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

One thousand six hundred and forty-two vessel segments (46% iliac, 54% femoro-distal) in 1141 patients have undergone percutaneous peripheral balloon dilatation at the Northern General Hospital, Sheffield over a 9 year period. Forty-two significant complications were encountered in all; 28 of these were occlusive and half of these were treated by angioplasty itself, either by thrombolysis or catheter suction. There was one case of distal ischaemia attributed to cholesterol embolisation which led to death (Gaines et al., 1988). There were two cases of perforation and haematoma requiring surgery, one retroperitoneal haemorrhage and one false aneurysm. One diabetic patient developed septicaemia following successful PTA for an ischaemic foot and died. One case each of bowel ischaemia, cerebrovascular accident and myocardial infarction occurred within 24 h of the angioplasty procedure, but there was no clear causal relationship. Arterial wall dissection or perforation per se was not considered a complication unless it progressed to haemorrhage or vessel occlusion. There were three cases of femoral nerve damage causing sensory loss in the thigh, two of which were permanent. Four hundred and thirty-five procedures were performed in patients with rest ischaemia. Of these, 2.8% developed complications requiring surgery, but only 0.9% required reconstructive bypass surgery. For intermittent claudication 1207 procedures were performed, 0.7% of these developed complications requiring surgery but only 0.5% required reconstructive surgery. These results justify the use of angioplasty in the treatment of intermittent claudication and in poor risk patients with threatened limb loss.
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PMID:The complication rate of percutaneous peripheral balloon angioplasty. 214 41

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension--clinical observations and long-term follow-up]. 787 Dec

Recipient selection criteria for pancreas (Px) transplantation differ among centers, based on perceived recipient risk factors, and their validity has not been determined. At the University of Minnesota we have been very liberal in accepting patients for Tx, some of whom have risk factors cited as exclusion criteria by other centers, giving us the opportunity to determine, retrospectively, the impact of their presence on outcome. Between July 1986 and March 1993, we performed 319 bladder-drained cadaver Px Txs at the University of Minnesota, 166 simultaneous with a kidney (SPK), 68 after a kidney (PAK), and 85 alone (PTA). To determine which putative "risk factors" influence patient and graft survival, we used uni- and multivariate (Cox regression) analyses to assess the impact of recipient category, duration of diabetes, and age at onset and at Tx; presence of pre-Tx cardiac (CD) disease (myocardial infarction, bypass, angioplasty), peripheral vascular disease (PVD) (stroke, bypass, angioplasty, amputation); blindness, hypertension, and excess weight; and of Px re-Txs. The incidences of all risk factors except re-Tx were significantly higher in SPK than PTA recipients. Px re-Txs comprised 40% of PAK, 26% of PTA, and 10% of SPK cases (P < 0.0001). Duration of diabetes correlated (P < or = 0.01) with all risk factors but one (hypertension). Recipient age correlated (P < or = 0.01) with CD, blindness, duration of diabetes, and age at onset of diabetes; CD risk factors correlated (P < 0.015) with hypertension and PVD. Recipient age (> or = 45) influenced the technical failure rate only in SPK recipients, with a relative risk (RR) of 2.13 (P = 0.08). Recipient age influenced Px graft and patient survival rates in both SPK and PAK recipients; for those > or = 45, the RR of graft loss was 1.73 and 1.76, respectively (P < or = 0.25), and the RR for ultimately dying was 3.07 in PAK (P = 0.02) and 5.86 in SPK (P = 0.17) recipients. SPK recipients with CD factors were at higher risk to ultimately die (RR = 3.78, P = 0.009), independent of age. Px re-Txs were not at higher risk to fail in PTA, but were in PAK recipients (RR = 1.86, P = 0.09); the risk for technical failure was higher for re-Txs only in SPK recipients (RR = 2.11, P = 0.24). Blindness, hypertension, PVD, and duration of diabetes did not negatively influence patient and graft outcome in any recipient category.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recipient risk factors have an impact on technical failure and patient and graft survival rates in bladder-drained pancreas transplants. 800 94

The risks of metallic stent deployment are quite low, and the likelihood of restenosis due to intimal hyperplasia is relatively high, particularly in small to medium-size vessels. The goal of all cerebrovascular interventions is to alleviate symptoms and prevent stroke. For symptomatic carotid bifurcation stenosis, insufficient information is available regarding carotid PTA and stent placement to make any recommendations. Carotid endarterectomy is the treatment of choice in patients with a 70%-99% stenosis of the involved internal carotid artery. For internal carotid artery dissection, stent placement seems to be a reasonable therapeutic alternative that may eventually assume a position as an accepted therapeutic alternative alongside surgery and anticoagulation. The gathering of level I and level II evidence by means of well-designed clinical trials is encouraged. Similarly, the application of stent placement to occlusive disorders of the dural venous sinuses is intriguing. Additional clinical studies should help define the role of stents in these diseases.
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PMID:Should metallic vascular stents be used to treat cerebrovascular occlusive diseases? 815 18

Carotid endarterectomy has been established as the standard treatment for high-grade carotid stenosis. The results of an ongoing prospective trial for the safety of percutaneous angioplasty with stenting (PTAS) were compared to retrospectively reviewed patients treated with carotid endarterectomy (CEA). During the same 14-month period, 273 patients underwent treatment of 310 carotid bifurcation stenoses: 107 by PTA with stenting, 166 by CEA. Indications for treatment included stroke 46 (16.8%), transient ischemic attack 109 (39.9%), syncope 7 (2.6%), and high-grade asymptomatic stenosis 111 (40.7%). Combined early stroke and death rates are listed as follows: [table: see text] Important nonneurologic complications were evident in six (5.6%) PTAS patients and two (1.2%) CEA patients. Six-month follow-up data was available for 193 patients (71%) with the following results: seven (6.5%) minor strokes in the PTAS group, one (0.6%) minor stroke in the CEA group, one (0.9%) major stroke in the PTAS group, one (0.6%) major stroke in the CEA group, four deaths (3.7%) in the PTAS group, and six deaths (3.6%) in the CEA group. Early results from PTA with stenting are promising but not safer than CEA for the treatment of carotid artery stenosis. Long-term follow-up is needed to determine the ultimate durability of this new technique. PTA with stenting may be an alternative for the treatment of carotid bifurcation lesions in selective high-risk surgical patients.
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PMID:A comparison of angioplasty with stenting versus endarterectomy for the treatment of carotid artery stenosis. 906 Nov 32

Every year more than 250,000 patients suffer from ischemic (80%) or hemorragic (20%) stroke. Some 40,000 of these strokes are induced by stenosis or occlusion of the extracranial carotid artery. Several randomized studies (NASCET, ECST, ACAS, etc.) have proved that operative removal of high-grade carotid stenoses is an effective method in the primary and secondary prophylaxis of ischemic stroke. Operative therapy is significantly better than medical therapy with thrombocyte aggregation inhibitors. The prerequisite for effective operative prophylaxis is a low perioperative stroke rate. Even though the prophylactic value of carotid thrombarterectomy (TEA) is obvious, only about 5% of all carotid-related strokes are prevented by this operation. Essential conditions for increased efficiency in carotid surgery are close cooperation with the neurologist and the internist, screening of patients with a high risk for ischemic stroke, sophisticated, mainly non-invasive diagnostics, and more operative capacity. Interventional methods (stent, PTA) have not yet been proved safe and effective. These methods should be employed only in special cases after interdisciplinary discussions or in randomized studies.
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PMID:[Carotid surgery for prophylaxis of ischemic stroke]. 1035 30

In recent years, organized basic care and the use of thrombolysis have been significantly effective in improving the acute stroke therapy especially for the ischemic stroke subtype. Combining the efforts for the basic care of stroke patients in the setting of the so-called stroke-units is the goal for a qualified therapy. Main parts in the basic care algorhythm are: optimization of the cerebral perfusion, maintenance of an initial high blood pressure, best oxygen supply, reduction of an increased body temperature and antiinfectious treatment, reduction in the rate of complications (like deep vein thrombosis, pneumonia, falls etc.) and the early physiotherapeutic therapy. Thrombolysis is restricted to selected patients with infarctions of the middle cerebral artery with symptoms starting not longer than three hours before treatment, without hemorrhage in CCT and fulfilling the strict in- and exclusion criteriae established by the recent multicenter trials. The use of rt-PA (0.9 mg/kg body weight) is recommended. Local fibrinolysis is used in patients suffering from basilar artery thrombosis. The use of other recanalizing techniques like PTA or stenting is yet still experimental in acute stroke patients. Neuroprotective agents which were proven in clinical trials are still not available. In recent years therapy with hemodilution was widely used, nowadays the intravenous application of fluids with hemodilutive properties is restricted to patients with reduced cardiac output and macroangiopathy to maintain or to improve cerebral perfusion. Early intravenous anticoagulation with heparin is defined as secondary prevention and not as therapeutical intervention.
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PMID:[Acute therapy of stroke]. 1041 99

From January 1994 to December 1997, 845 patients with stroke were admitted to Hakodate Municipal Hospital. They consisted of 514 patients with brain infarction, 206 with brain hemorrhage, 121 with subarachnoid hemorrhage and 4 with intracranial hemorrhage from arteriovenous malformation. The clinical categories of brain infarction were as follows; atherothrombotic recognized in 158 patients, cardioembolic in 114, lacunar in 217 and other categories in 25. With regard to the cures of brain infarction in the acute phase, direct percutaneous transluminal angioplasty (direct PTA) was carried out on three patients with atherothrombotic infarction, immediate PTA on two, superselective fibrinolytic therapy on two, and STA-MCA anastomosis on three. In all, ten atherothrombotic patients (6.3%) were treated by acute surgical or endovascular therapy. On the other hand, superselective fibrinolytic therapy was carried out on 35 patients (30.7%) with cardioembolic infarction. There were no patients in the lacunar infarction group who were given acute surgical treatment. Neurological improvement after 24 hours was recognized in 4 patients (40%) of 10 with atherothrombotic infarction, and in 9 patients (25.7%) of 35 with cardioembolic infarction. However, symptomatic intracerebral hematoma was recognized in 4 patients (11.4%) with cardioembolic infarction. Indication for acute surgical or endovascular treatment for brain infarction was very limited because of the time factor from the onset to admission. It is suggested that neurosurgeons might enlighten citizens about the necessity for acute surgical or endovascular therapy for stroke.
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PMID:[Acute surgical and endovascular therapy for stroke: especially patients with brain infarction]. 1087 6

Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed. Of unstaged procedures, a total of 131 patients (57.3% males; mean age, 66.4 12.1 years) met inclusion criteria. Forty-five patients (34.4%) had recent onset of claudication and 15 (11.5%) had ulceration. Thrombus was angiographically visualized in 16.7% of patients. Unfractionated heparin was administered at a mean of 4,672 1,238 U (59.1 20.0 U/kg) during the procedure. The highest activated clotting time (ACT) during the procedure was recorded in 114 patients. ACTs were < 300, 300 400 and > 400 seconds in 29.0%, 29.0% and 42.1%, respectively. In-hospital clinical events occurred in 12 patients (9.2%) who met any one of the following endpoints: death (0.8%), limb loss (1.5%), major bleeding (4.6%), emergent need for repeat revascularization of the same vessel (7.6%), embolic stroke (0.0%) and vascular complications (1.5%). The best model associated with salvage revascularization included cigarette smoking within the past year, recent onset of claudication and PTA treatment below the knee. Increased dosages of heparin (U/kg) were associated with a trend toward higher rates of complications. A significant number of patients have in-hospital major complications following PTA procedures using unfractionated heparin as the primary anticoagulant. Current ongoing registries are evaluating the feasibility of direct thrombin inhibitors bivalirudin instead of heparin as a primary anticoagulant during PTA.
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PMID:In-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant. 1273 Jun 31

This study analysed the cost-effectiveness of four different treatment modalities (medical therapy, PTA with and without stent, and surgery) for the therapy of renal-artery stenoses in hypertensive patients in Germany. A computerised, predictive decision-analytic model, based on economic input data and the cost of medical care in Germany, and the results of published data from prospective clinical trials, was developed. The economic analysis was performed from the perspective of a third-party payer. The base-case analysis showed that the primary end-point (major vascular bleeding, stroke, dialysis, or repeat arterial revascularisation) was reached at 36 months by 82.4% of the patients in the medical treatment group, 81.4% in the angioplasty group, 52.9% in the surgical group and 27.7% in the stent group. The average reimbursed treatment cost per patient after 3 years was &euro; 9121 (medication), &euro; 17 164 (surgery), &euro; 14 670 (PTA), and &euro; 8437 (stent). This resulted in a cost-effectiveness ratio of &euro; 51 752 (medical treatment), &euro; 36 454 (surgery), &euro; 78 766 (PTA), and &euro; 11 663 (stent) per event-free patient at 3 years. The accelerated cost-development after balloon dilatation was caused by higher rates of restenosis compared with primary stent implantation. The analysis of published prospective clinical data and current economic variables for renovascular interventions leads to the conclusion that a strategy using primary stent implantation is more cost-effective than stand-alone balloon dilatation. Both medical therapy and surgery offer a better cost-effectiveness ratio than PTA treatment alone.
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PMID:Cost-effectiveness analysis of treatment of renal-artery stenoses by medication, angioplasty, stenting and surgery. 1675 92


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