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Stroke and Cerebrovascular Diseases

Tanya N Turan, Sami Al Kasab, Alison Smock, George Cotsonis, David Bachman, Michael J Lynn, Azhar Nizam, Colin P Derdeyn, David Fiorella, Scott Janis, Bethany Lane, Jean Montgomery, Marc I Chimowitz
BACKGROUND: Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS: Subjects in the SAMMPRIS trial were included in this study. In order to have an assessment of cognitive function independent of stroke, patients with a stroke as a qualifying event whose deficits included aphasia or neglect were excluded from these analyses as were those with a cerebrovascular event during follow-up...
February 14, 2019: Cerebrovascular Diseases
Lianjun Xu, Zhan Gao, Ying Song, Huanhuan Wang, Jingjing Xu, Ping Jiang, Lin Jiang, Xiaofang Tang, Jue Chen, Lijian Gao, Lei Song, Yin Zhang, Xueyan Zhao, Shubin Qiao, Yuejin Yang, Runlin Gao, Bo Xu, Jinqing Yuan
BACKGROUND: With the advancements of percutaneous coronary interventions (PCI), it is not clear whether unprotected left main (ULM) coronary artery disease (CAD) remains an independent predictor of adverse outcomes after PCI therapy. We have therefore carried out a large cohort study to investigate the impact of ULM disease on 2-year clinical outcomes in Chinese patients undergoing contemporary PCI treatment. METHODS AND RESULTS: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were prospectively collected...
February 11, 2019: Coronary Artery Disease
Farah Francis, Lucia Ballerini, Joanna M Wardlaw
BACKGROUND: Perivascular spaces, visible on brain magnetic resonance imaging, are thought to be associated with small vessel disease, neuroinflammation, and to be important for cerebral hemodynamics and interstitial fluid drainage. AIMS: To benchmark current knowledge on perivascular spaces associations with risk factors, neurological disorders, and neuroimaging lesions, using systematic review and meta-analysis. SUMMARY OF REVIEW: We searched three databases for perivascular spaces publications, calculated odds ratios with 95% confidence interval and performed meta-analyses to assess adjusted associations with perivascular spaces...
February 14, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
Dian He, YunLi Yu, Shan Wu, ShuFen Tian, Hui Yu, Shu Xu, Lan Chu
BACKGROUND: Mixed cerebrovascular disease is a diagnostic entity that presents with hemorrhagic and ischemic stroke clinically and/or subclinically. Here, we report a patient with mixed vascular risk factors, who presented with multiple intracerebral hemorrhages and a simultaneously occurring cerebral infarction with hemorrhagic transformation. CASE PRESENTATION: A 63-year-old male with no history of trauma or prior neurological disease presented with a sudden onset of weakness in his right limbs, followed by an episode of focal seizure without impaired awareness...
February 12, 2019: BMC Neurology
Maryam Zulfiqar, Fares Qeadan, Asad Ikram, Mudassir Farooqui, Sarah P Richardson, Christopher S Calder, Syed A Quadri, Puja Mathur, Corey Ford, Santiago Ortega-Gutierrez, Enrique Leira, Harry Snow, Joel N Gonzalez, Atif Zafar
No abstract text is available yet for this article.
February 8, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Till-Karsten Hauser, Achim Seeger, Benjamin Bender, Uwe Klose, Johannes Thurow, Ulrike Ernemann, Marcos Tatagiba, Philipp T Meyer, Nadia Khan, Constantin Roder
BACKGROUND AND PURPOSE: Patients with Moyamoya Disease (MMD) need hemodynamic evaluation of vascular territories at risk of stroke. Today's investigative standards include H2 15 O PET/CT with pharmacological challenges with acetazolamide (ACZ). Recent developments suggest that CO2 -triggered blood‑oxygen-level-dependent (BOLD) functional MRI might provide comparable results to current standard methods for evaluation of territorial hemodynamics, while being a more widely available and easily implementable method...
February 4, 2019: NeuroImage: Clinical
Bo-Lin Ho, Ya-Ju Lin, Sheng-Feng Lin, Ping-Song Chou, Chien-Fu Chen, Ruey-Tay Lin, Han-Hwa Hu, A-Ching Chao
OBJECTIVES: Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with nonvalvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins...
February 11, 2019: Acta Neurologica Scandinavica
Ghina Al-Seddik, Dory Hachem, Chadia Haddad, Souheil Hallit, Pascale Salameh, Rita Nabout, Marouan Zoghbi
OBJECTIVE: To evaluate the occurrence of cardiovascular (CV), cerebrovascular events and mortality rates, and compare the predictive ability of two scores, Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD), of detecting a cardiovascular event in a cohort of schizophrenic patients. METHODS: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients' file review was performed to detect the CV events of interest...
February 10, 2019: International Journal of Psychiatry in Clinical Practice
Jennifer L Quon, Lily H Kim, Robert M Lober, Maryam Maleki, Gary K Steinberg, Kristen W Yeom
OBJECTIVEMoyamoya disease is a dynamic cerebrovascular condition that often requires vascular surveillance. Arterial spin labeling (ASL) is an MR perfusion method that is increasingly used for stroke and other various neurovascular pathologies. Unlike perfusion-weighted MRI, ASL uses endogenous water molecules for signal and therefore obviates gadolinium use; and provides direct, not relative, quantitative cerebral blood flow (CBF) measures. Presently, the potential role of ASL for evaluating postoperative pediatric moyamoya patients is relatively unexplored...
February 8, 2019: Journal of Neurosurgery. Pediatrics
Jenna Kaye Wildman, Bassam H Rimawi
Cerebrovascular disease is not uncommon during pregnancy as a result of either venous or arterial occlusion, or a hemorrhagic event, resulting in ischemia. Pregnancy may alter the prognosis of these neurologic disorders, with increased risks of morbidity and mortality for the mother and the developing fetus. Etiologies of stroke during pregnancy and the postpartum period include preeclampsia, eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), amniotic fluid embolism, postpartum angiopathy, postpartum cardiomyopathy, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), cerebral venous thrombosis, CNS infections, and maternal thrombophilia...
January 2019: Case Reports in Women's Health
Mohit N Gilotra, Ashley Klein, Nabil Elkassabany, Andrew F Kuntz, G Russell Huffman, David L Glaser
PURPOSE: The goals of this study were 2-fold: (1) to determine the risk factors for cerebral desaturation events (CDEs) after implementation of a comprehensive surgical and anesthetic protocol consisting of patient risk stratification, maintenance of normotensive anesthesia, and patient positioning in a staged fashion, and (2) to assess for subclinical neurologic decline associated with intraoperative ischemic events through cognitive testing. METHODS: One hundred patients undergoing shoulder surgery in the beach chair position were stratified for risk of CDE based on Framingham stroke criteria, body mass index (BMI), and history of cerebrovascular accidents...
February 4, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Kongyong Cui, Shuzheng Lyu, Xiantao Song, Hong Liu, Fei Yuan, Feng Xu, Min Zhang, Wei Wang, Mingduo Zhang, Dongfeng Zhang, Jing Dai, Jinfan Tian
BACKGROUND: The long-term relative benefit of culprit-only percutaneous coronary intervention (PCI) and staged PCI in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease remains disputable. This study aimed to compare the long-term outcomes of culprit-only PCI and in-hospital staged complete revascularization in real-world patients with STEMI and multivessel coronary artery disease. PATIENTS AND METHODS: A total of 452 patients were treated with in-hospital staged complete revascularization (n=133) or culprit-only PCI (n=319) between May 2012 and December 2015 in our center...
February 4, 2019: Coronary Artery Disease
Yong-Hoon Yoon, Pil Hyung Lee, Jung-Min Ahn, Do-Yoon Kang, Hanbit Park, Osung Kwon, Kyusup Lee, Seung-Whan Lee, Duk-Woo Park, Seung-Jung Park
BACKGROUND: Little is known about how the relative treatment effect of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) on clinical outcomes in ostial or shaft left main coronary artery (LMCA) disease has evolved over time. METHODS: This study included 2,112 patients with ostial or shaft LMCA disease from IRIS-MAIN registry who underwent PCI (n = 1,329) or CABG (n = 783). Patients were stratified by time period based on stent type availability: wave 1 (1995-2002, bare-metal stent [BMS] era); wave 2 (2003-2006, first-generation drug-eluting stent [DES] era); and wave 3 (2007-2014, second-generation DES era)...
February 5, 2019: Catheterization and Cardiovascular Interventions
Toshiaki Takeuchi, Yoshiharu Arii
Parkinson's disease is a slowly progressing disease where motor function gradually worsens. It is a well-known fact that neuronal plasticity is said to be said, and rehabilitation after developing a cerebrovascular disorder is important. After a stroke, the patient's condition start from its worst state and a goal for improvement can be set for the rehabilitation period However, in Parkinson's disease, rehabilitation is effective in preventing the patient's condition from worsening further, making it difficult to set a goal...
February 2019: Brain and Nerve, Shinkei Kenkyū No Shinpo
Timothy G White, Hussam Abou-Al-Shaar, Jung Park, Jeffrey Katz, David J Langer, Amir R Dehdashti
OBJECTIVECerebral revascularization for carotid occlusion was previously a mainstay procedure for the cerebrovascular neurosurgeon. However, the 1985 extracranial-intracranial bypass trial and subsequently the Carotid Occlusion Surgery Study (COSS) provided level 1 evidence via randomized controlled trials against bypass for symptomatic atherosclerotic carotid occlusion disease. However, in a small number of patients optimal medical therapy fails, and some patients with flow-limiting stenosis develop a perfusion-dependent neurological examination...
February 1, 2019: Neurosurgical Focus
Hang Xu, Tianlong Liu, Wenjun Wang, Ning Su, Liudi Yang, Zhifu Yang, Fang Dou, Jia Cui, Fei Fei, Jing Ma, Aidong Wen, Yi Ding
Ischemic stroke is a common cerebrovascular disease with high morbidity and mortality worldwide. However, treatment options for reducing cerebral ischemia-reperfusion injury (CIRI) are limited. Gallic acid (GA) as a plant polyphenol has been used to fight against CIRI. But its pharmacokinetic properties such as low absorption, poor bioavailability and quick elimination have negative effects on its clinical application. To strengthen its potency, a delivery system of GA-loaded o-carboxymethyl chitosan nanoparticle (GA-NP) was synthesized in our study...
February 2, 2019: Rejuvenation Research
Runzhi Chen, Peng Wu, Zheng Cai, Yingying Fang, Hao Zhou, Yi Lasanajak, Lan Tang, Ling Ye, Chuqi Hou, Jie Zhao
The combination of Puerariae Lobatae Radix (PLR) and Chuanxiong Rhizoma (CXR) is commonly used to treat cerebrovascular diseases. This work aimed to clarify the mechanisms of their action in treating cerebral ischemic stroke from the perspective of gut microecology. The PLR and CXR combination effectively improved the neurological function, reduced the cerebral infarction and relieved the complications of cerebral ischemic stroke, including dyslipidemia, increased blood viscosity and thrombotic risk. Cerebral ischemic stroke triggered gut microbial disturbances by enriching pathogens and opportunistic microorganisms, including Bacteroides, Escherichia_Shigella, Haemophilus, Eubacterium_nodatum_group, Collinsella, Enterococcus, Proteus, Alistipes, Klebsiella, Shuttleworthia and Faecalibacterium...
December 21, 2018: Journal of Nutritional Biochemistry
Mi Ji Lee, Soohyun Cho, Sook-Young Woo, Chin-Sang Chung
BACKGROUND: Previous studies reported an increased risk of ischemic stroke in younger migraineurs. We aimed to investigate the association between age and cerebrovascular reactivity (CVR) to vasodilatory stimuli in cerebral arteries in patients with migraine and normal controls. METHODS: In this cross-sectional study, we recruited 248 patients with migraine and 105 normal controls at Samsung Medical Center between October 2015 and July 2018. CVR was measured interictally by using the transcranial Doppler breath-holding test...
January 24, 2019: Journal of the Neurological Sciences
Fan Z Caprio, Farzaneh A Sorond
Despite advances in earlier diagnosis and available aggressive treatments for vascular risk factors, stroke remains a leading cause of death and long-term disability worldwide. Disparities exist in stroke risk, rates of stroke, and treatment. Stroke is a heterogeneous disease with multiple additive risk factors and causes. Primary prevention of stroke focusing on risk factor modification plays an important role in reducing the burden of stroke in an aging population. Secondary prevention of recurrent strokes relies on the workup and a tailored treatment targeted at the mechanisms responsible for the incident stroke or transient ischemic attack...
March 2019: Medical Clinics of North America
Michael E Farkouh, Mandeep S Sidhu, Maria M Brooks, Helen Vlachos, William E Boden, Robert L Frye, Pamela Hartigan, F S Siami, Vera A Bittner, Bernard R Chaitman, G B John Mancini, Valentin Fuster
BACKGROUND: The optimal coronary revascularization strategy in patients with stable ischemic heart disease (SIHD) who have type 2 diabetes (T2DM) and chronic kidney disease (CKD) remains unclear. OBJECTIVES: This patient-level pooled analysis sought to compare outcomes of 3 large, federally-funded randomized trials in SIHD patients with T2DM and CKD (COURAGE [Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation], BARI 2D [Bypass Angioplasty Revascularization Investigation 2 Diabetes], and FREEDOM [Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-vessel Disease])...
February 5, 2019: Journal of the American College of Cardiology
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