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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transient ischaemic attacks are common, having an incidence of at least 50 per 100,000 population per annum, and the risk of stroke and/or death is about 10% per annum. Death is more often due to the complications of coronary artery disease than cerebrovascular disease. The most important issues in management are distinguishing transient ischaemic attacks from several other causes of 'transient focal neurological attacks', and managing the risk factors for vascular disease in general, particularly hypertension. The utility of specific 'antithrombotic' treatments is still uncertain, but for long term use aspirin seems to be the most promising. The only dose so far tested in clinical trials has been about 600mg twice daily but lower doses may theoretically be as, or more, effective. Trials of aspirin and other antiplatelet agents, and also of carotid endarterectomy and extracranial-to-intracranial bypass surgery are continuing and should be strongly encouraged. Although transient ischaemic attacks recover - by definition - in 24 hours, the pathophysiology, natural history, and treatment of focal cerebral ischaemia which recovers in a matter of days or weeks is probably rather similar.
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PMID:Transient ischaemic attacks. Current treatment concepts. 389 4

Cerebral amyloid angiography can cause ischemic stroke and transient ischemic attacks (TIA's), as illustrated by this case report and literature review. It is possible that the use of anticoagulant or platelet-antiaggregant drugs in elderly patients with TIA's but no angiographic abnormalities may increase the risk of hemorrhage from unsuspected amyloid angiopathy.
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PMID:Cerebral amyloid angiopathy presenting as transient ischemic attacks. Case report. 405 10

This report describes the experimental design, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study on the effect of aspirin (325 mg t.i.d.) and dipyridamole (75 mg t.i.d.) (110 patients), or placebo (121 patients) on major vascular outcome variables in noninsulin-dependent diabetic patients with either a recent amputation for gangrene (n = 207) or active gangrene (n = 24). It also describes the baseline characteristics of the patients. A total of 231 patients of 563 screened (41%) were enrolled at 11 participating V.A. Medical Centers during a 39 month period. The median age at entry was 60 years, the median duration of diabetes was 10 years, and weight was 110% of desirable. All patients were men. Sixty-eight percent were treated with insulin and 32% with diet alone. Only 42% were smokers at entry, 40% had retinopathy, 61% sensory neuropathy, 42% hypertension, and 29% had a history of myocardial infarction, angina, and/or congestive heart failure. Thirteen percent had a history of cerebrovascular disease. Despite randomization, the treatment group had an increased frequency of a history of cerebrovascular disease (p = 0.01), diagnosed as stroke (p = 0.03), a finding suggesting that the treatment group was at a slightly increased risk for vascular disease upon enrollment in the study. Other baseline variables did not differ significantly between the two groups. This study should provide definitive data on the efficacy of these doses of antiplatelet agents in preventing further vascular disease in diabetic men with gangrene or recent amputation for gangrene, using death due to vascular disease and subsequent amputation of the opposite extremity for gangrene as major outcome variables. It should also give useful information on the effect of antiplatelet therapy on vascular outcome variables such as same side amputations, myocardial infarction, stroke, transient ischemic attack, retinopathy, and renal failure. Finally, the study should provide useful data on the natural history and significance of risk factors in this patient population.
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PMID:V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: I. Design, methods, and baseline characteristics. 637 22

133Xenon-DSPECT provides measurement of regional cerebral blood flow (rCBF in ml/100 g/min) during and after inhalation of 133Xe gas. The result is displayed as a flow map of three transaxial slices. ROI divide a slice into 12 areas (SA) computing flow values (FSA). The results in 36 patients with cranial vascular disease are presented in comparison to 12 "normals". In all patients, FSA in the diseased hemisphere were found to be below the standard range of normals. Related to number of SA, this was true in completed stroke (bilateral) in 55% or (unilateral) in 14%, in PRIND in 5% of SA and in TIA in 7%. The absolute flow values did not decrease with the severeness of the disease, presumably depending on patient's age. There were more (p less than 0,005) SA found with decreased rCBF (21%) than areas with low density in T-CT (10%). Since unilateral cerebrovascular findings presented also bilateral reduced FSA, the validity of the method lies in the calculation of flow values, which significantly adds to the results of imaging.
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PMID:[133Xe-DSPECT (Dynamic Single Photon Emission CT). Results of a new noninvasive method for measuring regional cerebral blood flow (rCBF). Comparison with cranial angiography and transmission CT]. 641 15

A prospective study was made of the morbidity and mortality from ischemic heart disease in 390 patients with focal TIA caused by atherosclerotic vascular disease. The 5-year cumulative rate of myocardial infarction or sudden death in these patients was 21.0%, a rate only slightly less than that of fatal or nonfatal cerebral infarction (22.7%). Risk factors including diabetes, angina, and ECG abnormalities were associated with an increase in morbidity and mortality from ischemic heart disease. A major factor associated with these cardiac events was the presence of atherosclerotic obstructive or ulcerative lesions in the carotid arteries. These observations indicate that focal TIA caused by carotid atherosclerosis is a predictor not only of cerebral infarction, but also of serious cardiac disease and death.
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PMID:Risk of ischemic heart disease in patients with TIA. 653 54

Three groups of patients were analyzed to ascertain the risk of combined carotid/coronary operations and the risk factors for perioperative stroke following coronary artery bypass (CAB). Group 1 (N = 132) had simultaneous carotid endarterectomy and CAB, Group 2 (N = 51) were patients having perioperative stroke following elective CAB, and Group 3 (N = 169) had CAB alone but had prior history of either asymptomatic cervical bruit, stroke/transient cerebral ischemic attack (TIA), or carotid endarterectomy. Hospital mortality and perioperative stroke rate in the combined carotid/coronary group were 3.0% (4/132) and 1.6% (2/126), respectively. These rates were not significantly different from those of a control group having CAB alone. Overall incidence of postoperative stroke in 5,676 patients having CAB alone was 0.9% (51 patients). The incidence of perioperative stroke in patients with asymptomatic bruit or prior history of stroke or TIA undergoing CAB alone was 3.3% (2/60) and 8.6% (6/70), respectively. The majority of strokes following CAB appear to be embolic in origin. Indications for simultaneous carotid/coronary operations are bilateral carotid disease and symptomatic carotid vascular disease associated with unstable angina, left main obstruction, or diffuse multivessel disease. Staged procedures are recommended for patients with stable angina and symptomatic carotid lesions and for difficult carotid revascularization procedures. CAB alone may be performed for most patients with asymptomatic cervical bruit, moderate or mild carotid artery obstruction, and unstable angina associated with prior stroke, although in the third situation postoperative risk of neurological injury may be increased.
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PMID:Combined carotid and coronary operations: when are they necessary? 660 38

A study of 192 personal cases of completed stroke, reversible ischaemic neurological deficit (RIND) or transient ischaemic attack (TIA) in patients aged 10-49 years seen between 1961 ad 1979 inclusive is reported. Three died acutely; 189 were followed for up to 15 years. The main cause of the initial event was atheromatous or hypertensive vascular disease. Of the 90 patients whose initial event was a completed stroke 19(21%) developed a second stroke, whereas only 4 of the 78 patients with TIA suffered a stroke later. In the entire series there were 6 cardiac deaths and one from mesenteric thrombosis during the follow-up period. The risk of stroke following TIA is less in persons under 50 years than in the older age group. The risk of a second stroke following an initial stroke depends on whether or not there is evidence of vascular disease. In the absence of such evidence the risk is small; in the presence of evidence it is high, being of the order of 20%.
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PMID:The cause and prognosis of strokes in people under 50 years. 706 44

The patterns of valve motion were analyzed in 14 patients with combined aortic and mitral valve prolapse by two-dimensional echocardiography. Four patients have also tricuspid valve prolapse. In one we could find evidence of a myxomatous pulmonic valve with prolapse of the posterior cusp. By two-dimensional echocardiography all patients had redundant aortic leaflets bulging into left ventricular outflow tract during diastole. M-mode examination of the aorta was normal in five patients; eccentricity of the diastolic aortic valve echo was found in two patients; seven showed multiple echoes from the valve leaflets, with diastolic fluttering. The aortic valve was visualized in the left ventricular outflow tract during diastole in one patient. The size of the aortic root was normal in all. Six patients had transient ischemic cerebral attacks and no evidence of extracranial or intracranial vascular disease by angiography. As polyvalvular prolapse as demonstrated by echo suggest a myxomatous degeneration of the valves, we hypothesize that there may be a causal relationship between TIA and this type of pathological process.
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PMID:[Observations on prolapse of the aortic cusps]. 716 May 66

Platelet factor 4 (PF4), the platelet antiheparin protein, was isolated from both the supernatant and the cells of recently outdated platelet concentrates. Following purification by affinity chromatography, a competitive binding radioimmunoassay was developed to detect this protein in human plasma. The normal range was determined to be 9.4 +/- 4.7 ng/ml (mean +/- SD for 52 healthy adults). In order to determine whether individuals with transient ischemic attack (TIA) or stroke had measurable increments of PF4 in their plasma, radioimmunoassay studies were performed on 11 patients with well-documented TIA, 10 patients with well-documented stroke and on 16 age-matched controls hospitalized on a neurology service with disorders unrelated to arterial thrombosis. The 16 hospitalized controls had PF4 levels of 10.3 +/- 9.1 ng/ml, a value not significantly different from the 52 normals (P greater than 0.50). Patients with TIA had PF4 levels of 24.6 +/- 12.1 ng/ml, a value significantly higher than both the 52 normals (P less than 0.001) and the 16 hospitalized control patients (P less than 0.005). Patients with stroke had PF4 levels of 35.4 +/- 29.2 ng/ml, a value significantly higher than both the 42 normals (P less than 0.001) and the 16 hospitalized control patients (P less than 0.005). Outdated platelet concentrates facilitate the development of a reproducible radioimmunoassay for PF4. The elevation of this platelet-derived protein in the plasma of patients with stroke and TIA provides evidence for recent or ongoing platelet activation in the cerebral vascular disease population.
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PMID:Human platelet factor 4: preparation from outdated platelet concentrates and application in cerebral vascular disease. 724 39

The authors investigated the behaviour of some markers of the haemostatic balance in a group of patients with acute focal cerebral vasculopathy. The series consists of 70 female patients (mean age: 61 +/- 5), 25 of whom suffering from TIA and 45 from thrombotic stroke; 40 normal controls (mean age 43 +/- 5) were also considered. For each patient after an overnight fasting a withdrawal of venous blood was done within 24-36 hours after the admission. For each sample the determination of seven prothrombotic markers [(fibrinogen (F), factor VII (F VII), antithrombin III (AT III), protein C (PC), protein S (PS) (coagulometric method IL), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) (ELISA method Boehringer)] and of three prethrombotic markers [(fibrinopeptide A (FPA), beta-thromboglobulin (BTG) and D-dimer (D-D) (ELISA method, Boehringer)] was performed. The results obtained in the group of the cerebrovasculopathic patients compared to the controls showed a significant increase of F (p < 0.001), F VII (p < 0.005), BTG (p < 0.05) and D-D (p < 0.01), whereas significant differences regarding AT III, PC, PS, t-PA, PAI and FPA were not observed. The authors hypothesized that the increased levels of fibrinogen and factor VII in the cerebrovascular subjects, globally considered, may depend on a marked prothrombotic state, linked in a pathogenetic sense to the vascular disease; the existence of a prethrombotic state is also documented by the increase of betathromboglobulin and D-dimer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Haemostatic balance in patients with acute focal cerebral vasculopathy. 760 35


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