Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coronary artery disease is a recognized risk factor for symptomatic ischaemic stroke but the influence on asymptomatic stroke has not been clearly determined. The purpose of this work was to determine the relationship between coronary heart disease and silent brain infarcts and the influence of vascular risk factors and carotid atherosclerosis in a representative sample of Spanish patients with symptomatic coronary artery disease. A consecutive sample of 100 subjects with myocardial infarction, angina or both were included in the survey. Patients with a potential source of emboli from the heart were excluded. As main baseline variables, we considered vascular risk factors; complete cardiological study, including coronary angiography; brain computed tomography (CT) to detect infarcts; echo-Doppler of supra-aortic vessels to detect stenosis; and carotid angiography, when appropriate. As the outcome variable, we observed the incidence of symptomatic stroke after an 18 month mean follow-up. We found silent brain infarction in 30 patients (93% were of lacunar type). None of the vascular risk factors was related to brain infarcts either in univariate or multivariate analysis. Carotid atherosclerosis was the only significant predictor in a model of logistic regression (P < 0.0005), although the lesions were bilateral in the majority of cases. We observed a very low incidence of symptomatic stroke after a mean follow-up of 18 months. Silent brain infarcts are a frequent finding on brain CT in patients with coronary heart disease and are associated with carotid atherosclerosis; however, it does not seem to have important prognostic significance.
 ...
PMID:Silent brain infarctions in patients with coronary heart disease. A Spanish population survey. 950 14

BACKGROUND: The ongoing Asymptomatic Carotid Surgery Trial (ACST) has randomized more than 1900 patients to determine whether carotid endarterectomy prolongs stroke-free survival compared with best medical treatment alone. Previously the Asymptomatic Carotid Atherosclerosis Study demonstrated that preoperative angiography caused stroke or death in 1 per cent of patients, and many centres have now reduced or abandoned this practice. This study determined the changing practice of carotid angiography in the ACST. METHODS: Collaborating surgeons completed questionnaires annually on their use and method of angiography. Information on patients in the ACST who had angiography at randomization was also obtained. RESULTS: In 1993, 77 per cent of responding collaborators always performed preoperative angiography and 23 per cent used angiography selectively. This trend has reversed: by 1997, 26 per cent always used preoperative angiography, 70 per cent of respondents used preoperative angiography selectively and 4 per cent had abandoned angiography (P < 0.001, chi2 for trend). Information on carotid angiography at randomization has to date been obtained on 1141 patients in the ACST. Some 44 per cent (497 of 1141) had carotid angiography at randomization. Surgical patients had angiography more commonly than those in the medical group (49 versus 42 per cent; P < 0.03, chi2 test). Changes in carotid angiography were analysed by year of randomization. In 1993, 61 per cent of patients randomized had carotid angiography compared with 42 per cent in 1996 and 1997 (P < 0.001, chi2 for trend). The use of carotid angiography was not related to degree of stenosis estimated by Doppler ultrasonography. CONCLUSION: In the ongoing ACST, there is increasingly selective use of carotid angiography. Less than half the patients in this study had carotid angiography and the use of angiography is now decreasing. This has important implications for validation of carotid duplex in this trial and in future studies.
 ...
PMID:Vascular surgical society of great britain and ireland: carotid angiography is used more selectively in the asymptomatic carotid surgery trial 1036 13

Carotid endarterectomy has proved to be beneficial in the prevention of stroke in selected patients. The procedure is indicated in symptomatic patients with carotid-territory transient ischemic attacks or minor strokes who have carotid artery stenosis of 70 to 99 percent. With a low surgical risk, carotid endarterectomy provides modest benefit in symptomatic patients with carotid artery stenosis of 50 to 69 percent. Platelet antiaggregants and risk factor modification are recommended in symptomatic patients with less than 50 percent stenosis. In the Asymptomatic Carotid Atherosclerosis Study, carotid endarterectomy was beneficial in patients who had asymptomatic carotid artery stenosis of 60 percent or greater and whose general health made them good candidates for elective surgery, provided that the arteriographic and surgical complication rates were low. However, in asymptomatic patients, surgery reduced the absolute risk of stroke by only 1 percent per year.
 ...
PMID:When to operate in carotid artery disease. 1067 Apr 99

The first carotid endarterectomy (CEA) is usually accredited to Eastcott who reported in 1954 the successful incision of a diseased carotid bulb with end-to-end anastomosis of the internal carotid artery (ICA) to the common carotid artery (CCA). During the following years surgeons were quick to adopt and improve the intuitively attractive procedure. But by the early to mid 1980s several leading neurologists began to question the growing number of CEAs performed at that time. Six major CEA trials were then designed which are now completed or nearing completion. Most conclusive data are available from the North American Symptomatic Carotid Endarterectomy Trial (NASCET) for symptomatic carotid disease, and from the Asymptomatic Carotid Atherosclerosis Study (ACAS) for asymptomatic carotid disease. The key result of these studies is that CEA is beneficial to high grade symptomatic and asymptomatic carotid stenosis. While the benefit in symptomatic disease is clear, it may be negligible in asymptomatic patients suffering from other medical conditions, the most important being coronary artery disease. Since the conclusions from the different studies vary significantly, guidelines and recommendations with regard to CEA have been issued by a number of interest groups, so-called consensus conferences. The best known guidelines are published by the American Heart Association (AHA). However, the practice of interest groups to issue guidelines is currently being criticized, the main reason being that interest groups have different ideas and all claim the right to issue guidelines. At present we recommend CEA for symptomatic high-grade stenosis in patients without significant coincident disease. With regard to asymptomatic stenosis we suggest surgery to otherwise healthy patients if the stenosis is very narrow or progressive. Preoperative evaluation has changed over the years. Currently we recommend duplex sonography in combination with intra- and extracranial magnetic resonance angiography (MRA). Concurrent coronary artery disease is a major consideration in the perioperative management, and the use of a specific algorithm is recommended. Surgery is performed under general anaesthesia with intraoperative monitoring such as electroencephalography (EEG) and transcranial Doppler (TCD). A temporary intraluminal shunt is used selectively if after cross-clamping the flow velocity in the middle cerebral artery (MCA) falls to below 30 to 40% of baseline. For years we employed routine barbiturate neuroprotection during cross-clamping. At the present time we use barbiturate selectively, if the flow velocity in the MCA falls to below 30 to 40% of baseline and if the use of a temporary intraluminal shunt is not possible due to difficult anatomic conditions. The reason to abandon systematic barbiturate protection was to accelerate recovery from anaesthesia. Our patients are monitored overnight on the ICU or a surveillance unit. Routine hospitalization after surgery is 5 to 7 days with a control duplex sonography being performed prior to discharge. A number of details with regard to surgical technique and perioperative management are a matter of discussion. Our surgical routine is described here step by step. Such management resulted in 6 major complications among the 402 cases with 4 of cardiopulmonary and 2 of cerebrovascular origin. For the future we can expect the development of percutaneous transluminal techniques competing with standard carotid endarterectomy. At the present time several comparative studies are under way. Irrespective of the technical approach to treat carotid stenosis, several other issues have to be clarified before long. One of the major unresolved items is the timing of treatment after completed stroke. In this regard prospective trials need to be performed. Although numerically not as important as carotid stenosis, vertebral artery (VA) and subclavian artery (SA) stenoses are more and more accepted as indication for surgical
 ...
PMID:Reconstructive surgery of the extracranial arteries. 1099 1

Stroke is the third most common cause of death and the leading cause of disability in the United States. Management of identifiable risk factors and careful selection of patients for operative intervention constitute the current approach to reducing the morbidity and mortality associated with stroke. A carefully performed carotid endarterectomy (CEA), which has a low periprocedural complication rate, is the only form of mechanical cerebral revascularization for which definitive evidence of clinical effectiveness has been reported. Recently, retrospective case reports and case series have demonstrated the feasibility of carotid angioplasty and stenting as a possible alternative to CEA. In the tradition of the two previous National Institutes of Health (NIH)-sponsored trials--the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS)--the National Institutes of Health has sponsored a clinical trial (CREST: Carotid Revascularization-Endarterectomy vs Stent Trial) that is currently under way to determine the efficacy and risks of carotid angioplasty and stenting compared with CEA.
 ...
PMID:Carotid Artery Occlusive Disease. 1109 30

Stroke is the second cause of death and one of the main determinant of disability worldwide. Prevention remains the most important measure for reducing its incidence and mortality. Carotid endarterectomy is one of the possible means for reducing stroke incidence, at least in a subgroup of patients at risk of ischemic stroke. The benefit of carotid endarterectomy has been demonstrated consistently by two large international randomised controlled trials (North American Symptomatic Carotid Endarterectomy Trial, and European Carotid Surgery Trial) in patients with severe symptomatic carotid stenosis. In subjects with asymptomatic carotid stenosis the benefit has been shown by the only available trial (Asymptomatic Carotid Atherosclerosis Study), but proved to be quantitatively less relevant. The benefit is marginal if one considers that only part of stroke events occurring in the territory of an asymptomatic carotid stenosis is preventable by the intervention, since a consistent proportion (almost 50%) of these events are due to other causes (cardioembolism, lacunar infarction). Based on these observations, to obtain a beneficial effect, the perioperative risk should be minimized. Every surgical group should monitor carefully this risk, not omitting minor strokes, that in some cases are functionally relevant. Estimating prevalence and natural history of asymptomatic carotid stenosis in a definite population, the population impact number is expected to be very high, not justifying a widespread screening of the population aimed to identify subjects with asymptomatic carotid stenosis.
 ...
PMID:[Endarterectomy in asymptomatic carotid stenosis: a controversial procedure for primary prevention of stroke]. 1147 93

The current incidence of stroke in Europe and the USA is about 200 per 100,000 population per annum. Eighty percent of strokes are ischaemic and 20% are due to hemorrhage. Approximately half the patients with ischaemic strike have carotid artery stenosis and about one third (10% all stroke victims) have had no warning symptoms such as transient ischaemi attacks. The European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have effectively shown that carotid endarterectomy (CEA) can prevent strokes in symptomatic patients. The benefit of operation is, at present, confined to those with at least 70% stenosis; for 30-69%, the trials have not yet reported a result. In asymptomatic patients the Veterans Administration Study and the Asymptomatic Carotid Atherosclerosis Study (ACAS) have yielded promising results that surgery may reduce the risk of TIA and minor stroke. There is as yet no convincing evidence in asymptomatic patients that moderate or severe stroke (or death) can be prevented by CEA. The aim of this trial is to determine whether CEA and appropriate best medical treatment (BMT) can improve stroke free survival time when compared with BMT alone.
 ...
PMID:[Prevention of cerebral ictus, of carotid origin]. 1164 64

Stroke ranks as the third leading cause of death, behind diseases of the heart and cancer. It is also the most important cause of disability. Approximately 750,000 people experience a stroke annually, costing an estimated $40 billion in direct and indirect costs. Approximately 25% of these ischemic events are related to occlusive disease of the cervical internal carotid artery. Carotid atherovascular stenosis increases the risk of ischemic stroke by acting as an embolic source, and causing hypoperfusion of the ipsilateral cerebral hemisphere. With some limitations, the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trialists' Collaborative Group (ECST), and Asymptomatic Carotid Atherosclerosis Study (ACAS) have shown that carotid endarterectomy (CEA) substantially reduces the risk of stroke associated with certain grades of carotid stenosis. During the past few years, carotid angioplasty and stenting (CAS) has evolved as an alternative to CEA, particularly in patients who are known to have a higher complication rate with CEA.
 ...
PMID:Management of carotid artery stenosis: comparing endarterectomy and stenting. 1258 61

Carotid atherosclerosis is one of the main risk factors for ischemic stroke. The annual risk of ipsilateral stroke for asymptomatic, albeit severe stenoses is as low as 1 to 2%, but increases to 13% in patients with recent ischemic symptoms. However the risk decreases after the first 2-3 years from the symptomatic episode, dropping to 3%. Echo-color Doppler ultrasonography is the screening method of choice, being highly accurate, noninvasive and low-cost. Carotid angiography still represents the gold standard, however, less invasive techniques as RM angiography and Angio-CT are becoming increasingly common. Based on NASCET, ECST and ACAS results, carotid endarterectomy (CE) is strongly recommended for severe symptomatic stenoses, while for the moderate symptomatic and the severe asymptomatic ones the benefit in terms of stroke risk reduction is modest and surgery should be restricted to selected cases in surgical centers of high experience. For severe asymptomatic stenoses NNT is too high to recommend indiscriminate surgery; we are waiting for the results of ACSRS trial, designed to identify a subset of patients at risk of ipsilateral stroke greater than 4%/y, that may be considered for CE, while patients at low risk will be spared from unnecessary operation. Apart from surgery, in all patients with carotid atherosclerosis correction of cardiovascular risk factors is mandatory. Antiplatelet therapy (ASA alone or with dypiridamole, ticlopidine) is effective in secondary prophylaxis of athero-thrombotic stroke; its use in asymptomatic carotid stenoses can be recommended, even if more because of a plausible rationale than of clinical trial-based evidences.
 ...
PMID:Management of patients with carotid stenosis. 1367 81

We determined intima-media thickness (IMT) and diameter of carotid artery and estimated their correlations with cardiovascular risk factors in 1129 men aged 60-74 years, who participated in a cardiovascular risk survey in three Japanese communities. The multivariate odds ratios (95% confidence interval) for the maximum IMT > or = 1.1 mm in the common carotid artery (CCA) were 1.3 (1.1-1.5) per 4 years of age, 1.8 (1.4-2.5) for hypertension, 1.4 (1.2-1.7) for a 34.4 mg/dl increase in serum total cholesterol, 0.7 (0.6-0.8) for a 14.7 mg/dl increase in serum HDL-cholesterol, and 2.4 (1.1-5.0) for history of stroke, while the maximum IMT > or = 1.5mm in the internal carotid artery (ICA) were 1.6 (1.4-1.8) per 4 years of age, 1.9 (1.5-2.4) for hypertension, 1.6 (1.2-2.1) for current smoking, and 3.5 (1.6-7.6) for history of stroke. Age, height, hypertension, current smoking, ethanol intake and history of coronary heart disease were independent determinants of both the outer and inner CCA diameter. Maximum IMT correlated positively with the outer diameter and inversely with the inner diameter in the CCA. Carotid atherosclerosis suggests to be a risk factor for stroke among Japanese elderly men, although future prospective studies are required to confirm this finding.
 ...
PMID:Prevalence and correlates of carotid atherosclerosis among elderly Japanese men. 1501 46


<< Previous 1 2 3 4 5 6 7 Next >>