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)

Sixteen patients with progressive systemic sclerosis (PSS), including 3 with the "CREST" (calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, and/or telangiectasias) variant, were evaluated with resting M-mode echocardiography and noninvasive measurements of cardiac output at rest and during submaximal exercise to determine the nature and extent of any cardiovascular impairment. No patient had arterial hypertension, significant renal impairment, clinical evidence of large vessel coronary artery disease, or severe pulmonary dysfunction. The duration of disease was 1 to 12 years (9 to 30 for patients with the CREST variant). Echocardiographic abnormalities included increased right ventricular dimension (3 patients), reduced left ventricular ejection fraction (3 patients), and pericardial effusion (3 patients). Cardiac index (CI) and stroke volume index (SVI) at rest were similar for patients and controls. Patients and controls were exercised to similar heart rates (130 +/- 3 vs 124 +/- 4; p, NS). Total peripheral resistance (TPR) was higher for patients (1123 +/- 81 vs 810 +/- 44 dyn X s X cm-5) and their mean SVI failed to increase significantly compared with sitting rest values (30 +/- 2 vs 35 +/- 3 ml/m2). The control subjects had the expected increase in SVI (36 +/- 2 vs 51 +/- 5; p less than 0.01). Ten patients with an abnormal hemodynamic response to exercise had a normal echocardiographic circumferential fiber shortening (VCF) or ejection fraction (EF) at rest. The data indicate that PSS patients have a greater degree of cardiovascular dysfunction than would be predicted from clinical data and laboratory evaluation of cardiovascular and pulmonary function at rest. Multiple mechanisms, including right and left ventricular dysfunction and abnormal vasoconstrictor activity, are likely to contribute to the reduction in exercise capacity seen in patients with PSS.
 ...
PMID:Cardiovascular function in patients with progressive systemic sclerosis (scleroderma). 621 13

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

Surgical and endovascular revascularization for ischemic cerebrovascular diseases (CVD) should be strictly indicated based on medical treatment. In this report, we describe current consensus and controversy in the treatment of ischemic CVD, and perspectives. 1) Local intra-arterial fibrinolytic therapy for acute cerebral embolism; intra-venous t-PA can be beneficial when given within 3 hours of stroke onset (NINDS), but many patients present later after stroke onset and alternative treatments are needed. Despite an increased frequency intracranial hemorrhage, treatment with intra-arterial proUK within 6 hours for MCA occlusion significantly improved clinical outcome at 90 days (mRS 40% >25%, PROACT-II). MELT-Japan are going now and waiting for results. 2) Carotid stenting; Carotid angioplasty and stenting (CAS) has been proposed as an alternative to carotid endarterectomy (CEA) in those considered at high risk for CEA. SAPPHIRE study confirmed CAS is an excellent option for patients with coexisting coronary artery disease, congestive heart failure, and other comorbid conditions that make them poor candidates for CEA. Now, CREST in USA and CSSA in Europe are going for randomized trial compared with CEA and CAS in any risk for CEA patients. 3) Stenting for intracranial arteries; Stroke rates in patients with symptomatic intracranial stenosis may be high on medical therapy. Although there is no clinical evidence and appropriate devices for intracranial vessels, it seems to be a potentially effective in the future.
 ...
PMID:[Consensus and controversy in the treatment of ischemic cerebrovascular diseases]. 1565 Dec 84

Although it has been clearly established that in certain groups of patients, such as in patients with symptomatic high-grade carotid stenosis and in selected asymptomatic patients with high-grade stenosis, carotid endarterectomy offers significant protection from stroke compared with medical therapy, the role of carotid stenting in this patients versus carotid endarterectomy is undergoing a rapid evolution. The definitive evidence awaits the results of ongoing prospective, randomized trials such as CREST and others, but it is clear that carotid stenting will increasingly occupy a significant role in the therapy of carotid bifurcation disease. In that context, vascular surgeons, traditionally the experts on the management of this condition, face the specter of other disciplines intervening in its treatment. In addition, if vascular surgeons do not acquire the skills and the expertise necessary to perform carotid stenting, it is self-evident that they run the risk of being spectators rather retaining the mantle of expert in the management of carotid bifurcation disease. As such, it is the duty of vascular surgeons to acquire the skills with which to retain their rightful place in its management and treatment. The purpose of this article is to describe the skills necessary to become competent in the endovascular management of carotid disease, offer some thoughts and strategy by which one can gain experience and develop an armamentarium of skills necessary to perform carotid stenting, and offer a comprehensive array of options of management and treatment to the patient with carotid disease.
 ...
PMID:What are the skills that prepare vascular surgeons for carotid stenting? 1611 Mar 69

Stenting has increasingly been used for the treatment of carotid artery stenosis, although it is still unknown whether it is as safe and successful as carotid endarterectomy. Several studies have been published, and the preliminary results have been variable, with evidence both in favor of and against this procedure. In the past few months, primary outcome data have been published from two large European randomized multicenter trials (SPACE and EVA-3S). So far, both of these trials have evaluated whether carotid stenting shows noninferiority compared with carotid endarterectomy in symptomatic patients with severe carotid disease over a period of 30 days after intervention. In this Review, we summarize current knowledge on effectiveness of both procedures, and provide an updated meta-analysis based on randomized trial data, including SPACE and EVA-3S. This meta-analysis shows a lower procedure-related rate of stroke or death in surgically treated patients. The long-term risk/benefit ratio of carotid stenting remains to be determined. Two other randomized multicenter trials-ICSS and CREST-are ongoing. With an intended sample size of up to 7,000 patients, future meta-analyses will allow more-accurate treatment recommendations and subgroup analysis.
 ...
PMID:Stenting for carotid artery stenosis. 1761 84

Stent-protected angioplasty of carotid artery stenosis may be an alternative to surgical endarterectomy. Results published so far are indecisive, with evidence both in favour of and against this procedure. After the recent publication of two large European multicentre trials (SPACE and EVA-3S) almost 3,000 patients have been included in randomized studies. For this report, we therefore conducted a systematic review of randomized studies that compared endovascular treatment with surgery for carotid stenosis. We evaluated seven trials including 2,973 patients. In our meta-analysis endovascular treatment seemed to carry a slightly higher risk for stroke or death within 30 days after the procedure as compared with surgery (8.2% vs. 6.2%; p = 0.04; OR 1.35), whereas the rates of disabling stroke or death within 30 days did not differ significantly (p = 0.47; n.s.). On the other hand, surgery carried a significantly higher risk for cranial nerve palsy (4.7% vs. 0.2%; p < 0.0001; OR 0.17) and myocardial infarction (2.3% vs. 0.9%; p = 0.03; OR 0.37). Long-term effects of both methods still need to be evaluated. Two other large multicentre trials (ICSS and CREST) are ongoing. Results of these studies will increase the database to about 7,000 randomized patients. Future meta-analyses should then allow definitive treatment recommendations.
 ...
PMID:Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. 1865 84

The International Carotid Stenting Study (ICSS) and an amalgamated 'super' Registry of 'high risk for surgery' patients undergoing carotid artery stenting (CAS) have issued seemingly contradictory conclusions following release of their 30-day procedural risks. This paper evaluates the impact of the two trials, regarding the current status of CAS, and concludes that there are still more questions than answers. The available evidence supports CAS in the treatment of selected 'high risk for CEA' non-octogenarian symptomatic patients, provided certain caveats are met (maintenance of acceptable procedural risk, rapid intervention). There is, however, no level I evidence supporting the routine use of CAS in 'standard risk' symptomatic patients and this Cochrane recommendation will not change once the ICSS data are included. It is anticipated, however, that following meta-analyses of individual patient data from 5000 patients recruited into the four large, randomised trials (SPACE, EVA-3S, ICSS, CREST), selected patient subgroups will be identified who will benefit by being treated by CAS. In the meantime, the majority of standard risk, symptomatic patients should probably undergo expedited CEA. However, established (or less experienced) practitioners who intend to continue offering CAS to this category of patient (because it is already approved practice in their health system) must ensure that their audited 30-day risks of death/stroke remain <6% and that they offer patients access to expedited intervention (ie within 2 weeks) wherever possible. Delaying intervention in order to reduce the procedural risk may improve the reputation of the surgeon/interventionist, but it confers little overall benefit to the patient.
 ...
PMID:ICSS and EXACT/CAPTURE: More questions than answers. 1965 93

Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery stenting (CAS) over carotid artery endarterectomy (CEA). There is at the moment no level-I evidence to support widespread use of endovascular management of carotid artery disease in routine practice. In order to shead some light on the continuing debate on the role of carotid artery stenting, the authors conducted a search in contemporary published literature concerning carotid artery stenting. This extensive literature review reveals a higher peri-procedural stroke-death rate after CAS and a higher cost. Two other events hamper the value of CAS: a higher late restenosis rate and a higher risk of micro-embolisation during the procedure, compared with CEA. The authors conclude that the prevailing overenthusiasm of interventionalists (vascular surgeons, radiologists, cardiologists) for carotid artery stenting is not justified.
 ...
PMID:Do we need a new carotid artery stenting trial? 2091 66

Stroke has a high incidence and is associated with a dramatic degree of morbidity and mortality. Carotid stenosis is responsible for approximately 20% of strokes in all patient populations, and is especially prevalent in elderly patients. Therapies to decrease the risk of stroke are urgently warranted. The first established therapy was surgical endarterectomy. Over the last few years, however, carotid artery stenting has evolved as a less invasive approach. Hitherto, the paper under evaluation (the North American Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]) is the largest and most important study comparing these two treatment modalities. The study demonstrates comparable effectiveness for carotid stenting and carotid artertectomy to reduce the risk for future strokes.
 ...
PMID:Carotid stenting or surgical carotid endarterectomy to prevent strokes? 2050 73

During the 35th International Stroke Conference held in February 2010, San Antonio, USA, the new definitions of transient ischemic attack, ischemic stroke, acute neurovascular syndrome, acute hypertensive reaction in stroke have been discussed. Data from recent clinical trials and meta-analysis covering different epidemiological, diagnostic and therapeutic aspects of cerebrovascular diseases discussed during conference has been presented. Results of new trials in primary and secondary stroke prevention assessing efficacy and safety of: stenting vs endarterectomy of carotid arteries (CREST), dabigatran in prevention of cardioembolic stroke in atrial fibrillation (RE-LY), cilostazole in secondary prevention of atherogenic stroke (CSPSS II) have been discussed.
 ...
PMID:[Report from International Stroke Conference 2010, San Antonio, USA]. 2126 22


1 2 3 Next >>