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

NASCET randomized patients with focal symptoms related to arteriosclerotic disease manifest by transient or nondisabling ischemic events in the ipsilateral hemisphere or retina. Patients were randomly assigned to receive best medical care including aspirin when tolerated and control of manageable risk factors or the same medical program to which carotid endarterectomy was added. Patients were stratified into those with arteriographic stenosis of 70% or greater or into the moderate category of less than 70% stenosis. Interim analyses after three years disclosed for patients with 70% or more stenosis a clear benefit from surgery. Below 70% there was no indication of benefit nor harm. The entry of patients with severe disease was stopped and the result published. At two years after surgery, 17 strokes are prevented for every 100 patients submitted to the procedure with severe stenosis. It can also be stated that the functional status of the patients in the surgical cohort exceeded that in the patients assigned to medicine. Subgroup analyses noted that: the risk experienced by medical patients with retinal events is only one-third for those with hemisphere events. A definite ulcerative lesion nearly doubles the risk. Age is an important risk factor but surgery benefits those in the later as in the younger decades. Contralateral stenosis adds only slightly to the risk of stroke whereas contralateral occlusion quadruples the risk. Surgical benefit is present despite contralateral occlusion. Silent brain infarctions in CT examinations added to the risk in the medical group compared to those without this phenomenon. Surgery benefited both of these subgroups equally.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1993
PMID:Status report on the North American symptomatic carotid surgery trial. 825 42

An analysis of the relevant data from the Veterans Affairs Cooperative Study Group in asymptomatic patients, showed that 26 of the 32 ipsilateral strokes occurred during the first two years of clinical follow-up. Furthermore, as observed in the medical group, half the neurologic outcome events were strokes and were not preceded by transient ischemic attacks. In the North American Symptomatic Carotid Endarterectomy Trial over a 2-year period, 45 percent of those with occlusion had a stroke compared to 15 percent in the surgical group. These data dispel the traditionally held view that patients with severe contralateral disease should not be subjected to surgery. However, the referral of patients to centers capable of low rates of surgical complications is essential in a plan that includes carotid endarterectomy with optimal medical management.
J Mal Vasc 1993
PMID:Severe bilateral carotid stenosis. 825 46

Carotid surgery in patients with carotid stenosis and contralateral occlusion is generally followed by a higher operative morbidity and mortality-rate than patients with monolateral stenosis. To verify our experience, the records of 167 patients affected with internal carotid stenosis with contralateral occlusion operated on between 1978-1991 were reviewed. They were 139 males and 28 females with a mean age of 62.3 years, and represent the 16% of the patients operated on for carotid lesion in the same time period. The indications for surgery were TIA or RIND in 52 patients, minor stroke or stroke in 9, non hemispheric symptoms in 19; 22 patients were asymptomatic, and 75 presented symptoms unrelated to the operated stenosis. The operative morbidity and mortality-rate of the whole sample were: stroke-rate 4.8%, mortality-rate 3% and cumulative stroke + mortality-rate 5.4%. In particular the operative risk was higher in patients operated on for stroke or for vertebro-basilar symptoms, while patients with reversible symptoms and asymptomatic patients had a significant lower stroke-rate both in the post-operative period and in the follow-up (p < 0.02). Patients operated on for completely asymptomatic lesions and for contralateral borderline symptoms had no operative symptoms. Relationships between operative complications and pre or per-operative monitoring have been analyzed; our results suggest a more extensive use of intraluminal shunt and an operation under general anaesthesia in patients with ischemic areas shown by a pre-operative SPECT or with a cerebral infarct even if SPECT monitoring does not suggest its use.
J Mal Vasc 1993
PMID:[Carotid stenosis associated with contralateral carotid occlusion]. 825 47

The most suitable treatment for intraluminal carotid thrombi remains still a much debated question. Some authors have reported a lower morbidity in patients treated with anticoagulant or antiplatelet therapy; on the other side, urgent or delayed surgery is burdened with a high risk of perioperative stroke. Over 11 years (october 1981-november 1992) 602 surgical revascularizations on epi-aortic vessels have been performed at Vascular Surgery Unit of Udine Regional Hospital. Only 2 cases of intraluminal carotid thrombi were observed: both fulfilled the angiographic requirements for endovasal filling defect, surrounded by contrast medium, adherent to posterior wall and extending to distal internal carotid artery. First patient suffered a TIA 20 days before surgery, the second one a previous major stroke contralateral to the thrombus. The former was given preoperatively a medical anticoagulant treatment (warfarin). At operation we discovered a nearly complete resolution of the thrombus: only its adherent base was still present. Therefore we performed a routine endarterectomy and a PTFE patch angioplasty. The latter case reported had no preliminary medical treatment; a thrombus extending from carotid bulbus to external and internal carotid was detected and then removed without any distal embolization. Arteriotomy was closed by Dacron Velour patch angioplasty. No perioperative stroke occurred in both cases: our second patient showed a partial resolution of his motility deficit. According to our limited experience, delayed surgical treatment of intraluminal carotid thrombi seems not to be affected with higher risk of perioperative stroke than prophylactic carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1993
PMID:Surgical management of intraluminal carotid thrombi. 825 50

To evaluate the role of carotid surgery in elderly patients 75 years and older, we reviewed 912 carotid endarterectomies performed on 806 patients between 1987 and 1990. There were 151 patients (19% of the whole series) aged 75 years and older (160 endarterectomies, group A), including 29 octogenarians, vs 655 patients under 75 years of age (group B). There were more women in the elderly age group (44%) than in the younger one (38%). Symptoms, risk factors, operative outcome and follow up data of the two groups were compared. The risk profile was similar for the two age groups, with exception for coronary heart disease, less frequent in the older patient group (25% had previous infarction vs 44%). Indication for carotid endarterectomy was different in the two age groups: 41% of group A underwent prophylactic thrombendarterectomy for high degree stenosis, while only 30% of group B had asymptomatic carotid disease. In group A, 6% of the patients had carotid endarterectomy after recovering from a mild stroke, vs 2% in group B. Angiography revealed bilateral carotid disease in 59% of the group A patients (including 15% with contralateral occlusion) vs 40% in group B. Operative mortality was 1.5% for the younger age group vs 2.5% for the older age group. The cause of death was cardiac in 60%. A follow up is available for all patients who benefited carotid endarterectomy since 1976, including 180 patients aged 75 years or older.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1993
PMID:[Is age a limiting factor for carotid surgery?]. 825 51

From January 1985 to October 1992 ten patients were submitted to reconstruction of the external carotid artery (ECA). Nine were males and one female with age that ranged from 64 to 74 years, mean 68. All were symptomatic due to TIAs in seven and amaurosis fugax in four of this group, previous completed stroke plus TIAs in two and chronic low perfusion in one. Associated risk factors were smoking (8 pts: 80%), coronary disease (5 pts: 50%), hypertension (4 pts: 40%), diabetes (4 pts: 40%) and peripheral arterial obstructive disease (2 pts: 20%). All patients were submitted to non invasive (Doppler C. W., Echo-color Doppler) studies as well as angiography. All the patients had an occlusion of the internal carotid artery (ICA) unilateral and homolateral to external carotid stenosis in 8 and bilateral in 2; in addition three patients had a non haemodynamic stenosis of the contralateral ICA. One patient had an occlusion of the common carotid artery with collateral supply to the ECA; nine had severe stenosis of the ECA at the origin. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Surgery was advised to correct amaurosis fugax, to increase external-internal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endarterectomy. All patients were operated upon under general anesthesia; an endarterectomy with a PTFE patch was performed in 9 cases, while in one a subclavian-ECA bypass was carried out using an autologous vein segment.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1993
PMID:External carotid artery repair in cerebrovascular insufficiency. 825 54

The cardiovascular risk of postmenopausal hormone replacement therapy is a controversial subject. A quantitative evaluation of 12 studies of cohorts show a global relative risk of major ischemic cardiac disease of 0.69 (95% confidence interval: 0.60-0.79) in women having or having had oestrogen therapy compared with women who have never taken this treatment. This relative risk was 0.94 (95% confidence interval: 0.77 to 1.15) for stroke and 0.80 (95% confidence interval: 0.65-0.97) for cardiovascular mortality. These results are coherent with the hypothesis of a protective effect of oestrogens against coronary artery disease in postmenopausal women. However, they cannot be generalised to hormone replacement therapy usually proposed in France. The influence of an association of oestrogen-progesterone therapy and the effects of administering oestrogens by an extra-gastrointestinal route on vascular risk are unknown. Randomised clinical trials are needed to determine the effects of postmenopausal hormone replacement therapy on athero-thrombotic disease.
Arch Mal Coeur Vaiss 1993 Feb
PMID:[Quantitative evaluation of the cardiovascular risk associated with hormone substitution therapy during menopause]. 836 27

Recent developments in the use of Magnetic Resonance Imaging (MRI) to measure and image molecular diffusion and blood microcirculation (perfusion) hold significant promise in the noninvasive evaluation of normal brain function and functional disorders. Molecular diffusion is the result of spontaneous random motion that involves all molecules and probes molecular motion at microscopic level. Using diffusion MRI, information on tissue geometry and compartmentation effects can be obtained. Diffusion MRI has been used to map myelin fiber orientation in brain with high accuracy. Diffusion MRI is also the only imaging modality which shows brain ischemia at a very early stage, even before T1w or T2w MR images become abnormal, offering great promises in the management of stroke patients. Also, diffusion imaging may be used to monitor tissue temperature changes noninvasively during hyperthermia or laser surgery. On the other hand, MRI can provide information on tissue perfusion. Several methods have been proposed, some of them including tracers or contrast agents. The most successful approach for brain function studies, however, is based on the sensitivity of MRI to magnetic effects induced by changes in the oxygenation status of hemoglobin (deoxyhemoglobin). These effects have already been used to characterize hematomas. These effects may also be exploited to detect small modulation in red blood cell oxygen content related to local variations in blood flow and oxygen consumption in tissues. In the brain cortex, such variations may be induced by external stimuli or internal cognitive processes. Capillary blood deoxyhemoglobin thus acts as a natural endogeneous contrast agent.(ABSTRACT TRUNCATED AT 250 WORDS)
J Mal Vasc 1995
PMID:[Diffusion, perfusion and functional magnetic resonance imaging]. 854 2

Acute and chronic administration of nitric oxide (NO) synthase (NOS) inhibitors increase mean arterial blood pressure (MAP) in rats but their hemodynamic effects in other species remain unknown. Moreover, the role of NO in the control of exercise-induced vasodilation is still debated. To answer these questions, six dogs were instrumented for the continuous measurement of cardiac output (CO, electromagnetic flow probe on the aorta), MAP (aortic catheter) and left ventricular pressure (Konigsberg gauge). Total peripheral resistance (TPR) was calculated as MAP/CO ratio and dP/dt was used as an index of cardiac inotropism. The dogs were treated from day 0 (D0) to 7 (D7) by the NOS inhibitor, N omega-nitro-L-arginine (L-NNA), 20 mg/kg/day (IV). Such a dose regimen resulted in NOS inhibition evidenced (a) in vivo by a reduction of the hypotensive responses to graded doses of acetylcholine and bradykinin, (b) ex vivo by a decrease in the relaxation of the femoral artery to acetylcholine (EC 50 = 2.2 +/- 0.6 10(-7) M after L-NNA vs 2.2 +/- 0.8 10(-8) M in controls). One month after instrumentation, the dogs being conscious, MAP measured at rest remained unchanged following one week L-NNA treatment (from 90 +/- 2 at D0 to 91 +/- 5 mmHg at D7). However, TPR increased (from 3,600 +/- 290 at D0 to 6,300 +/- 510 dyn.s.cm-5 at D7) and CO decreased (from 2.1 +/- 0.2 at D0 to 1.2 +/- 0.1 l/min at D7) (all p < 0.01), partly as the result of a marked bradycardia (from 100 +/- 7 at D0 to 60 +/- 7 beats/min at D7). L-NNA induced-increase in TPR was completely reversed by a bolus injection of nitroglycerin (10 micrograms/kg). During treadmill exercise (12 km/h), heart rate (251 +/- 9 at D0 vs 226 +/- 11 beats/min at D7), CO (6.3 +/- 0.9 at D0 vs 4.3 +/- 0.7 l/min at D7) and stroke volume remained significantly lower, and TPR significantly higher (1,662 +/- 278 at D0 vs 2,621 +/- 489 dyn.s.cm-5 at D7) after L-NNA than in the control state. Thus, NOS inhibition in resting conscious dogs by L-NNA markedly increases peripheral resistance but does not increase arterial pressure. In addition, L-NNA blunts both exercise-induced peripheral vasodilation and increase in cardiac output, despite metabolic vasodilation.
Arch Mal Coeur Vaiss 1995 Aug
PMID:[Hemodynamic effects of sub-chronic NO synthase inhibition in conscious dogs: role of EDRF/NO in muscular exertion]. 857 77

Thrombolytic therapy is used in many cardiovascular diseases other than myocardial infarction and pulmonary embolism. In unstable angina, the results of trials have rather been disappointing. In prosthetic valve thrombosis, the role of thrombolytic therapy is increasing. In peripheral arterial thrombosis, intravenous thrombolysis was practically abandonned and local administration has been tried but no systematic attitude can be deduced. In cerebral arterial thrombosis intravenous alteplase thrombolytic treatment is effective and relatively safe in a well defined subgroup of stroke patients with moderate to severe neurologic deficit and without extended infarct signs on the initial CT scan.
Arch Mal Coeur Vaiss 1996 Jan
PMID:[Thrombolytic therapy in arterial disorders other than myocardial infarction]. 867 42


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