of life and the savings in treating vascular events that may be postponed, or lessened in intensity, by effective drug therapy. One study, following a clinical trial of naftidrofuryl in stroke, suggested that there would be significant reductions in costs through reductions in hospital stay if recovery was aided. Further research and a large multicenter trial are under way to confirm these findings. In peripheral artery disease there are no economic data collected alongside clinical trials. It is known, however, that the costs of leg ischemia can be significant. A study in the U.K. found that arterial construction would cost around pounds 7,750 per person (1989 prices) and amputation around pounds 11,000 per person.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Economic evaluation of drugs in peripheral vascular disease and stroke. 751 76

Improvements in surgical technique and advances in myocardial protection have resulted in low rates of morbidity and mortality despite a greater incidence of high-risk patients. Noncardiac morbidity prolongs hospital stays and increases the costs of cardiac surgery. This study examines the preoperative predictors of stroke following isolated coronary bypass surgery. The clinical records of 3910 consecutive patients who underwent isolated coronary bypass surgery at the University of Toronto were reviewed. Stepwise logistic regression identified six independent predictors of stroke following CABG (percent in parentheses) and calculated factor adjusted odds ratios (OR) for each risk factor. Triple vessel coronary artery disease was the most important predictor (1.9%, OR 5.71), followed by normothermic systemic perfusion (3.8%, OR 4.85), age > 70 years (3.2%, OR 3.88), a previous history of transient ischemic attacks or stroke prior to surgery (6.1%, OR 3.7), peripheral vascular disease (4.7%, OR 2.77), and diabetes mellitus (2.6%, OR 2.01). The mechanism of stroke is likely different between these high-risk groups and strategies to prevent postoperative stroke should focus on the mechanisms responsible in high-risk patients.
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PMID:Risk factors for stroke following coronary bypass surgery. 757 44

Hypertension is a major risk factor for coronary artery disease, stroke, renal failure, and peripheral vascular disease. The importance of preventing hypertension and controlling blood pressure in patients with hypertension is well established and is associated with reduced cardiovascular morbidity and mortality rates. Treatment guidelines should consider the merits of dietary changes in addition to pharmacologic therapy in the control of mild hypertension.
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PMID:Nutritional factors and hypertension. 762 Jun 1


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