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Sample records for childhood arterial ischemic

  1. Risk Factors and Neurologic Outcomes in Childhood Arterial Ischemic Stroke

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    Taner Sezer

    2017-09-01

    Full Text Available Objective: The aim of this study is to describe clinical characteristics, treatment modalities and outcomes of children with arterial ischemic stroke (AIS. Material and Methods: We retrospectively reviewed the charts of 102 children (62 girls and 40 boys with AIS admitted at our hospital between 2009 and 2015. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Cardiac assessment, hematological and immunological tests, metabolic screening were all performed in the patients. Results: In 25 children stroke occured as a complication of cardiac disease, 12 had transient cerebral arteriopathy, 11 had Down’s syndrome, 9 had thalassemia, 7 had moyamoya disease, 6 had MTHFR mutation, 4 had homozygote for factor V Leiden, 3 had protein C deficiency, 1 had sickle cell disease, and in 24 children no underlying cause could be found. Multiple risk factors were found in 16 children and recurrent stroke was observed in 4 patients. Hemiplegia was the commonest initial clinical presentation (88.2% followed by seizure (66.6% and decreased level of consciousness (54.9%. The avarage length of follow-up was 32.1±5.4 months. The outcome in all 102 stroke patients was as follows: asymptomatic 57.8%; persistent neurologic deficit or epilepsy 40.2%; and death 2%. Conclusion: Our study showed an underlying cause for AIS in 76.5% of the patients; 42.2% of the patients either died or had motor and/or cognitive sequelae and recurrence occured despite prophylactic aspirin treatment in 4 patients. [J Contemp Med 2017; 7(3.000: 278-283

  2. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

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    Babl Franz E; Yock-Corrales Adriana; Mosley Ian T; Mackay Mark T

    2011-01-01

    Abstract Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS) Methods Children aged 1 month to < 18 years with radiologically confirmed acute AIS who present...

  3. Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke.

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    Hills, Nancy K; Johnston, S Claiborne; Sidney, Stephen; Zielinski, Brandon A; Fullerton, Heather J

    2012-12-01

    Trauma and acute infection have been associated with stroke in adults, and are prevalent exposures in children. We hypothesized that these environmental factors are independently associated with childhood arterial ischemic stroke (AIS). In a case-control study nested within a cohort of 2.5 million children (≤19 years old) enrolled in an integrated health care plan (1993-2007), childhood AIS cases (n = 126) were identified from electronic records and confirmed through chart review. Age- and facility-matched controls (n = 378) were randomly selected from the cohort. Exposures were determined from review of medical records prior to the stroke diagnosis, or the same date for the paired controls; time windows were defined a priori. A medical encounter for head or neck trauma within the prior 12 weeks was an independent risk factor for childhood AIS (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.9-19.3), present in 12% of cases (1.6% of controls). Median time from trauma to stroke was 0.5 days (interquartile range, 0-2 days); post hoc redefinition of trauma exposure (prior 1 week) was more strongly associated with AIS: OR, 39; 95% CI, 5.1-298. A medical encounter for a minor acute infection (prior 4 weeks) was also an independent risk factor (OR, 4.6; 95% CI, 2.6-8.2), present in 33% of cases (13% of controls). No single infection type predominated. Only 2 cases had exposure to trauma and infection. Trauma and acute infection are common independent risk factors for childhood AIS, and may be targets for stroke prevention strategies. Copyright © 2012 American Neurological Association.

  4. Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

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    Mauricio López-Espejo

    Full Text Available ABSTRACT Objective: To explore the influence of infarct location on long-term functional outcome following a first-ever arterial ischemic stroke (AIS in non-neonate children. Method: The MRIs of 39 children with AIS (median age 5.38 years; 36% girls; mean follow-up time 5.87 years were prospectively evaluated. Infarct location was classified as the absence or presence of subcortical involvement. Functional outcome was measured using the modified Rankin scale (mRS for children after the follow-up assessment. We utilized multivariate logistic regression models to estimate the odds ratios (ORs for the outcome while adjusting for age, sex, infarct size and middle cerebral artery territory involvement (significance < 0.05. Results: Both infarcts ≥ 4% of total brain volume (OR 9.92; CI 1.76 – 55.9; p 0.009 and the presence of subcortical involvement (OR 8.36; CI 1.76 – 53.6; p 0.025 independently increased the risk of marked functional impairment (mRS 3 to 5. Conclusion: Infarct extension and location can help predict the extent of disability after childhood AIS.

  5. Neuropsychological and neurobehavioral outcome following childhood arterial ischemic stroke: attention deficits, emotional dysregulation, and executive dysfunction.

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    O'Keeffe, Fiadhnait; Liégeois, Frédérique; Eve, Megan; Ganesan, Vijeya; King, John; Murphy, Tara

    2014-01-01

    To investigate neuropsychological and neurobehavioral outcome in children with arterial ischemic stroke (AIS). Childhood stroke can have consequences on motor, cognitive, and behavioral development. We present a cross-sectional study of neuropsychological and neurobehavioral outcome at least one year poststroke in a uniquely homogeneous sample of children who had experienced AIS. Forty-nine children with AIS aged 6 to 18 years were recruited from a specialist clinic. Neuropsychological measures of intelligence, reading comprehension, attention, and executive function were administered. A triangulation of data collection included questionnaires completed by the children, their parents, and teachers, rating behavior, executive functions, and emotions. Focal neuropsychological vulnerabilities in attention (response inhibition and dual attention) and executive function were found, beyond general intellectual functioning, irrespective of hemispheric side of stroke. Difficulties with emotional and behavioral regulation were also found. Consistent with an "early plasticity" hypothesis, earlier age of stroke was associated with better performance on measures of executive function. A significant proportion of children poststroke are at long-term risk of difficulties with emotional regulation, executive function, and attention. Data also suggest that executive functions are represented in widespread networks in the developing brain and are vulnerable to unilateral injury.

  6. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Babl Franz E

    2011-10-01

    Full Text Available Abstract Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS Methods Children aged 1 month to Results 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%, face (62%, leg weakness (57%, speech disturbance (46% and headache (46%. The most common signs were arm (61%, face (70% or leg weakness (57% and dysarthria (34%. 36 (78% of children had at least one positive variable on FAST and 38 (81% had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. Conclusion The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.

  7. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

    Science.gov (United States)

    Yock-Corrales, Adriana; Babl, Franz E; Mosley, Ian T; Mackay, Mark T

    2011-10-21

    Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke.Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS) METHODS: Children aged 1 month to Test) scales were applied retrospectively to all patients to determine test sensitivity. 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%), face (62%), leg weakness (57%), speech disturbance (46%) and headache (46%). The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on FAST and 38 (81%) had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.

  8. CE Neuropsychological and neurobehavioral outcome following childhood arterial ischemic stroke: Attention deficits, emotional dysregulation, and executive dysfunction

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    Liégeois, Frédérique; Eve, Megan; Ganesan, Vijeya; King, John; Murphy, Tara

    2013-01-01

    Objectives To investigate neuropsychological and neurobehavioral outcome in children with arterial ischemic stroke (AIS). Background Childhood stroke can have consequences on motor, cognitive, and behavioral development. We present a cross-sectional study of neuropsychological and neurobehavioral outcome at least one year poststroke in a uniquely homogeneous sample of children who had experienced AIS. Method Forty-nine children with AIS aged 6 to 18 years were recruited from a specialist clinic. Neuropsychological measures of intelligence, reading comprehension, attention, and executive function were administered. A triangulation of data collection included questionnaires completed by the children, their parents, and teachers, rating behavior, executive functions, and emotions. Key Findings Focal neuropsychological vulnerabilities in attention (response inhibition and dual attention) and executive function were found, beyond general intellectual functioning, irrespective of hemispheric side of stroke. Difficulties with emotional and behavioral regulation were also found. Consistent with an “early plasticity” hypothesis, earlier age of stroke was associated with better performance on measures of executive function. Conclusions A significant proportion of children poststroke are at long-term risk of difficulties with emotional regulation, executive function, and attention. Data also suggest that executive functions are represented in widespread networks in the developing brain and are vulnerable to unilateral injury. PMID:24028185

  9. Obstruction of cerebral arteries in childhood stroke

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    Velkey, I.; Lombay, B. (County Teaching Hospital, Miskolc (Hungary). Child Health Center); Panczel, G. (Semmelweis Medical Univ., Budapest (Hungary). Dept. of Psychiatry)

    1992-09-01

    Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized. (orig.).

  10. Parvovirus B19 Infection in Children With Arterial Ischemic Stroke.

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    Fullerton, Heather J; Luna, Jorge M; Wintermark, Max; Hills, Nancy K; Tokarz, Rafal; Li, Ying; Glaser, Carol; DeVeber, Gabrielle A; Lipkin, W Ian; Elkind, Mitchell S V

    2017-10-01

    Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases. The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens. Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries. Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis. © 2017 American Heart Association, Inc.

  11. Thrombophilia And Arterial Ischemic Stroke

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    A.A. Abrishamizadeh

    2017-02-01

    Full Text Available Ischemic stroke (IS is a common cause of morbidity and mortality with significant socioeconomic impact especially when it affects young patients. Compared to the older adults, the incidence, risk factors, and etiology are distinctly different in younger IS. Hypercoagulable states are relatively more commonly detected in younger IS patients. Thrombophilic states are disorders of hemostatic mechanisms that result in a predisposition to thrombosis .Thrombophilia is an established cause of venous thrombosis. Therefore, it is tempting to assume that these disorders might have a similar relationship with arterial thrombosis. Despite this fact that 1-4 % of ischemic strokes are attributed to Thrombophillia, this   alone rarely causes arterial occlusions .Even in individuals with a positive thrombophilia screen and arterial thrombosis, the former might not be the primary etiological factor. Thrombophilic   disorders can be broadly divided into inherited or acquired conditions. Inherited thrombophilic states include deficiencies of natural anticoagulants such as protein C, protein S, and antithrombin III (AT III deficiency, polymorphisms causing resistance to activated protein C(Factor V Leiden mutation, and disturbance in the clotting balance (prothrombin gene 20210G/A variant. Of all the inherited  thrombophilic disorders, Factor V Leiden mutation is perhaps the commonest cause. On the contrary, acquired thrombophilic disorders are more common and include conditions such as the antiphospholipid syndrome, associated with lupus anticoagulant and anticardiolipin antibodies. The more useful and practical approach of ordering various diagnostic tests for the uncommon thrombophilic states tests should be determined by a detailed clinical history, physical examination, imaging studies and evaluating whether an underlying hypercoagulable state appears more likely. The laboratory thrombophilia   screening should be comprehensive and avoid missing the

  12. Ischemic stroke: carotid and vertebral artery disease

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    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  13. Crossing the blood-brain barrier: clinical interactions between neurologists and hematologists in pediatrics - advances in childhood arterial ischemic stroke and cerebral venous thrombosis.

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    Witmer, Char; Ichord, Rebecca

    2010-02-01

    The past year has marked a period of growing awareness of the need for improved diagnosis and treatment in children with arterial ischemic stroke (AIS) and cerebral sinus venous thrombosis (CSVT). Here we review these conditions, highlighting the importance of the intersection between hematologic abnormalities and pediatric stroke as they impact clinical management. Recent multicenter cohort studies are beginning to clarify the incidence, risk factors, clinical course and outcomes of AIS and CSVT in children. Key findings include: diagnosis rests on adequate neuroimaging and is often delayed more than 24 h after symptom onset; multiple risk factors and inciting events are often involved; one or more prothrombotic risk factors are common; recurrence is common; and selected groups of patients benefit from anticoagulation, and less frequently, thrombolytic therapies. Progress in caring for children with AIS and CSVT requires greatly improved awareness of cerebrovascular disease among primary providers, who are most often the first point of contact, more rapid and specific diagnosis using appropriate advanced neuroimaging technologies, comprehensive hematologic evaluation for inherited and acquired thrombophilias, and multidisciplinary approaches to treatment. Additional large cohort studies and clinical trials are greatly needed to further clarify these issues.

  14. Perinatal arterial ischemic stroke: presentation, risk factors, evaluation, and outcome.

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    Lehman, Laura L; Rivkin, Michael J

    2014-12-01

    Perinatal arterial ischemic stroke is as common as large vessel arterial ischemic stroke in adults and leads to significant morbidity. Perinatal arterial ischemic stroke is the most common identifiable cause of cerebral palsy and can lead to cognitive and behavioral difficulties that are amortized over a lifetime. The literature on perinatal arterial ischemic stroke was reviewed and analyzed. Risk factors for perinatal arterial ischemic stroke include those that are maternal, neonatal, and placental. The most common clinical signs at presentation are seizures and hemiparesis. Evaluation should begin with thorough history acquisition and physical examination followed by magnetic resonance imaging of the brain, with consideration of magnetic resonance angiography of the head and neck, echocardiogram, and thrombophilia evaluation. Treatment beginning early to include physical, speech, and occupational therapies including constraint-induced movement therapy and close cognitive and developmental follow-up may be beneficial. Future treatments may include transcranial magnetic stimulation, hypothermia, and erythropoietin. Perinatal arterial ischemic stroke comprises a group of arterial ischemic injuries that can occur in the prenatal, perinatal, and postnatal periods in term and preterm infants with different types of perinatal arterial ischemic stroke having different clinical presentations, risk factors, and long-term outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Intra‐arterial treatment for acute ischemic stroke

    NARCIS (Netherlands)

    Berkhemer, O.A.

    2016-01-01

    This thesis deals with current issues in the field of acute ischemic stroke. The main objective has been to proof the effectiveness and safety of intra-arterial treatment in patients with acute ischemic stroke. MR CLEAN was the first study to proof the safety and effectiveness of intra-arterial

  16. Psoriasis and ischemic coronary artery disease.

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    Mahiques-Santos, L; Soriano-Navarro, C J; Perez-Pastor, G; Tomas-Cabedo, G; Pitarch-Bort, G; Valcuende-Cavero, F

    2015-03-01

    Psoriasis is a chronic inflammatory disease associated with an increased risk of ischemic coronary artery disease (CAD) in some populations. We aimed to determine the association between these 2 diseases in our geographic area. We performed a cross-sectional study of patient records between 2005 and 2012 in the database (Abucacis, Datamart) that contains all medical case histories in the province of Castellón, Spain. Patients diagnosed with psoriasis were compared with a control group of patients diagnosed with melanocytic nevus. The prevalence of CAD and the presence or absence of the main cardiovascular risk factors were analyzed in each group. A total of 9181 patients with psoriasis and 21925 with melanocytic nevus were studied. Univariate logistic regression analysis showed that CAD was significantly associated with psoriasis, age (in years), sex, hypertension, diabetes mellitus, dyslipidemia, and obesity (P<.05). On adjustment for age, sex, and the other cardiovascular risk factors, multivariate regression analysis established that psoriasis was independently associated with CAD (P<.029). Our findings in a large sample of patients in a Mediterranean area support the hypothesis that patients in this population have an increased risk of ischemic CAD. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  17. Relationship between carotid artery stenosis and ischemic ocular diseases

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    Qian Chen

    2015-01-01

    Full Text Available AIM: To investigate the relationship between carotid artery stenosis and ischemic ocular diseases.METHODS: The clinical data of 30 cases(37 eyesof patients with ischemic eye diseases were collected from November 2010 to May 2014, and they were accepted the fundus fluorescein angiography(FFA, transcranial Doppler(TCDultrasonic blood vessels of the eye, neck vascular color Doppler flow imaging(CDFI, the neck CT angiography(CTAand carotid artery digital subtraction angiography(DSAexamination, and then the ischemic eye disease patients with ocular symptoms were analyzed. The peak systolic velocity(PSVand resistance index(RIof ophthalmic artery and central retinal artery were compared. Correlation between the internal carotid artery intima-media thickness(IMTand ophthalmic artery, central retinal artery PSV and RI correlation risk; ipsilateral internal carotid artery plaque and ophthalmic artery PSV and RI; PSV and RI associated ipsilateral internal carotid artery plaque and central retinal artery were analyzed. RESULTS: Eye symptoms: a black dim, reduced vision, the eyes flash, and around the eye pain were 75.7%, 83.8%, 51.4% and 32.4%; The eye signs: the dilatation of retinal vein, retinal hemorrhage, arterial stenosis and cotton spot and the contralateral side were regarded as main signs. Ophthalmic artery PSV and RI value of the differences were statistically significant(PPP>0.05; The ipsilateral internal carotid artery plaque and ophthalmic artery PSV had no correlation with RI values(P>0.05; PSV and RI and the ipsilateral internal carotid artery plaque and central retinal artery had no correlation(P>0.05.CONCLUSION: The incidence of ischemic eye diseases and internal carotid artery stenosis is associated with very close, the clinical can regard the degree of internal carotid artery stenosis as an important basis for diagnosis and treatment of eye diseases.

  18. The relationship between renal artery stenosis and ischemic nephropathy

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    Reza Ghadimi

    2014-08-01

    Full Text Available Ischemic nephropathy is defined as a clinically significant progressive reduction in glomerular filtration rate that is usually associated with significant renal artery stenosis (unilateral or bilateral involvement. Atherosclerotic renal artery disease is known as the most common cause of the ischemic nephropathy. These patients may develop secondary hypertension. In  addition, epidemiologic data has showed a clear association  between atherosclerotic renal artery stenosis and coronary artery disease and other cardiovascular disease. Despite the preserving function of kidney on various autoregulation processes, unusual microvascular function will be resulted due to sustained decline in renal perfusion. The ischemic nephropathy of asymptomatic cases may result in renovascular hypertension and renal failure. The reduction of renal function in these patients might be decreased or stopped by early appropriate diagnosis and also might be treated with renal artery angioplasty or surgery, after medical management. There is a debate about the occurrence of ischemic nephropathy as a result of atherosclerotic renal artery stenosis. In this study we aimed to review the prevalence of ischemic nephropathy due to atherosclerotic renal artery stenosis.

  19. Paradoxical centrally increased diffusivity in perinatal arterial ischemic stroke

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    Stence, Nicholas V.; Mirsky, David M.; Deoni, Sean C.L. [University of Colorado Anschutz School of Medicine, Department of Radiology, Aurora, CO (United States); Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); Armstrong-Wells, Jennifer [University of Colorado Anschutz School of Medicine, Department of Pediatrics (Neurology) and OB/GYN, Aurora, CO (United States); University of Colorado Hemophilia and Thrombosis Center, Aurora, CO (United States)

    2016-01-15

    Restricted diffusion on acute MRI is the diagnostic standard for perinatal arterial ischemic stroke. In a subset of children with perinatal arterial ischemic stroke, primarily those with large infarct volumes, we noted a core of centrally increased diffusivity with a periphery of restricted diffusion. Given the paradoxical diffusion-weighted imaging (DWI) appearance observed in some children with perinatal arterial ischemic stroke, we sought to determine its significance and hypothesized that: (1) centrally increased diffusivity is associated with larger infarcts in perinatal arterial ischemic stroke and (2) this tissue is irreversibly injured (infarcted). We reviewed all perinatal arterial ischemic stroke cases in a prospective cohort study from Aug. 1, 2000, to Jan. 1, 2012. Infarct volumes were measured by drawing regions of interest around the periphery of the area of restricted diffusion on DWI. The Mann-Whitney U test was used to compare means between groups. Of 25 eligible cases, centrally increased diffusivity was seen in 4 (16%). Cases with centrally increased diffusivity had larger average infarct volumes (mean 117,182 mm{sup 3} vs. 36,995 mm{sup 3}; P = 0.008), higher average apparent diffusion coefficient (ADC) values in the infarct core (1,679 x 10{sup -6} mm{sup 2}/s vs. 611 x 10{sup -6} mm{sup 2}/s, P < 0.0001), and higher ADC ratio (1.2 vs. 0.5, P < 0.0001). At last clinical follow-up, children with perinatal arterial ischemic stroke and centrally increased diffusivity were more often treated for ongoing seizures (75% vs. 0%; P < 0.001) than those without. Centrally increased diffusivity was associated with larger stroke volume and the involved tissue was confirmed to be infarcted on follow-up imaging. Radiologists should be aware of this unusual appearance of perinatal arterial ischemic stroke in order to avoid underestimating infarct volume or making an incorrect early diagnosis. (orig.)

  20. The rs10757278 Polymorphism of the 9p21.3 Locus in Children with Arterial Ischemic Stroke: A Family-Based and Case-Control Study.

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    Niemiec, Pawel; Balcerzyk, Anna; Iwanicki, Tomasz; Emich-Widera, Ewa; Kopyta, Ilona; Nowak, Tomasz; Pilarska, Ewa; Pienczk-Ręcławowicz, Karolina; Kaciński, Marek; Wendorff, Janusz; Gorczynska-Kosiorz, Sylwia; Trautsolt, Wanda; Grzeszczak, Władysław; Zak, Iwona

    2017-12-01

    The association of 9p21.3 locus single nucleotide polymorphisms with arterial ischemic stroke in adults was demonstrated in many studies, but there are no studies in pediatric arterial ischemic stroke patients. We investigated whether the 9p21.3 locus polymorphism, namely rs10757278, is associated with the arterial ischemic stroke risk in children. The study group consisted of 335 individuals: 80 children with arterial ischemic stroke, their biological parents (n = 122), and 133 children (age and sex matched) without any symptoms of arterial ischemic stroke as a control group. The rs10757278 polymorphism was genotyped using the TaqMan® Pre-designed SNP Genotyping Assay (Applied Biosystems). Two different study design models were used: family-based association test (transmission-disequilibrium test) and case-control model. There were no statistically significant differences in the distribution of genotypes and alleles of the rs10757278 polymorphism between groups of children with arterial ischemic stroke and controls. The frequency of both transmitted alleles in transmission-disequilibrium test analysis was identical (50%). The A allele carrier state (AA+AG genotype) was more frequent in arterial ischemic stroke children with hemiparesis than in patients without this symptom (94.5% versus 68.0%, P = .004). There is no evidence to consider the 9p21.3 locus polymorphism as a risk factor for childhood arterial ischemic stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. An endovascular model of ischemic myopathy from peripheral arterial disease.

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    Long, Chandler A; Timmins, Lucas H; Koutakis, Panagiotis; Goodchild, Traci T; Lefer, David J; Pipinos, Iraklis I; Casale, George P; Brewster, Luke P

    2017-09-01

    Peripheral arterial disease (PAD) is a significant age-related medical condition with limited pharmacologic options. Severe PAD, termed critical limb ischemia, can lead to amputation. Skeletal muscle is the end organ most affected by PAD, leading to ischemic myopathy and debility of the patient. Currently, there are not any therapeutics to treat ischemic myopathy, and proposed biologic agents have not been optimized owing to a lack of preclinical models of PAD. Because a large animal model of ischemic myopathy may be useful in defining the optimal dosing and delivery regimens, the objective was to create and to characterize a swine model of ischemic myopathy that mimics patients with severe PAD. Yorkshire swine (N = 8) underwent acute right hindlimb ischemia by endovascular occlusion of the external iliac artery. The effect of ischemia on limb function, perfusion, and degree of ischemic myopathy was quantified by weekly gait analysis, arteriography, hindlimb blood pressures, femoral artery duplex ultrasound scans, and histologic examination. Animals were terminated at 5 (n = 5) and 6 (n = 3) weeks postoperatively. Ossabaw swine (N = 8) fed a high-fat diet were used as a model of metabolic syndrome for comparison of arteriogenic recovery and validation of ischemic myopathy. There was persistent ischemia in the right hindlimb, and occlusion pressures were significantly depressed compared with the untreated left hindlimb out to 6 weeks (systolic blood pressure, 31 ± 21 vs 83 ± 15 mm Hg, respectively; P = .0007). The blood pressure reduction resulted in a significant increase of ischemic myopathy in the gastrocnemius muscle in the treated limb. Gait analysis revealed a functional deficit of the right hindlimb immediately after occlusion that improved rapidly during the first 2 weeks. Peak systolic velocity values in the right common femoral artery were severely diminished throughout the entire study (P ischemic limb underwent significant arteriogenic

  2. Ischemic cardiomyopathy revealed by central retinal artery occlusion ...

    African Journals Online (AJOL)

    Here we report a case of central retinal artery occlusionrevealing an ischemic cardiomyopathy. A 54-year old smoker man presented at the hospital because of sudden visual loss in his left eye. There was cherry-red spot in the macula in his left eye. We performed a fluorescein angiogram and cervical color Doppler.

  3. Incidence and predictors of epilepsy after pediatric arterial ischemic stroke

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    Beslow, Lauren A.; Abend, Nicholas S.; Uohara, Michael; Jastrzab, Laura; Licht, Daniel J.; Ichord, Rebecca N.

    2017-01-01

    Objective: To determine the cumulative incidence and clinical predictors of remote symptomatic seizures and epilepsy after pediatric arterial ischemic stroke (AIS). Methods: We performed a retrospective analysis of 218 participants with neonatal AIS (NAIS), presumed perinatal AIS (PPAIS), and childhood AIS (CAIS) from a single-center prospective consecutive cohort enrolled from 2006 to 2014. Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis. Results: Acute symptomatic seizures occurred in 94% of NAIS (n = 70/74) and 17% of CAIS (n = 18/105). Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. Median follow-up for the entire cohort was 34 months, interquartile range 44.9 months (16.3–61.2). Estimated cumulative incidence of RSS at 2 years was 19% in NAIS, 24% in PPAIS, and 7% in CAIS. Estimated cumulative incidence of epilepsy at 2 years was 11% in NAIS, 19% in PPAIS, and 7% in CAIS. The median time to these outcomes was <2 years in all stroke subtypes. Among participants developing epilepsy (n = 34), seizures were often well-controlled at last follow-up with median Engel class of ≤2 (<1 seizure/month). Conclusions: RSS and epilepsy are important neurologic sequelae of pediatric AIS. Children with perinatal stroke and CAIS with acute symptomatic seizures are at increased risk of these outcomes. These cohorts need further study to identify biomarkers and potential therapeutic targets for epileptogenesis. PMID:28087825

  4. Childhood Stature and Growth in Relation to First Ischemic Stroke or Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Gjærde, Line Klingen; Truelsen, Thomas Clement; Baker, Jennifer Lyn

    2018-01-01

    BACKGROUND AND PURPOSE: Attained height, an indicator of genetic potential and childhood growth environment, is inversely associated with stroke, but the mechanisms are poorly understood. We investigated whether childhood height and growth are associated with ischemic stroke (IS) and intracerebra...

  5. Idiopathic arterial calcification in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Maya [Department of Paediatric Radiology, Red Cross Children' s Hospital, Cape Town (South Africa); Red Cross Children' s Hospital, School of Child and Adolescent Health, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town (South Africa); Andronikou, Savvas; Solomon, Rustum; Sinclair, Paul; McCulloch, Mignon [Department of Paediatric Radiology, Red Cross Children' s Hospital, Cape Town (South Africa)

    2004-08-01

    Idiopathic arterial calcification in infancy is usually fatal with death in early life and diagnosis at post mortem. This report describes a unique, late presentation with hypertension and cardiac failure in a child aged 33 months, found to have widespread arterial calcification at radiological imaging. The calcium-phosphate axis was normal and there was no other demonstrable cause for calcification. Additionally, the histological features of arterial calcification at renal biopsy paralleled the findings in infants with this disorder. The late presentation in this case is unusual and has not been previously reported. Ultrasound and CT are sensitive for calcification, and the disease should be suspected in children presenting with cardiac or respiratory manifestations and features of arterial calcification, where no metabolic cause is established. (orig.)

  6. [Ischemic stroke in childhood. A complication of tonsillectomy].

    Science.gov (United States)

    Matilla Álvarez, A; García Serrano, E; González de la Huebra Labrador, T; Morales Martín, A C; Yusta Martín, G; Vaquero Roncero, L M

    2016-02-01

    Tonsillectomy is one of the most frequently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Bright vessel appearance on arterial spin labeling MRI for localizing arterial occlusion in acute ischemic stroke.

    Science.gov (United States)

    Yoo, Roh-Eul; Yun, Tae Jin; Rhim, Jung Hyo; Yoon, Byung-Woo; Kang, Koung Mi; Choi, Seung Hong; Kim, Ji-Hoon; Kim, Jeong Eun; Kang, Hyun-Seung; Sohn, Chul-Ho; Han, Moon Hee

    2015-02-01

    The purpose of this study was to evaluate whether bright vessel appearance on arterial spin labeling (ASL) MRI can help localize arterial occlusion sites in patients with acute ischemic stroke. Patients who underwent MRI for suspected acute ischemic stroke, as identified by an area of restricted diffusion, were included. All images were visually analyzed for the presence or absence of (1) arterial occlusion on time-of-flight MR angiography, (2) bright vessel appearance on ASL images, and (3) susceptibility vessel sign. McNemar 2-tailed test was used to compare the sensitivities of ASL and susceptibility-weighted imaging for the detection of arterial occlusion, using MR angiography as the reference standard. ASL bright vessel appearance was significantly more common in the group with occlusion than in the group without occlusion (94% [33 of 35] versus 21% [17 of 82], respectively; Pappearance, when present, was seen proximal or distal to the occlusion site. The bright vessel appearance had a significantly higher sensitivity for the detection of occlusion than the susceptibility vessel sign (94% [33 of 35] versus 66% [23 of 35], respectively; P=0.002). In cases with negative MR angiography, the bright vessel appearance helped identify more additional arterial occlusions than the susceptibility vessel sign (21% [17 of 82] versus 10% [8 of 82], respectively; P=0.012). The bright vessel appearance on ASL imaging can provide an important diagnostic clue for the detection and localization of arterial occlusion sites in patients with acute ischemic stroke. © 2014 American Heart Association, Inc.

  8. Endovascular Hypothermia in Acute Ischemic Stroke: Pilot Study of Selective Intra-Arterial Cold Saline Infusion.

    Science.gov (United States)

    Chen, Jian; Liu, Liqiang; Zhang, Hongqi; Geng, Xiaokun; Jiao, Liqun; Li, Guilin; Coutinho, Jonathan M; Ding, Yuchuan; Liebeskind, David S; Ji, Xunming

    2016-07-01

    We conducted a pilot feasibility and safety study of selective brain cooling with intra-arterial infusion of cold saline combined with endovascular reperfusion for acute ischemic stroke. Patients with large-vessel occlusion within 8 hours after symptom onset were enrolled. All patients received intra-arterial recanalization combined with infusion of cold isotonic saline (4°C) in the ischemic territory through the angiographic catheter. Twenty-six patients underwent the procedure, which was technically successful in all. The temperature of ischemic cerebral tissue was decreased by at least 2°C during infusion of the cold solution, and systemic temperature was mildly reduced (maximum 0.3°C). No obvious complications related to intra-arterial hypothermia were observed. Selective brain cooling by intra-arterial infusion of cold saline combined with endovascular recanalization therapy in acute ischemic stroke seems feasible and safe. © 2016 American Heart Association, Inc.

  9. Imaging findings and cerebral perfusion in arterial ischemic stroke due to transient cerebral arteriopathy in children; Achados de imagem e perfusao arterial cerebral em acidente vascular cerebral isquemico devido a arteriopatia transitoria em crianca

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa Junior, Alcino Alves, E-mail: alcinojr@uol.com.br [Departamento de Diagnostico por Imagem, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Ellovitch, Saada Resende de Souza [Neuropediatria, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Pincerato, Rita de Cassia Maciel [Hospital Samaritano, Sao Paulo, SP (Brazil)

    2012-04-15

    We report the case of a 4-year-old female child who developed an arterial ischemic stroke in the left middle cerebral artery territory, due to a proximal stenosis of the supraclinoid internal carotid artery, most probably related to transient cerebral arteriopathy of childhood. Computed tomography scan, magnetic resonance imaging, perfusion magnetic resonance and magnetic resonance angiography are presented, as well as follow-up by magnetic resonance and magnetic resonance angiography exams. Changes in cerebral perfusion and diffusion-perfusion mismatch call attention. As far as we know, this is the first report of magnetic resonance perfusion findings in transient cerebral arteriopathy. (author)

  10. Erectile dysfunction and pcsychoemotional state in ischemic heart disease patients undergone coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ye. V. Pomeshkin

    2012-01-01

    Full Text Available The impact of erectile dysfunction on psychoemotional state of patients undergone coronary artery bypass graft surgery was evaluated. The International Index of Erectile Function, postcompression cavernous artery dilation test, nocturnal penile tumescence recording and psychophysiological exam were used. It was found that ischemic heart disease patients have higher incidence of associated psychoemotional and erectile dysfunctions.

  11. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Jensen, J S; Feldt-Rasmussen, B; Strandgaard, S

    2000-01-01

    Albumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among...

  12. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization.

    Science.gov (United States)

    Shashoua, Abraham R; Stringer, Nelson H; Pearlman, Julie B; Behmaram, Behnaz; Stringer, Erica A

    2002-05-01

    The exact frequency and extent of complications after uterine artery embolization (UAE) have yet to be documented in the literature. Ischemic necrosis and rupture of the uterus is a theoretical concern of this procedure. Rupture of the uterus from any cause is a very serious gynecologic complication requiring immediate surgical intervention to prevent death. Ischemic necrosis and rupture of the uterus can occur months after UAE. In our patient they occurred 3 months after UAE for treatment of symptomatic uterine myomas, and required hysterectomy. To our knowledge, this is the first report of ischemic uterine rupture after UAE in the United States.

  13. EXTRACRANIAL NON-ATHEROSCLEROTIC PATHOLOGY OF THE CAROTID ARTERY IN THE CAUSES OF ACUTE ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    I. P. Dudanov

    2017-01-01

    Full Text Available Purpose. We present the experience of treatment of patients with cerebral vascular accident by the ischemic type, the cause of which was non-atherosclerotic lesion of brachiocephalic arteries.Materials and methods. During 2011–2015 years 4118 patients with acute ischemic stroke were observed. Of these, 589 patients (14.3% were operated in the acute period of stroke in the period from 4–6 hours to 14 days. The cause of the stroke was various types of pathology of the extracranial divisions of the brachiocephalic arteries (EDBA. Of this number, with atherosclerotic carotid artery stenoses, 336 patients (57.1% were operated on, with non-atherosclerotic pathology of carotid arteries — 253 patients (42.9%. Of these 253 patients, dissection of the intima of the carotid arteries was detected in 10 (3.9% patients, aneurysms in the extracranial segment of the ECA and ICA were detected in 14 (5.5%, and 229 (90.6% revealed various types of tortuosity and kinks carotid arteries and fibrous dysplasia. All patients are operated on. Various types of reconstructions of carotid arteries with a good clinical effect have been performed. There were no lethal outcomes.Concusions. The data obtained in the study confirm the opinion that not only atherosclerotic lesions of the ICA are an indication for surgical treatment at an early date. This stage is an important part of the comprehensive rehabilitation of patients with acute ischemic stroke.

  14. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  15. Endovascular Hypothermia in Acute Ischemic Stroke: Pilot Study of Selective Intra-Arterial Cold Saline Infusion

    NARCIS (Netherlands)

    Chen, Jian; Liu, Liqiang; Zhang, Hongqi; Geng, Xiaokun; Jiao, Liqun; Li, Guilin; Coutinho, Jonathan M.; Ding, Yuchuan; Liebeskind, David S.; Ji, Xunming

    2016-01-01

    We conducted a pilot feasibility and safety study of selective brain cooling with intra-arterial infusion of cold saline combined with endovascular reperfusion for acute ischemic stroke. Patients with large-vessel occlusion within 8 hours after symptom onset were enrolled. All patients received

  16. Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Ghelfi, Julien, E-mail: JGhelfi@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Brichon, Pierre-Yves, E-mail: PYBrichon@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne (France); Frandon, Julien, E-mail: Julien.frandon@chu-nimes.fr [CHU de Nîmes, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Boussat, Bastien, E-mail: BBoussat@chu-grenoble.fr [CHU de Grenoble, Département d’Information Médicale, Pôle de Santé Publique (France); Bricault, Ivan, E-mail: IBricault@chu-grenoble.fr; Ferretti, Gilbert, E-mail: GFerretti@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France); Guigard, Sébastien, E-mail: SGuigard@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Chirurgie Thoracique, Vasculaire et Endocrinienne (France); Sengel, Christian, E-mail: CSengel@chu-grenoble.fr [CHU de Grenoble, Clinique Universitaire de Radiologie et Imagerie Médicale (France)

    2017-05-15

    PurposeSurgical esophagectomy is the gold standard treatment of early-stage esophageal cancer. The procedure is complicated with significant morbidity; the most severe complication being the anastomotic leakage. Anastomotic fistulas are reported in 5–25% of cases and are mainly due to gastric transplant ischemia. Here, we report our experience of ischemic pre-conditioning using preoperative arterial embolization (PreopAE) before esophagectomy.Materials and MethodsThe medical records of all patients who underwent oncologic esophagectomy from 2008 to 2015 were retrospectively reviewed. Patients were divided into two groups: patients who received PreopAE, and a control group of patients who did not benefit from ischemic pre-conditioning. The target arteries selected for PreopAE were the splenic artery, left gastric artery, and right gastric artery. Evaluation of the results was based on anastomotic leakage, postoperative mortality, technical success of PreopAE, and complications related to the embolization procedure.ResultsForty-six patients underwent oncologic esophagectomy with PreopAE and 13 patients did not receive ischemic conditioning before surgery. Thirty-eight PreopAE were successfully performed (83%), but right gastric artery embolization failed for 8 patients. Anastomotic leakage occurred in 6 PreopAE patients (13%) and in 6 patients (46%) in the control group (p = 0.02). The mortality rate was 2% in the PreopAE group and 23% in the control group (p = 0.03). Eighteen patients suffered from partial splenic infarction after PreopAE, all treated conservatively.ConclusionPreoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage.

  17. [DIAGNOSIS OF ISCHEMIC HEART DISEASE CAUSED BY TORTUOSITY OF CORONARY ARTERIES].

    Science.gov (United States)

    Lebedeva, E O; Lazoryshynets, V V; Beshliaga, V M; Grusha, M M

    2015-01-01

    This article is devoted to the problems of diagnostics of coronary artery tortuosity phenomenon. Given the lack of literature about the role of phenomenon tortuosity of coronary arteries in the genesis of ischemic myocardial damage, the purpose of study was to determine the clinical relevance as well as necessity for prevention and treatment of this vascular anomaly. Therefore were analyzed medical history, laboratory and clinical database as well as data functional studies of the heart and cardiovascular system in 1404 patients which were divided into four groups on the results of coronary angiography. The results of the study indicate tortuosity of coronary arteries may be independent and additional burdening factor in the development of ischemic heart disease.

  18. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, L; Nygård, A; Ovesen, C

    2014-01-01

    INTRODUCTION: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments....... METHOD: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA...... (2.8%) with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5%) and 15 cases (2.3%) were possible dissections. CONCLUSION: We found that in approximately 3...

  19. Ocular and cerebral ischemic mechanisms in disease of the internal carotid artery.

    Science.gov (United States)

    Ross, R T; Morrow, I M

    1984-05-01

    Stenosis of the internal carotid artery reduces the flow velocity in the ophthalmic artery. Lowered velocity permits increased red cell aggregation and decreased red cell deformability which increases viscosity. Contrary to the theory of remotely originating emboli, this is an alternate hypothesis regarding transient attacks of ocular and cerebral ischemia. The ophthalmic artery circulation time was measured in two groups of patients. The circulation time was defined as the interval between the appearance of contrast media in the siphon of the internal carotid artery and in the ocular choroid. The measurement was made on 151 angiograms of 108 subjects. These vessels were normal. An additional 76 patients had 108 angiograms which showed various amounts of internal carotid artery stenosis. These 76 patients had transient ischemic attacks; retinal, cerebral, or both. There is a significant difference in the ophthalmic artery circulation time in the two groups. The slowing in the ophthalmic artery is related to the degree of internal carotid artery narrowing. The circulation time in a cerebral branch of the internal carotid was not measured. It is presumed that stenosis of the internal carotid artery would have the same effect on a cerebral artery as on the ophthalmic artery.

  20. The Number of Stenotic Intracranial Arteries Is Independently Associated with Ischemic Stroke Severity.

    Directory of Open Access Journals (Sweden)

    Xiaodan Wei

    Full Text Available The severity of ischemic stroke symptoms varies among patients and is a critical determinant of patient outcome. To date, the association between the number of stenotic intracranial arteries and stroke severity remains unclear.We aimed to investigate the association between the number of stenotic major intracranial arteries (NSMIA and ischemic stroke severity, as well as the degree of stenosis and common stroke risk factors.We performed a retrospective analysis of patients with digital subtraction angiography (DSA-confirmed ischemic stroke. Clinical stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS. The number of stenotic vessels was counted from the internal carotid arteries and vertebral arteries, bilaterally.Eighty three patients were recruited from a single center and included in the study. NSMIA was significantly correlated with stroke severity (Pearson Correlation Coefficient = 0.485, P < 0.001, but not with the degree of stenosis (Pearson Correlation Coefficient = 0.01, P = 0.90. Multivariate regression analysis revealed that NSMIA was significantly associated with the NIHSS score after adjusting for stroke risk factors. The adjusted odds ratio (per lateral was 2.092 (95% CI, 0.865 to 3.308, P = 0.001. The degree of stenosis was also significantly associated with the NIHSS score after adjusting for common risk factors. The odds ratio (per 10% was 0.712 (95% CI, 0.202 to 1.223, P = 0.007.The number of stenotic intracranial major arteries is associated with the severity of ischemic stroke independent of the degree of stenosis and other stroke risk factors. To the best of our knowledge, this has not been previosuly studied in great detail using DSA. Our data highlight the importance of examining all major arteries in stroke patients.

  1. Effect of cilostazol on cerebral arteries in secondary prevention of ischemic stroke.

    Science.gov (United States)

    Guo, Jian-Jun; Xu, En; Lin, Qing-Yuan; Zeng, Guo-Ling; Xie, Hai-Feng

    2009-12-01

    To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography (MRA) and transcranial doppler ultrasonography (TCD) at the beginning of the study and after 12-month medication. During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication (27.5%) (P = 0.04). Furthermore, as a major side effect of antiplatelet therapy, the frequency of bleeding was much less in cilostazol group (0 case in cilostazol group vs 5 in aspirin, Ppreventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.

  2. Collared Pecary (tayassu tajacu) as a new model of renal ischemic injury induced by clamping the renal artery

    OpenAIRE

    Bezerra,Dayseanny de Oliveira; Feitosa,Matheus Levi Tajra; Almeida,Hatawa Melo de; Costa,Francisco Assis Lima; Braga,Juliana Fortes Vilarinho; Souza,Francisco de Assis Leite; Alves,Flávio Ribeiro; Pessoa,Gerson Tavares; Carvalho,Maria Acelina Martins de

    2014-01-01

    PURPOSE: The use of the collared peccary as an experimental model for ischemic nephropathy. METHODS: A total of 12 collared peccary (Tayassu tajacu) was used and ischemic nephropathy was induced in six of these animals that constituted the experimental group (G1) while the other six formed the control group (G2). Ischemic nephropathy was induced surgically by partial occlusion of the left renal artery. The disease course was assessed by hematological tests, serum chemistry, urinalysis, ultras...

  3. Arterial spin-labeled perfusion imaging to predict mismatch in acute ischemic stroke.

    Science.gov (United States)

    Niibo, Takeya; Ohta, Hajime; Yonenaga, Kazuma; Ikushima, Ichiro; Miyata, Shirou; Takeshima, Hideo

    2013-09-01

    We assigned a threshold to arterial spin-labeling (ASL) perfusion-weighted images (PWI) from patients with acute ischemic stroke and compared them with dynamic susceptibility contrast perfusion images to examine whether mismatch can be determined. Pseudocontinuous ASL was combined with dynamic susceptibility contrast PWI in 23 patients with acute ischemic stroke. Scans were obtained within 24 hours of symptom onset. PWI volumes were defined by ASL cerebral blood flow (10 s) that show a strong association with cerebral blood flow PWI and the baseline diffusion-weighted imaging lesion, respectively, and the final infarct volume were assessed. The lesion volumes defined by MTT>10 s and ASL10 s and ASLPWI lesions defined by ASL10 s. In acute ischemic stroke, PWI lesions based on ASL threshold of 10 s.

  4. Adenosine Preconditioning versus Ischemic Preconditioning in Patients undergoing Off-Pump Coronary Artery Bypass (OPCAB

    Directory of Open Access Journals (Sweden)

    SeyedKhalil Forouzannia

    2015-10-01

    Full Text Available Background: During off-pump coronary artery bypass (OPCAB, the heart is subjected to ischemic and reperfusion injury. Preconditioning is a mechanism that permits the heart to tolerate myocardial ischemia. The aim of this study was to compare the effects of Adenosine preconditioning with ischemic preconditioning on the global ejection fraction (EF in patients undergoing OPCAB.Methods: In this single-blind, randomized controlled trial, sixty patients undergoing OPCAB were allocated into three equally-numbered groups through simple randomization: Adenosine group, ischemic group, and control group. The patients in the Adenosine group received an infusion of Adenosine. In the ischemic group, ischemic preconditioning was induced by the temporary occlusion of the left anterior descending coronary artery twice for a 2-minute period, followed by 3-minute reperfusion before bypass grafting of the first coronary vessel. The control group received an intravenous infusion of 0.9% saline. Blood samples at different times were sent for the measurement of creatine kinase isoenzyme MB (CK-MB and cardiac troponin I (cTnI. We also recorded electrocardiographic indices and clinical parameters, including postoperative use of inotropic drugs and preoperative and postoperative EF.Results: History of myocardial infarction, hyperlipidemia, diabetes mellitus, kidney disease, preoperative arrhythmias, and utilization of postoperative inotrope was the same between the three groups. The incidence of postoperative arrhythmias was not significant between the three groups. Also, there were no significant differences in preoperative and postoperative EF and the serum levels of enzymes (cTnI and CK-MB between the groups.Conclusion: Based on the findings of this study, there was no significant difference in the postoperative EF between the groups. Although the incidence of arrhythmias was higher in the ischemic preconditioning group than in the other groups, the difference

  5. [Ischemic hepatitis in an 81 year old patient with congenitally corrected transposition of the great arteries].

    Science.gov (United States)

    Labeaga, R; Muniesa, M; Urbiola, E; Jiménez Bermejo, F; Urdánoz, C

    2005-01-01

    The congenitally corrected transposition of the great arteries is a rare form of congenital heart disease, with survival beyond the 6th decade of life being rare. Even more unusual is its presentation alone, without any other form of congenital heart disease. Ischemic hepatitis is a rare entity characterized by an elevation of transaminasas and a centrilobular necrosis due to a reduction in hepatic blood flow, generally of reversible evolution. The authors present a case of ischemic hepatitis in an 81-year-old patient with congenitally corrected transposition of the great arteries. The fatal evolution of the episode and the longevity of the patient are both notable. We comment on the clinical and diagnostic aspects of both entities.

  6. Childhood Antecedents to Adult Coronary Artery Diseases. Special Reference Briefs.

    Science.gov (United States)

    Winick, Myron

    This reference brief deals with the childhood antecedents to atherosclerosis and hypertension. While diet is related to the development of coronary artery diseases, there is some disagreement about what dietary changes are necessary or desirable in children to prevent their development, and at what age such changes should be made. Fifty-five…

  7. CDKN2B methylation is associated with carotid artery calcification in ischemic stroke patients

    OpenAIRE

    Shuyu Zhou; Yumeng Zhang; Li Wang; Zhizhong Zhang; Biyang Cai; Keting Liu; Hao Zhang; Minhui Dai; Lingli Sun; Xiaomeng Xu; Huan Cai; Xinfeng Liu; Guangming Lu; Gelin Xu

    2016-01-01

    Background Cyclin-dependent kinase inhibitor 2A/2B (CDKN2A/2B) near chromosome 9p21 have been associated with both atherosclerosis and artery calcification, but the underlying mechanisms remained largely unknown. Considering that CDKN2A/2B is a frequently reported site for DNA methylation, this study aimed to evaluate whether carotid artery calcification (CarAC) is related to methylation levels of CDKN2A/2B in patients with ischemic stroke. Methods DNA methylation levels of CDKN2A/2B were mea...

  8. Intra-arterial thrombolysis for acute ischemic stroke: Our institutional experience

    Directory of Open Access Journals (Sweden)

    R V Narayana

    2012-01-01

    Full Text Available Introduction: The standard treatment for acute ischemic stroke is intravenous (IV rtPA for patients who can reach the hospital within 3 to 4.5 h. There are case reports, where IA thrombolysis has helped patients in case an IV thrombolysis has failed. We report 14 cases of acute ischemic stroke treated by intra-arterial (IA thrombolysis. Materials and Methods: We have retrospectively analyzed 14 cases of acute ischemic stroke treated at our department between December 2008 and October 2011 by intra-arterial thrombolysis. The patients with suspected large vessel occlusion (11 patients and patients not responding to IV rtPA (3 patients were considered for the IA thrombolysis. Results: We achieved complete recanalization (TIMI 3 in 11 patients. One patient had a bleed following the procedure but recovered well during the hospital stay. All the patients were followed up to 90 days. Majority of them have good functional outcome. Conclusions: Our study suggests that intra-arterial thrombolysis is a feasible option in the subgroup of patients with large vessel occlusion. However, there is a need for a randomized multi-centric study to support our results.

  9. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Yu CS

    2016-03-01

    Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m

  10. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign.

    Science.gov (United States)

    Ichinose, Nobuhiko; Hama, Seiji; Tsuji, Toshio; Soh, Zu; Hayashi, Hideaki; Kiura, Yoshihiro; Sakamoto, Shigeyuki; Okazaki, Takahito; Ishii, Daizo; Shinagawa, Katsuhiro; Kurisu, Kaoru

    2017-07-07

    OBJECTIVE Carotid artery stenting (CAS) has been considered to prevent ischemic strokes caused by stenosis of the cervical carotid artery. The most common complication of CAS is new cerebral infarction. The authors have previously reported that the jellyfish sign-the rise and fall of the mobile component of the carotid plaque surface detected by carotid ultrasonography-suggests thinning and rupture of the fibrous cap over the unstable plaque content, such as the lipid-rich necrotic core or internal plaque hemorrhage. The authors' aim in the present study was to evaluate the risk of a new ischemic lesion after CAS by using many risk factors including calcification (size and location) and the jellyfish sign. METHODS Eighty-six lesions (77 patients) were treated with CAS. The presence of ischemic stroke was determined using diffusion-weighted imaging (DWI). Risk factors included calcification of the plaque (classified into 5 groups for size and 3 groups for location) and the jellyfish sign, among others. Multiple linear regression analysis (stepwise analysis and partial least squares [PLS] analysis) was conducted, followed by a machine learning analysis using an artificial neural network (ANN) based on the log-linearized gaussian mixture network (LLGMN). The additive effects of the jellyfish sign and calcification on ischemic stroke after CAS were examined using the Kruskal-Wallis test, followed by the Steel-Dwass test. RESULTS The stepwise analysis selected the jellyfish sign, proximal calcification (proximal Ca), low-density lipoprotein (LDL) cholesterol, and patient age for the prediction model to predict new DWI lesions. The PLS analysis revealed the same top 3 variables (jellyfish sign, proximal Ca, and LDL cholesterol) according to the variable importance in projection scores. The ANN was then used, showing that these 3 variables remained. The accuracy of the ANN improved; areas under the receiver operating characteristic curves of the stepwise analysis, the PLS

  11. Outcome of acute ischemic stroke after intra-arterial thrombolysis: A study from India.

    Science.gov (United States)

    Chaudhuri, Jaydip Ray; Kumar, Randhir; Umamahesh, Matapathi; Mridula, Kandadai Rukmini; Alladi, Suvarnal; Bandaru, Srinivasarao

    2016-10-07

    Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is the currently standard treatment of acute ischemic stroke within 4.5 hours of the onset of stroke. Recent studies have looked at the benefits of administration of intra-arterial (IA) rt-PA within 8 hours onset of symptoms. Our objective was to assess the outcome of stroke after administration of IA rt-PA in patients with acute ischemic stroke. Methods: We recruited 10 consecutive acute ischemic stroke patients with onset of stroke from 4.5 hours to 6.5 hours. The present study was conducted at Yashoda Hospital, Hyderabad, India, between January 2008 and December 2013. All patients underwent stroke subtyping and were administered rt-PA. We measured the thrombolysis in cerebral infarction (TICI) score after thrombolysis and functional outcomes at time of admission, after 24 hours, 30, 60, and 90 days. A good outcome was defined as modified Rankin Scale (mRS) ≤ 2 after 90 days. Results: Out of 10 patients 9 were men, mean age 56.3 ± 1.8 years and age range from 35-68 years. On stroke subtyping, 6 (60%) patients had large artery atherosclerosis, 3 (30%) had a stroke of indeterminate etiology and 1 (10%) had a stroke of other etiologies. Mean time of recanalization was 6.2 ± 0.5 hours, 7 (70%) patients showed major neurological improvement with a mRS score of ≤ 2 at 90 days and one patient was lost to follow-up. Conclusion: Our study established good outcome at 90 days after administration of IA thrombolysis rt-PA in acute ischemic stroke.

  12. Superselective intra-arterial fibrinolysis for acute cerebral ischemic infarct : usefulness of diffusion weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Woo Mok; Lee, Se Jin [Yeungnam Univ. College of Medicine, Kyongnam (Korea, Republic of); Kim, Yong Sun [Kyungpook National Univ. School of Medicine, Taegu (Korea, Republic of); Han, Gun Soo; Bae, Won Kyong [Chunan Hospital, Soonchunhang Univ., Asan (Korea, Republic of)

    1999-12-01

    To evaluate the efficacy of superselective intra-arterial fibrinolysis for acute cerebral stroke and the usefulness of pre-and postfibrinolysis diffusion-weighted MRI (DWI). In 41 patients with acute ischemic stroke whose treatment involved intra-arterial fibrinolysis, the occlusion site, degree of recanalization, and clinical results were compared. In 12 patients, diffusion weighted MRI was performed before fibrinolysis, and eight of these also underwent diffusion-weighted MRI after fibrinolysis. Using diffusion-weighted MRI, neurological outcomes were compared with signal intensity ratio (SIR, or the average signal intensity within the region of interest divided by that in the contralateral, nonischemic, homologous region). Twenty patients showed complete recanalization, nine partial recanalization, and in twelve there was no recanalization. Fourteen patients (34%) improved neurologically. No relationship existed between occlusion sites, degree of recanalization, and clinical outcome. Among 12 patients who underwent DWI before fibrinolysis, complete recanalization was noted in eight. Neurological improvement was seen in four patients with low SIR(<1.55), while in four with high SIR(>1.7), neurological outcome was poor despite complete recanalization. Although superselective intra-arterial fibrinolysis for acute cerebral stroke is a good therapeutic method for recanalization, the clinical outcome can be disappointing. We therefore suggest that in cases of acute cerebral ischemic infaret, SIR-as seen on DWI-might be useful for predicting the benefits of recanalization. In such cases, further investigation of the use of DWI prior to fibrinolysis is therefore needed.

  13. Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Arda [Mersin University, Department of Neurology, Faculty of Medicine, Mersin (Turkey); Akpinar, Erhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Topcuoglu, Mehmet Akif; Arsava, Ethem Murat [Hacettepe University, Department of Neurology, Faculty of Medicine, Ankara (Turkey)

    2015-05-01

    Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period. (orig.)

  14. The benefits of ASCOD phenotyping strategy in patients with Ischemic stroke with extracranial arteries atherosclerosis

    Directory of Open Access Journals (Sweden)

    E. K. Sidorovich

    2016-01-01

    Full Text Available As a result of ASCOD phenotyping of 238 ischemic stroke (IS patients with extracranial arteries atherosclerosis (AS versus TOAST it is determined that ASCOD is useful to assess the contribution of the ethiopathogenetic mechanisms (EPM and their combinations in development of IS including AS of low grades and subclinical microvascular complication that is important for development of strategies of phenotypeoriented therapy and preventive IS treatment.Combination of EPM with increase of total ASC score>5 is associated with decreaseof overall survival maybe taken into account when predicting IS outcomes.

  15. Intracarotid Sodium Nitroprusside on Fifth Post Ischemic Stroke Day in Middle Cerebral Artery Occlusion Rat Model.

    Science.gov (United States)

    Tewari, Vinod Kumar; Bhosale, Vivek; Shukla, Rakesh; Gupta, Hari Kishan Das; Sheeba

    2017-08-01

    Ischemic stroke at later stages (>4.5 hour) have very few treatment options left. In those cases Nitric Oxide (NO) may provide promising results. NO is active in signaling pathways. Sodium Nitroprusside (SNP), a NO donor was tested earlier in rat Middle Cerebral Artery Occlusion (MCAO) model in early stages (5-60 minutes) and found useful but in delayed stroke cases (60-120 minutes) found useless. This was due to local inducible Nitric Oxide Synthase Enzyme (iNOS) and superoxide (causes destructive effect) formation which was skipped. To evaluate the effect of Intracarotid Sodium Nitroprusside (ICSNP) in MCAO rat model of ischemic stroke (I/R model) fifth post ischemic stroke day. A total of 24 Sprague Dawley rats, weighing 250 gm to 280 gm, at CDRI-Lucknow, India were used. Rats were divided in three groups. Group A (n=4) were taken as sham with standard procedure but without any injection on fifth day, Group B (n=8) as control with injection of saline on fifth day and Group C (n=12) received SNP at dose of 3 mcg/kg/minute given directly in internal carotid artery via External Carotid Artery (ECA) with a modified intraluminal stump technique as Ischemia/Reperfusion (I/R) in ipsilateral MCAO at intracarotid artery region as a single dose therapy on fifth day and then wound was closed. Waited for full recovery for two hours, then neurobehavioural assessment scores were noted. Thereafter, the brains were quickly removed and sliced at 2 mm intervals. Animals showing no sign of neurological deficit, were excluded from the study. Tested animals were compared with control animals for neurological deficit, percentage of infarction by 2,3,5-Triphenyl Tetrazolium Chloride (TTC) staining, nNOS expression and scores were summed up. The statistical analysis was done by Newman-Keuls test, Graph Pad prism (version.5.0) and pgroup (Group C) showed a good reduction in the cerebral infarction of 53.42% as compared to control (Group B). Group A mean change in Newman-Keuls test and

  16. Correlation between ABCD, ABCD2 scores and craniocervical artery stenosis in patients with transient ischemic attack.

    Science.gov (United States)

    Sun, Wen; Dai, Jiafei; Xiong, Yunyun; Huang, Zhixin; Li, Yongkun; Liu, Wenhua; Zhu, Wusheng; Xu, Gelin; Liu, Xinfeng

    2013-01-01

    Craniocervical artery stenosis is an important etiology for transient ischemic attack (TIA). We hypothesized ABCD and ABCD2 scores can predict craniocervical artery stenosis in patients with TIA. ABCD and ABCD2 scores were calculated in a total of 479 consecutive first-ever TIA patients in Nanjing Stroke Registry Program and compared with angiographic imaging derived from MRI or invasive catheter-based angiography. Overall craniocervical artery (O-CA) stenosis was found in 197 (41.1%) patients. Extracranial craniocervical artery (E-CA) and intracranial craniocervical artery (I-CA) stenosis was found in 101 (21.1%) and 110 (23%) cases, respectively. ABCD and ABCD2 scores with similar accuracy for O-CA (AUCABCD 0.71, AUCABCD2 0.70), E-CA (AUCABCD 0.72, AUCABCD2 0.72) and I-CA stenosis (AUCABCD 0.62, AUCABCD2 0.62) were both independent predictors for various categories of artery stenosis after being adjusted for non-ABCD2 parameters. The cut-off points were equally 4 in both predicting rules. For ABCD, sensitivity was 57.4, 65.3 and 52.7% and specificity 77.0, 70.4 and 67.5% for O-CA/E-CA/I-CA, respectively. For ABCD2, sensitivity was 61.9, 69.3 and 58.2% and specificity 72.3, 65.6 and 63.1%. In patients with TIA, despite an association between ABCD and ABCD2 scores and underlying craniocervical artery stenosis, the clinical utility was limited by unsatisfactory sensitivity and specificity. Copyright © 2013 S. Karger AG, Basel.

  17. Association of childhood body mass index and change in body mass index with first adult ischemic stroke

    DEFF Research Database (Denmark)

    Gjærde, Line K.; Gamborg, Michael; Ängquist, Lars

    2017-01-01

    IMPORTANCE: The incidence of ischemic stroke among young adults is rising and is potentially due to an increase in stroke risk factors occurring at younger ages, such as obesity. OBJECTIVES: To investigate whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic...... of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.14; 95% CI, 1.06-1.23) and in men (HR, 1.10; 95% CI, 1.04-1.18). Adjusting for birth weight minimally affected the associations. CONCLUSIONS AND RELEVANCE: Independent of birth weight, above...

  18. Ischemic Colitis

    Science.gov (United States)

    ... supply blood to the colon are the superior mesenteric artery and the inferior mesenteric artery. Ischemic colitis occurs when blood flow to ... patterns of presentation, diagnosis, and management of colon ischemia (CI). American Journal of Gastroenterology. 2015;110:18. ...

  19. Association of Childhood Body Mass Index and Change in Body Mass Index With First Adult Ischemic Stroke.

    Science.gov (United States)

    Gjærde, Line K; Gamborg, Michael; Ängquist, Lars; Truelsen, Thomas C; Sørensen, Thorkild I A; Baker, Jennifer L

    2017-08-21

    The incidence of ischemic stroke among young adults is rising and is potentially due to an increase in stroke risk factors occurring at younger ages, such as obesity. To investigate whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and to assess whether the associations are age dependent or influenced by birth weight. This investigation was a population-based cohort study of schoolchildren born from 1930 to 1987, with follow-up through national health registers from 1977 to 2012 in Denmark. Participants were 307 677 individuals (8899 ischemic stroke cases) with measured weight and height at ages 7 to 13 years. The dates of the analysis were September 1, 2015, to May 27, 2016. Childhood BMI, change in BMI, and birth weight. Ischemic stroke events were divided into early (≤55 years) or late (>55 years) age at diagnosis. The study cohort comprised 307 677 participants (approximately 49% female and 51% male). During the study period, 3529 women and 5370 men experienced an ischemic stroke. At all ages from 7 to 13 years, an above-average BMI z score was positively associated with early ischemic stroke. At age 13 years, a BMI z score of 1 was associated with hazard ratios (HRs) of 1.26 (95% CI, 1.11-1.43) in women and 1.21 (95% CI, 1.10-1.33) in men. No significant associations were found for below-average BMI z scores. Among children with above-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.10; 95% CI, 1.01-1.20) and in men (HR, 1.08; 95% CI, 1.00-1.16). Similarly, among children with below-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.14; 95% CI, 1.06-1.23) and in men (HR, 1.10; 95% CI, 1.04-1.18). Adjusting for birth weight minimally affected the associations. Independent of birth weight, above

  20. Ischemic ulcers - self-care

    Science.gov (United States)

    ... ulcers - self-care; Arterial insufficiency ulcer self-care; Ischemic wounds - self-care; Peripheral artery disease - ulcer; Peripheral ... arteries ( atherosclerosis ) are the most common cause of ischemic ulcers. Clogged arteries prevent a healthy supply of ...

  1. CDKN2B methylation is associated with carotid artery calcification in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Shuyu Zhou

    2016-12-01

    Full Text Available Abstract Background Cyclin-dependent kinase inhibitor 2A/2B (CDKN2A/2B near chromosome 9p21 have been associated with both atherosclerosis and artery calcification, but the underlying mechanisms remained largely unknown. Considering that CDKN2A/2B is a frequently reported site for DNA methylation, this study aimed to evaluate whether carotid artery calcification (CarAC is related to methylation levels of CDKN2A/2B in patients with ischemic stroke. Methods DNA methylation levels of CDKN2A/2B were measured in 322 ischemic stroke patients using peripheral blood leukocytes. Methylation levels of 36 CpG sites around promoter regions of CDKN2A/2B were examined with BiSulfite Amplicon Sequencing. CarAC was quantified with Agatston score based on results of computed tomography angiography. Generalized liner model was performed to explore the association between methylation levels and CarAC. Results Of the 322 analyzed patients, 187 (58.1% were classified as with and 135 (41.9% without evident CarAC. The average methylation levels of CDKN2B were higher in patents with CarAC than those without (5.7 vs 5.4, p = 0.001. After adjustment for potential confounders, methylation levels of CDKN2B were positively correlated with cube root transformed calcification scores (β = 0.591 ± 0.172, p = 0.001 in generalized liner model. A positive correlation was also detected between average methylation levels of CDKN2B and cube root transformed calcium volumes (β = 0.533 ± 0.160, p = 0.001. Conclusions DNA methylation of CDKN2B may play a potential role in artery calcification.

  2. Bypass versus endovascular intervention for healing ischemic foot wounds secondary to tibial arterial disease.

    Science.gov (United States)

    Mohapatra, Abhisekh; Henry, Jon C; Avgerinos, Efthimios D; Boitet, Aureline; Chaer, Rabih A; Makaroun, Michel S; Leers, Steven A; Hager, Eric S

    2018-01-11

    Pedal (inframalleolar) bypass is a long-standing therapy for tibial arterial disease in patients with ischemic tissue loss. Endovascular tibial intervention is an appealing alternative with lower risks of perioperative mortality or complications. Our objective was to compare the effectiveness of these two treatment modalities with respect to patency and limb-related clinical outcomes. We performed a retrospective chart review of patients presenting between 2006 and 2013 with ischemic foot wounds and infrapopliteal arterial disease who underwent a revascularization procedure (either open surgical bypass to an inframalleolar target or endovascular tibial intervention). Data were collected on baseline demographics and comorbidities, procedural details, and postprocedure outcomes. The primary outcome was successful healing of the index wound, with mortality, major amputation, and patency assessed as secondary outcomes. We identified 417 patients who met our eligibility criteria; 105 underwent surgical bypass and 312 underwent endovascular intervention, with mean follow-up of 25.0 and 20.2 months, respectively (P = .08). The endovascular patients were older at baseline (P = .009), with higher rates of hyperlipidemia (P = .02), prior cerebrovascular accidents (P = .04), and smoking history (P = .04). Within 30 days postoperatively, there was no difference in mortality (P = .31), but bypass patients had longer hospital length of stay (P bypass group compared with 29.0% in the endovascular group (P = .02). At 1 year, survival was higher after bypass (86.2% vs 70.4%; P bypass group, but there was no difference in secondary patency (77.3% vs 73.8%; P = .13). Endovascular tibial intervention is associated with poorer primary patency but similar secondary patency and wound healing rates compared with the "gold standard" of surgical bypass to a pedal target. In patients with tibial arterial disease, endovascular intervention should be considered a lower risk

  3. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke

    NARCIS (Netherlands)

    Treurniet, K.M.; Yoo, A.J.; Berkhemer, O.A.; Lingsma, H.F.; Boers, A.M.; Fransen, P.S.; Beumer, D.; Berg, L.A. van den; Sprengers, M.E.; Jenniskens, S.F.M.; Lycklama, A.N.G.J.; Walderveen, M.A. van; Bot, J.C.; Beenen, L.F.; Berg, R. van den; Zwam, W.H. van; Lugt, A. van der; Oostenbrugge, R.J. van; Dippel, D.W.; Roos, Y.B.; Marquering, H.A.; Majoie, C.B.; Dijk, E.J. van; Vries, J. de

    2016-01-01

    BACKGROUND AND PURPOSE: A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation

  4. Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woo Jin; Choi, Hyun Seok; Jang, Jinhee; Sung, Jinkyeong; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Kim, Tae-Won; Koo, Jaseong [The Catholic University of Korea, Department of Neurology, College of Medicine, Seoul (Korea, Republic of); Shin, Yong Sam [The Catholic University of Korea, Department of Neurosurgery, College of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    The aim of this study is to evaluate the degree of atherosclerotic changes in intracranial arteries by assessing arterial wall thickness using T1-weighted 3D-turbo spin echo (3D-TSE) and time-of-flight MR angiography (TOF-MRA) in patients with acute ischemic stroke as compared with unaffected controls. Thirty-three patients with acute ischemic stroke and 36 control patients were analyzed. Acute ischemic stroke patients were divided according to TOAST classification. At both distal internal carotid arteries and basilar artery without stenosis, TOF-MRA was used to select non-stenotic portion of assessed arteries. 3D-TSE was used to measure the area including the lumen and wall (Area{sub Outer}) and luminal area (Area{sub Inner}). The area of the vessel wall (Area{sub VW}) of assessed intracranial arteries and the ratio index (RI) of each patient were determined. Area{sub Inner}, Area{sub Outer}, Area{sub VW}, and RI showed good inter-observer reliability and excellent intra-observer reliability. Area{sub Inner} did not significantly differ between stroke patients and controls (P = 0.619). However, Area{sub Outer}, Area{sub VW}, and RI were significantly larger in stroke patients (P < 0.001). The correlation coefficient between Area{sub Inner} and Area{sub Outer} was higher in the controls (r = 0.918) than in large vessel disease patients (r = 0.778). RI of large vessel disease patients was significantly higher than that of normal control, small vessel disease, and cardioembolic groups. In patients with acute ischemic stroke, wall thickening and positive remodeling are evident in non-stenotic intracranial arteries. This change is more definite in stroke subtype that is related to atherosclerosis than that in other subtypes which are not. (orig.)

  5. Clinical Predictors of Attention and Executive Functioning Outcomes in Children After Perinatal Arterial Ischemic Stroke.

    Science.gov (United States)

    Bosenbark, Danielle D; Krivitzky, Lauren; Ichord, Rebecca; Vossough, Arastoo; Bhatia, Aashim; Jastrzab, Laura E; Billinghurst, Lori

    2017-04-01

    Children with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet the clinical predictors of these outcomes are understudied. We examined the influence of clinical and infarct characteristics on attention and executive functioning in children following PAIS. Forty children born at term (≥37 weeks' gestation) with PAIS (28 with neonatal arterial ischemic stroke and 12 with presumed PAIS) underwent a comprehensive neuropsychological battery at age three to 16 years (median age 7.2 years; 58% male) to assess attention and executive functioning. Parents also completed questionnaires regarding real-world functioning. Clinical variables including perinatal stroke subtype, infarct characteristics (location, laterality, and volume), and the presence of comorbid epilepsy were ascertained from the medical record. Presumed PAIS, larger infarct volume, and comorbid epilepsy negatively influenced the performance on attention and executive functioning measures. These clinical variables were also associated with greater functional problems on parent reports, including a higher frequency of attention-deficit/hyperactivity disorder symptoms and greater difficulties in some subdomains of executive functioning. Infarct location and laterality were not associated with performance measures or parental report of functioning. Although all children with PAIS are at risk for later deficits in attention and executive functioning, those with presumed PAIS, larger infarct size, and comorbid epilepsy appear to be the most vulnerable. As they approach and reach school age, these children should undergo neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioral strategies. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications.

    Science.gov (United States)

    Payabvash, Seyedmehid; Taleb, Shayandokht; Benson, John C; Hoffman, Benjamin; Oswood, Mark C; McKinney, Alexander M; Rykken, Jeffrey B

    2017-07-01

    Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.

  7. Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting: A Proof-of-Concept, Randomized Controlled Trial.

    Science.gov (United States)

    Zhao, Wenbo; Meng, Ran; Ma, Chun; Hou, Baojun; Jiao, Liqun; Zhu, Fengshui; Wu, Weijuan; Shi, Jingfei; Duan, Yunxia; Zhang, Renling; Zhang, Jing; Sun, Yongxin; Zhang, Hongqi; Ling, Feng; Wang, Yuping; Feng, Wuwei; Ding, Yuchuan; Ovbiagele, Bruce; Ji, Xunming

    2017-04-04

    Remote ischemic preconditioning (RIPC) can inhibit recurrent ischemic events effectively in patients with acute or chronic cerebral ischemia. However, it is still unclear whether RIPC can impede ischemic injury after carotid artery stenting (CAS) in patients with severe carotid artery stenosis. Subjects with severe carotid artery stenosis were recruited in this randomized controlled study, and assigned to RIPC, sham, and no intervention (control) groups. All subjects received standard medical therapy. Subjects in the RIPC and sham groups underwent RIPC and sham RIPC twice daily, respectively, for 2 weeks before CAS. Plasma neuron-specific enolase and S-100B were used to evaluate safety, hypersensitive C-reactive protein, and new ischemic diffusion-weighted imaging lesions were used to determine treatment efficacy. The primary outcomes were the presence of ≥1 newly ischemic brain lesions on diffusion-weighted imaging within 48 hours after stenting and clinical events within 6 months after stenting. We randomly assigned 189 subjects in this study (63 subjects in each group). Both RIPC and sham RIPC procedures were well tolerated and completed with high compliance (98.41% and 95.24%, respectively). Neither plasma neuron-specific enolase levels nor S-100B levels changed significantly before and after treatment. No severe adverse event was attributed to RIPC and sham RIPC procedures. The incidence of new diffusion-weighted imaging lesions in the RIPC group (15.87%) was significantly lower than in the sham group (36.51%; relative risk, 0.44; 96% confidence interval, 0.20-0.91; P<0.01) and the control group (41.27%; relative risk, 0.39; 96% confidence interval, 0.21-0.82; P<0.01). The volumes of lesions were smaller in the RIPC group than in the control and sham groups (P<0.01 each). Ischemic events that occurred after CAS were 1 transient ischemic attack in the RIPC group, 2 strokes in the control group, and 2 strokes and 1 transient ischemic attack in the sham group

  8. Remote ischemic preconditioning prevents reduction in brachial artery flow-mediated dilation after strenuous exercise.

    Science.gov (United States)

    Bailey, Tom G; Birk, Gurpreet K; Cable, N Timothy; Atkinson, Greg; Green, Daniel J; Jones, Helen; Thijssen, Dick H J

    2012-09-01

    Strenuous exercise is associated with an immediate decrease in endothelial function. Repeated bouts of ischemia followed by reperfusion, known as remote ischemic preconditioning (RIPC), is able to protect the endothelium against ischemia-induced injury beyond the ischemic area. We examined the hypothesis that RIPC prevents the decrease in endothelial function observed after strenuous exercise in healthy men. In a randomized, crossover study, 13 healthy men performed running exercise preceded by RIPC of the lower limbs (4 × 5-min 220-mmHg bilateral occlusion) or a sham intervention (sham; 4 × 5-min 20-mmHg bilateral occlusion). Participants performed a graded maximal treadmill running test, followed by a 5-km time trial (TT). Brachial artery endothelial function was examined before and after RIPC or sham, as well as after the 5-km TT. We measured flow-mediated dilation (FMD), an index of endothelium-dependent function, using high-resolution echo-Doppler. We also calculated the shear rate area-under-the-curve (from cuff deflation to peak dilatation; SR(AUC)). Data are described as mean and 95% confidence intervals. FMD changed by 0.30). In the sham trial, FMD changed from 5.1 (4.4-5.9) to 3.7% (2.6-4.8) following the 5-km TT (P = 0.02). In the RIPC trial, FMD changed negligibly from 5.4 (4.4-6.4) post-IPC and 5.7% (4.6-6.8) post 5-km TT (P = 0.60). Baseline diameter, SR(AUC), and time-to-peak diameter were all increased following the 5-km TT (P < 0.05), but these changes did not influence the IPC-mediated maintenance of FMD. In conclusion, these data indicate that strenuous lower-limb exercise results in an acute decrease in brachial artery FMD of ~1.4% in healthy men. However, we have shown for the first time that prior RIPC of the lower limbs maintains postexercise brachial artery endothelium-dependent function at preexercise levels.

  9. Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke.

    Science.gov (United States)

    Ji, Ya-Bin; Wu, Yong-Ming; Ji, Zhong; Song, Wei; Xu, Sui-Yi; Wang, Yao; Pan, Su-Yue

    2012-07-01

    Intracarotid artery cold saline infusion (ICSI) is an effective method for protecting brain tissue, but its use is limited because of undesirable secondary effects, such as severe decreases in hematocrit levels, as well as its relatively brief duration. In this study, the authors describe and investigate the effects of a novel ICSI pattern (interrupted ICSI) relative to the traditional method (uninterrupted ICSI). Ischemic strokes were induced in 85 male Sprague-Dawley rats by occluding the middle cerebral artery for 3 hours using an intraluminal filament. Uninterrupted infusion groups received an infusion at 15 ml/hour for 30 minutes continuously. The same infusion speed was used in the interrupted infusion groups, but the whole duration was divided into trisections, and there was a 20-minute interval without infusion between sections. Forty-eight hours after reperfusion, H & E and silver nitrate staining were utilized for morphological assessment. Infarct sizes and brain water contents were determined using H & E staining and the dry-wet weight method, respectively. Levels of neuron-specific enolase (NSE), S100β protein, and matrix metalloproteinase 9 (MMP-9) in the serum were determined using enzyme-linked immunosorbent assay. Neurological deficits were also evaluated. Histology showed that interrupted ICSI did not affect neurons or fibers in rat brains, which suggests that this method is safe for brain tissues with ischemia. The duration of hypothermia induced by interrupted ICSI was longer than that induced via the traditional method, and the decrease in hematocrit levels was less pronounced. There were no differences in infarct size or brain water content between uninterrupted and interrupted ICSI groups, but neuron-specific enolase and matrix metalloproteinase 9 serum levels were more reduced after interrupted ICSI than after the traditional method. Interrupted ICSI is a safe method. Compared with traditional ICSI, the interrupted method has a longer

  10. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Woranan Kirisattayakul

    2013-01-01

    Full Text Available The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  11. Arterial spin-labelling perfusion MRI and outcome in neonates with hypoxic-ischemic encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Vis, Jill B. de; Hendrikse, Jeroen [University Medical Center Utrecht, Department of Radiology, HP E 01.132, P.O. Box 85500, Utrecht (Netherlands); Petersen, Esben T. [University Medical Center Utrecht, Department of Radiology, HP E 01.132, P.O. Box 85500, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiotherapy, Utrecht (Netherlands); Vries, Linda S. de; Bel, Frank van; Alderliesten, Thomas; Negro, Simona; Groenendaal, Floris; Benders, Manon J.N.L. [Wilhelmina Children' s Hospital/University Medical Center Utrecht, Department of Neonatology, Utrecht (Netherlands)

    2015-01-15

    Hyperperfusion may be related to outcome in neonates with hypoxic-ischemic encephalopathy (HIE). The purpose of this study was to evaluate whether arterial spin labelling (ASL) perfusion is associated with outcome in neonates with HIE and to compare the predictive value of ASL MRI to known MRI predictive markers. Twenty-eight neonates diagnosed with HIE and assessed with MR imaging (conventional MRI, diffusion-weighted MRI, MR spectroscopy [MRS], and ASL MRI) were included. Perfusion in the basal ganglia and thalami was measured. Outcome at 9 or 18 months of age was scored as either adverse (death or cerebral palsy) or favourable. The median (range) perfusion in the basal ganglia and thalami (BGT) was 63 (28-108) ml/100 g/min in the neonates with adverse outcome and 28 (12-51) ml/100 g/min in the infants with favourable outcome (p < 0.01). The area-under-the-curve was 0.92 for ASL MRI, 0.97 for MRI score, 0.96 for Lac/NAA and 0.92 for ADC in the BGT. The combination of Lac/NAA and ASL MRI results was the best predictor of outcome (r {sup 2} = 0.86, p < 0.001). Higher ASL perfusion values in neonates with HIE are associated with a worse neurodevelopmental outcome. A combination of the MRS and ASL MRI information is the best predictor of outcome. (orig.)

  12. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

    Science.gov (United States)

    Wattanathorn, Jintanaporn; Tong-Un, Terdthai; Muchimapura, Supaporn; Wannanon, Panakaporn; Jittiwat, Jinatta

    2013-01-01

    The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g) once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO) and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration. PMID:24367723

  13. Correlation of Folic Intake and Internal Carotid Artery Intima-Media Thickness Changes In Post Ischemic Stroke Patients

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    Dodik Tugasworo

    2015-03-01

    Full Text Available The thickness of the carotid artery intima media / intima-media thickness (IMT is one of atherosclerosis markers. Atherosclerosis is one of the causes of ischemic stroke. Some studies suggest that low folate intake is predicted to affect the atherosclerotic process, but this remains controversial. Our objective is to analyze the relationship between folate intake with changes in the internal carotid artery IMT after ischemic stroke patients.The study is one group pretest posttest design with 72 post ischemic stroke subjects from neurology polyclinic of Kariadi Hospital, from June to December 2013. Folate intake was measured by Food Frequency Questionnaire and the internal carotid artery IMT by duplex ultrasonography. Measurements were taken at two periods with 6 months interval. Other factors that affect atherosclerosis consisting of age, obesity, hypertension, dyslipidemia, diabetes mellitus. The analysis in this study using Spearman correlation, chi-square and logistic regression. Resultwas significant if the p value were <0.05.There were 44 male subjects (61.1% and 28 female subjects (38.9%. The mean age was 61.6 (SD = 7.99 years. The mean intake of folate was 178.10 (SD = 38.875 mg / day. Median serum folic acid level 8.43 (4.96 to 55.01 NML / L. The mean change in ICA IMT was 0.10 (SD = 0.156 mm. Folate intake was not correlated with serum levels of folic acid. Serum folic acid levels are not correlated with changes in the internal carotid artery IMT. There was correlation between the risk factors of age, BMI, hypertension, diabetes and dyslipidemia with changes in the internal carotid artery IMT.

  14. Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease.

    Science.gov (United States)

    Bonaca, Marc P; Bhatt, Deepak L; Storey, Robert F; Steg, Ph Gabriel; Cohen, Marc; Kuder, Julia; Goodrich, Erica; Nicolau, José C; Parkhomenko, Alexander; López-Sendón, José; Dellborg, Mikael; Dalby, Anthony; Špinar, Jindřich; Aylward, Philip; Corbalán, Ramón; Abola, Maria Teresa B; Jensen, Eva C; Held, Peter; Braunwald, Eugene; Sabatine, Marc S

    2016-06-14

    Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with prior myocardial infarction (MI). This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI. PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke) and major adverse limb events (MALE) (defined as acute limb ischemia or peripheral revascularization for ischemia) were recorded in follow-up. A total of 1,143 patients (5%) had known PAD. In the placebo arm, those with PAD (n = 404) had higher rates of MACE at 3 years than those without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after adjusting for baseline differences (adjusted hazard ratio: 1.60; 95% confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures (9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with ticagrelor was consistent, regardless of PAD, patients with PAD had a greater absolute risk reduction of 4.1% (number needed to treat: 25) due to their higher absolute risk. The absolute excess of TIMI major bleeding was 0.12% (number needed to harm: 834). The 60-mg dose had particularly favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence interval: 0.44 to 0.95; p = 0.026). Among stable patients with prior MI, those with concomitant PAD have heightened ischemic

  15. Transcriptomics and proteomics analyses of the PACAP38 influenced ischemic brain in permanent middle cerebral artery occlusion model mice

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    Hori Motohide

    2012-11-01

    Full Text Available Abstract Introduction The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP is considered to be a potential therapeutic agent for prevention of cerebral ischemia. Ischemia is a most common cause of death after heart attack and cancer causing major negative social and economic consequences. This study was designed to investigate the effect of PACAP38 injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO along with corresponding SHAM control that used 0.9% saline injection. Methods Ischemic and non-ischemic brain tissues were sampled at 6 and 24 hours post-treatment. Following behavioral analyses to confirm whether the ischemia has occurred, we investigated the genome-wide changes in gene and protein expression using DNA microarray chip (4x44K, Agilent and two-dimensional gel electrophoresis (2-DGE coupled with matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS, respectively. Western blotting and immunofluorescent staining were also used to further examine the identified protein factor. Results Our results revealed numerous changes in the transcriptome of ischemic hemisphere (ipsilateral treated with PACAP38 compared to the saline-injected SHAM control hemisphere (contralateral. Previously known (such as the interleukin family and novel (Gabra6, Crtam genes were identified under PACAP influence. In parallel, 2-DGE analysis revealed a highly expressed protein spot in the ischemic hemisphere that was identified as dihydropyrimidinase-related protein 2 (DPYL2. The DPYL2, also known as Crmp2, is a marker for the axonal growth and nerve development. Interestingly, PACAP treatment slightly increased its abundance (by 2-DGE and immunostaining at 6 h but not at 24 h in the ischemic hemisphere, suggesting PACAP activates neuronal defense mechanism early on. Conclusions This study provides a detailed inventory of PACAP influenced gene expressions

  16. Polymorphism in the methylenetetrahydrofolate reductase (C677T) gene and homocysteine levels: a comparison in Brazilian patients with coronary arterial disease, ischemic stroke and peripheral arterial obstructive disease.

    Science.gov (United States)

    Sabino, Adriano; Fernandes, Ana Paula; Lima, Luciana Moreira; Ribeiro, Daniel Dias; Sousa, Marinez Oliveira; de Castro Santos, Maria Elizabeth Rennó; Mota, Ana Paula Lucas; Dusse, Luci Maria Sant'Ana; das Graças Carvalho, Maria

    2009-01-01

    This study aimed to compare plasma levels of total homocysteine (tHcy) in different arterial events as well as to investigate an association between homocysteine levels and C677T polymorphism in Brazilian patients. A total of 145 subjects were enrolled in this study including 43 patients with coronary arterial disease (CAD), 21 with ischemic stroke (IS), 44 with peripheral arterial obstructive disease (PAOD) and 37 control subjects. A preliminary analysis showed significant difference for tHcy plasma levels between patients with CAD (P = 0.003) or PAOD (P = 0.03) compared to controls. However, after adjustment for sex, age, total cholesterol, LDL, diabetes, tabagism or C677T polymorphism, no significant differences were detected in tHcy levels among patients groups and controls. No significant correlation was demonstrated for C677T polymorphism and homocysteine levels. These results indicate that increased Hcy levels may not be considered an independent risk factor for atherothrombotic diseases in Brazilian patients.

  17. Change of hepatic arterial systolic/diastolic ratio predicts ischemic type biliary lesion after orthotropic liver transplantation.

    Science.gov (United States)

    Zhang, Haiming; Shi, Yuexian; Wu, Hongtao; Chen, Guang; Tang, Ying; Liu, Lei; Zhu, Zhijun

    2016-01-01

    We conducted this prospective nested case-control study for the hepatic artery and portal vein hemodynamic changes after orthotopic liver transplantation. A total 128 cases of orthotropic liver transplantation were analyzed, including 25 cases of ischemic type biliary lesions (ITBL). The portal vein and hepatic artery flow velocities were detected by ultrasound on days 28, 42, and 84 after liver transplantation. In the GLM analysis of Lg(S/D), the P values of Group Effect, Time Effect, and Time×Group were 0.014, 0.376, and 0.008, respectively. Our results show a relatively reduced hepatic artery S/D in ITBL, especially in extrahepatic ITBL. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Calcifications of Vertebrobasilar Arteries on CT: Detailed Distribution and Relation to Risk Factors in 245 Ischemic Stroke Patients

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    Slaven Pikija

    2013-01-01

    Full Text Available Introduction. Intracranial atherosclerosis is responsible for a substantial proportion of strokes worldwide but its detailed morphology in the vertebrobasilar arteries (VBA is unknown. Subject and Methods. Cases with ischemic strokes were retrospectively sought from the hospital database. Native CT scans were assessed for vessel area and intracranial artery calcifications (ICACs in VBA. The calcifications were classified as focal (FCs, crescent, and circular. Results. 245 patients (mean age: years, 57.6% females had visible ICACs. Calcifications were found in 75.9%, 63.3%, and 17.1% in the left vertebral artery (LVA, the right vertebral artery (RVA, and the basilar artery (BA, respectively. FCs were present in 91.0%, 90.3%, and 100.0%; crescents in 30.3%, 29.0%, and 7.1%, and circulars in 6.4%, 4.8%, and 0.0% of the RVA, LVA, and BA, respectively. FCs in dorsolateral quadrant were least prevalent in both vertebral arteries (VAs: 46 (29.8% and 46 (27.4% for RVA and LVA, respectively. Risk factors associated with vertical dispersion of ICACs were male gender (OR : 2.69, 1.38–5.28 and diabetes (OR : 2.28, 1.04–4.99. Conclusions. FCs in VAs are least prevalent in dorsolateral quadrants. The vertical dispersion of ICACs seems to be associated with the male gender and diabetes.

  19. Outcomes of emergent carotid artery stenting within 6 hours of symptom onset in patients with acute ischemic stroke

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    Jeong, Won Gi; Yoon, Woong; Yim, Nam Yeol; Jung, Min Young; Jung, Se Hee; Kang, Heoung Keun [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2013-08-15

    To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke. Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions. Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months. Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

  20. Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.

    Science.gov (United States)

    Aytac, Emrah; Gürkaş, Erdem; Akpinar, Cetin Kursad; Saleem, Muhammad A; Qureshi, Adnan I

    2017-10-01

    To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA). Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000). We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  1. Influential factors of clinical outcome of local intra-arterial thrombolysis using urokinase in patients with hyperacute ischemic stroke

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    Song, Jae Min; Yoon, Woong; Kim, Jae Kyu; Seo, Jeong Jin; Heo, Sook Hee; Park, Jin Gyoon; Jeong, Yoon Yeon; Kang, Heoung Keun [Chonam University Hospital, Kwangju (Korea, Republic of)

    2002-10-01

    To evaluate the clinical outcome and other relevant factors in cases where local intra-arterial thrombolysis (LIT) is used for the treatment of hyperacute ischemic stroke. Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the national institutes of health stroke scale (NIHSS) score was used. Angiography recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.

  2. Analyzing Circle of Willis blood flow in ischemic stroke patients through 3D Stroke Arterial Flow Estimation.

    Science.gov (United States)

    Chien, Aichi; Viñuela, Fernando

    2017-08-01

    Background The objective of ischemic stroke (IS) treatment is to achieve revascularization in cerebral arteries to restore blood flow. However, there is no available method to extract arterial flow data from clinical CTA images. We developed 3D Stroke Arterial Flow Estimation (SAFE), which provides blood flow data throughout the Circle of Willis based on 3D CTA and allows comparison of arterial flow distribution in the brain. Methods We implemented a newly developed 3D vascular reconstruction algorithm for clinical stroke CTA images. Based on the patient-specific vascular structure, SAFE calculates time-resolved blood flow information for the entire Circle of Willis and allows quantitative flow study of IS cases. Clinical IS cases are presented to demonstrate the feasibility. Four patients with CTA images and CT perfusion data were studied. To validate the SAFE analysis, correlation analysis comparing blood flow at the MCA, ICA, and BA was performed. Results Different blood flow patterns were found in individual IS patients. Altered flow patterns and high collateral flow rates were found near occlusions in all cases. Quantitative comparison of blood flow data showed that SAFE obtained flow data and CTP were significantly correlated and provide complementary information about cerebral blood flow for individual patients. Conclusions We present SAFE analysis for collecting detailed time-resolved cerebral arterial flow data in the entire Circle of Willis for IS. Further study with more cases may be important to test the clinical utilization of SAFE and helpful to the study of the underlying hemodynamics of stroke.

  3. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only difference between a stroke ...

  4. Correlation between transient ischemic dilatation (TID) and coronary artery disease in Saudi male patients.

    Science.gov (United States)

    Aldhilan, Asim; Syed, Ghulam M S; Suleiman, Ihab; Al Zaibag, M; Fielding, Henry

    2014-01-01

    A high transient ischemic dilatation ratio (TID) for the left ventricle (LV) from a gated myocardial perfusion imaging (G-MPI) study is widely believed to be associated with significant coronary artery disease (CAD). We have investigated the relationship between TID and CAD for our male Saudi Arabian patient population. In this retrospective study, all male Saudi Arabian patients who underwent a two-day G-MPI study using Tc99m MIBI during the year 2011 having a TID ⩾ 1.20 were included. Quantitative perfusion and gated parameters were obtained using Cedar Sinai's AutoQuant software version 3.0, 2003, Means of summed stress scores, summed rest scores and summed difference scores (SSS, SRS, SDS, respectively), stress and rest ejection fraction (EF) were calculated. Visual interpretation was performed to classify the perfusion as normal, fixed, mixed (fixed and reversible defects), single reversible or multiple reversible defects. Coronary angiograms were assessed as normal with no CAD, single vessel, two-vessel or three-vessel disease. Correlations between the TID and other parameters were studied using analysis of variance (ANOVA) with IBM-SPSS version 20. A total of 52 male patients had a high TID of ⩾1.20 (mean 1.30 ± 0.13). Ten patients had a SSS of 0-3 and 16 were classified as normal by visual assessment. Stress EF (mean 50.4 ± 12%) was lower than the rest EF (mean 56.6 ± 12.8%) with the difference being statistically significant (Students paired t-test, p = 0.001). Angiography results were available in 44 patients, 3 having a normal angiogram, 24 having three vessel disease, 7 having two vessel disease and 10 having one vessel disease. Five patients with normal perfusion and SSS = 0-3 had CAD as seen on a coronary angiography. CAD on coronary angiography showed a significant correlation with perfusion abnormalities as assessed by visual interpretation (p = 0.002). TID showed a significantly correlation with both perfusion abnormalities (p

  5. Evaluation of Left Ventricular Dyssynchrony after Coronary Artery Bypass Grafting in Patients with Ischemic Left Ventricular Dysfunction

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    MA Babaee Beigi

    2009-12-01

    Full Text Available Background: Ischemic left ventricular (LV dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%. Echocardiography with Tissue Doppler Imaging (TDI was performed to assess LV dyssynchrony (calculated by basal LV segment,to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em ,systolic function by measurement of peak early systolic mitral annular velocity (Sm and Ejection Fraction (EF by Simpson method.Results: Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04.There was also improved diastolic and systolic function after CABG ( Em 0.04m/s versus 0.05 m/s , P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01.The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01.Conclusion: CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

  6. [Perioperative intensive statin therapy improves outcomes in patients with ischemic stroke undergoing middle cerebral artery stent implantation].

    Science.gov (United States)

    Gao, Ju-Hua; Gao, Xiao-Ping; Pan, Su-Yue

    2016-03-01

    To investigate whether intensive statin therapy during the perioperative period improves outcomes in patients undergoing middle cerebral artery (MCA) stent implantation for ischemic stroke. Forty patients with ischemic stroke undergoing delayed stent implantation in our department from January, 2010 to November, 2014 were randomized to intensive statin group (atorvastatin, 80 mg/day, 3 days before till 3 days after intervention; n=20) and standard therapy group (atorvastatin, 20 mg/day, n=20). All the patients received long-term atorvastatin treatment thereafter (20 mg/day). Serum levels of C-reactive protein (CRP), vascular cell adhesion molecule-1 (VCAM-1), and soluble extracellular matrix metalloproteinase inducer (EMMPRIN/CD147) were measured at 24 h before and 24 h after the intervention. The primary end point was procedure-related intra-stent thrombosis, 1-month incidence of major adverse cerebrovascular events (stroke, transient ischemic attack, in-stent restenosis, death or unplanned revascularization). The basic clinical data were similar between the two groups before the intervention (P>0.05). In the intensive therapy group, the levels of CRP, VCAM-1, and sCD147 were significantly lower at 24 h after the intervention than the levels before intervention (Ptherapy group (Ptherapy group (P>0.05). The incidence of primary end point was lower in intensive therapy group than in standard therapy group (Pintensive statin therapy improves the patients' outcomes, reduces the levels of CRP, VCAM-1 and sCD147 molecules, and lowers the incidences of cerebrovascular events.

  7. Change apparent diffusion coefficient immediately after recanalization through intra-arterial revascularization therapy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Ji Eun; Yeom, Joeng A; Kim, Young Soo; Yoon, Chang Hyo; Park, Min Gyu; Park, Kyung Pil; Baik, Seung Kug [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2016-04-15

    Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm{sup 2}/sec, and increased to 619.08 × 10-6 mm{sup 2}/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

  8. Arterial Obstruction on Computed Tomographic or Magnetic Resonance Angiography and Response to Intravenous Thrombolytics in Ischemic Stroke.

    Science.gov (United States)

    Mair, Grant; von Kummer, Rüdiger; Adami, Alessandro; White, Philip M; Adams, Matthew E; Yan, Bernard; Demchuk, Andrew M; Farrall, Andrew J; Sellar, Robin J; Sakka, Eleni; Palmer, Jeb; Perry, David; Lindley, Richard I; Sandercock, Peter A G; Wardlaw, Joanna M

    2017-02-01

    Computed tomographic angiography and magnetic resonance angiography are used increasingly to assess arterial patency in patients with ischemic stroke. We determined which baseline angiography features predict response to intravenous thrombolytics in ischemic stroke using randomized controlled trial data. We analyzed angiograms from the IST-3 (Third International Stroke Trial), an international, multicenter, prospective, randomized controlled trial of intravenous alteplase. Readers, masked to clinical, treatment, and outcome data, assessed prerandomization computed tomographic angiography and magnetic resonance angiography for presence, extent, location, and completeness of obstruction and collaterals. We compared angiography findings to 6-month functional outcome (Oxford Handicap Scale) and tested for interactions with alteplase, using ordinal regression in adjusted analyses. We also meta-analyzed all available angiography data from other randomized controlled trials of intravenous thrombolytics. In IST-3, 300 patients had prerandomization angiography (computed tomographic angiography=271 and magnetic resonance angiography=29). On multivariable analysis, more extensive angiographic obstruction and poor collaterals independently predicted poor outcome (Pangiography findings and alteplase effect on Oxford Handicap Scale (P≥0.075) in IST-3. In meta-analysis (5 trials of alteplase or desmoteplase, including IST-3, n=591), there was a significantly increased benefit of thrombolytics on outcome (odds ratio>1 indicates benefit) in patients with (odds ratio, 2.07; 95% confidence interval, 1.18-3.64; P=0.011) versus without (odds ratio, 0.88; 95% confidence interval, 0.58-1.35; P=0.566) arterial obstruction (P for interaction 0.017). Intravenous thrombolytics provide benefit to stroke patients with computed tomographic angiography or magnetic resonance angiography evidence of arterial obstruction, but the sample was underpowered to demonstrate significant treatment

  9. Comparison of classification methods for voxel-based prediction of acute ischemic stroke outcome following intra-arterial intervention

    Science.gov (United States)

    Winder, Anthony J.; Siemonsen, Susanne; Flottmann, Fabian; Fiehler, Jens; Forkert, Nils D.

    2017-03-01

    Voxel-based tissue outcome prediction in acute ischemic stroke patients is highly relevant for both clinical routine and research. Previous research has shown that features extracted from baseline multi-parametric MRI datasets have a high predictive value and can be used for the training of classifiers, which can generate tissue outcome predictions for both intravenous and conservative treatments. However, with the recent advent and popularization of intra-arterial thrombectomy treatment, novel research specifically addressing the utility of predictive classi- fiers for thrombectomy intervention is necessary for a holistic understanding of current stroke treatment options. The aim of this work was to develop three clinically viable tissue outcome prediction models using approximate nearest-neighbor, generalized linear model, and random decision forest approaches and to evaluate the accuracy of predicting tissue outcome after intra-arterial treatment. Therefore, the three machine learning models were trained, evaluated, and compared using datasets of 42 acute ischemic stroke patients treated with intra-arterial thrombectomy. Classifier training utilized eight voxel-based features extracted from baseline MRI datasets and five global features. Evaluation of classifier-based predictions was performed via comparison to the known tissue outcome, which was determined in follow-up imaging, using the Dice coefficient and leave-on-patient-out cross validation. The random decision forest prediction model led to the best tissue outcome predictions with a mean Dice coefficient of 0.37. The approximate nearest-neighbor and generalized linear model performed equally suboptimally with average Dice coefficients of 0.28 and 0.27 respectively, suggesting that both non-linearity and machine learning are desirable properties of a classifier well-suited to the intra-arterial tissue outcome prediction problem.

  10. Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood: The Cardiovascular Risk in Young Finns Study.

    Science.gov (United States)

    Juonala, Markus; Pulkki-Råback, Laura; Elovainio, Marko; Hakulinen, Christian; Magnussen, Costan G; Sabin, Matthew A; Burgner, David P; Hare, David L; Hartiala, Olli; Ukkonen, Heikki; Saraste, Antti; Kajander, Sami; Hutri-Kähönen, Nina; Kähönen, Mika; Rinta-Kiikka, Irina; Laitinen, Tomi; Kainulainen, Sakari; Viikari, Jorma S A; Raitakari, Olli T

    2016-05-01

    There is increasing evidence supporting the importance of psychosocial factors in the pathophysiology of atherosclerotic disease. They have been shown to be associated with the population attributable risk for myocardial infarction. To determine if a score of favorable childhood psychosocial factors would be associated with decreased coronary artery calcification in adulthood. The analyses were performed in 2015 using data gathered in 1980 and 2008 within the longitudinal Cardiovascular Risk in Young Finns Study. The data source consisted of 311 individuals who had psychosocial factors measured at ages 12 years to 18 years and coronary artery calcification measured 28 years later in adulthood. The summary measure of psychosocial factors in childhood comprised measures of socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. Coronary artery calcification at ages 40 years to 46 years. Of the 311 participants, 48.2% were men. Of the participants, 55 (17.7%) had some calcium observed in their coronary arteries. A 1-SD increase in a favorable summary score of childhood psychological factors was associated with an adulthood coronary artery calcification probability of 0.85 (95% CI, 0.76-0.95) (P = .006). This inverse relationship remained significant after adjustment for age, sex, and conventional childhood risk factors (0.85; 95% CI, 0.74-0.97; P = .02) or for age, sex, adulthood conventional cardiovascular risk factors, socioeconomic status, social support, and depressive symptoms (0.83; 95% CI, 0.71-0.97; P = .02). In this longitudinal study, we observed an independent association between childhood psychosocial well-being and reduced coronary artery calcification in adulthood. A positive childhood psychosocial environment may decrease cardiovascular risk in adulthood and may represent a potentially modifiable risk determinant.

  11. Clinical experience of intra-arterial therapy in patients with acute ischemic stroke from a single institute

    Energy Technology Data Exchange (ETDEWEB)

    Park, So Young [Dept. Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul (Korea, Republic of); Lee, Han Bin; Kim, Jong Guk; Oh, Seung Hun; Kim, Jin Kwon; Kim, Sang Heum; Kim, Ok Joon [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of); Kim, Nam Keun [Institute for Clinical Research, School of Medicine, CHA University, Seongnam (Korea, Republic of)

    2016-11-15

    To compare the efficacy and safety between intra-arterial therapy (IAT) and intra-venous and intra-arterial combined therapy (IVIACT) in patients with acute ischemic stroke in the anterior circulation territory. Forty-one patients treated with IAT using Solitaire were retrospectively reviewed. Nineteen patients were treated with IAT, twenty-two patients were treated with IVIACT, and ten patients of the forty-one patients were managed with multimodal treatment like stent, balloon angioplasty etc. We investigated the rate of recanalization and hemorrhage, NIH stroke scale and 3-month modified Rankin Scale. The overall recanalization rate was 93% and symptomatic ICH occurred in 10% of the patients. There was no difference in hemorrhage, recanalization rate, and early improvement between IAT and IVIACT. Good outcome was more frequently observed in 59% of the patients with IVIACT than 36% of the patients treated with IAT without any significant difference. The patients managed with multimodal treatment did not show any significant hemorrhage outcome. IAT using Solitaire is a useful treatment method without high risk in patients with acute ischemic stroke in the anterior circulation territory. Also, IVIACT and multimodal treatment might be considered as reasonable therapeutic options in these patients.

  12. ST-depression in right precordial leads with inferior STEMI and occluded right coronary artery: intertwined anatomy and ischemic areas.

    Science.gov (United States)

    De Gennaro, Luisa; Brunetti, Natale Daniele; Ruggiero, Massimo; Rutigliano, David; Locuratolo, Nicola; Di Biase, Matteo; Caldarola, Pasquale

    2017-10-01

    Right coronary artery (RCA) occlusion in inferior acute myocardial infarction is usually heralded by ST-elevation both in inferior and in right precordial leads. We report the case of a 68-year-old male, who presented marked ST-elevation in inferior leads, mirrored by ST-depression in anterior-septal and lateral leads. Right precordial lead electrocardiogram unexpectedly showed ST-depression V1R-V5R leads. Coronary angiography showed mid-left anterior descending (LAD) coronary near-complete occlusion with distal wrapping LAD. Left circumflex artery was not occluded, while RCA was occluded mid tract. The patient was treated with coronary angioplasty on RCA and LAD. Absence of ST-elevation in right precordial leads may be presumably explained by the presence of a large ischemic area distal to mid-LAD near-occlusive stenosis and of a long-wrapping LAD. Complex coronary anatomy and intertwined ischemic areas may underlie apparently discording electrocardiograms.

  13. Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry.

    Science.gov (United States)

    Abtan, Jérémie; Bhatt, Deepak L; Elbez, Yedid; Sorbets, Emmanuel; Eagle, Kim; Reid, Christopher M; Baumgartner, Iris; Wu, David; Hanson, Mary E; Hannachi, Hakima; Singhal, Puneet K; Steg, Philippe Gabriel; Ducrocq, Gregory

    2017-09-01

    Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. We analyzed baseline characteristics and 4-year follow-up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%-5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Four-year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality. © 2017 Wiley Periodicals, Inc.

  14. Cerebral Hyperperfusion after Revascularization Inhibits Development of Cerebral Ischemic Lesions Due to Artery-to-Artery Emboli during Carotid Exposure in Endarterectomy for Patients with Preoperative Cerebral Hemodynamic Insufficiency: Revisiting the "Impaired Clearance of Emboli" Concept.

    Science.gov (United States)

    Fujimoto, Kentaro; Matsumoto, Yoshiyasu; Oikawa, Kohki; Nomura, Jun-Ichi; Shimada, Yasuyoshi; Fujiwara, Shunrou; Terasaki, Kazunori; Kobayashi, Masakazu; Yoshida, Kenji; Ogasawara, Kuniaki

    2016-08-03

    The purpose of the present study was to determine whether cerebral hyperperfusion after revascularization inhibits development of cerebral ischemic lesions due to artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). In patients undergoing CEA for internal carotid artery stenosis (≥70%), cerebral blood flow (CBF) was measured using single-photon emission computed tomography (SPECT) before and immediately after CEA. Microembolic signals (MES) were identified using transcranial Doppler during carotid exposure. Diffusion-weighted magnetic resonance imaging (DWI) was performed within 24 h after surgery. Of 32 patients with a combination of reduced cerebrovascular reactivity to acetazolamide on preoperative brain perfusion SPECT and MES during carotid exposure, 14 (44%) showed cerebral hyperperfusion (defined as postoperative CBF increase ≥100% compared with preoperative values), and 16 (50%) developed DWI-characterized postoperative cerebral ischemic lesions. Postoperative cerebral hyperperfusion was significantly associated with the absence of DWI-characterized postoperative cerebral ischemic lesions (95% confidence interval, 0.001-0.179; p = 0.0009). These data suggest that cerebral hyperperfusion after revascularization inhibits development of cerebral ischemic lesions due to artery-to-artery emboli during carotid exposure in CEA, supporting the "impaired clearance of emboli" concept. Blood pressure elevation following carotid declamping would be effective when embolism not accompanied by cerebral hyperperfusion occurs during CEA.

  15. Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Bangsgaard, Regitze; Carstensen, Steen

    2002-01-01

    was correlated to the LV extent of myocardial metabolism--blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%. CONCLUSIONS: Patients with chronic ischemic heart disease...... indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. METHODS: Forty......-five consecutive patients with a mean duration of ischemic heart symptoms of 9 years and LV ejection fraction (EF) metabolism--blood flow positron emission tomography imaging and dobutamine stress...

  16. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke.

    Science.gov (United States)

    Treurniet, Kilian M; Yoo, Albert J; Berkhemer, Olvert A; Lingsma, Hester F; Boers, Anna M M; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Lycklama À Nijeholt, Geert J; van Walderveen, Marianne A A; Bot, Joseph C J; Beenen, Ludo F M; van den Berg, René; van Zwam, Wim H; van der Lugt, Aad; van Oostenbrugge, Robert J; Dippel, Diederik W J; Roos, Yvo B W E M; Marquering, Henk A; Majoie, Charles B L M

    2016-12-01

    A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ2 test to assess treatment effect modification by CBS. Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758. © 2016 American Heart Association, Inc.

  17. Increased arterial stiffness in young adults with end-stage renal disease since childhood

    NARCIS (Netherlands)

    Groothoff, Jaap W.; Gruppen, Mariken P.; Offringa, Martin; de Groot, Eric; Stok, Willem; Bos, Willem Jan; Davin, Jean Claude; Lilien, Marc R.; van de Kar, Nicole Caj; Wolff, Eric D.; Heymans, Hugo S.

    2002-01-01

    Increased arterial stiffness is a risk factor for mortality in adults over 40 yr of age with end-stage renal disease (ESRD). As no data exist on vascular changes in young adults with ESRD since childhood, a long-term outcome study was performed. All living Dutch adult patients with onset of ESRD

  18. TBX4 mutations (small patella syndrome) are associated with childhood-onset pulmonary arterial hypertension

    NARCIS (Netherlands)

    Kerstjens-Frederikse, Wilhelmina S.; Bongers, Ernie M. H. F.; Roofthooft, Marcus T. R.; Leter, Edward M.; Douwes, J. Menno; Van Dijk, Arie; Vonk-Noordegraaf, Anton; Dijk-Bos, Krista K.; Hoefsloot, Lies H.; Hoendermis, Elke S.; Gille, Johan J. P.; Sikkema-Raddatz, Birgit; Hofstra, Robert M. W.; Berger, Rolf M. F.

    Background Childhood-onset pulmonary arterial hypertension (PAH) is rare and differs from adult-onset disease in clinical presentation, with often unexplained mental retardation and dysmorphic features (MR/DF). Mutations in the major PAH gene, BMPR2, were reported to cause PAH in only 10-16% of

  19. Evaluation of Cranial and Cervical Arteries and Brain Tissue in Transient Ischemic Attack Patients with Magnetic Resonance Angiography and Diffusion-Weighted Imaging.

    Science.gov (United States)

    Li, Jian-Long; Li, Chang-Shan; Fu, Jun-Hua; Zhang, Ke; Xu, Rui; Xu, Wen-Jian

    2015-06-15

    Magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) have been widely used in the prediction of ischemic stroke; however, the differences of the 2 methods in detection the artery lesion differences between transient ischemic attack (TIA) and infarction patients have been long neglected. We performed the present study to investigate the differences between vessel characteristics detected by MRA and DWI in acute stroke and TIA patients. We classified 110 subjects into 2 groups and all the patients underwent both MRA and DWI. The degree of stenosis of cranial and cervical arteries, the distribution of the stenosis, the development and changes of the vessels, and the DWI scanning results of the brain tissue were all analyzed. We detected a significant difference in the number and the degree of stenosis of cranial and cervical arteries among the 3 groups (P=0.006). Compared with health controls, patients with TIA and cerebral infraction had much more severe stenosis and occlusive arteries (Psystem (4/8, 50%). Vessel characteristics were not significantly different between TIA and infarction patients. Unilateral vertebral artery hypoplasia was a predisposing factor for vertebrobasilar TIA and ischemic focus in DWI detection was always caused by severe artery lesions.

  20. Suspected Carotid Artery Stenosis : Cost-effectiveness of CT Angiography in Work-up of Patients with Recent TIA or Minor Ischemic Stroke

    NARCIS (Netherlands)

    Tholen, Aletta T. R.; de Monye, Cecile; Genders, Tessa S. S.; Buskens, Erik; Dippel, Diederik W. J.; van der Lugt, Aad; Hunink, M. G. Myriam

    Purpose: To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack (TIA) or minor stroke who are suspected of having carotid artery stenosis (CAS). Materials and Methods: All prospectively evaluated

  1. Suspected carotid artery stenosis: Cost-effectiveness of CT angiography in work-up of patients with recent TIA or minor ischemic stroke

    NARCIS (Netherlands)

    A.T.R. Tholen; C. de Monyé (Cécile); T.S.S. Genders (Tessa); E. Buskens (Erik); D.W.J. Dippel (Diederik); A. van der Lugt (Aad); M.G.M. Hunink (Myriam)

    2010-01-01

    textabstractPurpose: To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack (TIA) or minor stroke who are suspected of having carotid artery stenosis (CAS). Materials and Methods: All prospectively

  2. Arterial foci of F-18 fluorodeoxyglucose are associated with an enhanced risk of subsequent ischemic stroke in cancer patients: a case-control pilot study.

    Science.gov (United States)

    Grandpierre, Solène; Desandes, Emmanuel; Meneroux, Benoit; Djaballah, Wassila; Mandry, Damien; Netter, Fanny; Wahl, Denis; Fay, Renaud; Karcher, Gilles; Marie, Pierre-Yves

    2011-02-01

    Imaging of F-18 fluorodeoxyglucose (FDG) by positron emission tomography/computed tomography (PET/CT) hybrid systems allows detecting arterial FDG foci, which relate to inflammatory and presumably unstable atherosclerosis, and is increasingly used in cancer patients among whom many are at risk for ischemic events. However, the link between an enhanced arterial FDG uptake and subsequent ischemic events remains to be clearly established. This pilot study aimed at determining whether the prior arterial FDG uptake in cancer patients presenting a subsequent stroke was higher than that of stroke-free controls. Patients referred to FDG PET/CT for conventional oncologic indications were retrospectively included and compared between: (i) 7 case-patients with subsequent hospitalizations for documented ischemic stroke and (ii) 16 event-free controls, matched to the case-patients according to age, gender, and cancer site. Stroke was related with previous arterial FDG foci when detected on the aortic arch (stroke patients, 86% vs. Controls, 31%; P = 0.03) and especially on carotid bifurcations (stroke patients, 71% vs. Controls, 6%; P = 0.006); and among the 5 case-patients with stroke from carotid territory, 4 (80%) had FDG foci on ipsilateral carotid bifurcations. This pilot study shows that the previous detection of FDG foci on aortic arch and especially on carotid bifurcations of cancer patients is associated with the risk of subsequent ischemic stroke. A further confirmation on larger populations is needed.

  3. Childhood Socioeconomic Status and Arterial Stiffness in Adulthood: The Cardiovascular Risk in Young Finns Study.

    Science.gov (United States)

    Puolakka, Elina; Pahkala, Katja; Laitinen, Tomi T; Magnussen, Costan G; Hutri-Kähönen, Nina; Kähönen, Mika; Lehtimäki, Terho; Tossavainen, Päivi; Jokinen, Eero; Sabin, Matthew A; Laitinen, Tomi; Elovainio, Marko; Pulkki-Råback, Laura; Viikari, Jorma S A; Raitakari, Olli T; Juonala, Markus

    2017-10-01

    Increasing evidence supports the importance of socioeconomic factors in the development of atherosclerotic cardiovascular disease. However, the association of childhood socioeconomic status (SES) with arterial stiffness in adulthood has not been reported. Our aim was to determine whether higher childhood family-level SES is associated with lower arterial stiffness in adulthood. The analyses were performed using data gathered within the longitudinal Young Finns Study. The sample comprised 2566 participants who had data concerning family SES at ages 3 to 18 years in 1980 and arterial pulse wave velocity and carotid artery distensibility measured 21 or 27 years later in adulthood. Higher family SES in childhood was associated with lower arterial stiffness in adulthood; carotid artery distensibility being higher (β value±SE, 0.029±0.0089%/10 mm Hg; P=0.001) and pulse wave velocity lower (β value±SE, -0.062±0.022 m/s; P=0.006) among those with higher family SES in a multivariable analysis adjusted with age, sex, and conventional childhood cardiometabolic risk factors. The association remained significant after further adjustment for participant's SES in adulthood (β value±SE, 0.026±0.010%/10 mm Hg; P=0.01 for carotid artery distensibility and β value±SE, -0.048±0.023 m/s; P=0.04 for pulse wave velocity) but attenuated after adjustment for adulthood cardiometabolic risk factors (β value±SE, 0.015±0.008%/10 mm Hg; P=0.08 for carotid artery distensibility and β value±SE, -0.019±0.02 m/s; P=0.38 for pulse wave velocity). In conclusion, we observed an association between higher family SES in childhood and lower arterial stiffness in adulthood. Our findings suggest that special attention could be paid to children from low SES families to prevent cardiometabolic diseases primordially. © 2017 American Heart Association, Inc.

  4. Early and noninvasive evaluation using superficial temporal artery duplex ultrasonography after indirect bypass for adult ischemic moyamoya disease.

    Science.gov (United States)

    Ogawa, Sayaka; Abe, Hiroshi; Katsuta, Toshiro; Fukuda, Kenji; Ogata, Toshiyasu; Miki, Koichi; Inoue, Tooru

    2017-03-01

    The validity of indirect bypass for adult patients with moyamoya disease is still debatable. Some patients are poor responders to indirect bypass, and additive intervention is occasionally required in these cases. Therefore, it is necessary to evaluate the development of collateral circulation as early as possible postoperatively. Fifteen adult patients (>17 years old) with moyamoya disease (22 affected sides) who underwent encephalo-duro-arterio-synangiosis (EDAS) at Fukuoka University Hospital from April 2008 to August 2014 were included. All patients had ischemic symptoms of at least one hemisphere. Superficial temporal artery duplex ultrasonography (STDU) was performed before and 3, 6, and 12 months postoperatively. Digital subtraction angiography was performed 1 year after the operation to evaluate the development of collateral circulation. Hemispheres exhibiting collateral formation of more than one-third of the MCA distribution were defined as good responders, and those with less than one-third were defined as poor responders. EDAS induced the formation of well-developed collaterals in 17 of 22 affected sides (77.3%) of adult patients with ischemic moyamoya disease. Regardless of the degree of collateral formation, the ischemic event subsided eventually with time in all patients. In good responders, the pulsatility index obtained by STDU showed a drastic decrease 3 months after the operation, while it did not change significantly in poor responders. Absence of this decrease in the pulsatility index along with no change in the flow velocity reliably indicated poor responders. Neovascularization after EDAS can be evaluated noninvasively in early phase using STDU.

  5. Transient Ischemic Rectitis as a Potential Complication after Prostatic Artery Embolization: Case Report and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, Airton Mota, E-mail: motamoreira@gmail.com [University of Sao Paulo Medical School, Division of Interventional Radiology, Department of Radiology (Brazil); Marques, Carlos Frederico Sparapan, E-mail: sparapanmarques@gmail.com [University of Sao Paulo Medical School, Colorectal Surgery Division, Department of Gastroenterology (Brazil); Antunes, Alberto Azoubel, E-mail: antunesuro@uol.com.br [University of Sao Paulo Medical School, Department of Urology (Brazil); Nahas, Caio Sergio Rizkallah, E-mail: caionahas@usp.br; Nahas, Sergio Carlos, E-mail: sergionahas@uol.com.br [University of Sao Paulo Medical School, Colorectal Surgery Division, Department of Gastroenterology (Brazil); Gregorio Ariza, Miguel Angel de, E-mail: mgregori@unizar.es [University of Zaragoza, Division of Minimally Invasive Image Guided Surgery (Spain); Carnevale, Francisco Cesar, E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Division of Interventional Radiology, Department of Radiology (Brazil)

    2013-12-15

    Prostatic artery embolization (PAE) is an alternative treatment for benign prostatic hyperplasia. Complications are primarily related to non-target embolization. We report a case of ischemic rectitis in a 76-year-old man with significant lower urinary tract symptoms due to benign prostatic hyperplasia, probably related to nontarget embolization. Magnetic resonance imaging revealed an 85.5-g prostate and urodynamic studies confirmed Inferior vesical obstruction. PAE was performed bilaterally. During the first 3 days of follow-up, a small amount of blood mixed in the stool was observed. Colonoscopy identified rectal ulcers at day 4, which had then disappeared by day 16 post PAE without treatment. PAE is a safe, effective procedure with a low complication rate, but interventionalists should be aware of the risk of rectal nontarget embolization.

  6. Distensibility of the aorta and carotid artery and left ventricular mass from childhood to early adulthood.

    Science.gov (United States)

    Mikola, Hanna; Pahkala, Katja; Rönnemaa, Tapani; Viikari, Jorma S A; Niinikoski, Harri; Jokinen, Eero; Salo, Pia; Simell, Olli; Juonala, Markus; Raitakari, Olli T

    2015-01-01

    In adults, arterial distensibility decreases with age and relates to changes in cardiac left ventricular mass. Longitudinal data on changes in arterial distensibility from childhood to adulthood are lacking. Our aim was to study the effect of age and sex, and low-saturated fat dietary counseling on arterial distensibility from childhood to early adulthood. In addition, we assessed the association of arterial distensibility with left ventricular mass. Distensibility of the abdominal aorta and common carotid artery was measured repeatedly at ages 11, 13, 15, 17, and 19 years (n=395-472) in an atherosclerosis prevention trial (Special Turku Coronary Risk Factor Intervention Project [STRIP]). Aortic and carotid distensibility decreased with age (both PSTRIP was not significantly associated with arterial distensibility. Left ventricular mass increased with age (P<0.0001), and it was greater in boys (P<0.0001). In conclusion, a marked age-related decrease in vascular distensibility was found already at this young age, and this decrease was more pronounced in boys than girls. The longitudinal progression of aortic and carotid distensibility was related with changes in left ventricular mass. http://www.clinicaltrials.gov. Unique identifier: NCT00223600. © 2014 American Heart Association, Inc.

  7. Cannabidiol reduces brain damage and improves functional recovery in a neonatal rat model of arterial ischemic stroke.

    Science.gov (United States)

    Ceprián, Maria; Jiménez-Sánchez, Laura; Vargas, Carlos; Barata, Lorena; Hind, Will; Martínez-Orgado, Jose

    2017-04-01

    and purpose: Currently there is no effective treatment for neonatal arterial ischemic stroke (AIS). Cannabidiol (CBD) is neuroprotective in models of newborn hypoxic-ischemic brain damage and adult stroke. The purpose of this work was to study the protective effect of CBD in a neonatal rat model of AIS. Middle Cerebral Artery Occlusion (MCAO) was achieved in neonatal Wistar rats by introducing a nylon filament to the left MCA for 3 h; 15 min after removing the occluder vehicle (MCAO-V) or CBD single dose 5 mg/kg (MCAO-C) were administered i. p. Similarly manipulated but non-occluded rats served as controls (SHM). A set of behavioral tests was then conducted one week (P15) or one month (P38) after MCAO. Brain damage was then assessed by magnetic resonance imaging (MRI), proton magnetic resonance spectroscopy (H + -MRS) and histologic (TUNEL for cell death, immunohistochemistry for neuron, astrocyte and microglia identification) studies. CBD administration improved neurobehavioral function regarding strength, hemiparesis, coordination and sensorimotor performance as assessed at P15 and P38. MRI indicated that CBD did not reduce the volume of infarct but reduced the volume of perilesional gliosis. H + -MRS indicated that CBD reduced metabolic derangement and excitotoxicty, and protected astrocyte function. Histologic studies indicated that CBD reduced neuronal loss and apoptosis, and modulated astrogliosis and microglial proliferation and activation. CBD administration after MCAO led to long-term functional recovery, reducing neuronal loss and astrogliosis, and modulating apoptosis, metabolic derangement, excitotoxicity and neuro-inflammation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  9. Automated Ischemic Lesion Segmentation in MRI Mouse Brain Data after Transient Middle Cerebral Artery Occlusion.

    Science.gov (United States)

    Mulder, Inge A; Khmelinskii, Artem; Dzyubachyk, Oleh; de Jong, Sebastiaan; Rieff, Nathalie; Wermer, Marieke J H; Hoehn, Mathias; Lelieveldt, Boudewijn P F; van den Maagdenberg, Arn M J M

    2017-01-01

    Magnetic resonance imaging (MRI) has become increasingly important in ischemic stroke experiments in mice, especially because it enables longitudinal studies. Still, quantitative analysis of MRI data remains challenging mainly because segmentation of mouse brain lesions in MRI data heavily relies on time-consuming manual tracing and thresholding techniques. Therefore, in the present study, a fully automated approach was developed to analyze longitudinal MRI data for quantification of ischemic lesion volume progression in the mouse brain. We present a level-set-based lesion segmentation algorithm that is built using a minimal set of assumptions and requires only one MRI sequence (T2) as input. To validate our algorithm we used a heterogeneous data set consisting of 121 mouse brain scans of various age groups and time points after infarct induction and obtained using different MRI hardware and acquisition parameters. We evaluated the volumetric accuracy and regional overlap of ischemic lesions segmented by our automated method against the ground truth obtained in a semi-automated fashion that includes a highly time-consuming manual correction step. Our method shows good agreement with human observations and is accurate on heterogeneous data, whilst requiring much shorter average execution time. The algorithm developed here was compiled into a toolbox and made publically available, as well as all the data sets.

  10. Current and advancing treatments for pulmonary arterial hypertension in childhood

    NARCIS (Netherlands)

    Zijlstra, Willemijn M. H.; Ploegstra, Mark-Jan; Berger, Rolf M. F.

    2014-01-01

    Pulmonary arterial hypertension (PAH) is a severe and progressive intrinsic disease of the precapillary lung vasculature. Since the introduction of PAH-targeted drugs, survival of PAH patients seems to have improved. Randomized controlled trials have led to evidence-based guidelines to direct

  11. Ischemic symptoms induced by occlusion of the unilateral vertebral artery with head rotation together with contralateral vertebral artery dissection--case report.

    Science.gov (United States)

    Wakayama, Kouji; Murakami, Mineko; Suzuki, Megumi; Ono, Seiitsu; Shimizu, Natsue

    2005-09-15

    We report a 45-year-old woman whose unilateral vertebral artery (VA) was potentially occluded with head rotation at the C1-C2 level and her ischemic symptoms suddenly appeared because of contralateral VA dissection. She noticed first pain around the posterior part of her neck on the right side, and then dizziness when turning the head to the right side. The dizziness disappeared immediately after her head returned to the natural position. Digital subtraction angiography (DSA) showed a string sign of the right VA. DSA and computed tomography angiography (CTA) showed high grade extrinsic compression of the left VA at the C1-C2 level with head rotation more than 90 degrees to the right. Three-dimensional (3D) CTA also showed clearly kinking of the left VA at the C2 neuroforamina. Her symptoms disappeared completely with conservative therapy, and recanalization of the right VA was also confirmed by 3D-CTA. 3D-CTA was thought to be valuable to diagnose and manage the rotational compression of the artery. VA dissection must be remembered to differentially diagnose the etiology of transient attacks of posterior circulation ischemia due to rotational contralateral VA occlusion.

  12. Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

    Energy Technology Data Exchange (ETDEWEB)

    El-Fayech, Chiraz; Haddy, Nadia; Allodji, Rodrigue Sètchéou; Veres, Cristina; Diop, Fara; Kahlouche, Amar; Llanas, Damien; Jackson, Angela; Rubino, Carole; Guibout, Catherine [Inserm U1018, Villejuif (France); Gustave Roussy, Villejuif (France); University of Paris XI, Villejuif (France); Pacquement, Hélène [Institut Curie, Paris (France); Oberlin, Odile [Gustave Roussy, Villejuif (France); Thomas-Teinturier, Cécile [Inserm U1018, Villejuif (France); Hôpital Bicêtre, Le Kremlin Bicêtre (France); Scarabin, Pierre-Yves [Inserm U1018, Villejuif (France); Chavaudra, Jean; Lefkopoulos, Dimitry [Gustave Roussy, Villejuif (France); Giroud, Maurice; Bejot, Yannick [Registre Dijonnais des accidents vasculaires cérébraux, Dijon (France); Bernier, Valérie [Centre Alexis Vautrin, Vandoeuvre-lès-Nancy (France); Carrie, Christian [Centre Léon Bérard, Lyon (France); and others

    2017-02-01

    Background and Purpose: The aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer. Methods: We evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT. Results: Fifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expected from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients. Conclusion: The WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.

  13. When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

    Directory of Open Access Journals (Sweden)

    Alessandro Zuccalà

    2013-11-01

    Full Text Available In recent years, decisions taken on the optimal management of patients with renal artery stenosis have triggered off controversy and debate among clinicians dealing with renovascular disease. The main reason underlying this ongoing controversy may be the heterogeneity of the clinical entities that are normally associated with the umbrella definition of renal artery stenosis. Indeed a causal link between the stenosis and its clinical consequences (i.e. hypertension, renal failure can often demonstrated in some entities, such as fibromuscular dysplasia, truncal stenosis or arterial stenosis in the transplanted kidney, which can be defined as pure renal artery stenosis. On the contrary, the entity generally called ostial stenosis is a disease of the abdominal aorta where it encroaches the ostium of the renal artery at the end of a long process involving the entire vascular tree. Patients affected by ostial stenosis also suffer from generalized atherosclerosis, and kidney damage is often caused by the atherosclerotic environment with the stenosis acting as an innocent bystander. This may account for the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate along with a careful understanding of the mechanisms underpinning renal damage, particularly the intrarenal activation of the renin angiotensin system which in turn induces renal inflammation and oxidative stress, may enable clinicians to make the right decisions in regard to revascularization.

  14. Ischemic neuromyopathy due to peripheral arterial embolization of an adenocarcinoma in a cat.

    Science.gov (United States)

    Sykes, J E

    2003-12-01

    A case of peripheral arterial tumor embolization in a cat is described. The cat presented with signs of aortic thromboembolism, including decreased peripheral pulse quality, pallor, and coolness of the distal limbs, as well as proprioceptive deficits. Thoracic radiographs revealed a cavitary lung mass; echocardiography was unremarkable. Cytologic evaluation of aspirates of the mass suggested malignancy. The left hindlimb was amputated, and histopathology confirmed embolization of an adenocarcinoma. Although rare, peripheral arterial tumor embolization should be considered as a differential in cats presenting with signs of thromboembolic disease.

  15. Predictive value of vertebral artery extracranial color-coded duplex sonography for ischemic stroke-related vertigo

    Directory of Open Access Journals (Sweden)

    Li-Min Liou

    2013-12-01

    Full Text Available Vertigo can be a major presentation of posterior circulation stroke and can be easily misdiagnosed because of its complicated presentation. We thus prospectively assessed the predictive value of vertebral artery extracranial color-coded duplex sonography (ECCS for the prediction of ischemic stroke-related vertigo. The inclusion criteria were: (1 a sensation of whirling (vertigo; (2 intractable vertigo for more than 1 hour despite appropriate treatment; and (3 those who could complete cranial magnetic resonance imaging (MRI and vertebral artery (V2 segment ECCS studies. Eventually, 76 consecutive participants with vertigo were enrolled from Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan between August 2010 and August 2011. Demographic data, neurological symptoms, neurologic examinations, and V2 ECCS were assessed. We chose the parameters of peak systolic velocity (PSV, end diastolic velocity (EDV, PSV/EDV, mean velocity (MV, resistance index (RI, and pulsatility index (PI to represent the hemodynamics. Values from both sides of V2 segments were averaged. We then calculated the average RI (aRI, average PI (aPI, average PSV (aPSV/EDV, and average (aMV. Axial and coronal diffusion-weighted MRI findings determined the existence of acute ischemic stroke. We grouped and analyzed participants in two ways (way I and way II analyses based on the diffusion-weighted MRI findings (to determine whether there was acute stroke and neurological examinations. Using way I analysis, the “MRI (+” group had significantly higher impedance (aRI, aPI, and aPSV/EDV ratio and lower velocity (aPSV, aEDV, and aMV(PSV + EDV/2, compared to the “MRI (–” group. The cutoff value/sensitivity/specificity of aPSV, aEDV, aMV, aPI, aRI, and aPSV/EDV between the MRI (+ and MRI (– groups were 41.15/61.5/66.0 (p = 0.0101, 14.55/69.2/72.0 (p = 0.0003, 29.10/92.1/38.0 (p = 0.0013, 1.07/76.9/64.0 (p = 0.0066, 0.62/76.9/64.0 (p = 0.0076, and 2

  16. PACAP38 differentially effects genes and CRMP2 protein expression in ischemic core and penumbra regions of permanent middle cerebral artery occlusion model mice brain.

    Science.gov (United States)

    Hori, Motohide; Nakamachi, Tomoya; Shibato, Junko; Rakwal, Randeep; Tsuchida, Masachi; Shioda, Seiji; Numazawa, Satoshi

    2014-09-23

    Pituitary adenylate-cyclase activating polypeptide (PACAP) has neuroprotective and axonal guidance functions, but the mechanisms behind such actions remain unclear. Previously we examined effects of PACAP (PACAP38, 1 pmol) injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO) along with control saline (0.9% NaCl) injection. Transcriptomic and proteomic approaches using ischemic (ipsilateral) brain hemisphere revealed differentially regulated genes and proteins by PACAP38 at 6 and 24 h post-treatment. However, as the ischemic hemisphere consisted of infarct core, penumbra, and non-ischemic regions, specificity of expression and localization of these identified molecular factors remained incomplete. This led us to devise a new experimental strategy wherein, ischemic core and penumbra were carefully sampled and compared to the corresponding contralateral (healthy) core and penumbra regions at 6 and 24 h post PACAP38 or saline injections. Both reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to examine targeted gene expressions and the collapsin response mediator protein 2 (CRMP2) protein profiles, respectively. Clear differences in expression of genes and CRMP2 protein abundance and degradation product/short isoform was observed between ischemic core and penumbra and also compared to the contralateral healthy tissues after PACAP38 or saline treatment. Results indicate the importance of region-specific analyses to further identify, localize and functionally analyse target molecular factors for clarifying the neuroprotective function of PACAP38.

  17. PACAP38 Differentially Effects Genes and CRMP2 Protein Expression in Ischemic Core and Penumbra Regions of Permanent Middle Cerebral Artery Occlusion Model Mice Brain

    Directory of Open Access Journals (Sweden)

    Motohide Hori

    2014-09-01

    Full Text Available Pituitary adenylate-cyclase activating polypeptide (PACAP has neuroprotective and axonal guidance functions, but the mechanisms behind such actions remain unclear. Previously we examined effects of PACAP (PACAP38, 1 pmol injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO along with control saline (0.9% NaCl injection. Transcriptomic and proteomic approaches using ischemic (ipsilateral brain hemisphere revealed differentially regulated genes and proteins by PACAP38 at 6 and 24 h post-treatment. However, as the ischemic hemisphere consisted of infarct core, penumbra, and non-ischemic regions, specificity of expression and localization of these identified molecular factors remained incomplete. This led us to devise a new experimental strategy wherein, ischemic core and penumbra were carefully sampled and compared to the corresponding contralateral (healthy core and penumbra regions at 6 and 24 h post PACAP38 or saline injections. Both reverse transcription-polymerase chain reaction (RT-PCR and Western blotting were used to examine targeted gene expressions and the collapsin response mediator protein 2 (CRMP2 protein profiles, respectively. Clear differences in expression of genes and CRMP2 protein abundance and degradation product/short isoform was observed between ischemic core and penumbra and also compared to the contralateral healthy tissues after PACAP38 or saline treatment. Results indicate the importance of region-specific analyses to further identify, localize and functionally analyse target molecular factors for clarifying the neuroprotective function of PACAP38.

  18. Ischemic preconditioning protects against ischemic brain injury

    Directory of Open Access Journals (Sweden)

    Xiao-meng Ma

    2016-01-01

    Full Text Available In this study, we hypothesized that an increase in integrin αv ß 3 and its co-activator vascular endothelial growth factor play important neuroprotective roles in ischemic injury. We performed ischemic preconditioning with bilateral common carotid artery occlusion for 5 minutes in C57BL/6J mice. This was followed by ischemic injury with bilateral common carotid artery occlusion for 30 minutes. The time interval between ischemic preconditioning and lethal ischemia was 48 hours. Histopathological analysis showed that ischemic preconditioning substantially diminished damage to neurons in the hippocampus 7 days after ischemia. Evans Blue dye assay showed that ischemic preconditioning reduced damage to the blood-brain barrier 24 hours after ischemia. This demonstrates the neuroprotective effect of ischemic preconditioning. Western blot assay revealed a significant reduction in protein levels of integrin αv ß 3, vascular endothelial growth factor and its receptor in mice given ischemic preconditioning compared with mice not given ischemic preconditioning 24 hours after ischemia. These findings suggest that the neuroprotective effect of ischemic preconditioning is associated with lower integrin αv ß 3 and vascular endothelial growth factor levels in the brain following ischemia.

  19. Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion.

    Science.gov (United States)

    Goyal, Nitin; Tsivgoulis, Georgios; Nickele, Chris; Doss, Vinodh T; Hoit, Dan; Alexandrov, Andrei V; Arthur, Adam; Elijovich, Lucas

    2016-08-01

    The natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion. To examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT. We conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0-2 at 3 months. A total of 21 patients with AIS due to BAO (age range 31-84 years, median admission NIHSS score: 18 points, range 2-38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)). The presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Association between Single Nucleotide Polymorphism rs1044925 and the Risk of Coronary Artery Disease and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Dong-Feng Wu

    2014-02-01

    Full Text Available The present study was performed to clarify the association between the acyl-CoA:cholesterol acyltransferase-1 (ACAT-1 single nucleotide polymorphism (SNP rs1044925 and the risk of coronary artery disease (CAD and ischemic stroke (IS in the Guangxi Han population. Polymerase chain reaction and restriction fragment length polymorphism was performed to determine the genotypes of the ACAT-1 SNP rs1044925 in 1730 unrelated subjects (CAD, 587; IS, 555; and healthy controls; 588. The genotypic and allelic frequencies of rs1044925 were significantly different between the CAD patients and controls (p = 0.015 and borderline different between the IS patients and controls (p = 0.05. The AC/CC genotypes and C allele were associated with a decreased risk of CAD and IS (CAD: p = 0.014 for AC/CC vs. AA, p = 0.022 for C vs. A; IS: p = 0.014 for AC/CC vs. AA; p = 0.017 for C vs. A. The AC/CC genotypes in the healthy controls, but not in CAD or IS patients, were associated with an increased serum high-density lipoprotein cholesterol (HDL-C concentration. The present study shows that the C allele carriers of ACAT-1 rs1044925 were associated with an increased serum HDL-C level in the healthy controls and decreased risk in CAD and IS patients.

  1. The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Medical School, Kwangju (Korea, Republic of)

    2001-06-01

    To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method.

  2. Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.

    Science.gov (United States)

    Kukulski, Tomasz; She, Lilin; Racine, Normand; Gradinac, Sinisa; Panza, Julio A; Velazquez, Eric J; Chan, Kwan; Petrie, Mark C; Lee, Kerry L; Pellikka, Patricia A; Romanov, Alexander; Biernat, Jolanta; Rouleau, Jean L; Batlle, Carmen; Rogowski, Jan; Ferrazzi, Paolo; Zembala, Marian; Oh, Jae K

    2015-05-01

    Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors

  3. Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy.

    Science.gov (United States)

    Graziosi, Pedro; Ianni, Barbara; Ribeiro, Expedito; Perin, Marco; Beck, Leonardo; Meneghetti, Claudio; Mady, Charles; Martinez Filho, Eulogio; Ramires, Jose A F

    2007-09-26

    In patients with advanced non-ischemic cardiomyopathy (NIC), right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA) flow pattern and flow reserve (CFR) are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire) data was obtained in RCA and left anterior descendent coronary artery (LAD) before and after adenosine. Resting RCA phasic pattern (diastolic/systolic) was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV) dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress) more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. LV fractional shortening and end diastolic diameter were 15.3 +/- 3.5 % and 69.4 +/- 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS) either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS); RCA vs. LAD was 1.35 vs. 2.85 (p 38 vs. 3.34, p = NS), as well as in pulmonary hypertension (3.09 vs. 3.10, p = NS) either in RV dysfunction (3.06 vs. 3.22, p = NS) subgroups. In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV

  4. Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Mady Charles

    2007-09-01

    Full Text Available Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC, right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA flow pattern and flow reserve (CFR are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire data was obtained in RCA and left anterior descendent coronary artery (LAD before and after adenosine. Resting RCA phasic pattern (diastolic/systolic was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS; RCA vs. LAD was 1.35 vs. 2.85 (p Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or

  5. Relationship between vascular dysfunction in peripheral arteries and ischemic episodes during daily life in patients with ischemic heart disease and hypercholesterolemia

    DEFF Research Database (Denmark)

    Søndergaard, Eva; Møller, Jacob E; Egstrup, Kenneth

    2002-01-01

    BACKGROUND: It is well established that endothelial dysfunction is present in patients with ischemic heart disease and hypercholesterolemia. Some of these patients will have signs of transient myocardial ischemia during Holter monitoring. We sought to describe the correlation between daily life i...

  6. Assessment of the arterial stiffness in patients with acute ischemic stroke using longitudinal elasticity modulus measurements obtained with Shear Wave Elastography.

    Science.gov (United States)

    Li, Zhaojun; Du, Lianfang; Wang, Feng; Luo, Xianghong

    2016-06-01

    Arterial wall elasticity including the circumferential and longitudinal modulus is a measure of sub-clinical cardiovascular disease; the circumferential modulus is increased in acute ischemic stroke (AIS). There are still no reports of non-invasive measurement of longitudinal elastic modulus of arterial wall and its prospect of clinical application. In this study, the longitudinal elastic modulus of the arterial wall was assessed using real-time shear wave elastography in patients with AIS. The technique's feasibility and its related factors were studied initially. In this study 179 patients with AIS and 168 age- and sex-matched controls were examined. The pulse wave velocity (PWV) of the bilateral carotid arteries was measured using radio frequency ultrasound technology. The 20 areas of superficial walls of bilateral carotid artery were analyzed by real-time shear wave elastography (SWE), and the average values of longitudinal average elastic modulus (ME-mean), maximum elastic modulus (ME-max), minimum elastic modulus (ME-min), and elastic modulus standard deviation (MESD) were measured. The PWV, ME-mean, ME-max and ME-sp of the carotid artery in patients with AIS were greater than those in the control group. Age, systolic blood pressure, PWV, and low-density lipoprotein were positively related to ME-mean and ME-max (r=0.221and r=0.248, r=0.174 and r=0.176, r=0.776 and r=0.716, r=0.173 and r=0.200, pelastic modulus of the arterial wall and evaluate the arterial stiffness. It was equivalent to the PWV which showed circular elastic modulus of arterial wall on evaluating AIS. Age, systolic blood pressure, pulse wave velocity, and low-density lipoprotein were independent risk factors for longitudinal elastic modulus. SWE may be effective in the assessment of arterial stiffness and offer a potential clinical benefit.

  7. Arterially perfused neurosphere-derived cells distribute outside the ischemic core in a model of transient focal ischemia and reperfusion in vitro.

    Science.gov (United States)

    Pastori, Chiara; Librizzi, Laura; Breschi, Gian Luca; Regondi, Cristina; Frassoni, Carolina; Panzica, Ferruccio; Frigerio, Simona; Gelati, Maurizio; Parati, Eugenio; De Simoni, Maria Grazia; de Curtis, Marco

    2008-07-23

    Treatment with neural stem cells represents a potential strategy to improve functional recovery of post-ischemic cerebral injury. The potential benefit of such treatment in acute phases of human ischemic stroke depends on the therapeutic viability of a systemic vascular delivery route. In spite of the large number of reports on the beneficial effects of intracerebral stem cells injection in experimental stroke, very few studies demonstrated the effectiveness of the systemic intravenous delivery approach. METODOLOGY/PRINCIPAL FINDINGS: We utilized a novel in vitro model of transient focal ischemia to analyze the brain distribution of neurosphere-derived cells (NCs) in the early 3 hours that follow transient occlusion of the medial cerebral artery (MCA). NCs obtained from newborn C57/BL6 mice are immature cells with self-renewal properties that could differentiate into neurons, astrocytes and oligodendrocytes. MCA occlusion for 30 minutes in the in vitro isolated guinea pig brain preparation was followed by arterial perfusion with 1x10(6) NCs charged with a green fluorescent dye, either immediately or 60 minutes after reperfusion onset. Changes in extracellular pH and K(+) concentration during and after MCAO were measured through ion-sensitive electrodes. It is demonstrated that NCs injected through the vascular system do not accumulate in the ischemic core and preferentially distribute in non-ischemic areas, identified by combined electrophysiological and morphological techniques. Direct measurements of extracellular brain ions during and after MCA occlusion suggest that anoxia-induced tissue changes, such as extracellular acidosis, may prevent NCs from entering the ischemic area in our in vitro model of transitory focal ischemia and reperfusion suggesting a role played by the surrounding microenviroment in driving NCs outside the ischemic core. These findings strongly suggest that the potential beneficial effect of NCs in experimental focal brain ischemia is not

  8. Arterially perfused neurosphere-derived cells distribute outside the ischemic core in a model of transient focal ischemia and reperfusion in vitro.

    Directory of Open Access Journals (Sweden)

    Chiara Pastori

    Full Text Available BACKGROUND: Treatment with neural stem cells represents a potential strategy to improve functional recovery of post-ischemic cerebral injury. The potential benefit of such treatment in acute phases of human ischemic stroke depends on the therapeutic viability of a systemic vascular delivery route. In spite of the large number of reports on the beneficial effects of intracerebral stem cells injection in experimental stroke, very few studies demonstrated the effectiveness of the systemic intravenous delivery approach. METODOLOGY/PRINCIPAL FINDINGS: We utilized a novel in vitro model of transient focal ischemia to analyze the brain distribution of neurosphere-derived cells (NCs in the early 3 hours that follow transient occlusion of the medial cerebral artery (MCA. NCs obtained from newborn C57/BL6 mice are immature cells with self-renewal properties that could differentiate into neurons, astrocytes and oligodendrocytes. MCA occlusion for 30 minutes in the in vitro isolated guinea pig brain preparation was followed by arterial perfusion with 1x10(6 NCs charged with a green fluorescent dye, either immediately or 60 minutes after reperfusion onset. Changes in extracellular pH and K(+ concentration during and after MCAO were measured through ion-sensitive electrodes. CONCLUSION/SIGNIFICANCE: It is demonstrated that NCs injected through the vascular system do not accumulate in the ischemic core and preferentially distribute in non-ischemic areas, identified by combined electrophysiological and morphological techniques. Direct measurements of extracellular brain ions during and after MCA occlusion suggest that anoxia-induced tissue changes, such as extracellular acidosis, may prevent NCs from entering the ischemic area in our in vitro model of transitory focal ischemia and reperfusion suggesting a role played by the surrounding microenviroment in driving NCs outside the ischemic core. These findings strongly suggest that the potential beneficial effect

  9. Massive Ischemic Stroke Due to Pulmonary Barotrauma and Cerebral Artery Air Embolism During Commercial Air Travel.

    Science.gov (United States)

    Farshchi Zarabi, Sara; Parotto, Matteo; Katznelson, Rita; Downar, James

    2017-06-13

    BACKGROUND Air embolism into the systemic arterial circulation secondary to pulmonary barotrauma has rarely been reported. Herein, we report the clinical course of an extremely rare presentation of cerebral air embolism likely due to ruptured pulmonary bullae during commercial air travel. CASE REPORT A 65-year-old man suddenly became unconscious during an airplane descent. Upon landing, he was immediately transferred to the nearest emergency department where he was intubated for airway protection. His head CT angiogram showed multiple air pockets in the right parietal lobe suspicious for multiple air emboli. His chest CT scan showed multiple large bullae in the left upper and lower lobes as well as diffusely emphysematous lung tissue. After initial stabilization, he underwent emergent hyperbaric oxygen treatment (HBOT) in the multiplace chamber at 2.8 atmospheres. The patient tolerated HBOT well with no complications. However, his neurologic status deteriorated in the following 24 hours due to progression of his cerebral edema and mass effects. The patient's clinical status was discussed with his family and the decision was made to withdraw life-sustaining measures. He died shortly after withdrawal of life support. Post-mortem examination confirmed the presence of very large bullae in the lungs bilaterally. CONCLUSIONS Spontaneous cerebral air embolism is a possible complication of ruptured pulmonary bullae during air travel. HBOT is well-tolerated and may be used with caution even in the presence of emphysematous bullae.

  10. Protective effects of allicin against ischemic stroke in a rat model of middle cerebral artery occlusion.

    Science.gov (United States)

    Zhang, Benping; Li, Feng; Zhao, Weijiang; Li, Jiebing; Li, Qingsong; Wang, Weizhi

    2015-09-01

    Allicin, a molecule predominantly responsible for the pungent odor and the antibiotic function of garlic, exhibits various pharmacological activities and has been suggested to be beneficial in the treatment of various disorders. The present study aimed to elucidate the effect of allicin in cerebral ischemia/reperfusion (I/R) injury in rats. Rats were subjected to 1.5 h of transient middle cerebral artery occlusion (MCAO), followed by 24 h of reperfusion. Rats were randomly assigned to the sham surgery group, the MCAO group and the MCAO + allicin group. Neurological score, cerebral infarct size, brain water content, neuronal apoptosis, serum tumor necrosis factor (TNF)‑α and myeloperoxidase (MPO) activity were measured. The results suggested that allicin reduced cerebral infarction area, brain water content, neuronal apoptosis, TNF‑α levels and MPO activity in the serum. The results of the present study indicated that allicin protects the brain from cerebral I/R injury, which may be ascribed to its anti‑apoptotic and anti‑inflammatory effects.

  11. CT and MRI findings of cerebral ischemic lesions in the cortical and perforating arterial system

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Masakuni; Udaka, Fukashi; Nishinaka, Kazuto; Kodama, Mitsuo; Urushidani, Makoto; Kawamura, Kazuyuki; Inoue, Haruhisa; Kageyama, Taku [Sumitomo Hospital, Osaka (Japan)

    1995-07-01

    It is clinically useful to divide the location of infarction into the cortical and perforating arterial system. Computerized tomography (CT) and magnetic resonance imaging (MRI) now make the point of infarction a simple and useful task in daily practice. The diagnostic modality has also demonstrated that risk factors and clinical manifestations are different for infarction in the cortical as opposed to the perforating system. In this paper, we present various aspects of images of cerebral ischemia according to CT and/or MRI findings. With the advance of imaging mechanics, diagnostic capability of CT or/and MRI for cerebral infarction has markedly been improved. We must consider these points on evaluating the previously reported results. In addition, we always consider the pathological background of these image-findings for the precise interpretation of their clinical significance. In some instances, dynamic study such as PET or SPECT is needed for real interpretations of CT and/or MRI images. We paid special reference to lacunar stroke and striatocapsular infarct. In addition, `branch atheromatous disease (Caplan)` was considered, in particular, for their specific clinical significances. Large striatocapsular infarcts frequently show cortical signs and symptoms such as aphasia or agnosia in spite of their subcortical localization. These facts, although have previously been known, should be re-considered for their pathoanatomical mechanism. (author).

  12. Carotid artery wall thickness and ischemic symptoms: evaluation using multi-detector-row CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Caddeo, Giancarlo; Mallarini, Giorgio [Azienda Ospedaliero Universitaria Polo di Monserrato, Department of Radiology, Cagliari (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria Polo di Monserrato, Department of Vascular Surgery, Cagliari (Italy); Pascalis, Luigi [Azienda Ospedaliero Universitaria Polo di Cagliari, Division of II Internal Medicine, Cagliari (Italy)

    2008-09-15

    The purpose of this study was to determine if carotid artery wall thickness (CAWT) studied by using multi-detector-row CT angiography (MDCTA) can be considered an effective parameter predictive of increased risk of stroke. A total of 217 patients were retrospectively studied by using MDCTA. In all patients CAWT was measured with an internal digital caliper. Continuous data were described as the mean value {+-} standard deviation (SD), and they were compared with Student's t-test. Scatter plots to determine interobserver agreement were performed, and correlation coefficient was calculated with Pearson statistics. A P value <0.05 was considered to mean statistical significance. Measurements of the distal common CAWT ranged from 0.5 to 1.6 mm. In the patient group without stroke, average CAWT was 0.82 mm (0.22 SD), whereas in patient group with stroke it was 1.096 mm (0.21 SD). CAWT in patients without stroke showed statistical difference (P<0.0001) when compared to patients with stroke. By using a threshold of 1 mm, an important statistical association between thick CAWT and stroke was found (P<0.0001). In fact, patients with {>=}1 mm CAWT had stroke with an odds ratio of 8.16 when compared with patients with <1 mm CAWT. Resulting data suggested that an increased CAWT is an indicator for risk of stroke. This parameter should be considered in addition to other well-known risk factors such as diabetes, hypertension, smoking, and dyslipidemia. (orig.)

  13. Stem cell registry programme for patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting: what benefits does it derive?

    Science.gov (United States)

    Nesteruk, Julia; Voronina, Natalia; Kundt, Guenther; Donndorf, Peter; Klopsch, Christian; Kaminski, Alexander; Duckers, Henrick J; Steinhoff, Gustav

    2017-05-01

    Standardization of stem cell therapy requires application of appropriate methods to evaluate safety and efficacy, including long-term pharmacovigilance. To accomplish this objective, a long-term registry programme was installed. We analysed 150 patients with ischemic cardiomyopathy, who received intramyocardial CD133+ bone marrow mononuclear stem cell treatment combined with coronary artery bypass grafting (CABG) or CABG alone. The mortality rate, major adverse cerebral and cardiac events, and functional outcome parameters were evaluated for the time period up to 14 years follow-up. As a result, we have stratified the patient population (96 patients) into responders and non-responders. Furthermore, the analysis of relevant predictors of good response to CD133+ bone marrow mononuclear stem cell treatment was performed. Several positive tendencies related to stem cells transplantation were demonstrated. First, no significant difference in major adverse cardiovascular and cerebral events was observed between stem cell and control group up to 14 years follow-up. Second, an improvement of left ventricle ejection fraction (LVEF) in stem cell group retained for 5 years in contrast with CABG-only group, where no significant changes in LVEF after 2 years were observed. In addition, LVEF under 30% and left ventricle end diastolic diameter above 60 mm were independent predictors of functional response to CD133+ cell therapy. Participants with overt heart failure benefit most from CABG combined with intramyocardial injection of CD133+ bone marrow mononuclear cell within the group. An improvement LVEF in stem cell group remained for 5 years in contrast with the CABG-only group. The patients, in whom the improvement of both LVEF and LVED was observed, have benefited by increased life expectancy.

  14. Meta-Analysis of miR-146a Polymorphisms Association with Coronary Artery Diseases and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Mei-Hua Bao

    2015-06-01

    Full Text Available Coronary artery disease (CAD and ischemic stroke (IS are manifestations of atherosclerosis, with a high death rate. miR-146a is a microRNA that participates in the progress of CAD and IS. A single nucleotide polymorphism (SNP in the precursor of miR-146a, rs2910164, was found to be associated with the risks of CAD and IS. However, the results were inconsistent and inconclusive. A meta-analysis was performed to assess the relationship of rs2910164 and CAD as well as IS susceptibility. The database Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL, Chinese National Knowledge Infrastructure (CNKI, and Chinese Biomedical Literature Database (CBM were searched for related studies. Crude odds ratios with 95% confidence intervals were used to investigate the strength of the association by random- or fixed-effect model. A total of eight studies, with 3138 cases and 3097 controls were identified for the meta-analysis. The results shows that rs2910164 is associated with the risk of CAD significantly in allelic model (OR = 0.86, homozygous model (OR = 0.70, heterozygous model (OR = 0.80 and dominant model (OR = 0.76. The subjects carrying the GG genotype, GG + GC genotype or G allele are at lower risks of CAD. For the susceptibility of IS, there are no significant associations between rs2910164 and total studies. However, in subgroup analysis by sample size and ethnicity, the GG, GG + GC and G allele of rs2910164 are found to be associated with higher risks of IS in large sample size group and in Koreans, under homozygous and dominant models. In conclusion, the current meta-analysis suggests lower risks of CAD for GG, GG + GC genotype and G allele of rs2910164, while rs2910164 is not associated with the risk of IS. Thus rs2910164 might be recommended as a predictor for susceptibility of CAD, but not IS.

  15. Global fibrinolytic activity, PAI-1 level, and 4G/5G polymorphism in Thai children with arterial ischemic stroke.

    Science.gov (United States)

    Natesirinilkul, Rungrote; Sasanakul, Werasak; Chuansumrit, Ampaiwan; Kadegasem, Praguywan; Visudtibhan, Anannit; Wongwerawattanakoon, Pakawan; Sirachainan, Nongnuch

    2014-01-01

    Prolonged euglobulin clot lysis time (ECLT) and increased level of plasminogen activator inhibitor-1 (PAI-1) were reported to be risk factors of arterial ischemic stroke (AIS) by some studies; however, these findings were not supported by other studies. The objective of this study was to determine the association of ECLT, PAI-1 level, and polymorphisms of 4G and 5G of PAI-1 gene to the development of AIS in Thai children. This study included patients aged 1-18 years old. Diagnosis of AIS was confirmed by imaging study. The control group was age- and sex-matched healthy subjects. Demographic data were recorded, and blood was tested for ECLT, PAI-1 level, lipid profiles, fasting blood sugar (FBS), and 4G and 5G polymorphisms of PAI-1 gene. There were 70 subjects participating in this study, consisting of 30 patients and 40 controls. Demographic data, lipid profiles, and FBS were similar between the 2 groups. Furthermore, ECLT and PAI-1 level did not differ between patient and control groups; however, both showed significant correlation (r = .352, P = .006). The 4G/5G polymorphism was the most common genotype in both patient and control groups (69.0% vs. 80.0%). However, 4G and 5G polymorphisms of PAI-1 gene did not correlate with PAI-1 level in this study (P = .797). The PAI-1 level and 4G/5G polymorphism may not be a risk factor of AIS in this population. It was also found that the 4G/5G polymorphism was the most common PAI-1 genotype in this study. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT.

    Science.gov (United States)

    Xu, Yuan; Arsanjani, Reza; Clond, Morgan; Hyun, Mark; Lemley, Mark; Fish, Mathews; Germano, Guido; Berman, Daniel S; Slomka, Piotr J

    2012-06-01

    Transient ischemic dilation (TID) of the left ventricle in myocardial perfusion SPECT (MPS) has been shown to be a clinically useful marker of severe coronary artery disease (CAD). However, TID has not been evaluated for 99mTc-sestamibi rest/stress protocols (Mibi-Mibi). We aimed to develop normal limits and evaluate diagnostic power of TID ratio for Mibi-Mibi scans. TID ratios were automatically derived from static rest/stress MPS (TID) and gated rest/stress MPS from the end-diastolic phase (TID(ed)) in 547 patients who underwent Mibi-Mibi scans [215 patients with correlating coronary angiography and 332 patients with low likelihood (LLk) of CAD]. Scans were classified as severe (≥ 70% stenosis in proximal left anterior descending (pLAD) artery or left main (LM), or ≥ 90% in ≥ 2 vessels), mild to moderate (≥ 90% stenosis in 1 vessel or ≥ 70%-90% in ≥ 1 vessel except pLAD or LM), and normal (TID and 1.23 for TID(ed) as established in 259 LLk patients. Both ratios increased with disease severity (P TID increased from 2% in normal patients to >36% in patients with severe CAD. Similarly, when DI was used to classify disease severity, the average ratios showed significant increasing trend with DI increase (P TID also increased with increasing DI. The incidence of abnormal TID in the group with high perfusion scores significantly increased compared to the group with low perfusion scores (stress total perfusion deficit, TPD TID when added to mild to moderate perfusion abnormality (3% ≤ TPD TID(ed)/TID(es): 69% vs 64%, P = .08, while the accuracy remained consistent if abnormal TID was considered as a marker in addition to stress TPD. Similar results were obtained when DI was used for the definition of severe CAD (sensitivity: 76% vs 66%, P TID was combined with stress TPD). TID ratios obtained from gated or ungated Mibi-Mibi MPS and are useful markers of severe CAD.

  17. Association of Collateral Blood Vessels Detected by Arterial Spin Labeling Magnetic Resonance Imaging With Neurological Outcome After Ischemic Stroke.

    Science.gov (United States)

    de Havenon, Adam; Haynor, David R; Tirschwell, David L; Majersik, Jennifer J; Smith, Gordon; Cohen, Wendy; Andre, Jalal B

    2017-04-01

    Robust collateral blood vessels have been associated with better neurologic outcome following acute ischemic stroke (AIS). The most commonly used methods for identifying collaterals are contrast-based angiographic imaging techniques, which are not possible in all patients after AIS. To assess the association between the presence of collateral vessels identified using arterial spin labeling (ASL) magnetic resonance imaging, a technique that does not require exogenous administration of contrast, and neurologic outcome in patients after AIS. This retrospective cohort study examined 38 patients after AIS admitted to a tertiary academic medical center between 2012 and 2014 who underwent MRI with ASL. According to a prespecified hypothesis, ASL images were graded for the presence of collaterals by 2 neuroradiologists. Modified Rankin Scale (mRS) scores at discharge and other composite data were abstracted from the medical record by a neurologist blinded to radiologic data. Of the 38 patients, 19 (50.0%) were male, and the mean (SD) age was 61 (20) years. In 25 of 38 patients (65.8%), collaterals were detected using ASL, which were significantly associated with both a good outcome (mRS score of 0-2 at discharge; P = .02) and a 1-point decrease in mRS score at discharge (odds ratio, 6.4; 95% CI, 1.7-23.4; P = .005). In a multivariable ordinal logistic regression model, controlling for admission National Institutes of Health Stroke Scale score, history of atrial fibrillation, premorbid mRS score, and stroke parent artery status, there was a strong association between the presence of ASL collaterals and a 1-point decrease in the mRS score at discharge (odds ratio, 5.1; 95% CI, 1.2-22.1; P = .03). Following AIS, the presence of ASL collaterals is strongly associated with better neurological outcome at hospital discharge. This novel association between ASL collaterals and improved neurologic outcome may help guide prognosis and management, particularly in patients

  18. Arterial spin labeling imaging findings in transient ischemic attack patients: comparison with diffusion- and bolus perfusion-weighted imaging.

    Science.gov (United States)

    Zaharchuk, Greg; Olivot, Jean-Marc; Fischbein, Nancy J; Bammer, Roland; Straka, Matus; Kleinman, Jonathan T; Albers, Gregory W

    2012-01-01

    Since transient ischemic attacks (TIAs) can predict future stroke, it is important to distinguish true vascular events from non-vascular etiologies. Arterial spin labeling (ASL) is a non-contrast magnetic resonance (MR) method that is sensitive to cerebral perfusion and arterial arrival delays. Due to its high sensitivity to minor perfusion alterations, we hypothesized that ASL abnormalities would be identified frequently in TIA patients, and could therefore help increase clinicians' confidence in the diagnosis. We acquired diffusion-weighted imaging (DWI), intracranial MR angiography (MRA), and ASL in a prospective cohort of TIA patients. A subset of these patients also received bolus contrast perfusion-weighted imaging (PWI). Two neuroradiologists evaluated the images in a blinded fashion to determine the frequency of abnormalities on each imaging sequence. Kappa (ĸ) statistics were used to assess agreement, and the χ(2) test was used to detect differences in the proportions of abnormal studies. 76 patients met the inclusion criteria, 48 (63%) of whom received PWI. ASL was abnormal in 62%, a much higher frequency compared with DWI (24%) and intracranial MRA (13%). ASL significantly increased the MR imaging yield above the combined DWI and MRA yield (62 vs. 32%, p PWI was abnormal in 31% of patients, and in these, ASL was abnormal in 14 out of 15 cases (93%). In hemispheric TIA patients, both PWI and ASL findings were more common in the symptomatic hemisphere. Agreement between neuroradiologists regarding abnormal studies was good for ASL and PWI [ĸ = 0.69 (95% CI 0.53-0.86) and ĸ = 0.66 (95% CI 0.43-0.89), respectively]. In TIA patients, perfusion-related alterations on ASL were more frequently detected compared with PWI or intracranial MRA and were most frequently associated with the symptomatic hemisphere. Almost all cases with a PWI lesion also had an ASL lesion. These results suggest that ASL may aid in the workup and triage of TIA patients, particularly

  19. Transient Ischemic Attack

    Medline Plus

    Full Text Available Transient Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only ... TIA is that with TIA the blockage is transient (temporary). TIA symptoms occur rapidly and last a ...

  20. Efficacy versus safety: the dilemma of using novel platelet inhibitors for the treatment of patients with ischemic stroke and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Iannopollo G

    2014-05-01

    Full Text Available Gianmarco Iannopollo,1 Rita Camporotondo,2 Gaetano M De Ferrari,2 Sergio Leonardi2 1Università degli Studi di Pavia, Pavia, 2Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Abstract: Coronary and cerebrovascular atherothrombosis are the leading cause of mortality and morbidity worldwide. Novel antiplatelet agents have been established for the management of patients with clinically evident coronary atherothrombosis and are increasingly used in these patients. These agents, however, have shown limited efficacy in the prevention of cerebrovascular events and potential harm in patients with history of stroke or transient ischemic attack. Herein, the efficacy and safety of two established antiplatelet agents in patients with stroke – aspirin and clopidogrel – are reviewed with a focus on the use and challenges related to novel antiplatelet agents – prasugrel, ticagrelor, and vorapaxar – in patients at risk for and with a history of stroke or transient ischemic attack. Keywords: cerebrovascular disease, coronary artery disease, aspirin, clopidogrel, novel antiplatelet agents

  1. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study.

    Science.gov (United States)

    Paciaroni, Maurizio; Inzitari, Domenico; Agnelli, Giancarlo; Caso, Valeria; Balucani, Clotilde; Grotta, James C; Sarraj, Amrou; Sung-Il, Sohn; Chamorro, Angel; Urra, Xabier; Leys, Didier; Henon, Hilde; Cordonnier, Charlotte; Dequatre, Nelly; Aguettaz, Pierre; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Zini, Andrea; Vallone, Stefano; Dell'Acqua, Maria Luisa; Menetti, Federico; Nencini, Patrizia; Mangiafico, Salvatore; Barlinn, Kristian; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Bovi, Paolo; Cappellari, Manuel; Linfante, Italo; Dabus, Guilherme; Marcheselli, Simona; Pezzini, Alessandro; Padovani, Alessandro; Alexandrov, Andrei V; Shahripour, Reza Bavarsad; Sessa, Maria; Giacalone, Giacomo; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; De Vito, Alessandro; Azzini, Cristiano; Saletti, Andrea; Fainardi, Enrico; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Silvestrini, Mauro; Ferrarese, Carlo; Beretta, Simone; Tassi, Rossana; Martini, Giuseppe; Tsivgoulis, Georgios; Vasdekis, Spyros N; Consoli, Domenico; Baldi, Antonio; D'Anna, Sebastiano; Luda, Emilio; Varbella, Ferdinando; Galletti, Giampiero; Invernizzi, Paolo; Donati, Edoardo; De Lodovici, Maria Luisa; Bono, Giorgio; Corea, Francesco; Sette, Massimo Del; Monaco, Serena; Riva, Maurizio; Tassinari, Tiziana; Scoditti, Umberto; Toni, Danilo

    2015-02-01

    The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of

  2. Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature.

    Science.gov (United States)

    Nicosia, Giancarlo; Cicala, Domenico; Mirone, Giuseppe; Spennato, Pietro; Trischitta, Vincenzo; Ruggiero, Claudio; Guarneri, Gianluigi; Muto, Mario; Cinalli, Giuseppe

    2017-02-01

    Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents. We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent. To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three

  3. Central vestibular syndrome in a red fox (Vulpes vulpes with presumptive right caudal cerebral artery ischemic infarct and prevalent midbrain involvement

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    Mario Ricciardi

    2017-06-01

    Full Text Available A wild young male red fox (Vulpes vulpes was found in the mountainous hinterland of Rome (Italy with a heavily depressed mental status and unresponsive to the surrounding environment. Neurological examination revealed depression, left circling, right head tilt, ventromedial positional strabismus and decreased postural reactions on the left side. Neurological abnormalities were suggestive of central vestibular syndrome. Two consecutive MRIs performed with 30 days interval were compatible with lacunar ischemic infarct in the territory of right caudal cerebral artery and its collateral branches. The lesion epicentre was in the right periaqueductal portion of the rostral mesencephalic tegmentum. Neuroanatomical and neurophysiological correlation between lesion localization and clinical presentation are discussed.

  4. Central vestibular syndrome in a red fox (Vulpes vulpes) with presumptive right caudal cerebral artery ischemic infarct and prevalent midbrain involvement.

    Science.gov (United States)

    Ricciardi, Mario; Gernone, Floriana; Simone, Antonio De; Giannuzzi, Pasquale

    2017-01-01

    A wild young male red fox ( Vulpes vulpes ) was found in the mountainous hinterland of Rome (Italy) with a heavily depressed mental status and unresponsive to the surrounding environment. Neurological examination revealed depression, left circling, right head tilt, ventromedial positional strabismus and decreased postural reactions on the left side. Neurological abnormalities were suggestive of central vestibular syndrome. Two consecutive MRIs performed with 30 days interval were compatible with lacunar ischemic infarct in the territory of right caudal cerebral artery and its collateral branches. The lesion epicentre was in the right periaqueductal portion of the rostral mesencephalic tegmentum. Neuroanatomical and neurophysiological correlation between lesion localization and clinical presentation are discussed.

  5. Correlation between early revascularization and major cardiac events demonstrated by ischemic myocardium in Japanese patients with stable coronary artery disease.

    Science.gov (United States)

    Yoda, Shunichi; Hori, Yusuke; Hayase, Misa; Mineki, Takashi; Hatta, Takumi; Suzuki, Yasuyuki; Matsumoto, Naoya; Hirayama, Atsushi

    2018-01-01

    There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD. We retrospectively investigated 3581 stable CAD patients who underwent rest 201Tl and stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio (n=450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups. The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p=0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p=0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p=0.0036). The incidence of MCEs in the patients with 6-10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p=0.3235). Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia

  6. Clinical significance of factor V leiden and prothrombin G20210A-mutations in cerebral venous thrombosis - comparison with arterial ischemic stroke.

    Science.gov (United States)

    Beye, Aida; Pindur, Gerhard

    2017-08-28

    Cerebrovascular diseases are considered in a different way concerning their etiology with regard to arterial and venous occlusion. The role of thrombophilia in this context remains undetermined. For this reason, a case-control study was conducted including a total of 202 patients (154 females, 48 males) aged from 18 to 76 years (mean: 39.8 years) suffering either from cerebral sinus venous thrombosis (n = 101) or from arterial ischemic stroke (n = 101). Study groups were evaluated on the basis of age- and gender-matched pairs. Gene mutations of factor V-1691 (factor V Leiden) and prothrombin-20210 being considered as the most common thrombophilia markers were analyzed in this study. Factor V Leiden-mutations were found in 16.8% of patients with cerebral sinus venous thrombosis (CVT) and in 17.8% of patients with arterial ischemic stroke (AIS), which was significantly more frequent than in controls at a rate of 4.95% (ORs: 3.89 and 4.16). Prothrombin-mutations were significantly more frequent in CVT at a rate of 14.9% versus 2.97% in controls (OR: 5.70). This does not apply for AIS showing a rate of 4.95% prothrombin-mutations. Rates of factor V Leiden-mutations are not different in CVT compared with AIS. In contrast, however, prothrombin-mutations were significantly more frequent in CVT than in AIS with a rate of 14.9% versus 4.95% (OR 3.35). Furthermore, 3 cases with combined heterozygosity of factor V Leiden- and prothrombin-mutation have been identified in CVT, but not in AIS or controls. All of the above mentioned mutations were exclusively heterozygous. We conclude from these data that thrombophilia in terms of factor V Leiden genotype is a risk factor for both CVT and AIS in equal measure. In contrast, prothrombin-20210-mutations were different playing a significant role in the pathogenesis of cerebral sinus vein- thrombosis, but not in arterial ischemic stroke. Also, the combined occurrence of heterozygous prothrombin- and factor V Leiden

  7. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-09-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  8. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-01-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  9. Planning interventional trials in childhood arterial ischaemic stroke using a Delphi consensus process.

    Science.gov (United States)

    Steinlin, Maja; O'callaghan, Finbar; Mackay, Mark T

    2017-07-01

    There is a paucity of data from randomized controlled treatment trials in childhood arterial ischaemic stroke. Our objectives were to identify and plan a trial through use of a Delphi consensus process. The Delphi panel consisted of Australian, New Zealand, and European paediatric neurologists with interests in childhood stroke. Four rounds were conducted using a REDCap (Research Electronic Data Capture) Web-based application: the first consisted of open-ended questions; the second evaluated agreement for the most important trial; the third and fourth reached consensus on design. Forty-seven out of 66 neurologists answered the first round. Eight areas of research for important and feasible trials were identified. In the second round, 43 paediatric neurologists ranked the three highest rated trials: (1) aspirin versus aspirin plus steroids in focal arteriopathy (n=31); (2) heparin versus aspirin (n=6); and (3) heparin versus aspirin versus modern anticoagulation (n=6). The third and fourth surveys reached consensus among 43 out of 44 respondents on design of the highest ranked trial, and allowed agreement on inclusion/exclusion criteria, clinical/neuroimaging data, and treatment protocols. The Delphi consensus process is an efficient method of identifying and planning paediatric stroke trials. An international, multicentre trial is now in preparation. © 2017 Mac Keith Press.

  10. Is "ischemic" colitis ischemic?

    Science.gov (United States)

    Carlson, Ryan M; Madoff, Robert D

    2011-03-01

    Ischemic colitis appears to be a collection of diseases rather than a single entity. On the one hand, there is the colitis that truly appears to be caused by a lack of blood flow and, on the other hand, there is the disease that is called "ischemic" for lack of a better diagnosis-the colitis that is more "idiopathic" than "ischemic." Four widely held tenets of "ischemic" colitis are wrong: 1) the colon is not particularly sensitive to ischemia; 2) ischemic colitis is rarely preceded by a period of global hypoperfusion; 3) the "watershed areas" are not disproportionately affected; and 4) colonoscopy with biopsy is not specific for the disease. The cause of "ischemic" colitis is unknown. Therefore it is, until proven otherwise, "acute idiopathic colitis."

  11. Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study.

    Science.gov (United States)

    Carroll, Judith E; Gruenewald, Tara L; Taylor, Shelley E; Janicki-Deverts, Denise; Matthews, Karen A; Seeman, Teresa E

    2013-10-15

    Childhood abuse increases adult risk for morbidity and mortality. Less clear is how this "toxic" stress becomes embedded to influence health decades later, and whether protective factors guard against these effects. Early biological embedding is hypothesized to occur through programming of the neural circuitry that influences physiological response patterns to subsequent stress, causing wear and tear across multiple regulatory systems. To examine this hypothesis, we related reports of childhood abuse to a comprehensive 18-biomarker measure of multisystem risk and also examined whether presence of a loving parental figure buffers against the impact of childhood abuse on adult risk. A total of 756 subjects (45.8% white, 42.7% male) participated in this ancillary substudy of the Coronary Artery Risk Development in Young Adults Study. Childhood stress was determined by using the Risky Families Questionnaire, a well-validated retrospective self-report scale. Linear regression models adjusting for age, sex, race, parental education, and oral contraceptive use found a significant positive relationship between reports of childhood abuse and multisystem health risks [B (SE) = 0.68 (0.16); P < 0.001]. Inversely, higher amounts of reported parental warmth and affection during childhood was associated with lower multisystem health risks [B (SE) = -0.40 (0.14); P < 0.005]. A significant interaction of abuse and warmth (P < 0.05) was found, such that individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multisystem risk in adulthood.

  12. Quality of life after intra-arterial treatment for acute ischemic stroke in the MR CLEAN trialUpdate

    NARCIS (Netherlands)

    Schreuders, Jennifer; van den Berg, Lucie A.; Fransen, Puck Ss; Berkhemer, Olvert A.; Beumer, Debbie; Lingsma, Hester F.; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Majoie, Charles B. L. M.; van der Lugt, Aad; de Kort, Paul L. M.; Roos, Yvo B. W. E. M.; Dippel, Diederik W. J.

    2017-01-01

    Background Health-related quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire was one of the secondary outcomes in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN). We reported no

  13. Quality of life after intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial—Update

    NARCIS (Netherlands)

    Schreuders, J. (Jennifer); L.A. Van Den Berg (Lucie A.); P.S.S. Fransen (Puck); O.A. Berkhemer (Olvert); D. Beumer (Debbie); H.F. Lingsma (Hester); R.J. van Oostenbrugge (Robert); W.H. van Zwam (Wim); C.B. Majoie (Charles); A. van der Lugt (Aad); P.L.M. de Kort (Paul); Y.B.W.E.M. Roos (Yvo); D.W.J. Dippel (Diederik)

    2017-01-01

    textabstractBackground: Health-related quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire was one of the secondary outcomes in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN). We reported

  14. Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke : mapping of intra-arterial treatment effect

    NARCIS (Netherlands)

    Boers, A M M; Berkhemer, O A; Slump, C H; van Zwam, W H; Roos, Y B W E M; van der Lugt, A; van Oostenbrugge, R J; Yoo, A J; Dippel, D W J; Marquering, H A; Majoie, C B L M; Vroomen, P. C.

    2017-01-01

    BACKGROUND: Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT

  15. The impact of coronary artery disease risk loci on ischemic heart failure severity and prognosis : association analysis in the COntrolled ROsuvastatin multiNAtional trial in heart failure (CORONA)

    NARCIS (Netherlands)

    Haver, Vincent G.; Verweij, Niek; Kjekshus, John; Fox, Jayne C.; Wedel, Hans; Wikstrand, John; van Gilst, Wiek H.; de Boer, Rudolf A.; van Veldhuisen, Dirk J.; van der Harst, Pim

    2014-01-01

    Background: Recent genome-wide association studies have identified multiple loci that are associated with an increased risk of developing coronary artery disease (CAD). The impact of these loci on the disease severity and prognosis of ischemic heart failure due to CAD is currently unknown. Methods:

  16. Simultaneous multi-vessel coronary artery bypass grafting, ischemic mitral regurgitation repair and descending aortic aneurysm replacement: analysis of technical points.

    Science.gov (United States)

    Malyshev, Michael; Safuanov, Alexander; Borovikov, Dmitry; Malyshev, Anton

    2008-04-01

    The combination of coronary artery disease and its complications (ischemic mitral regurgitation etc.) with the aneurysm of the descending thoracic aorta is not a rare case. The single-stage correction of coronary/intracardiac/aortic lesions may be considered as a way of managing the combined patients. Simultaneous multi-vessel coronary artery bypass grafting, suture mitral annuloplasty and descending aortic aneurysm replacement with synthetic prosthesis is described. The operation was performed through the left thoracotomy with cardiopulmonary bypass established by the cannulation of the ascending aorta and of the right atrial appendage. Ventricular fibrillation and no clamping of the ascending aorta were used. The circulatory arrest was induced for the construction of the proximal anastomosis between the descending aorta and the synthetic prosthesis. No complications related to the operation were diagnosed for the 14-month follow-up. Several technical points seem optimal for the combined procedure: (1) Minimization of manipulations on the ascending aorta (using of pedicled left internal thoracic artery; construction of the proximal anastomoses with synthetic aortic prosthesis; unclamped ascending aorta). (2) Revascularization of all coronary areas and correction of intracardiac lesions through the left thoracotomy. Individual planning of the procedural technical points for every patient may provide a safe feasibility of the combined procedure.

  17. Association Between the 20210G>A Prothrombin Gene Polymorphism and Arterial Ischemic Stroke in Children and Young Adults-Two Meta-analyses of 3586 Cases and 6440 Control Subjects in Total.

    Science.gov (United States)

    Sarecka-Hujar, Beata; Kopyta, Ilona; Skrzypek, Michal; Sordyl, Joanna

    2017-04-01

    Previous data have shown that the 20210G>A polymorphism of the Factor II gene is related to an increased prothrombin level, which may in turn lead to a procoagulant state. The heterogeneous and multifactorial character of arterial ischemic stroke often results in contradictory reports describing the association between the 20210G>A polymorphism and arterial ischemic stroke in different populations. We performed a meta-analysis of available data addressing the relation between the FII 20210G>A polymorphism and arterial ischemic stroke, both in young adults and children. We searched PubMed using appropriate keywords. The inclusion criteria for the study were as follows: case-control study, study population consisting of children, study population consisting of young adults, arterial ischemic stroke confirmed by magnetic resonance imaging or computed tomography, and English language. The exclusion criteria included lack of genotype or allele frequencies, study design other than a case-control study, outcome definition other than arterial ischemic stroke, and previously overlapped patient groups. Finally, 30 case-control studies (14 in children and 16 in young adults) were included. Statistical analyses were conducted using R software. Heterogeneity between the studies was evaluated using the Dersimonian and Laird's Q test. In the case of significant between-studies heterogeneity, the pooled odds ratio was estimated with a random-effects model, otherwise a fixed-effects model was used. The pooled analysis showed that carriers of 20210A allele (GA+AA genotypes) of the prothrombin gene are more common in arterial ischemic stroke patients, both in children and young adults, than in control subjects (P = 0.006; odds ratio, 1.83; 95% confidence interval, 1.19 to 2.80 and P = 0.001; odds ratio, 1.69; 95% confidence interval, 1.25 to 2.28, respectively). The results of the present meta-analysis have proven that the FII 20210G>A polymorphism is associated with arterial

  18. [Effect of childhood adiposity on long-term risks of carotid atherosclerosis and arterial stiffness in adulthood].

    Science.gov (United States)

    Yan, Yinkun; Hou, Dongqing; Liu, Junting; Zhao, Xiaoyuan; Cheng, Hong; Yang, Ping; Shan, Xinying; Mi, Jie

    2016-01-01

    To observe the effect of childhood excessive adiposity on long-term risk of adult carotid atherosclerosis and arterial stiffness. At baseline, in 1987, by using stratified cluster sampling design, 3 198 healthy children aged 6-18 were recruited from six primary schools and six middle schools from three districts (Chaoyang, Xicheng, and Haidian) in Beijing, with blood pressure, weight, height and left scapular skinfold thickness (LSSF) measured. From April 2010 to July 2012, 1 225 subjects were followed from childhood to adulthood. Questionnaire, biochemistry parameters, carotid-femoral pulse wave velocity (cfPWV), and carotid intima media thickness (cIMT) were measured at follow-up. Based on weight statuses in childhood and adulthood, subjects were classified into four groups (persistent non-overweight from childhood to adulthood, overweight in childhood but non-overweight in adulthood, non-overweight in childhood but overweight in adulthood, persistent overweight from childhood to adulthood). Multiple logistic regression model was used to analyze the association between weight statuses changing from childhood to adulthood and adult high cfPWV and high cIMT. The prevalence of overweight (including obesity) at adulthood was 52.2% (639). Males had higher prevalence of smoking (62.5%(422/675) vs 29.4%(160/550), χ(2)=133.21, Padulthood, subjects with overweight in childhood but non-overweight in adulthood had similar risks of high cfPWV (OR=1.59, 95%CI: 0.77-3.30)and high cIMT (OR=1.47, 95%CI:0.65-3.31). The risks of high cfPWV and high cIMT increased among subjects with non-overweight in childhood but overweight in adulthood (OR=1.92, 95%CI:1.37-2.68; OR=3.69, 95% CI:2.61- 5.23) and among subjects with persistent overweight from childhood to adulthood (OR=2.53, 95%CI:1.70-3.76; OR=5.37, 95%CI:3.62-7.97). We concluded that a overweight children changed to a healthy weight adult, the risks of adult subclinical atherosclerosis and arterial stiffness would not be

  19. Epicardial and microvascular coronary vasomotor dysfunction and its relation to myocardial ischemic burden in patients with non-obstructive coronary artery disease.

    Science.gov (United States)

    Verna, Edoardo; Ghiringhelli, Sergio; Provasoli, Stefano; Scotti, Simone; Salerno-Uriarte, Jorge

    2017-04-03

    To assess the relative contribution of epicardial endothelium-dependent (EDD) and microvascular endothelium-independent (EIMVD) coronary vasomotor dysfunction to the extent of myocardial ischemia in patients with normal angiograms or non-obstructive coronary artery disease (NOCAD). Coronary vasomotion was evaluated by quantitative angiography and blood flow (CBF) measurements during intracoronary acetylcholine, nitroglycerine, and adenosine in 101 patients. Myocardial SPECT ischemic burden was evaluated by semi-quantitative scoring of summed stress (SSS) and summed ischemic (SDS) perfusion defect size. Coronary vasomotor dysfunction was found in most patients (83; 77%) with a divergent behavior of EDD and EIMVD in one half of them (52.4%). There was no significant difference in SDS between patients with and without EIMVD, whereas SDS was significantly greater in subjects with EDD as compared to patients with normal response to acetylcholine (4.31 ± 2.44 vs 1.35 ± 1.45; P < .0001). Patients with EDD, either alone or in combination with EIMVD, had significantly higher SSS as compared to patients with lone EIMVD or normal vasomotor function (8.50 ± 5.32; 5.55 ± 3.21; 2.60 ± 2.14; and 1.74 ± 1.66, respectively; P < .0001). Acetylcholine CBF correlated inversely with both SDS (r = -0.545; P < .001) and SSS (r = 0.538; P < .001). In NOCAD patients with symptoms and signs of myocardial ischemia, vasomotor dysfunction is common. EDD is associated with greater extent of ischemia as compared to isolated EIMVD. Thus, assessment of both EIMVD and EDD is needed to recognize mechanisms of ischemia and identify patients with greater ischemic burden.

  20. A Pilot Study for the Neuroprotective Effect of Gongjin-dan on Transient Middle Cerebral Artery Occlusion-Induced Ischemic Rat Brain

    Directory of Open Access Journals (Sweden)

    Yun-Young Sunwoo

    2012-01-01

    Full Text Available In this study, we investigated whether gongjin-dan improves functional recovery and has neuroprotective effects on reducing the infarct volume after transient middle cerebral artery occlusion (MCAo. Infarct volume was measured using TTC staining and glucose utilization by F-18 FDG PET. Functional improvement was evaluated with the Rota-rod, treadmill, Garcia score test, and adhesive removal test. At 14 days after MCAo, neuronal cell survival, astrocytes expansion, and apoptosis were assessed by immunohistofluorescence staining in the peri-infarct region. Also, the expression of neurotrophic factors and inflammatory cytokines such as VEGF, BDNF, Cox-2, TNF-α, IL-1β, and IL-1α was measured in ischemic hemisphere regions. The gongjin-dan-treated group showed both reduced infarct volume and increased glucose utilization. Behavior tests demonstrated a significant improvement compared to the control. Also in the gongjin-dan treated group, NeuN-positive cells were increased and number of astrocytes, microglia, and apoptotic cells was significantly decreased compared with the control group in the ischemic peri-infarct area. Furthermore, the expression of VEGF and BDNF was increased and level of Cox-2, TNF-α, IL-1β, and IL-1α was decreased. These results suggest that gongjin-dan may improve functional outcome through the rapid restoration of metabolism and can be considered as a potential neuroprotective agent.

  1. Factores de riesgo de los ictus arteriales isquémicos en la infancia Risk factors of arterial ischemic strokes in children

    Directory of Open Access Journals (Sweden)

    José Vargas Díaz

    2008-09-01

    Full Text Available Los ictus isquémicos infantiles pueden ocurrir en territorio arterial, la mayoría de ellos en la zona carotídea. Menos frecuentemente se presentan obstrucciones senovenosas, cuyo diagnóstico requiere adecuados índices de sospecha y técnicas de diagnóstico por la imagen capaces de detectarlas. Existen múltiples factores de riesgo genéticos y adquiridos relacionados con los ictus isquémicos. Las enfermedades cardíacas, los trastornos de la coagulación sanguínea, la anemia de células falciformes, las infecciones, el síndrome moyamoya, la disección arterial y otros trastornos genéticos infrecuentes, están entre los factores de riesgo más frecuentemente documentados. Las obstrucciones senovenosas parecen estar más relacionadas con infecciones de la cabeza o cuello, deshidratación, complicaciones perinatales y trastornos de la coagulación. Existe además la posibilidad de que varios de estos factores actúen al unísono en un paciente con ictus. La identificación y posible control de los factores de riesgo de los ictus infantiles son motivo de intensa investigación multicéntrica, en un intento de esclarecer la fisiopatogenia y verdadera relación causal de estos.Ischemic stroke in children may occur in the arterial area, most of them in the carotid zone. The sinovenous obstructions, whose diagnosis requires proper rates of suspicion and imaging diagnostic techniques capable of detecting them are less common. There are many genetic and acquired risk factors related to ischemic stroke. Cardiac diseases, blood coagulation disorders, sickle cell anemia, infections, moyamoya syndrome, arterial dissection, and other rare genetic disorders, are among the most frequent documented risk factors. Sinovenous obstructions seem to be connected with head or neck infections, dehydratation, perinatal complications, and coagulation disorders. There is also the possibility that many of these factors act at the same time on the patient with

  2. Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    da Silva Guimarães, Sheila; de Souza Cruz, Wanise; da Silva, Licinio; Maciel, Gabrielle; Huguenin, Ana Beatriz; de Carvalho, Monicque; Costa, Bárbara; da Silva, Geisiane; da Costa, Carlos; D'Ippolito, João Alvaro; Colafranceschi, Alexandre; Scalco, Fernanda; Boaventura, Gilson

    2017-01-01

    During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. L-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of L-carnitine and increases the oxidative stress. This study demonstrates the effect of L-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with L-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the L-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. L-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the L-carnitine group may indicate a clinical benefit of L-carnitine supplementation. © 2017 S. Karger AG, Basel.

  3. Intelligence in Childhood and Atherosclerosis of the Carotid and Peripheral Arteries in Later Life: The Lothian Birth Cohort 1936

    Science.gov (United States)

    Gale, Catharine R.; Eadie, Elizabeth; Thomas, Avril; Bastin, Mark E.; Starr, John M.

    2015-01-01

    Objective There is some evidence that people who score higher on tests of intelligence in childhood have lower carotid intima-media thickness and higher ankle brachial index in middle age. These findings need replicating in other, older populations. We investigated the prospective relationship between intelligence in childhood and atherosclerosis in the carotid and peripheral arteries at age 73 years. Methods Participants were 713 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11 years. At age 73 years, carotid intima-media thickness and degree of stenosis were measured using ultrasound imaging; ankle-brachial index was measured using Doppler ultrasound. Results There were no significant associations between intelligence at age 11 and measures of atherosclerosis at age 73. In age- and sex-adjusted analyses, for a standard deviation higher score in intelligence, intima-media thickness (x 10) was lower by 0.07 (-0.20, 0.06) mm and ankle brachial index (x 10) was lower by 0.09 (-0.24, 0.07); odds ratios for having carotid stenosis >25% or peripheral arterial disease were 0.98 (0.82, 1.16) and 1.05 (0.81, 1.36) respectively. Conclusion In this study of people aged 73 years, higher childhood intelligence was not associated with reduced risk of atherosclerosis in the carotid or peripheral arteries. PMID:25915652

  4. Higher Levels of Cystatin C Are Associated with Extracranial Carotid Artery Steno-Occlusive Disease in Patients with Noncardioembolic Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Toshitaka Umemura

    2016-01-01

    Full Text Available Background: Large artery atherosclerosis is a major cause of ischemic stroke worldwide. Differential biomarker profiles associated with extra- and intracranial atherosclerosis are a topic of considerable interest. Cystatin C (CysC, a marker of renal function, is a risk factor for cardiovascular disease. Aim: We sought to determine whether CysC levels were associated with extra- and intracranial large artery stenosis (LAS in patients with acute ischemic stroke. Methods: We retrospectively analyzed data of acute noncardioembolic ischemic stroke patients who were admitted to our stroke center within 5 days from symptom onset. Serum CysC levels were measured using latex agglutination turbidimetric immunoassay. Extra- and intracranial LAS were defined as ≥50% diameter stenosis or occlusion of the relevant internal carotid artery (ICA and/or middle cerebral artery (MCA using carotid echography and volume rendering on magnetic resonance angiography. Multivariate logistic analyses were used to assess the association between CysC levels and LAS after adjustment for potential confounders. Results: Of 205 patients (mean age 70.2 years, 76 (37.1% had LAS. The distribution of LAS was 29 extracranial ICA, 34 intracranial ICA/MCA (8 ICA only, 25 MCA only, 1 ICA+MCA and 13 tandem stenosis (both extracranial ICA and intracranial ICA/MCA. Levels of CysC were higher in patients with extracranial ICA stenosis than in those with intracranial ICA/MCA stenosis (1.23 ± 0.33 vs. 0.97 ± 0.21 mg/l, p 1.04 mg/l was significantly associated with extracranial ICA stenosis (adjusted odds ratio [OR] 5.01, 95% confidence interval [CI] 1.51-16.63, p = 0.009 after adjustment for age, sex, diabetes, chronic kidney disease, current smoking, systolic blood pressure, HDL cholesterol, high-sensitivity C-reactive protein (hs-CRP and premorbid lipid-lowering drugs use. When CysC was considered as a continuous variable, 1 SD increase in CysC was significantly associated with

  5. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Raul G. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States); Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J. [Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States)

    2008-04-15

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score {<=}2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66{+-}17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17{+-}3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9{+-}3.9 h (anterior circulation) and 11.0{+-}7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and

  6. Magnetic resonance imaging of blood-brain barrier permeability in ischemic stroke using diffusion-weighted arterial spin labeling in rats.

    Science.gov (United States)

    Tiwari, Yash V; Lu, Jianfei; Shen, Qiang; Cerqueira, Bianca; Duong, Timothy Q

    2017-08-01

    Diffusion-weighted arterial spin labeling magnetic resonance imaging has recently been proposed to quantify the rate of water exchange (K w ) across the blood-brain barrier in humans. This study aimed to evaluate the blood-brain barrier disruption in transient (60 min) ischemic stroke using K w magnetic resonance imaging with cross-validation by dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology in the same rats. The major findings were: (i) at 90 min after stroke (30 min after reperfusion), group K w magnetic resonance imaging data showed no significant blood-brain barrier permeability changes, although a few animals showed slightly abnormal K w . Dynamic contrast-enhanced magnetic resonance imaging confirmed this finding in the same animals. (ii) At two days after stroke, K w magnetic resonance imaging revealed significant blood-brain barrier disruption. Regions with abnormal K w showed substantial overlap with regions of hyperintense T 2 (vasogenic edema) and hyperperfusion. Dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology confirmed these findings in the same animals. The K w values in the normal contralesional hemisphere and the ipsilesional ischemic core two days after stroke were: 363 ± 17 and 261 ± 18 min -1 , respectively (P magnetic resonance imaging is sensitive to blood-brain barrier permeability changes in stroke, consistent with dynamic contrast-enhanced magnetic resonance imaging and Evans blue extravasation. K w magnetic resonance imaging offers advantages over existing techniques because contrast agent is not needed and repeated measurements can be made for longitudinal monitoring or averaging.

  7. Genetic Causes of Cerebrovascular Disorders in Childhood

    NARCIS (Netherlands)

    M.E.C. Meuwissen (Marije)

    2014-01-01

    markdownabstract__Abstract__ Cerebrovascular disorders in childhood comprise ischemic stroke and hemorrhagic stroke. This thesis comprises a escription of genetic causes of childhood cerebrovascular disorders. Two examples of genetic causes of ischemic stroke, comprising a case of ACTA2 mutation

  8. Anti-ischemic intervention as prognosis improvement in patients with coronary artery disease, with special focus on verapamil

    DEFF Research Database (Denmark)

    Jespersen, C M

    1996-01-01

    traditional antiarrhythmic drugs have no effect or even worsen the arrhythmias, especially during episodes with elevated sympathetic activity. Verapamil significantly reduces plasma norepinephrine levels and the norepinephrine release during ischemia, whereby ventricular arrhythmias may be prevented. Also...... as non-arrhythmic death. The lack of preferential association of ventricular arrhythmias with arrhythmic death rather than nonarrhythmic death may imply that arrhythmias are provoked by ischemia. Antiarrhythmic intervention in postinfarction patients significantly increases death and arrhythmic events...... compared with placebo, especially in patients with residual ischemia. This may be due to a significant slowing of conduction during ischemia in patients treated with antiarrhythmic agents. In animal studies anti-ischemic agents prevent or suppress ventricular arrhythmias during ischemia, whereas...

  9. Unraveling the Specific Ischemic Core and Penumbra Transcriptome in the Permanent Middle Cerebral Artery Occlusion Mouse Model Brain Treated with the Neuropeptide PACAP38

    Directory of Open Access Journals (Sweden)

    Motohide Hori

    2015-01-01

    Full Text Available Our group has been systematically investigating the effects of the neuropeptide pituitary adenylate-cyclase activating polypeptide (PACAP on the ischemic brain. To do so, we have established and utilized the permanent middle cerebral artery occlusion (PMCAO mouse model, in which PACAP38 (1 pmol injection is given intracerebroventrically and compared to a control saline (0.9% sodium chloride, NaCl injection, to unravel genome‑wide gene expression changes using a high-throughput DNA microarray analysis approach. In our previous studies, we have accumulated a large volume of data (gene inventory from the whole brain (ipsilateral and contralateral hemispheres after both PMCAO and post-PACAP38 injection. In our latest research, we have targeted specifically infarct or ischemic core (hereafter abbreviated IC and penumbra (hereafter abbreviated P post-PACAP38 injections in order to re-examine the transcriptome at 6 and 24 h post injection. The current study aims to delineate the specificity of expression and localization of differentially expressed molecular factors influenced by PACAP38 in the IC and P regions. Utilizing the mouse 4 × 44 K whole genome DNA chip we show numerous changes (≧/≦ 1.5/0.75-fold at both 6 h (654 and 456, and 522 and 449 up- and down-regulated genes for IC and P, respectively and 24 h (2568 and 2684, and 1947 and 1592 up- and down-regulated genes for IC and P, respectively after PACAP38 treatment. Among the gene inventories obtained here, two genes, brain-derived neurotrophic factor (Bdnf and transthyretin (Ttr were found to be induced by PACAP38 treatment, which we had not been able to identify previously using the whole hemisphere transcriptome analysis. Using bioinformatics analysis by pathway- or specific-disease-state focused gene classifications and Ingenuity Pathway Analysis (IPA the differentially expressed genes are functionally classified and discussed. Among these, we specifically discuss some novel and

  10. Low-density lipoprotein subfraction, carotid artery intima-media thickness, nitric oxide, and tumor necrosis factor alpha are associated with newly diagnosed ischemic stroke

    Directory of Open Access Journals (Sweden)

    Medine Cumhur Cure

    2013-01-01

    Full Text Available Objectives: Small dense (sd low-density lipoprotein (LDL, tumor necrosis factor (TNF alpha (a, and nitric oxide (NO have recently emerged as important stroke risk factors. The aim of the study was to investigate the effects of increased levels of small LDL particle size, TNF-a and NO on the developed ischemic stroke and increased carotid artery intima-media thickness (CIMT. Materials and Methods: A total of 29 women and 25 men (a total of 54 ischemic stroke patients and a similar age group of 50 controls (29 females and 21 males were included in the study. CIMT, C-reactive protein (CRP, TNF-a, NO, and lipid subfraction test of the two groups were measured. Results: The mean LDL particle size was smaller in patients with stroke than in the controls (26.8 ± 0.31 nm vs. 27.0 ± 0.31 nm, P = 0.003. sd-LDL, TNF-a, NO, CRP, right CIMT, and left CIMT were higher in patients with stroke than in the controls (respectively; 8.2 ± 7.8 mg/dL vs. 3.3 ± 3.5 mg/dL, P < 0.001;75.6 ± 25.0 pg/mL vs. 65.4 ± 9.1 pg/mL, P = 0.009;76.4 ± 53.3 mmol/L vs. 41.5 ± 27.0 mmol/L, P < 0.001;1.9 ± 2.6 mm vs. 0.4 ± 0.3 mm P < 0.001;0.97 ± 0.38 mm vs. 0.83 ± 0.15 mm, P = 0.007;1.04 ± 0.44 mm vs. 0.87 ± 0.19 mm, P = 0.010. Conclusion: These results show that sd-LDL is independently associated with the incidence of stroke and may be a risk factor in the development of stroke. In addition, TNF-a, NO, right CIMT, and left CIMT may be a risk factor in the development of ischemic stroke.

  11. Unraveling the Specific Ischemic Core and Penumbra Transcriptome in the Permanent Middle Cerebral Artery Occlusion Mouse Model Brain Treated with the Neuropeptide PACAP38.

    Science.gov (United States)

    Hori, Motohide; Nakamachi, Tomoya; Shibato, Junko; Rakwal, Randeep; Shioda, Seiji; Numazawa, Satoshi

    2015-01-21

    Our group has been systematically investigating the effects of the neuropeptide pituitary adenylate-cyclase activating polypeptide (PACAP) on the ischemic brain. To do so, we have established and utilized the permanent middle cerebral artery occlusion (PMCAO) mouse model, in which PACAP38 (1 pmol) injection is given intracerebroventrically and compared to a control saline (0.9% sodium chloride, NaCl) injection, to unravel genome‑wide gene expression changes using a high-throughput DNA microarray analysis approach. In our previous studies, we have accumulated a large volume of data (gene inventory) from the whole brain (ipsilateral and contralateral hemispheres) after both PMCAO and post-PACAP38 injection. In our latest research, we have targeted specifically infarct or ischemic core (hereafter abbreviated IC) and penumbra (hereafter abbreviated P) post-PACAP38 injections in order to re-examine the transcriptome at 6 and 24 h post injection. The current study aims to delineate the specificity of expression and localization of differentially expressed molecular factors influenced by PACAP38 in the IC and P regions. Utilizing the mouse 4 × 44 K whole genome DNA chip we show numerous changes (≧/≦ 1.5/0.75-fold) at both 6 h (654 and 456, and 522 and 449 up- and down-regulated genes for IC and P, respectively) and 24 h (2568 and 2684, and 1947 and 1592 up- and down-regulated genes for IC and P, respectively) after PACAP38 treatment. Among the gene inventories obtained here, two genes, brain-derived neurotrophic factor (Bdnf) and transthyretin (Ttr) were found to be induced by PACAP38 treatment, which we had not been able to identify previously using the whole hemisphere transcriptome analysis. Using bioinformatics analysis by pathway- or specific-disease-state focused gene classifications and Ingenuity Pathway Analysis (IPA) the differentially expressed genes are functionally classified and discussed. Among these, we specifically discuss some novel and previously

  12. Computer derived transient ischemic dilation ratio for identifying extensive coronary artery disease using a CZT camera and imaging in the upright position.

    Science.gov (United States)

    Jameria, Zenith A; Abdallah, Mouhamad; Dwivedi, Alok; Washburn, Erica; Khan, Naseer; Khaleghi, Mahyar; Kalakota, Nischelle; Gerson, Myron C

    2017-10-01

    Transient ischemic dilation (TID) of the left ventricle (LV) has not been validated as a marker of extensive coronary artery disease (CAD) for studies using a cadmium-zinc-telluride (CZT) camera with upright imaging. TID ratios were obtained from upright stress and rest images on a CZT camera. Separate cut-off values were determined for exercise and for regadenoson stress. The cutoffs were then applied to 28 patients with extensive CAD and 101 patients without extensive CAD. With treadmill exercise, an upright TID ratio ≥1.16 provided a positive predictive value of 50% and a negative predictive value of 85.4% for the identification of extensive CAD. In the regadenoson group, an upright TID ratio of 1.29 provided a positive predictive value of 20% and a negative predictive value of 75.9%. Although not an independent predictor of extensive CAD in all subjects, in subjects with a normal upright LVEF, it provided a predictive value by receiver operating characteristics comparable to the SSS. Increased upright TID measurements on a CZT camera are associated with extensive CAD. The upright TID measurements can serve in an adjunctive role to SSS, and may be most effective in patients with a normal upright exercise LVEF.

  13. Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect.

    Science.gov (United States)

    Boers, A M M; Berkhemer, O A; Slump, C H; van Zwam, W H; Roos, Y B W E M; van der Lugt, A; van Oostenbrugge, R J; Yoo, A J; Dippel, D W J; Marquering, H A; Majoie, C B L M

    2017-05-01

    Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance. To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type. Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions. The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct. Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

    Science.gov (United States)

    Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

    2017-02-01

    Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

  15. MODELS OF MAJOR ADVERSE CARDIAC EVENT RISK USING RESULTS OF EXERCISE STRESS ECHOCARDIOGRAPHY WITH NONINVASIVE CORONARY ARTERY FLOW ASSESSMENT IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    A. V. Zagatina

    2017-01-01

    Full Text Available Ultrasound non-invasive coronary artery imaging contributes to the diagnosis of ischemic heart disease (IHD in clinical practice. However, data of the prognostic value obtained from a complex analysis of contractility disorders and coronary blood flow parameters during exercise tests in the world literature are still not available. Aim. To develop risk models for adverse outcomes in patients with probable or definite IHD based on the results of a stress test with a noninvasive coronary blood flow study. Material and methods. Medical data of 689 patients with probable or definite IHD who underwent stress echocardiography with satisfactory visualization of the anterior interventricular artery (AIVA were included in the analysis. All patients had stress echocardiography on a horizontal bicycle ergometer. Registration of coronary blood flow in the middle third of the AIVA was performed at rest and at the peak of the load with calculation of the coronary reserve value. Further patient follow-up lasted 3 years. Models of further negative outcomes were developed on the basis of the stress echocardiography results and of coronary blood flow parameters. Results. Three models that take into account the factors associated with further mortality, mortality/myocardial infarction and sum of negative outcomes were developed in the study. These models divide a cohort of patients with probable or definite IHD into groups of low, medium and very high risks. Factors associated with the risk of death include: age >56 years, load power <100 W, breach of contractility in the blood supply zone of the circumflex artery initially and during exercise, the difference in blood flow velocities in the AIVA<10 cm/s, coronary reserve of AIVA<2. The risk model of death, taking into account these factors, suggests dividing patients into low-risk group if there are ≤2 factors (mortality 0.6% for 3 years, medium risk – from 2 to 4 factors (mortality 1.8%, high risk – ≥5

  16. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

  17. Multimodal Therapy for the Treatment of Severe Ischemic Stroke Combining Endovascular Embolectomy and Stenting of Long Intracranial Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Matjaž Bunc

    2010-01-01

    Case Report. We present a case of a 49-year-old female patient who—according to the National Institute of Health Stroke Scale (NIHSS—was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA. After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach—without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA.

  18. Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation.

    Science.gov (United States)

    Mihos, Christos G; Xydas, Steve; Williams, Roy F; Pineda, Andrés M; Yucel, Evin; Davila, Hector; Beohar, Nirat; Santana, Orlando

    2017-06-01

    The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0-2] versus 3 units (IQR, 1-4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.

  19. Blood pressure, risk of ischemic cerebrovascular and ischemic heart disease, and longevity in alpha(1)-antitrypsin deficiency

    DEFF Research Database (Denmark)

    Dahl, Morten; Tybjaerg-Hansen, Anne; Sillesen, Henrik

    2003-01-01

    Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity.......Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity....

  20. No evidence for activated autophagy in left ventricular myocardium at early reperfusion with protection by remote ischemic preconditioning in patients undergoing coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Nilgün Gedik

    Full Text Available Remote ischemic preconditioning (RIPC by repeated brief limb ischemia/reperfusion reduces myocardial injury in patients undergoing coronary artery bypass grafting (CABG. Activation of signal transducer and activator of transcription 5 (STAT5 in left ventricular (LV myocardium at early reperfusion is associated with such protection. Autophagy, i.e., removal of dysfunctional cellular components through lysosomes, has been proposed as one mechanism of cardioprotection. Therefore, we analyzed whether or not the protection by RIPC is associated with activated autophagy.CABG patients were randomized to undergo RIPC (3×5 min blood pressure cuff inflation/5 min deflation or placebo (cuff deflated before skin incision (n = 10/10. Transmural myocardial biopsies were taken from the LV before cardioplegia (baseline and at early (5-10 min reperfusion. RIPC-induced protection was reflected by decreased serum troponin I concentration area under the curve (194±17 versus 709±129 ng/ml × 72 h, p = 0.002. Western blotting for beclin-1-phosphorylation and protein expression of autophagy-related gene 5-12 (ATG5-12 complex, light chain 3 (LC3, parkin, and p62 was performed. STAT3-, STAT5- and extracellular signal-regulated protein kinase 1/2 (ERK1/2-phosphorylation was used as positive control to confirm signal activation by ischemia/reperfusion.Signals of all analyzed autophagy proteins did not differ between baseline and early reperfusion and not between RIPC and placebo. STAT5-phosphorylation was greater at early reperfusion only with RIPC (2.2-fold, p = 0.02. STAT3- and ERK1/2-phosphorylation were greater at early reperfusion with placebo and RIPC (≥2.7-fold versus baseline, p≤0.05.Protection through RIPC in patients undergoing CABG surgery does not appear to be associated with enhanced autophagy in LV myocardium at early reperfusion.

  1. Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood

    NARCIS (Netherlands)

    Geelhoed, J.J.M.; El Marroun, H.; Verburg, B.O.; van Osch-Gevers, L.; Hofman, A.; Huizink, A.C.; Moll, H.A.; Verhulst, F.C.; Helbing, W.A.; Steegers, E.A.P.; Jaddoe, V.W.V.

    2011-01-01

    Objective: To unravel the mechanisms underlying the previously demonstrated associations between low birthweight and cardiovascular disease in adulthood, we examined whether maternal smoking during pregnancy leads to fetal arterial resistance adaptations, and subsequently to fetal growth retardation

  2. Coronary Arteries in Childhood Heart Disease: Implications for Management of Young Adults.

    Science.gov (United States)

    Baraona, Fernando; Valente, Anne Marie; Porayette, Prashob; Pluchinotta, Francesca Romana; Sanders, Stephen P

    2012-06-15

    Survival of patients with congenital heart defects has improved dramatically. Many will undergo interventional catheter or surgical procedures later in life. Others will develop atherosclerotic or post-surgical coronary heart disease. The coronary artery anatomy in patients with congenital heart disease differs substantially from that seen in the structurally normal heart. This has implications for diagnostic procedures as well as interventions. The unique epicardial course seen in some defects could impair interpretation of coronary angiograms. Interventional procedures, especially at the base of the heart, risk injuring unusually placed coronary arteries so that coronary artery anatomy must be delineated thoroughly prior to the procedure. In this review, we will describe the variants of coronary artery anatomy and their implications for interventional and surgical treatment and for sudden death during late follow-up in several types of congenital heart defects including: tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, double outlet right ventricle, congenitally corrected transposition of the great arteries and defects with functionally one ventricle. We will also discuss the coronary abnormalities seen in Kawasaki disease.

  3. Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Prakkamakul, Supada; Pitakvej, Nantaporn [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Dumrongpisutikul, Netsiri; Lerdlum, Sukalaya [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Chulalongkorn University, Department of Radiology, Faculty of Medicine, Bangkok (Thailand)

    2017-10-15

    Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients. We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated. Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90. The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting. (orig.)

  4. Idiopathic Infantile Arterial Calcification: A Rare Cause of Sudden Unexpected Death in Childhood

    Directory of Open Access Journals (Sweden)

    Susana Guimarães

    2010-01-01

    Full Text Available Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death.

  5. Associations of risk factors in childhood with arterial stiffness 26 years later: the Hanzhong adolescent hypertension cohort.

    Science.gov (United States)

    Chu, Chao; Dai, Yi; Mu, Jianjun; Yang, Ruihai; Wang, Man; Yang, Jun; Ren, Yong; Xie, Bingqing; Dong, Zhenzhen; Yang, Fan; Wang, Dan; Yan, Dingyi; Guo, Tong-Shuai; Wang, Yang

    2017-05-01

    The relationship between childhood risk factors and long-term arterial stiffness was explored. A baseline survey was conducted in 4623 school children aged 6-15 years in rural areas of Hanzhong city, Shaanxi, in 1987. According to three independent measurements of SBP in 1987, 1989, and 1992, cases of the same age and sex with continuous SBP at least 75 percentile were classified as the high-blood pressure (BP) group, whereas those with SBP less than 50 percentile were classified as the normal-BP group. The cohort was followed up again after 26 years (in 2013). Blood biochemistry indexes, including fasting glucose, uric acid, and blood lipid, were measured. Brachial-ankle pulse wave velocity (baPWV) was recorded by noninvasive automatic waveform analyzer. Follow-up rate was 71.6%. The high-BP group had a higher incidence of hypertension (39.5 vs. 18.0%, P hypertension, SBP at both baseline and follow-up, fasting glucose, and uric acid in adulthood are independent impact factors of baPWV in adults. Higher SBP in children and adolescents, family history of hypertension, and male sex may increase the risk of developing long-term arterial stiffness.

  6. [Acute ischemic proctitis following an epileptic attack

    DEFF Research Database (Denmark)

    Klintmann, C.K.; Hillingso, J.G.; Glenthøj, Andreas

    2008-01-01

    Acute ischemic proctitis is a rare diagnosis mainly because the rectum is supplied by an extensive arterial network. Consequently, in more than 90% of patients with ischemic colitis the rectum is spared. Previously reported cases are related to severe vascular insufficiency of the rectal...... circulation caused by systemic atherosclerosis, usually following aortic or aortoiliac operations. We report one case of acute ischemic proctitis following an epileptic attack Udgivelsesdato: 2008/9/29...

  7. Differential diagnosis of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and ischemic stroke using 3D pseudocontinuous arterial spin labeling.

    Science.gov (United States)

    Li, Rui; Xiao, Hua-Feng; Lyu, Jin-Hao; J J Wang, Danny; Ma, Lin; Lou, Xin

    2017-01-01

    To evaluate the efficacy of 3D pseudocontinuous arterial spin labeling (3D pCASL) in the differential diagnosis between mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and acute ischemic stroke (AIS). Conventional magnetic resonance imaging (MRI) including T2 -weighted imaging (T2 WI) and diffusion-weighted imaging (DWI), and 3D pCASL perfusion data were obtained on a 3.0T MR scanner in 16 newly appearing lesions in nine patients with MELAS and 14 acute lesions in 12 patients with AIS. A postlabeling delay (PLD) time of 2025 msec was applied. The cerebral blood flow (CBF) values were measured in the central part and the peripheral part of the lesions and the CBF values were compared between MELAS and AIS patients. The lesions of both MELAS and AIS showed high signal intensity on T2 WI and demonstrated hyperintensity on DWI. Compared with the perfusion defects or hypoperfusion in all AIS, hyperperfusion was revealed in 16 acute MELAS lesions, especially in the peripheral part of the lesions. The CBF values of 16 lesions in MELAS were 11.20-73.11 ml/100g/min in the central part and 65.33-169.11 ml/100g/min in the peripheral part. The CBF values of 14 lesions in AIS were 12.32-19.94 ml/100g/min in the central part and 11.66-18.37 ml/100g/min in the peripheral part. The CBF value of the peripheral part (119.80 ± 35.41) in MELAS was significantly higher than that (14.66 ± 2.61) in AIS (P = 0.0001). The whole-brain 3D pCASL technique might be useful in differentiating MELAS from AIS. 3 J. Magn. Reson. Imaging 2017;45:199-206. © 2016 International Society for Magnetic Resonance in Medicine.

  8. Suspected carotid artery stenosis: cost-effectiveness of CT angiography in work-up of patients with recent TIA or minor ischemic stroke.

    Science.gov (United States)

    Tholen, Aletta T R; de Monyé, Cécile; Genders, Tessa S S; Buskens, Erik; Dippel, Diederik W J; van der Lugt, Aad; Hunink, M G Myriam

    2010-08-01

    To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack (TIA) or minor stroke who are suspected of having carotid artery stenosis (CAS). All prospectively evaluated patients provided informed consent, and the local ethics committee approved this study. Diagnostic performance, treatment, long-term events, quality of life, and costs resulting from strategies employing duplex ultrasonography (US), computed tomographic (CT) angiography, contrast material-enhanced magnetic resonance (MR) angiography, and combinations of these modalities were modeled in a decision tree and Markov model. Data sources included a prospective diagnostic cohort study, a meta-analysis, and a review of the literature. Outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net health benefits (QALY-equivalents), with a willingness-to-pay threshold of euro 50,000 per QALY and a societal perspective. The strategy with the highest net health benefit was considered the most cost effective. Extensive one-way, two-way, and probabilistic sensitivity analyses to explore the effect of varying parameter values were performed. The reference case analysis assumed that patients underwent surgery 2-4 weeks after the first symptoms, and the effect of earlier intervention was explored. The reference case analysis showed that duplex US combined with CT angiography and surgery for 70%-99% stenoses was the most cost-effective strategy, with a net health benefit of 13.587 and 15.542 QALY-equivalents in men and women, respectively. In men, the CT angiography strategy with a 70%-99% cutoff yielded slightly more QALYs, at an incremental cost of euro 71,419 per QALY, compared with duplex US combined with CT angiography. In patients with a high-risk profile, in patients with a high prior probability of disease, and when patients could be treated within 2 weeks after the

  9. Self-reported history of childhood smoking is associated with an increased risk for peripheral arterial disease independent of lifetime smoking burden.

    Directory of Open Access Journals (Sweden)

    James R Priest

    Full Text Available Atherosclerotic disorders are well known to be associated with obesity, lipid profile, smoking, hypertension and other medical comorbidities, and large cohort studies have explored the childhood correlates to these adult risk factors. However, there has been little investigation into the childhood risk factors for peripheral arterial disease (PAD. We endeavored to better understand the role of smoking in childhood in the risk for PAD in a well described cohort of 1,537 adults at high risk for cardiovascular disease. In a multivariate regression model, we observed an increased risk of PAD among those who reported a history of smoking during childhood (OR = 2.86; 95% CI, 1.99-4.11; P<0.001, which remained statistically significant after controlling for lifetime smoking burden (OR = 1.55; 95% CI, 1.00-2.41; P = 0.049. Our novel observation of disproportionate risk of PAD conferred by a history of childhood smoking may reflect an unrecognized biological mechanism such as a unique susceptibility to vascular injury or an unaccounted for covariate such as secondhand smoke exposure in childhood. This observation suggests further investigation is required into the pathophysiology of smoking in the developing vasculature and the need for detailed clinical data about patterns of childhood smoking and smoke exposure.

  10. Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction: Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial.

    Science.gov (United States)

    Wrobel, Krzysztof; Stevens, Susanna R; Jones, Robert H; Selzman, Craig H; Lamy, Andre; Beaver, Thomas M; Djokovic, Ljubomir T; Wang, Nan; Velazquez, Eric J; Sopko, George; Kron, Irving L; DiMaio, J Michael; Michler, Robert E; Lee, Kerry L; Yii, Michael; Leng, Chua Yeow; Zembala, Marian; Rouleau, Jean L; Daly, Richard C; Al-Khalidi, Hussein R

    2015-08-25

    Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. URL: http

  11. Fetal umbilical artery Doppler pulsatility index and childhood neurocognitive outcome at 12 years

    OpenAIRE

    Mone, Fionnuala; McConnell, Barbara; Thompson, Andrew; Segurado, Ricardo; Hepper, Peter; Stewart, Moira C.; Dornan, James C; Ong, Stephen; McAuliffe, Fionnuala M.; Shields, Michael D.

    2016-01-01

    OBJECTIVE: To determine whether an elevated fetal umbilical artery Doppler (UAD) pulsatility index (PI) at 28 weeks' gestation, in the absence of fetal growth restriction (FGR) and prematurity, is associated with adverse neurocognitive outcome in children aged 12 years.METHODS: Prospective cohort study, comparing children with a normal fetal UAD PI (<90th centile) (n=110) and those with an elevated PI (≥90th centile) (n=40). UAD was performed at 28, 32 and 34 weeks gestation. At 12 years o...

  12. Ischemic Colitis

    Science.gov (United States)

    ... Leiden, may increase the risk of ischemic colitis. High cholesterol, which can lead to atherosclerosis. Reduced blood flow, due to heart failure, low blood pressure and shock. Previous abdominal surgery. Scar tissue that forms after surgery may cause ...

  13. Arterial spin-labeling perfusion imaging of childhood meningitis: a case series.

    Science.gov (United States)

    Wong, Alex Mun-Ching; Yeh, Chih-Hua; Liu, Ho-Ling; Lin, Kuang-Lin; Wang, Huei-Shyong; Toh, Cheng-Hong

    2016-03-01

    Conventional magnetic resonance imaging (MRI), which is mainly used to detect complications, is ineffective in determining the neurological status of patients with meningitis. Hemodynamic change in the brain may be more indicative of the neurological status but few imaging studies have verified this. Arterial spin-labeling (ASL) perfusion, a noninvasive MR method requiring no contrast agent injection, can be used to measure cerebral blood flow (CBF). We describe three pediatric patients with meningitis, who all showed regions of increased CBF on perfusion imaging. One patient, presenting with headache and conscious disturbance, had CBF changes in the frontal, temporal, and occipital regions. The other two patients, presenting with hallucinations, memory deficits, and seizures, had CBF changes in the frontal and temporal regions. ASL perfusion imaging may be helpful in assessing patients with meningitis, demonstrating CBF changes more strongly correlating with the neurological status, and detecting active brain abnormalities.

  14. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands).

    Science.gov (United States)

    Mulder, Maxim J H L; Ergezen, Saliha; Lingsma, Hester F; Berkhemer, Olvert A; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Lycklama À Nijeholt, Geert; Emmer, Bart J; van der Worp, H Bart; Nederkoorn, Paul J; Roos, Yvo B W E M; van Oostenbrugge, Robert J; van Zwam, Wim H; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2017-07-01

    High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09-1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758. © 2017 American Heart Association, Inc.

  15. Multiple Vascular Accidents Including Rupture of a Sinus of Valsalva Aneurysm, a Minor Ischemic Stroke and Intracranial Arterial Anomaly in a Patient with Systemic Congenital Abnormalities: A Case Report

    Directory of Open Access Journals (Sweden)

    Masataka Nakajima

    2013-11-01

    Full Text Available A 39-year-old man with a history of rupture of a sinus of Valsalva aneurysm experienced an ischemic stroke. Although the patient presented left-sided hemiparesis for a week, no abnormal signals were indicated on diffusion-weighted imaging with repeated magnetic resonance scans. Carotid ultrasound and cerebral angiography were conducted, and they revealed hypoplasty of the left internal carotid artery with a low-lying carotid bifurcation at the level of the C6 vertebra. In addition, he was diagnosed with intellectual disabilities, evaluated by the Wechsler Adult Intelligence Scale-III, and congenital velopharyngeal insufficiency. We herein present the first report of a patient with cardio-cerebrovascular abnormalities, intellectual disabilities, and an otorhinolaryngological abnormality.

  16. Genetic variants are not associated with outcome in patients with coronary artery disease and left ventricular dysfunction: results of the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) trials.

    Science.gov (United States)

    Feldman, Arthur M; She, Lilin; McNamara, Dennis M; Mann, Douglas L; Bristow, Michael R; Maisel, Alan S; Wagner, Daniel R; Andersson, Bert; Chiariello, Luigi; Hayward, Christopher S; Hendry, Paul; Parker, John D; Racine, Normand; Selzman, Craig H; Senni, Michele; Stepinska, Janina; Zembala, Marian; Rouleau, Jean; Velazquez, Eric J; Lee, Kerry L

    2015-01-01

    We evaluated the ability of 23 genetic variants to provide prognostic information in patients enrolled in the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) trials. Patients assigned to STICH Hypothesis 1 were randomized to medical therapy with or without coronary artery bypass grafting (CABG). Those assigned to STICH Hypothesis 2 were randomized to CABG or CABG with left ventricular reconstruction. In patients assigned to STICH Hypothesis 2 (n = 714), no genetic variant met the prespecified Bonferroni-adjusted threshold for statistical significance (p < 0.002); however, several variants met nominal prognostic significance: variants in the β2-adrenergic receptor gene (β2-AR Gln27Glu) and in the A1-adenosine receptor gene (A1-717 T/G) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem (p = 0.027 and 0.031, respectively). These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables. However, none of the 23 genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis 1 population (n = 532) by either univariate or multivariable analysis. We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations.

  17. Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry.

    Science.gov (United States)

    Tajstra, Mateusz; Pyka, Łukasz; Gorol, Jarosław; Pres, Damian; Gierlotka, Marek; Gadula-Gacek, Elżbieta; Kurek, Anna; Wasiak, Michał; Hawranek, Michał; Zembala, Michał Oskar; Lekston, Andrzej; Poloński, Lech; Bryniarski, Leszek; Gąsior, Mariusz

    2016-09-12

    This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy. The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed. The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint. Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (-CTO). The 12-month mortality for the +CTO and -CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006). Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Vascularização temporária de membros isquêmicos por meio de shunt arteriomedular: trabalho experimental Temporary vascularization on ischemic limbs through arterial-medullar shunt: an experimental work

    Directory of Open Access Journals (Sweden)

    Ronaldo André Poerschke

    2012-03-01

    Full Text Available CONTEXTO: Os autores idealizaram um shunt temporário entre a artéria femoral e o canal medular de ossos longos para manter a viabilidade dos membros agudamente isquêmicos, enquanto não é possível estabelecer um tratamento definitivo. OBJETIVO: Avaliar a perviedade de shunts temporários arteriomedulares e a perfusão dos membros, durante duas horas em cães de experimentação, que tiveram a artéria femoral ligada. MÉTODOS: Alocaram-se aleatoriamente dois grupos, com três cães no Grupo Controle e seis no Grupo Intervenção. Os controles tiveram a artéria femoral comum direita ligada. O Grupo Intervenção, além da ligadura da artéria, recebeu um shunt. Após duas horas, realizou-se a medida de pH dos membros isquêmicos; avaliação do fluxo arterial por meio de um sonar Doppler; avaliação da coloração do sangramento na extremidade distal do membro e foram retirados em bloco torácico os pulmões para análise anatomopatológica. RESULTADOS: A média do pH do sangue capilar das extremidades do membros no Grupo Controle foi de 6,97 (±0,39; no Grupo Intervenção o pH foi de 7,25 (±0,46, com pBACKGROUND: The authors idealized a temporary shunt between the femoral artery and the medullar canal on long bones to keep the viability of acutely ischemic limbs, while waiting for a definitive treatment. OBJECTIVE: To assess the flow on temporary shunts between the femoral artery and the marrow canal of the tibia during two hours in experimental dogs, which had the femoral artery interrupted. METHODS: Two groups with three dogs on the Control Group and six on the Intervention Group were allocated at random. The controls had the right femoral common artery interrupted. The Intervention Group received a shunt between the iliac external artery and the medullar canal of the right tibia in addition. After two hours, the measure of the pH, blood coloration, blood flow in sonar Doppler on the ischemic limbs were performed. The lungs were

  19. [Our experience with the measurement of transcutaneous oxygen tension for evaluation of blood circulation in peripheral arteries in patients with critical ischemic disease of lower limbs].

    Science.gov (United States)

    Žižlavský, V; Kubíček, L; Staffa, R

    2015-11-01

    The measurement of transcutaneous oxygen pressure (TcpO2) is a non-invasive method to quantify skin oxygenation at capillary level and their nutritive ability needed to heal the ischemic defect. TcpO2 pressure values below 30 mm Hg are specific for critical limb ischemia and predict complicated healing. The purpose of this study was to verify the cut-off pressure in patient unable to undergo vascular reconstruction, and to verify the possibility of using this method to evaluate the effectiveness of vascular reconstructive surgery. The group included 52 patients (35 men and 17 women). The mean age of patients in the group was 66.5 years (max. 85, min. 44). In our group of patients we confirmed that the TcpO2 values of successfully healed ischemic wounds were equal or greater than 30 mm Hg (mean TcpO2 value at the dorsum of the foot was 37.0 mm Hg ± 9.5 mm Hg), compared to the group of unsuccessfully healed patients whose values were lower (mean TcpO2 value at the dorsum of the foot was 9.0 mm Hg ± 5.3 mm Hg). TcpO2 is a suitable method in predicting the healing of ischemic defects and any possible need for surgical or endovascular revascularization. Thanks to its non-invasive nature and undemanding measurement, it surely helps to make better decisions in choosing the therapeutic procedure needed to heal the defect.

  20. Chronic dipeptidyl peptidase-4 inhibition with sitagliptin is associated with sustained protection against ischemic left ventricular dysfunction in a pilot study of patients with type 2 diabetes mellitus and coronary artery disease.

    Science.gov (United States)

    McCormick, Liam M; Kydd, Anna C; Read, Philip A; Ring, Liam S; Bond, Simon J; Hoole, Stephen P; Dutka, David P

    2014-03-01

    The incretin hormone, glucagon-like peptide-1, promotes myocardial glucose uptake and may improve myocardial tolerance to ischemia. Endogenous glucagon-like peptide-1 (7-36) is augmented by pharmacological inhibition of dipeptidyl peptidase-4. We investigated whether chronic dipeptidyl peptidase-4 inhibition by sitagliptin protected against ischemic left ventricular dysfunction during dobutamine stress in patients with type 2 diabetes mellitus and coronary artery disease. A total of 19 patients with type 2 diabetes mellitus underwent dobutamine stress echocardiography with tissue Doppler imaging on 2 separate occasions: the first (control) while receiving oral hypoglycemic agents, and the second after the addition of sitagliptin (100 mg once daily) for ≈4 weeks. Sitagliptin increased plasma glucagon-like peptide-1 (7-36) levels and, at peak stress, enhanced both global (ejection fraction, 70.5±7.0 versus 65.7±8.0%; Pdiabetes mellitus and coronary artery disease is associated with a sustained improvement in myocardial performance during dobutamine stress and a reduction in postischemic stunning. URL: http://www.isrctn.org. Unique identifier ISRCTN61646154.

  1. «MEMORIES OF FUTURE»: CHANGE IN VERAPAMIL SIGNIFICANCE IN THE TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevskiy

    2015-09-01

    Full Text Available The significance of verapamil in the treatment of patients with ischemic heart disease (IHD and hypertension (HT is considered. Data on the limited role of beta-blockers in the improvement of patient’s status in stable IHD, data about negative effect of heart rate (HR reduction on the central aortic pressure, as well as the relationship between HR and risk of complications in the INVEST trial are presented. Verapamil therapy in patients with HT and IHD without heart failure/systolic dysfunction and/or recent myocardial infarction may have advantages due to achievement of the sufficient antiischemic effect with less HR reduction.

  2. Parental smoking in childhood and brachial artery flow-mediated dilatation in young adults: the Cardiovascular Risk in Young Finns study and the Childhood Determinants of Adult Health study.

    Science.gov (United States)

    Juonala, Markus; Magnussen, Costan G; Venn, Alison; Gall, Seana; Kähönen, Mika; Laitinen, Tomi; Taittonen, Leena; Lehtimäki, Terho; Jokinen, Eero; Sun, Cong; Viikari, Jorma S A; Dwyer, Terence; Raitakari, Olli T

    2012-04-01

    Passive smoking has been associated with increased cardiovascular morbidity. The present study aimed to examine the long-term effects of childhood exposure to tobacco smoke on endothelium-dependent vasodilation in adults. The analyses were based on 2171 participants in the population-based Cardiovascular Risk in Young Finns (N=2067) and Childhood Determinants of Adult Health (N=104) studies who had measures of conventional risk factors (lipids, blood pressure, adiposity, socioeconomic status) and self-reported parental smoking status when aged 3 to 18 years at baseline. They were re-examined 19 to 27 years later when aged 28 to 45 years. Brachial artery flow-mediated dilatation was measured at follow-up with ultrasound. In analyses adjusting for age, sex, and childhood risk factors, flow-mediated dilatation was reduced among participants who had parents that smoked in youth compared to those whose parents did not smoke (Young Finns: 9.2 ± 0.1% (mean ± SEM) versus 8.6 ± 0.1%, P=0.001; Childhood Determinants of Adult Health: 7.4 ± 0.6% versus 4.9 ± 0.9%, P=0.04). These effects remained after adjustment for adult risk factors including own smoking status (Young Finns, P=0.003; Childhood Determinants of Adult Health, P=0.03). Parental smoking in youth is associated with reduced flow-mediated dilatation in young adulthood measured over 20 years later. These findings suggest that passive exposure to cigarette smoke among children might cause irreversible impairment in endothelium-dependent vasodilation.

  3. Ischemic stroke and incomplete infarction

    DEFF Research Database (Denmark)

    Garcia, Javier; Lassen, N A; Weiller, C

    1996-01-01

    The concept of selective vulnerability or selective loss o f individual neurons, with survival of glial and vascular elements as one of the consequences of a systemic ischemic-hypoxic insult (eg, transient cardiac arrest or severe hypotension), has been recognized for decades. In contrast, select......, selective neuronal death as one of the lesions that may develop in the brain after occluding an intracranial artery is an idea not readily acknowledged in the current medical literature dealing with human stroke....

  4. The significance of automatically measured transient ischemic dilation in identifying severe and extensive coronary artery disease in regadenoson, single-isotope technetium-99m myocardial perfusion SPECT.

    Science.gov (United States)

    Golzar, Yasmeen; Olusanya, Adebayo; Pe, Nadith; Dua, Sumeet G; Golzar, Jaafer; Gidea, Claudia; Doukky, Rami

    2015-06-01

    The critical threshold and clinical significance of transient ischemic dilation (TID) for regadenoson, single-isotope (99m)Tc SPECT myocardial perfusion imaging (MPI) are not defined. From 100 patients with low likelihood of CAD, we derived the abnormal TID threshold (mean + 2 SD). We validated the threshold in a cohort of 547 patients who received one-day, rest/regadenoson-stress, (99m)Tc-tetrofosmin SPECT-MPI followed by coronary angiography within 6 months. Patients were classified into three CAD severity strata: no significant CAD, mild to moderate CAD, and severe and extensive CAD. The abnormal TID threshold was determined to be 1.31. Though mean TID ratios were different between the three CAD severity groups and the derivation cohort (P regadenoson-stress MPI in this era of declining CAD burden is questionable.

  5. Ischemic Strokes (Clots)

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Ischemic Strokes (Clots) Updated:Apr 26,2017 Ischemic stroke ... stroke. Let's Talk Numbers Updated Guidelines for Acute Ischemic Strokes Infographic : Attacking Brain Clots to Save Lives ...

  6. Volkmann ischemic contracture

    Science.gov (United States)

    Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture ... Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there ...

  7. Prolonged multifocal electroretinographic implicit times in the ocular ischemic syndrome

    DEFF Research Database (Denmark)

    Kofoed, Peter Kristian; Munch, Inger Christine; Sander, Birgit

    2010-01-01

    Purpose. To examine retinal function in chronic ocular ischemia using multifocal electroretinography (mfERG). Methods. Thirteen patients with unilateral ocular ischemic syndrome (OIS) underwent assessment of ophthalmic systolic blood pressure by ocular pneumoplethysmography, carotid artery patenc...

  8. ANTIPLATELET DRUGS RESISTANCE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND OBLITERATIVE ATHEROSCLEROSIS OF LOWER LIMB ARTERIES ASSOCIATED WITH DIABETES MELLITUS TYPE 2

    Directory of Open Access Journals (Sweden)

    E. V. Gorjacheva

    2009-01-01

    Full Text Available Aim. To study a rate of resistance to acetylsalicylic acid (ASA and clopidogrel and clinical outcomes in patients with atherosclerosis and diabetes mellitus type 2 (DM2.Material and methods. 154 patients were involved in the study and split into two groups. 100 patients (47 men, 53 women; aged 66,4±7,8 y.o. with ischemic heart disease (IHD (which was presented by angina pectoris, class I-III, or myocardial infarction history were included into the first group (G1. Other 54 patients (38 men, 16 women; aged 64,1±10,2 y.o. with IHD associated with obliterative atherosclerosis of lower limb were included into the 2nd group (G2. Platelet aggregation was evaluated by Born's method (inducers of platelet aggregation were arachidonic acid and ADP. Reduction of platelet aggregation ≥20% after arachidonic acid induction was considered as criterion of resistance to ASA. Patients were considered as resistant, partly resistant and sensitive to clopidogrel if platelet aggregation reduced on <10%, 10-29%, and ≥30% respectively.Results. Rate of ASA and clopidogrel resistance in patients with DM2 was significantly higher than these in patients without DM2 (48% vs 16% respectively, р=0,003 in G1; 42% vs 7% respectively, р=0,007 in G2.Conclusion. Resistance to antiplatelet drugs is observed more often in patients with DM2 and can result in increased risk of cardiovascular complications.

  9. Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8-year-old children: the Childhood Asthma Prevention Study (CAPS).

    Science.gov (United States)

    Marshall, Nathaniel S; Ayer, Julian G; Toelle, Brett G; Harmer, Jason A; Phillips, Craig L; Grunstein, Ronald R; Celermajer, David S; Marks, Guy B

    2011-08-01

    To study the association between childhood snoring and cardiovascular risk factors. Cross-sectional analyses of a population-based birth cohort, who had been participants in a randomised controlled trial of interventions to prevent asthma and who were assessed at age 8 years. The presence and frequency of snoring were assessed by parent-completed questionnaire. We measured a wide range of cardiovascular function markers including non-fasting serum lipoproteins, blood pressure, high-sensitivity C-reactive protein, carotid artery intima media thickness (by ultrasound), brachial pulse wave velocity and augmentation index (by applanation tonometry). Of 409 children whose snoring status was assessed at age 8 years, 321 had lipid and 386 had arterial structure and function measurements. Snoring was not independently associated with blood pressure, carotid artery intima media thickness or measures of arterial stiffness (all P > 0.05). Increasing snoring frequency was independently associated with lower high-density lipoprotein cholesterol (-0.032 g/dL per step, 95% confidence interval -0.060 to -0.003), although the difference in high-density lipoprotein between snorers and non-snorers was not significant (P = 0.052). An association of snoring frequency with brachial pulse wave velocity differed according to body mass index (P = 0.03) and was the reverse of that expected. Parentally reported snoring was not independently associated with adverse measurements of metabolic markers, vascular structure or function in 8-year-old children. Parental reports of snoring may be below the treatment threshold without additional diagnosis via sleep studies. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  10. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    Science.gov (United States)

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review.

    Science.gov (United States)

    Plummer, Chris; Henderson, Robert D; O'Sullivan, John D; Read, Stephen J

    2011-09-01

    Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. We examined studies on the epidemiology, imaging, pathogenesis, and management of medium- and large-artery intra- and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy. Chronic radiation vasculopathy affecting medium and large intra- and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke. Evidence-based guidelines for the management of asymptomatic and symptomatic (medium- and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival.

  12. The utility of middle cerebral artery clot density and burden assessment by noncontrast computed tomography in acute ischemic stroke patients treated with thrombolysis.

    Science.gov (United States)

    Topcuoglu, Mehmet A; Arsava, E Murat; Kursun, Oguzhan; Akpinar, Erhan; Erbil, Bulent

    2014-02-01

    Quantitative and qualitative evaluation of middle cerebral artery (MCA) density, together with extent of thrombi, was assessed on plain computerized tomography (CT) to delineate better the prognostic value of the hyperdense MCA sign (HMCAS) in a cohort of patients who underwent intravenous or intra-arterial thrombolysis. Density of MCA was quantified by maximum pixel-sized measurement of Hounsfield unit (HU) in 105 patients with acute MCA proximal segment occlusion, 15 patients with vertebrobasilar circulation stroke (VBS) and 44 nonstroke control subjects. Predictive value of HMCAS, absolute HU value of within MCA, side-to-side HU ratio, and difference along with a newly introduced hyperdense MCA burden score in early dramatic recovery (EDR) and third-month favorable prognosis were determined with multivariate adjustment for age, baseline stroke severity, and thrombus length as measured on CT angiography. Receiver operator characteristics (ROC) curves were used to determine the cutoffs of quantitative indices to determine HMCAS and their prognostic significance. Higher HU was present in the ipsilateral MCA of the patients compared with their contralateral side and basilar tip and any MCA of VBS stroke and control subjects (area under the curve [AUC] of ROC curves was .753). Symptomatic-to-asymptomatic HU difference and ratio of MCA stroke were also significantly higher than side-to-side difference calculated in VBS stroke and control groups (AUC of ROC curves: .770 and .764, respectively). Optimal thresholds of absolute HU (44), side-to-side HU difference (2), and ratio (1.0588) showed borderline sensitivity and specificity. HMCAS and its quantitative indices were not significantly associated with EDR and favorable third-month outcome. Furthermore, there was no difference in terms of cardioembolic and atherothrombotic thrombi HU. Utility of the HMCAS as a prognostic marker in stroke thrombolysis is not high in the CT angiography era. Previous observation

  13. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study.

    Science.gov (United States)

    Yeo, Sang Seok; Jang, Sung Ho; Kwon, Jung Won

    2017-12-01

    Central vestibular disorder is common after middle cerebral artery (MCA) territory infarction. The MCA supplies blood to the parieto-insular vestibular cortex (PIVC), a core region of central vestibular symptoms. We report on patients that sustained injuries of the core vestibular pathway to the PIVC with central vestibular disorder following MCA territory infarction, demonstrated on diffusion tensor imaging (DTI). Nineteen patients with MCA territory infarction and 12 control subjects were recruited. To reconstruct the core vestibular pathway to the PIVC, we defined seed region of interest (ROI) as vestibular nuclei of pons and target ROI as the PIVC. Fractional anisotropy (FA), mean diffusivity, and tract volume were measured. In the affected hemisphere, FA value of the core vestibular pathway to the PIVC revealed significant difference between all patient groups and the control group (P territory infarction. Analysis of the core vestibular pathway to the PIVC using DTI would be beneficial in clinical evaluation and management of patients with MCA territory infarction. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  14. The ischemic preconditioning effect of adenosine in patients with ischemic heart disease

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    Berglund Margareta

    2009-11-01

    Full Text Available Abstract Introduction In vivo and in vitro evidence suggests that adenosine and its agonists play key roles in the process of ischemic preconditioning. The effects of low-dose adenosine infusion on ischemic preconditioning have not been thoroughly studied in humans. Aims We hypothesised that a low-dose adenosine infusion could reduce the ischemic burden evoked by physical exercise and improve the regional left ventricular (LV systolic function. Materials and methods We studied nine severely symptomatic male patients with severe coronary artery disease. Myocardial ischemia was induced by exercise on two separate occasions and quantified by Tissue Doppler Echocardiography. Prior to the exercise test, intravenous low-dose adenosine or placebo was infused over ten minutes according to a randomized, double blind, cross-over protocol. The LV walls were defined as ischemic if a reduction, no increment, or an increment of Results PSV increased from baseline to maximal exercise in non-ischemic walls both during placebo (P = 0.0001 and low-dose adenosine infusion (P = 0.0009. However, in the ischemic walls, PSV increased only during low-dose adenosine infusion (P = 0.001, while no changes in PSV occurred during placebo infusion (P = NS. Conclusion Low-dose adenosine infusion reduced the ischemic burden and improved LV regional systolic function in the ischemic walls of patients with exercise-induced myocardial ischemia, confirming that adenosine is a potential preconditioning agent in humans.

  15. Segurança do transplante autólogo, intra-arterial, de células mononucleares da medula óssea na fase aguda do acidente vascular cerebral isquêmico Intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Lúcia Furtado de Mendonça

    2006-01-01

    Full Text Available O acidente vascular cerebral (AVC é a terceira causa de óbito e a principal causa de incapacidade em indivíduos adultos. Embora a mortalidade do AVC esteja diminuindo em alguns países, a morbidade tem aumentado em razão do envelhecimento da população e do aumento da sobrevida dos pacientes¹. O tratamento com ativador do plasminogênio tissular recombinante (rt-PA é eficaz quando instituído em até 3 horas após o início dos sintomas², porém seu uso está limitado a cerca de 5% dos pacientes na fase aguda do AVC isquêmico. Além disso, nenhum agente para neuroproteção teve sua eficácia comprovada em estudos clínicos em humanos. Portanto, outras estratégias terapêuticas precisam ser desenvolvidas. Em modelos animais, o uso de células-tronco correlacionou-se com melhora funcional após o AVC³. Publicações recentes têm demonstrado a segurança do tratamento com células mononucleares da medula óssea (CMMO injetadas via intracoronária em pacientes portadores de cardiopatia isquêmica aguda ou crônica4,5. Baseado nesses dados iniciais, há crescente interesse no estudo do transplante com CMMO na fase aguda do AVC. Relatamos o primeiro caso de transplante autólogo de CMMO via intra-arterial na fase aguda do AVC isquêmico.Stroke is the third cause of death and the leading cause of disability in adult subjects. Although stroke mortality has been declining in some countries, stroke morbidity has been increasing due to the aging of population and patients improved survival.¹ Treatment with recombinant tissue plasminogen activator (rtPA is successful provided it is administered within 3 hours of symptoms onset,² but its use is limited to about 5% of the patients with acute ischemic stroke. Furthermore, no neuroprotective agent has yet been proven effective in human clinical trials. The development of other therapeutic strategies is, therefore, warranted. The use of stem cells in animal models has led to functional improvement

  16. CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH ISCHEMIC HEART DISEASE RESISTANT TO ACETYLSALICYLIC ACID IN PERIOPERATIVE PERIOD OF CORONARY ARTERY BYPASS GRAFT: RESULTS OF AN OPEN PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Yu. I. Grinshtein

    2016-01-01

    Full Text Available Aim. To study the clinical and laboratory characteristics of patients with stable angina that are sensitive or resistant to acetylsalicylic acid (ASA before and after coronary artery bypass graft (CABG surgery. Material and methods. Patients (n=60 with stable angina III-IV functional class, undergoing CABG, were included into the study. In the first postoperative day all patients started to take ASA in enteric form at a dose of 100 mg. To determine the sensitivity to ASA platelet aggregation induced by adenosine diphosphate (ADP 5μM and arachidonic acid (1 mM before and after incubation with ASA in vitro was studied one day before CABG and at the 1st and 10th days after CABG using an optical aggregometer. Dielectric properties of blood and its components were also studied with the original Fourier spectrometer. Results. The ASA-resistance rate was 26.7%. The ASA-resistant patients as compared with ASA-sensitive patients more often received selective cyclooxygenase 2 (COX-2 inhibitors (44% vs. 17%, respectively, p<0.05 after CABG. They had higher serum creatinine levels at the 1st day after CABG (153.7±49.9mmol/L vs 115.3±29mmol/L, respectively, p=0.028, >and very high erythrocyte sedimentation rate at 10th day after CABG (80.625±21.3 mm/h vs 54.6±26.5 mm/h; respectively, p=0.028. 33% of patients had resistance to en-teric form of ASA during 10-day therapy after CABG, however, platelet aggregation induced by arachidonic acid was low in in vitro platelet incubation with ASA. This points at decreased bioavailability of enteric forms of ASA. “Transient” ASA-resistance was detected in 12.5% of ASA-resistant patients on the 1st day after CABG due to cardiopulmonary bypass. Significant differences in the dielectric characteristics of blood and platelets were found in the groups of ASA-resistant and ASA-sensitive patients 10 days after CABG. Conclusion. Cardiopulmonary bypass, COX-2 inhibitors, renal dysfunction, the inflammatory response, may

  17. Ischemic Gastropathic Ulcer Mimics Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Saleh Daher

    2016-01-01

    Full Text Available Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

  18. Intracranial arterial aneurysms in childhood: case report Aneurismas arteriais intracranianos na infância: relato de caso

    Directory of Open Access Journals (Sweden)

    Fernando Campos Gomes Pinto

    2006-09-01

    Full Text Available A case of an intracranial arterial aneurysm at internal carotid bifurcation in a 10-year-old girl is described with the special features of cerebral aneurysm which occur in children, comparing with the adults. We alert for the necessity of carefully operative technique in order to avoid damage and intraoperative rupture of the aneurysm due to the very thin vessel wall that this population can develop. Our recommendation is early surgery in these patients.Relatamos o caso de aneurisma arterial intracraniano na bifurcação da carótida interna em menina de 10 anos de idade. As características especiais dos aneurismas intracranianos que acometem a faixa etária pediátrica são descritas, comparando com a faixa etária adulta. Alertamos a necessidade de emprego de técnica operatória microcirúrgica cautelosa para evitar lesão e ruptura intraoperatória do aneurisma, devido a parede do aneurisma geralmente ser muito fina na faixa etária pediátrica. Recomendamos cirurgia precoce nestes pacientes.

  19. Efeito da cirurgia de revascularização miocárdica sobre os episódios isquêmicos assintomáticos Effect of coronary artery bypass graft surgery on ischemic asymptomatic episodes

    Directory of Open Access Journals (Sweden)

    Humberto Pierri

    1998-04-01

    Full Text Available OBJETIVO: Avaliar o efeito da cirurgia de revascularização miocárdica (CRM sobre episódios isquêmicos assintomáticos (EIA. MÉTODOS: Foram estudados 28 homens, com angina estável (idade média 57,3±9,6 anos sem condições relacionadas a alterações de microcirculação e que, após retirada da medicação, apresentaram EIA à eletrocardiografia ambulatorial (ECGA. No pré-operatório e 4 meses após a cirurgia foram analisados os comportamentos dos EIA, segundo sua freqüência, e o de suas freqüências cardíacas (FC. A revascularização miocárdica foi completa em 75% dos casos. RESULTADOS: O número dos EIA foi reduzido de 162 (9 sintomáticos no pré-operatório para, apenas, 4 no pós-operatório (pPURPOSE: To evaluate the effect of coronary artery bypass graft surgery (CABG on ischemic asymptomatic episodes (IAE. METHODS: Twenty eight males (mean age 57.3±9.6 years with stable angina and no microcirculation abnormalities, who presented with IAE after medication withdrawal, were studied using ambulatory electrocardiography monitoring. Presence of IEA was analyzed before and 4 months after CABG according to its frequency and heart rate (HR response. CAGB was considered complete in 75% of the cases. RESULTS: The number of IAE was reduced from 162 (9 symptomatic in the preoperative period to 4 after surgery (p<0.05. In two patients with IAE in the postoperative period, coronariography confirmed obstruction of aortocoronary grafts. Analysis of HR at the beginning and peak of IAE suggested as mechanisms both reduced blood flow and increased oxygen consumption by the myocardium. CONCLUSION: CABC eliminated IAE regardless of HR. When IAE is present after surgery, graft occlusion should be suspected.

  20. Feocromocitoma: uma causa rara de hipertensão arterial na infância Pheochromocytoma: a rare cause of hypertension in childhood

    Directory of Open Access Journals (Sweden)

    Flávia Carolina D. Georgetti

    2007-09-01

    Full Text Available OBJETIVO: Relatar o caso de um adolescente com feocromocitoma, uma causa rara de hipertensão arterial na infância. DESCRIÇÃO: Adolescente internado em unidade de terapia intensiva infantil em decorrência de emergência hipertensiva, conseqüente à presença de feocromocitoma em adrenal esquerda, diagnosticado por meio de tomografia computadorizada do abdome e pela dosagem de adrenalina e noradrenalina urinárias. O paciente foi submetido à adrenalectomia esquerda, após o uso de alfa-bloqueador para controle do quadro hipertensivo. O anatomopatológico confirmou o diagnóstico do tumor. No pós-operatório, o paciente permaneceu estável, possibilitando a suspensão dos anti-hipertensivos. COMENTÁRIOS: Os feocromocitomas são tumores capazes de produzir catecolaminas, especialmente adrenalina e/ou noradrenalina. Cerca de 85 a 95% dos tumores são únicos, benignos e encontrados na medula adrenal. O feocromocitoma é um tumor de incidência rara e apenas 10 a 20% ocorrem na infância, representando uma causa rara de hipertensão arterial. Esta última é um sinal freqüente na maioria das crianças (80%, podendo ser acompanhada por cefaléia e sudorese. A encefalopatia hipertensiva consiste em uma forma de apresentação excepcional da doença. O diagnóstico pode ser realizado, na maioria dos casos, pela tomografia de abdome e pela dosagem das catecolaminas e seus metabólitos produzidos pelo tumor. O tratamento de escolha consiste na ressecção completa do tumor após o preparo farmacológico do paciente com o uso de alfa-bloqueador. No pós-operatório, a maioria dos pacientes evolui com controle do quadro de hipertensão arterial.OBJECTIVE: Report an adolescent with pheochromocytoma, a rare cause of hypertension in childhood. CASE DESCRIPTION: Adolescent admitted to the pediatric intensive care unit due to hypertension, secondary to the presence of pheochromocytoma on the left adrenal. Diagnosis of the pheochromocytoma was made by

  1. Ischemic cerebrovascular disease in childhood: cognitive assessment of 15 patients Doença cerebrovascular isquêmica na infância: avaliação cognitiva de 15 pacientes

    Directory of Open Access Journals (Sweden)

    Sônia D. Rodrigues

    2004-09-01

    Full Text Available The aim of this study was to evaluate and to compare the cognitive function of children with ischemic cerebrovascular disease (ICVD. Fifteen children, 7 girls and 8 boys, aged 7.9 to 16.1 years, were evaluated by Piaget's clinical method. The control group was composed by fifteen children whose ages, sex and socioeconomic conditions were similar to those of the ICVD group. The cognitive function evaluation of the ICVD group showed that most of the children (10/15 were under their age group. The SPECT was performed on 14 children with ICVD and the results showed that 8/9 children with hypoperfusion presented a poor cognitive estimation and 3/5 children with normal perfusion demonstrated an adequate performance. We conclude that ICVD in childhood may compromise cognition; therefore, it needs a follow up of acquisitions during alI the stages of development.O objetivo deste estudo foi avaliar e comparar as funções cognitivas de crianças acometidas por doença cerebrovascular isquêmica (DCV-I. Quinze crianças com idade entre 7,9 e 16, 1 anos foram avaliadas pelo método clínico de Piaget, sendo 8 do sexo masculino. Outras 15 crianças, com idade, sexo e nível sócio-econômico similares aos do grupo propósito compuseram o grupo controle. A avaliação das funções cognitivas mostrou que a maioria das crianças (10/15 do grupo DCV-I apresentou defasagem para a faixa etária. Catorze crianças do Grupo DCV-I realizaram o SPECT. Comparando-se o resultado deste exame com a avaliação cognitiva, verificou-se que a maioria das crianças com hipoperfusão (8/9 apresentou déficit na avaliação cognitiva e 3/5 com perfusão normal tiveram desempenho adequado. Concluímos que a DCV-I na infância pode comprometer a cognição da criança, indicando a necessidade do acompanhamento evolutivo das aquisições em todas as etapas do desenvolvimento.

  2. Ischemic gastritis: a rare but lethal consequence of celiac territory ischemic syndrome.

    Science.gov (United States)

    Chambon, J P; Bianchini, A; Massouille, D; Perot, C; Lancelevée, J; Zerbib, P

    2012-10-01

    Ischemic gastritis is poorly known by physicians and is often fatal if not correctly diagnosed. Here, we report on the clinical, endoscopic and imaging features and treatment outcomes for five ischemic gastritis patients. This was a retrospective, single-centre study of patients treated for ischemic gastritis between January 2009 and April 2012. All patients underwent transluminal angioplasty or open revascularization surgery. Five patients (4 men, 1 female) were included in the present study. The condition was diagnosed in two cases of peritonitis with gastric or duodenal perforation, two cases of acute epigastric pain and one case of gastric bleeding, profuse vomiting and hypovolemic shock. Three of the five patients had endoscopically proven gastric ulcerations or necrosis. A computed tomography scan contributed to the diagnosis in all cases. The symptoms resolved in all cases after gastric revascularization via an aortohepatic bypass (N.=1), a renohepatic bypass (N.=1), a retrograde iliosuperior mesenteric bypass (N.=2) with associated celiac artery angioplasty (N.=1) and celiac and superior mesenteric artery angioplasty (N.=1). During follow-up, three patients died of starvation due to short bowel syndrome (N.=1) or metastatic lung cancer (N.=2). Ischemic gastritis is a component of celiac territory ischemia syndrome and is closely associated with chronic or acute mesenteric ischemia. Computed tomography always informs the diagnosis. The rapid healing observed here after revascularization confirmed the ischemic nature of the condition and the inappropriateness of gastric resection in this context.

  3. Magnetic resonance imaging arterial-spin-labelling perfusion alterations in childhood migraine with atypical aura: a case-control study.

    Science.gov (United States)

    Boulouis, Grégoire; Shotar, Eimad; Dangouloff-Ros, Volodia; Grévent, David; Calmon, Raphaël; Brunelle, Francis; Naggara, Olivier; Kossorotoff, Manoelle; Boddaert, Nathalie

    2016-09-01

    Atypical migraine with aura can be challenging to diagnose. Arterial-spin-labelling (ASL) is able to non-invasively quantify brain perfusion. Our aim was to report cerebral blood flow (CBF) alterations using ASL, at the acute phase of atypical migraine with aura in children. Paediatric patients were retrospectively included if (1) referred for acute neurological deficit(s), (2) underwent brain magnetic resonance imaging (MRI) at presentation with ASL sequence, and (3) had subsequent diagnosis of migraine with aura. Neurological symptom-free controls were matched for age. Twenty-eight regions of interest (ROIs) were drawn on CBF maps for each participant/control. Ten patients were included (median age 13y, range 8-16y). Eight of 10 had multiple aura symptoms during the episode. For every patient, CBF was decreased in a brain region consistent with symptoms when MRI was performed less than 14 hours after onset (n=7 patients) and increased if the MRI was performed 17 hours or more after (n=4 MRIs). MRI-ASL appears to be a promising tool for the diagnostic workup and differentials exclusion in paediatric migraine with aura. Constant and time-consistent non-territorial CBF modifications were found in our sample providing additional insight to migraine with aura pathophysiology. The authors encourage implementing this sequence at the acute phase of unexplained paediatric neurological deficits, with or without accompanying headache. © 2016 Mac Keith Press.

  4. Relationship of APOA5, PPARγ and HL gene variants with serial changes in childhood body mass index and coronary artery disease risk factors in young adulthood

    Directory of Open Access Journals (Sweden)

    Sinha Shikha

    2011-05-01

    Full Text Available Abstract Background Triglycerides is an independent risk factor for coronary artery disease (CAD and is especially important in Indians because of high prevalence of hypertriglyceridemia in this population. Both genetic and environmental factors determine triglyceride levels. In a birth cohort from India, hypertriglyceridemia was found in 41% of men and 11% of women. Subjects who had high triglycerides had more rapid body mass index (BMI or weight gain than rest of the cohort throughout infancy, childhood and adolescence. We analysed polymorphisms in APOA5, hepatic lipase and PPARγ genes and investigated their association with birth weight and serial changes in BMI. Results Polymorphisms in APOA5 (-1131T > C, S19W, PPARγ (Pro12Ala and hepatic lipase (-514C > T were studied by polymerase chain reaction (PCR followed by restriction digestion in 1492 subjects from the New Delhi Birth Cohort (NDBC. We assessed whether these polymorphisms influence lipid and other variables and serial changes in BMI, both individually and together. The risk allele of APOA5 (-1131C resulted in 23.6 mg/dl higher triglycerides as compared to normal allele (P PPARγ Pro12Ala variation with a lower conditional weight at 6 months, (P = 0.020 and APOA5 S19W with a higher conditional BMI at 11 yrs of age (P = 0.030, none of the other associations between the gene polymorphisms and serial changes in body mass index from birth to young adulthood were significant. Conclusion The promoter polymorphism in APOA5 was associated with raised serum triglycerides and that of HL with raised HDL2 levels. None of the polymorphisms had any significant relationship with birth weight or serial changes in anthropometry from birth to adulthood in this cohort.

  5. Bedside Diagnosis of Mitochondrial Dysfunction After Malignant Middle Cerebral Artery Infarction

    DEFF Research Database (Denmark)

    Nielsen, T H; Schalén, W; Ståhl, N

    2014-01-01

    The study explores whether the cerebral biochemical pattern in patients treated with hemicraniectomy after large middle cerebral artery infarcts reflects ongoing ischemia or non-ischemic mitochondrial dysfunction....

  6. Peripheral Arteries May Be Reliable Indicators of Coronary Vascular Disease.

    Science.gov (United States)

    Hoehmann, Christopher L; Futterman, Bennett; Beatty, Brian Lee

    2017-07-01

    Atherosclerosis is a stronger predictor for ischemic cardiovascular events than traditional risk factors such as race, age, sex, history, and metabolic profile. Previous research had primarily used ultrasound; however, we performed a study using histopathology to more accurately grade atherosclerosis development using the American Heart Association's grading scale. We cross-sectioned 13 different arteries from 48 cadavers and placed them into three separate groups based on anatomic location: central arteries, peripheral arteries, and carotid arteries. The central artery group included arteries that are non-palpable and commonly lead to ischemic diseases when occluded. The peripheral artery group included arteries that are accessible to palpation. The carotid artery group included branches of the carotid artery. We investigated whether a centrally located atherosclerotic vessel was associated with atherosclerosis of a specific peripheral artery. We hypothesized a correlation between carotid, peripheral and central arteries that may point to specific arteries that are more effective to analyze clinically when assessing cardiovascular risk. We observed a correlation between pathology in the left coronary artery and bifurcation of the carotid artery (r = 0.37 P ≤ 0.016), two arteries known to be implicated in ischemic stroke and ischemic heart disease. Importantly, our study demonstrates that the radial artery, a peripheral vessel, exhibited a positive correlation between both the pathologic left coronary (r = 0.33 P ≤ 0.041) and bifurcation of the carotid arteries (r = 0.34 P ≤ 0.025). Therefore, we propose investigating the radial artery as a clinically accessible location to monitor with ultrasound when assessing a patient's risk for ischemic cardiovascular disease. Anat Rec, 300:1230-1239, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  7. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke

    NARCIS (Netherlands)

    Santos, E.M.; Marquering, H.A.; Blanken, M.D. den; Berkhemer, O.A.; Boers, A.M.; Yoo, A.J.; Beenen, L.F.; Treurniet, K.M.; Wismans, C.; Noort, K. van; Lingsma, H.F.; Dippel, D.W.; Lugt, A. van der; Zwam, W.H. van; Roos, Y.B.; Oostenbrugge, R.J. van; Niessen, W.J.; Majoie, C.B.; Heijden, E.H.F.M. van der; Dijk, E.J. van; Vries, J. de; Jenniskens, S.F.M.

    2016-01-01

    BACKGROUND AND PURPOSE: Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment

  8. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke

    NARCIS (Netherlands)

    Santos, Emilie M. M.; Marquering, Henk A.; den Blanken, Mark D.; Berkhemer, Olvert A.; Boers, Anna M. M.; Yoo, Albert J.; Beenen, Ludo F.; Treurniet, Kilian M.; Wismans, Carrie; van Noort, Kim; Lingsma, Hester F.; Dippel, Diederik W. J.; van der Lugt, Aad; van Zwam, Wim H.; Roos, Yvo B. W. E. M.; van Oostenbrugge, Robert J.; Niessen, Wiro J.; Majoie, Charles B.; Vroomen, P.C.

    Background and Purpose- Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment

  9. Dual Antiplatelet Therapy of Clopidogrel and Aspirin in Secondary Prevention of Ischemic Stroke: Evidence and Indications.

    Science.gov (United States)

    Su, Ya; Cheng, Xin; Dong, Qiang

    2015-11-01

    Nowadays the dual antiplatelet therapy (DAPT) becomes more widely used in patients with ischemic stroke. Nevertheless, controversies exist for indications of DAPT. In view of evidence-based medicine analysis, patients with high-risk transient ischemic attack and minor stroke, severe symptomatic intracranial artery stenosis, symptomatic intracranial and extracranial artery stenosis causing artery-to-artery embolism, ischemic stroke attributed to aortic arch plaques, high-risk atrial fibrillation not suitable for oral anticoagulants, intracranial and extracranial stent implantation, and ischemic stroke with acute coronary syndrome may gain great benefit from DAPT of clopidogrel and aspirin. In clinical practice, individualized antiplatelet therapy strategies should be taken by weighing risks of ischemia and hemorrhage. © 2015 John Wiley & Sons Ltd.

  10. Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

    National Research Council Canada - National Science Library

    Lin, Charles K; McDonough, Ryan J; Prentice, Ryan L; Thomas, Dustin M; Steel, Kevin E; Rubal, Bernard J; Shry, Eric A; Villines, Todd C; Hulten, Edward A; Slim, Ahmad M

    2014-01-01

    ... of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period...

  11. Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy.

    Science.gov (United States)

    Bart, B A; Shaw, L K; McCants, C B; Fortin, D F; Lee, K L; Califf, R M; O'Connor, C M

    1997-10-01

    We sought to characterize the clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. Patients with ischemic cardiomyopathy may have a worse prognosis than patients with nonischemic cardiomyopathy. Few studies have assessed the effect of ischemic versus nonischemic etiology on outcomes. We analyzed prospectively collected data on 3,787 patients with a left ventricular ejection fraction cardiomyopathy (n = 3,112) if they had a history of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery or at least one major epicardial coronary artery with > or = 75% stenosis; all others were considered to have nonischemic cardiomyopathy (n = 675). The median age, ejection fraction and proportion of patients with New York Heart Association functional class III or IV symptoms for the nonischemic and ischemic groups were 55 years versus 63 years, 27% versus 32% and 57% versus 25%, respectively. After adjustment for baseline clinical risk factors and presenting characteristics, ischemic etiology remained an important independent predictor of 5-year mortality (p disease was a better predictor of survival than ischemic or nonischemic etiology (log likelihood chi-square 700 vs. 675, respectively). Ischemic etiology is a significant independent predictor of mortality in patients with cardiomyopathy. However, the extent of coronary artery disease contributes more prognostic information than the clinical diagnosis of ischemic or nonischemic cardiomyopathy. Further research is needed to refine the clinical definition of ischemic cardiomyopathy so that physicians can appropriately prescribe treatment and accurately predict outcome.

  12. Pulmonary Embolism in Ischemic Stroke.

    Science.gov (United States)

    Eswaradass, Prasanna Venkatesan; Dey, Sadanand; Singh, Dilip; Hill, Michael D

    2018-01-28

    Silent pulmonary embolism (PE) may be associated with acute ischemic stroke (AIS). We identified 10 patients from 3,132 unique patients (3,431 CT scans). We retrospectively examined CT angiogram of patients with AIS to determine the frequency of concurrent PE in AIS. The period prevalence of PE was 0.32. Seven patients had concurrent PE, whereas three had PE diagnosed 2 days after their AIS presentation. We suspected paradoxical embolism via patent foramen ovale as the cause of stroke in three patients and thrombophilia in four patients. Seven patients had poor outcome including four deaths. CT angiogram stroke protocol images from aortic arch to vertex allows visualization of upper pulmonary arteries and PE detection in AIS.

  13. Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

    OpenAIRE

    Fox, CK; Glass, HC; Sidney, S; Smith, SE; Fullerton, HJ

    2016-01-01

    © 2016 American Academy of Neurology. To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke. Methods: We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of li...

  14. Myeloperoxidase Inhibition Increases Neurogenesis after Ischemic Stroke.

    Science.gov (United States)

    Kim, HyeonJu; Wei, Ying; Lee, Ji Yong; Wu, Yue; Zheng, Yi; Moskowitz, Michael A; Chen, John W

    2016-11-01

    The relationship between inflammation and neurogenesis in stroke is currently not well understood. Focal ischemia enhances cell proliferation and neurogenesis in the neurogenic regions, including the subventricular zone (SVZ), dentate gyrus, as well as the non-neurogenic striatum, and cortex in the ischemic hemisphere. Myeloperoxidase (MPO) is a potent oxidizing enzyme secreted during inflammation by activated leukocytes, and its enzymatic activity is highly elevated after stroke. In this study, we investigated whether the inhibition of MPO activity by a specific irreversible inhibitor, 4-aminobenzoic acid hydrazide (ABAH) (MPO(-/-) mice) can increase neurogenesis after transient middle cerebral artery occlusion in mice. ABAH administration increased the number of proliferating bromodeoxyuridine (BrdU)-positive cells expressing markers for neural stems cells, astrocytes, neuroprogenitor cells (Nestin), and neuroblasts (doublecortin) in the ischemic SVZ, anterior SVZ, striatum, and cortex. MPO inhibition also increased levels of brain-derived neurotrophic factor, phosphorylation of cAMP response element-binding protein (Ser133), acetylated H3, and NeuN to promote neurogenesis in the ischemic SVZ. ABAH treatment also increased chemokine CXC receptor 4 expression in the ischemic SVZ. MPO-deficient mice treated with vehicle or ABAH both showed similar effects on the number of BrdU(+) cells in the ischemic hemisphere, demonstrating that ABAH is specific to MPO. Taken together, our results underscore a detrimental role of MPO activity to postischemia neurogenesis and that a strategy to inhibit MPO activity can increase cell proliferation and improve neurogenesis after ischemic stroke. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

  15. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  16. TOWARD THE QUESTION OF ISCHEMIC MYOCARDIAL DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    V. V. Kalyuzhin

    2014-01-01

    Full Text Available The authors of the review have analyzed papers published on the problem of ischemic myocardial dysfunction. They begin with a definition of the term “ischemia” (derived from two Greek words: ischō, meaning to hold back, and haima, meaning blood - a condition at which the arterial blood flow is insufficient to provide enough oxygen to prevent intracellular respiration from shifting from the aerobic to the anaerobic form. The poor rate of ATP generation from this process causes a decrease in cellular ATP, a concomitant rise in ADP, and ultimately, to depression inotropic (systolic and lusitropic (diastolic function of the affected segments of the myocardium. But with such simplicity of basic concepts, the consequences of ischemia so diverse. Influence of an ischemia on myocardial function so unequally at different patients, which is almost impossible to find two identical cases (as in the case of fingerprints. It depends on the infinite variety of lesions of coronary arteries, reperfusion (time and completeness of restoration of blood flow and reactions of a myocardium which, apparently, has considerable flexibility in its response. Ischemic myocardial dysfunction includes a number of discrete states, such as acute left ventricular failure in angina, acute myocardial infarction, ischemic cardiomyopathy, stunning, hibernation, pre- and postconditioning. There are widely differing underlying pathophysiologic states. The possibility exists that several of these states can coexist.

  17. Hyperglycemia Increases Susceptibility to Ischemic Necrosis

    Directory of Open Access Journals (Sweden)

    D. Lévigne

    2013-01-01

    Full Text Available Diabetic patients are at risk for spontaneous foot ulcers, chronic wounds, infections, and tissue necrosis. Current theories suggest that the development and progression of diabetic foot ulcers are mainly caused by arteriosclerosis and peripheral neuropathy. Tissue necrosis plays a primordial role in the progression of diabetic foot ulcers but the underlying mechanisms are poorly understood. The aim of the present study was to investigate the effects of hyperglycemia per se on the susceptibility of ischemic tissue to necrosis, using a critical ischemic hind limb animal model. We inflicted the same degree of ischemia in both euglycemic and streptozotocin-induced hyperglycemic rats by resecting the external iliac, the femoral, and the saphenous arteries. Postoperative laser Doppler flowmetry of the ischemic feet showed the same degree of reduction in skin perfusion in both hyperglycemic and euglycemic animals. Nevertheless, we found a significantly higher rate of limb necrosis in hyperglycemic rats compared to euglycemic rats (71% versus 29%, resp.. In this study, we revealed that hyperglycemia per se increases the susceptibility to limb necrosis in ischemic conditions. Our results may help to better understand the physiopathology of progressive diabetic wounds and underline the importance of strict glycemic control in patients with critical limb ischemia.

  18. The effects of citicoline on acute ischemic stroke

    DEFF Research Database (Denmark)

    Overgaard, Karsten

    2014-01-01

    Early reopening of the occluded artery is, thus, important in ischemic stroke, and it has been calculated that 2 million neurons die every minute in an ischemic stroke if no effective therapy is given; therefore, "Time is Brain." In massive hemispheric infarction and edema, surgical decompression...... lowers the risk of death or severe disability defined as a modified Rankin Scale score greater than 4 in selected patients. The majority, around 80%-85% of all ischemic stroke victims, does not fulfill the criteria for revascularization therapy, and also for these patients, there is no effective acute......,000 patients with various neurologic disorders, including acute ischemic stroke (AIS). The conclusion is that citicoline is safe to use and may have a beneficial effect in AIS patients and most beneficial in less severe stroke in older patients not treated with recombinant tissue plasminogen activator...

  19. Acute Ischemic Stroke and Acute on Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Raja Ahsan Aftab

    2016-06-01

    Full Text Available Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled. He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis, acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition. Keywords: ischemic disease; chronic kidney disease; uncontrolled hypertension. | PubMed

  20. Ischemic colitis complicating reconstruction of the abdominal aorta

    DEFF Research Database (Denmark)

    Schroeder, T V; Christoffersen, J K; Andersen, J

    1985-01-01

    A review of 23 patients with ischemic colitis after surgical treatment of the abdominal aorta disclosed a pathogenetic heterogeneous finding. Ligation of the inferior mesenteric artery, abolished collateral blood supply or nonocclusive low flow state, or both, was a common feature. An incidence...

  1. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  2. Lubiprostone induced ischemic colitis.

    Science.gov (United States)

    Sherid, Muhammed; Sifuentes, Humberto; Samo, Salih; Deepak, Parakkal; Sridhar, Subbaramiah

    2013-01-14

    Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding. It is often multifactorial and more commonly encountered in the elderly. Several medications have been implicated in the development of colonic ischemia. We report a case of a 54-year old woman who presented with a two-hour history of nausea, vomiting, abdominal pain, and bloody stool. The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding. The radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her condition improved without any serious complications after the cessation of lubiprostone. This is the first reported case of ischemic colitis with a clear relationship with lubiprostone (Naranjo score of 10). Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.

  3. Preterm Hypoxic Ischemic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Krishna G Gopagondanahalli

    2016-10-01

    Full Text Available Hypoxic ischemic encephalopathy (HIE is a recognizable and defined clinical syndrome in term infants that results from a severe or prolonged hypoxic ischemic episode before or during birth. However, in the preterm infant, defining hypoxic ischemic injury, its clinical course, monitoring and outcomes remains complex. Few studies examine preterm HIE, and these are heterogeneous, with variable inclusion criteria and outcomes reported. We examine the available evidence that implies that the incidence of hypoxic ischemic insult in preterm infants is probably higher than recognized, and follows a more complex clinical course, with higher rates of adverse neurological outcomes, compared to term infants. This review aims to elucidate the causes and consequences of preterm hypoxia ischemia, the subsequent clinical encephalopathy syndrome, diagnostic tools and outcomes. Finally, we suggest a uniform definition for preterm HIE that may help in identifying infants most at risk of adverse outcomes and amenable to neuroprotective therapies.

  4. Acute ischemic cerebral attack

    OpenAIRE

    Franco-Garcia Samir; Barreiro-Pinto Belis

    2010-01-01

    The decrease of the cerebral blood flow below the threshold of autoregulation led to changes of cerebral ischemia and necrosis that traduce in signs and symtoms of focal neurologic dysfunction called acute cerebrovascular symdrome (ACS) or stroke. Two big groups according to its etiology are included in this category the hemorragic that constitue a 20% and the ischemic a 80% of cases. Great interest has wom the ischemic ACS because of its high social burden, being the third cause of no violen...

  5. Limb-shaking transient ischemic attack

    Directory of Open Access Journals (Sweden)

    Abhijit Das

    2013-01-01

    Full Text Available Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually present with seizure like activity and often misdiagnosed as focal seizures. Only on careful history the important clinical clues-which may help in differentiating from seizure-are revealed: Lack of Jacksonian march or aura; precipitation by maneuvers that lead to carotid compression. We present the case of an elderly gentleman with recurrent limb shaking transient ischemic attacks that was initially diagnosed as a case of epilepsy. His symptoms responded to optimization of blood pressure. The case report highlights the importance of accurate diagnosis as the treatment of the associated carotid artery occlusion may not only abolish the attacks but also reduce the risk of future stroke.

  6. Ischemic stroke related to anabolic abuse.

    Science.gov (United States)

    Santamarina, Rodrigo Daniel; Besocke, Ana Gabriela; Romano, Lucas Martin; Ioli, Pablo Leonardo; Gonorazky, Sergio Eduardo

    2008-01-01

    Anabolic-androgenic steroid (AAS) abuse increased in recent years, and it is associated with numerous adverse effects. Few reports on ischemic stroke related to anabolic steroid abuse have been published. We report a case of a 26-year-old male amateur athlete who suffered a posterior territory ischemic stroke. No abnormalities were found in angiography and echocardiography studies, neither in hemostatic profile. His only significant risk factor was nonmedical use of stanozolol, an anabolic steroid. Anabolic steroids are capable of increasing vascular tone, arterial tension, and platelet aggregation; therefore, they are prone to produce atherothrombotic phenomena. Because of young people's widespread use of anabolic steroids, physicians should be aware of this kind of complication.

  7. Basilar artery strokes in children: good outcomes with conservative medical treatment.

    Science.gov (United States)

    Lagman-Bartolome, Ana Marissa; Pontigon, Ann-Marie; Moharir, Mahendranath; MacGregor, Daune L; Askalan, Rand; Yau, Ivanna; Deveber, Gabrielle

    2013-05-01

    To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS). We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores. Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty-four (14 males, 10 females) children met study criteria (mean age at stroke was 8 y 10 mo; range 0-17 y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow-up (3 y 2 mo, range 1 mo-11 y 8 mo), 12 had a 'good outcome' (seven normal, five insignificant deficit) and 12 had 'poor outcome' (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6-274.9) but not BAO, altered level of consciousness, or age. Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population. © The Authors. Developmental Medicine & Child Neurology © 2013 Mac Keith Press.

  8. Post-ischemic bowel stricture: CT features in eight cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Sil [Dept. of Radiology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul (Korea, Republic of); Kim, Hyun Jin; Hong, Sung Mo; Park, Seong Ho; Lee, Jong Seok; Kim, Ah Young; Ha, Hyun Kwon [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-11-15

    To investigate the characteristic radiologic features of post-ischemic stricture, which can then be implemented to differentiate that specific disease from other similar bowel diseases, with an emphasis on computed tomography (CT) features. Eight patients with a diagnosis of ischemic bowel disease, who were also diagnosed with post-ischemic stricture on the basis of clinical or pathologic findings, were included. Detailed clinical data was collected from the available electronic medical records. Two radiologists retrospectively reviewed all CT images. Pathologic findings were also analyzed. The mean interval between the diagnosis of ischemic bowel disease and stricture formation was 57 days. The severity of ischemic bowel disease was variable. Most post-ischemic strictures developed in the ileum (n = 5), followed by the colon (n = 2) and then the jejunum (n = 1). All colonic strictures developed in the “watershed zone.” The pathologic features of post-ischemic stricture were deep ulceration, submucosal/subserosal fibrosis and chronic transmural inflammation. The mean length of the post-ischemic stricture was 7.4 cm. All patients in this study possessed one single stricture. On contrast-enhanced CT, most strictures possessed concentric wall thickening (87.5%), with moderate enhancement (87.5%), mucosal enhancement (50%), or higher enhancement in portal phase than arterial phase (66.7%). Post-ischemic strictures develop in the ileum, jejunum and colon after an interval of several weeks. In the colonic segment, strictures mainly occur in the “watershed zone.” Typical CT findings include a single area of concentric wall thickening of medium length (mean, 7.4 cm), with moderate and higher enhancement in portal phase and vasa recta prominence.

  9. A feasible strategy for focal cerebral ischemia-reperfusion injury: remote ischemic postconditioning.

    Science.gov (United States)

    Liu, Qiang; Zhou, Shengnian; Wang, Yaodong; Qi, Fang; Song, Yuan; Long, Siwei

    2014-08-01

    It is difficult to control the degree of ischemic postconditioning in the brain and other ischemia-sensitive organs. Remote ischemic postconditioning could protect some ischemia-sensitive organs through measures on terminal organs. In this study, a focal cerebral ischemia-reperfusion injury model was established using three cycles of remote ischemic postconditioning, each cycle consisted of 10-minute occlusion of the femoral artery and 10-minute opening. The results showed that, remote ischemic postconditioning significantly decreased the percentage of the infarct area and attenuated brain edema. In addition, inflammatory nuclear factor-κB expression was significantly lower, while anti-apoptotic Bcl-2 expression was significantly elevated in the cerebral cortex on the ischemic side. Our findings indicate that remote ischemic postconditioning attenuates focal cerebral ischemia/reperfusion injury, and that the neuroprotective mechanism is mediated by an anti-apoptotic effect and reduction of the inflammatory response.

  10. Fractal analysis of the ischemic transition region in chronic ischemic heart disease using magnetic resonance imaging.

    Science.gov (United States)

    Michallek, Florian; Dewey, Marc

    2017-04-01

    To introduce a novel hypothesis and method to characterise pathomechanisms underlying myocardial ischemia in chronic ischemic heart disease by local fractal analysis (FA) of the ischemic myocardial transition region in perfusion imaging. Vascular mechanisms to compensate ischemia are regulated at various vascular scales with their superimposed perfusion pattern being hypothetically self-similar. Dedicated FA software ("FraktalWandler") has been developed. Fractal dimensions during first-pass (FDfirst-pass) and recirculation (FDrecirculation) are hypothesised to indicate the predominating pathomechanism and ischemic severity, respectively. Twenty-six patients with evidence of myocardial ischemia in 108 ischemic myocardial segments on magnetic resonance imaging (MRI) were analysed. The 40th and 60th percentiles of FDfirst-pass were used for pathomechanical classification, assigning lesions with FDfirst-pass ≤ 2.335 to predominating coronary microvascular dysfunction (CMD) and ≥2.387 to predominating coronary artery disease (CAD). Optimal classification point in ROC analysis was FDfirst-pass = 2.358. FDrecirculation correlated moderately with per cent diameter stenosis in invasive coronary angiography in lesions classified CAD (r = 0.472, p = 0.001) but not CMD (r = 0.082, p = 0.600). The ischemic transition region may provide information on pathomechanical composition and severity of myocardial ischemia. FA of this region is feasible and may improve diagnosis compared to traditional noninvasive myocardial perfusion analysis. • A novel hypothesis and method is introduced to pathophysiologically characterise myocardial ischemia. • The ischemic transition region appears a meaningful diagnostic target in perfusion imaging. • Fractal analysis may characterise pathomechanical composition and severity of myocardial ischemia.

  11. Supra-aortic arteries: three-dimensional time-resolved k-t BLAST contrast-enhanced MRA using a nondedicated body coil at 3 tesla in acute ischemic stroke.

    Science.gov (United States)

    Ferré, Jean-Christophe; Raoult, Hélène; Breil, Stéphane; Carsin-Nicol, Béatrice; Ronzière, Thomas; Gauvrit, Jean-Yves

    2014-11-01

    To assess the image quality and diagnostic performance achieved by using supra-aortic 3D-TR-CE-k-t BLAST MRA and a nondedicated body coil as compared with conventional CE-MRA in patients with acute ischemic stroke. In this prospective study, 36 consecutive patients with a suspected acute ischemic stroke underwent both k-t BLAST MRA and conventional CE-MRA. Image quality was assessed using visual and quantitative criteria and the techniques were compared. Both techniques were compared for degree of visual and quantitative measurement of carotid stenosis. Delineation of vessel lumen and overall diagnostic confidence were significantly better with CE-MRA, respectively 3.4 ± 0.5 and 3.3 ± 0.6 (mean score ± SD), than with k-t BLAST MRA, respectively 2.8 ± 0.4 and 2.9 ± 0.5 (P coil offering and dynamic information was a effective diagnostic tool for detection and characterization of carotid stenosis. © 2013 Wiley Periodicals, Inc.

  12. Ischemic Nerve Block.

    Science.gov (United States)

    Williams, Ian D.

    This experiment investigated the capability for movement and muscle spindle function at successive stages during the development of ischemic nerve block (INB) by pressure cuff. Two male subjects were observed under six randomly ordered conditions. The duration of index finger oscillation to exhaustion, paced at 1.2Hz., was observed on separate…

  13. Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling.

    Science.gov (United States)

    Kawabata, Shuhei; Imamura, Hirotoshi; Suzuki, Keita; Tani, Shoichi; Adachi, Hidemitsu; Sakai, Nobuyuki

    2017-11-03

    A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Association of physical activity in childhood and early adulthood with carotid artery elasticity 21 years later: the cardiovascular risk in Young Finns Study.

    Science.gov (United States)

    Pälve, Kristiina S; Pahkala, Katja; Magnussen, Costan G; Koivistoinen, Teemu; Juonala, Markus; Kähönen, Mika; Lehtimäki, Terho; Rönnemaa, Tapani; Viikari, Jorma S A; Raitakari, Olli T

    2014-04-22

    Decreased arterial elasticity is a risk factor for several cardiovascular outcomes. Longitudinal data on the effect of physical activity in youth on adult arterial elasticity are limited. The aim of this study was to determine the long-term effects of physical activity in children and young adults on carotid artery elasticity after 21 years of follow-up. Participants were 1417 children (aged 9 to 15 years) and 999 young adults (aged 18 to 24 years) from the prospective Cardiovascular Risk in Young Finns Study. Participants had questionnaire measures of leisure-time physical activity available from 1986 and ultrasound-derived indices of carotid artery elasticity measured in 2007. Carotid artery elasticity indices were distensibility (%/10 mm Hg), Young's elastic modulus (kPa), and stiffness index (unitless). Physical activity at age 18 to 24 years was directly associated with distensibility (β=0.068, P=0.014) and inversely with Young's elastic modulus (β=-0.057, P=0.0037) and indirectly with stiffness index (β=-0.050, P=0.0028) 21 years later in males and females. The associations remained after adjustment for age, sex, body mass index, smoking, systolic blood pressure, serum lipids and insulin, and 21-year change in physical activity. At age 9 to 15 years, the favorable association, remaining after adjustment, was found in males (distensibility [β=0.097, P=0.010], Young's elastic modulus [β=-0.060, P=0.028], and stiffness index [β=-0.062, P=0.007]) but not in females (P=0.70, P=0.85, and P=0.91, respectively). Leisure-time physical activity in boys and young adults is associated with carotid artery elasticity later in life, suggesting that higher levels of physical activity in youth may benefit future cardiovascular health.

  15. Association of Physical Activity in Childhood and Early Adulthood With Carotid Artery Elasticity 21 Years Later: The Cardiovascular Risk in Young Finns Study

    Science.gov (United States)

    Pälve, Kristiina S.; Pahkala, Katja; Magnussen, Costan G.; Koivistoinen, Teemu; Juonala, Markus; Kähönen, Mika; Lehtimäki, Terho; Rönnemaa, Tapani; Viikari, Jorma S. A.; Raitakari, Olli T.

    2014-01-01

    Background Decreased arterial elasticity is a risk factor for several cardiovascular outcomes. Longitudinal data on the effect of physical activity in youth on adult arterial elasticity are limited. The aim of this study was to determine the long‐term effects of physical activity in children and young adults on carotid artery elasticity after 21 years of follow‐up. Methods and Results Participants were 1417 children (aged 9 to 15 years) and 999 young adults (aged 18 to 24 years) from the prospective Cardiovascular Risk in Young Finns Study. Participants had questionnaire measures of leisure‐time physical activity available from 1986 and ultrasound‐derived indices of carotid artery elasticity measured in 2007. Carotid artery elasticity indices were distensibility (%/10 mm Hg), Young's elastic modulus (kPa), and stiffness index (unitless). Physical activity at age 18 to 24 years was directly associated with distensibility (β=0.068, P=0.014) and inversely with Young's elastic modulus (β=−0.057, P=0.0037) and indirectly with stiffness index (β=−0.050, P=0.0028) 21 years later in males and females. The associations remained after adjustment for age, sex, body mass index, smoking, systolic blood pressure, serum lipids and insulin, and 21‐year change in physical activity. At age 9 to 15 years, the favorable association, remaining after adjustment, was found in males (distensibility [β=0.097, P=0.010], Young's elastic modulus [β=−0.060, P=0.028], and stiffness index [β=−0.062, P=0.007]) but not in females (P=0.70, P=0.85, and P=0.91, respectively). Conclusions Leisure‐time physical activity in boys and young adults is associated with carotid artery elasticity later in life, suggesting that higher levels of physical activity in youth may benefit future cardiovascular health. PMID:24755150

  16. Intermittent fasting attenuates inflammasome activity in ischemic stroke.

    Science.gov (United States)

    Fann, David Yang-Wei; Santro, Tomislav; Manzanero, Silvia; Widiapradja, Alexander; Cheng, Yi-Lin; Lee, Seung-Yoon; Chunduri, Prasad; Jo, Dong-Gyu; Stranahan, Alexis M; Mattson, Mark P; Arumugam, Thiruma V

    2014-07-01

    Recent findings have revealed a novel inflammatory mechanism that contributes to tissue injury in cerebral ischemia mediated by multi-protein complexes termed inflammasomes. Intermittent fasting (IF) can decrease the levels of pro-inflammatory cytokines in the periphery and brain. Here we investigated the impact of IF (16h of food deprivation daily) for 4months on NLRP1 and NLRP3 inflammasome activities following cerebral ischemia. Ischemic stroke was induced in C57BL/6J mice by middle cerebral artery occlusion, followed by reperfusion (I/R). IF decreased the activation of NF-κB and MAPK signaling pathways, the expression of NLRP1 and NLRP3 inflammasome proteins, and both IL-1β and IL-18 in the ischemic brain tissue. These findings demonstrate that IF can attenuate the inflammatory response and tissue damage following ischemic stroke by a mechanism involving suppression of NLRP1 and NLRP3 inflammasome activity. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Impact of in Vivo Ischemic Time on RNA Quality

    DEFF Research Database (Denmark)

    Olsen, Jesper; Kirkeby, Lene T; Eiholm, Susanne

    2015-01-01

    immediately following the tumor removal. The time from clamping the main arterial supply to resection and removal of the tumor was used to estimate the in vivo ischemic time. We did not observe a significant difference in RNA quality between normal tissue and tumor tissue. We observed a significant...... correlation between in vivo ischemic time and RNA quality in normal tissue (r = -0.24, pgender and laparoscopic procedure were also significantly associated with lower RNA quality in normal tissue only. In tumor tissue, poor differentiation was associated with low RNA...... quality. In conclusion, in vivo ischemic time, surgical procedure, and gender have minor but significant effects on the quality of RNA from normal colon tissue but not tumor tissue. Poorly differentiated tumors are associated with lower RNA quality. Although its impact is low, it can still be considered...

  18. Fusiform dilatation of the internal carotid artery in childhood-onset craniopharyngioma : multicenter study on incidence and long-term outcome

    NARCIS (Netherlands)

    Hoffmann, Anika; Warmuth-Metz, Monika; Lohle, Kristin; Reichel, Julia; Daubenbuchel, Anna M. M.; Sterkenburg, Anthe S.; Mueller, Hermann L.

    Fusiform dilatations of the internal carotid artery (FDCA) represent a vascular complication following surgery for suprasellar tumors in children. Incidence rate and long-term prognosis of FDCA in terms of survival rates, vascular complications, and quality of survival are unknown for patients with

  19. "Ostrich sign" indicates bilateral vertebral artery dissection.

    Science.gov (United States)

    Rose, David Z; Husain, M Rizwan

    2012-11-01

    Vertebral artery dissections (VADs) comprise about 2% of ischemic strokes and can be associated with trauma, chiropractic manipulation, motor vehicle collisions, whiplash, amusement park rides, golfing, and other motion-induced injuries to the neck. We present a case of bilateral extracranial VAD as a complication of conducting an orchestra. To our knowledge, this has not been documented in the literature. Conceivably, vigorous neck twisting in an inexperienced, amateur conductor may place excessive rotational forces upon mobile portions of the verterbral arteries, tear the intima, deposit subintimal blood that extends longitudinally, and cause neck pain and/or posterior fossa ischemic symptoms. Magnetic resonance angiography examinations of axially oriented slices of bilateral VADs resemble the face of an ostrich. This observation is similar to the "puppy sign," in which bilateral internal carotid artery dissections resemble the face of a dog. Craniocervical dissections of either the carotid or vertebral arteries have the potential to form an aneurysm, cause artery-to-artery embolism, or completely occlude the parent artery, resulting in an ischemic stroke. Because bilateral VADs in axial magnetic resonance angiographic sections stand out like the eyes of an ostrich, and because the fast identification of VADs is so critical, we eponymize this image the "ostrich sign." Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Ischemic Amnesia: Causes and Outcome.

    Science.gov (United States)

    Michel, Patrik; Beaud, Valérie; Eskandari, Ashraf; Maeder, Philippe; Demonet, Jean-François; Eskioglou, Elissavet

    2017-08-01

    We aimed to describe the frequency and characteristics of acute ischemic stroke and transient ischemic attacks presenting predominantly with amnesia (ischemic amnesia) and to identify clinical clues for differentiating them from transient global amnesia (TGA). We retrospectively analyzed and described all patients presenting with diffusion-weighted imaging magnetic resonance imaging-confirmed acute ischemic stroke/transient ischemic attacks with antero- and retrograde amnesia as the main symptom over a 13.5-year period. We also compared their clinical features and stroke mechanisms with 3804 acute ischemic stroke from our ischemic stroke registry. Thirteen ischemic amnesia patients were identified, representing 0.2% of all patients with acute ischemic stroke/transient ischemic attack. In 69% of ischemic amnesia cases, amnesia was transient with a median duration of 5 hours. Ischemia was not considered in 39% of cases. Fifty-four percent of cases were clinically difficult to distinguish from TGA, including 15% who were indistinguishable from TGA. 1.2% of all presumed TGA patients at our center were later found to have ischemic amnesia. Amnesic strokes were more often cardioembolic, multiterritorial, and typically involved the posterior circulation and limbic system. Clinical clues were minor focal neurological signs, higher age, more risk factors, and stroke favoring circumstances. Although all patients were independent at 3 months, 31% had persistent memory problems. Amnesia as the main symptom of acute ischemic cerebral events is rare, mostly transient, and easily mistaken for TGA. Although clinical clues are often present, the threshold for performing diffusion-weighted imaging in acute amnesia should be low. © 2017 American Heart Association, Inc.

  1. Sex differences in ischemic stroke sensitivity are influenced by gonadal hormones, not by sex chromosome complement

    OpenAIRE

    Manwani, Bharti; Bentivegna, Kathryn; Benashski, Sharon E; Venna, Venugopal Reddy; Xu, Yan; Arnold, Arthur P; McCullough, Louise D

    2014-01-01

    Epidemiologic studies have shown sex differences in ischemic stroke. The four core genotype (FCG) mouse model, in which the testes determining gene, Sry, has been moved from Y chromosome to an autosome, was used to dissociate the effects of sex hormones from sex chromosome in ischemic stroke outcome. Middle cerebral artery occlusion (MCAO) in gonad intact FCG mice revealed that gonadal males (XXM and XYM) had significantly higher infarct volumes as compared with gonadal females (XXF and XYF)....

  2. Predictors of Stroke Events in Patients with Transient Ischemic Attack Attributable to Intracranial Stenotic Lesions.

    Science.gov (United States)

    Uehara, Toshiyuki; Ohara, Tomoyuki; Minematsu, Kazuo; Nagatsuka, Kazuyuki; Toyoda, Kazunori

    2018-02-01

    Objective The purpose of this study was to identify the predictors of subsequent ischemic stroke events in patients with transient ischemic attack (TIA) attributable to intracranial arterial occlusive lesions. Methods The study population included 82 patients (55 men; mean age, 69.3±12.1 years) with TIA caused by intracranial arterial occlusive lesions who were admitted to our stroke care unit within 48 h of the onset of a TIA between April 2008 and November 2015. TIA was diagnosed if focal neurological symptoms ascribable to a vascular etiology lasted less than 24 h, irrespective of the presence of ischemic insults on imaging. The primary endpoint was an ischemic stroke event within 90 days of the onset of a TIA. Results The 90-day risk of ischemic stroke after the onset of a TIA was 14.6% [95% confidence interval (CI): 8.6-23.9%]. Cox proportional hazards multivariate analyses revealed that diffusion-weighted imaging (DWI) positivity [hazard ratio (HR), 8.73; 95%CI, 2.20-41.59; p=0.002], prior ischemic stroke (HR, 4.03; 95%CI, 1.07-15.99; p=0.040), and a high serum level of alkaline phosphatase (ALP) on admission (HR, 1.15; 95%CI, 1.05-1.26; p=0.002, for every +10 U/L) were significant independent predictors of ischemic stroke within 90 days after the onset of a TIA. Conclusion Our results suggested that patients with a TIA attributable to intracranial artery disease who showed DWI lesions, prior ischemic stroke, or high serum levels of ALP on admission were at high risk of subsequent ischemic stroke events.

  3. Remote Ischemic Conditioning

    OpenAIRE

    Heusch, Gerd; Bøtker, Hans Erik; Przyklenk, Karin; Redington, Andrew; Yellon, Derek

    2015-01-01

    In remote ischemic conditioning (RIC) brief, reversible episodes of ischemia with reperfusion in one vascular bed, tissue or organ confer a global protective phenotype and render remote tissues and organs resistant to ischemia/reperfusion injury. The peripheral stimulus can be chemical, mechanical or electrical and involves activation of peripheral sensory nerves. The signal transfer to the heart or other organs is through neuronal and humoral communications. Protection can be transferred, ev...

  4. Elevated admission blood pressure and acute ischemic lesions in spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Arsava, Ethem Murat; Kayim-Yildiz, Ozlem; Oguz, Kader K; Akpinar, Erhan; Topcuoglu, Mehmet Akif

    2013-04-01

    Concomitant acute ischemic lesions are detected in a subset of patients with intracerebral hemorrhage (ICH). In this study, our aim was to analyze the pattern of acute ischemic lesions detected by diffusion-weighted imaging (DWI) in patients with ICH, and to use this information, in combination with clinical characteristics of patients, to understand the underlying mechanisms of these lesions. We retrospectively analyzed patients with a diagnosis of ICH who underwent DWI within 14 days of symptom onset. We compared demographic, clinical, and imaging characteristics in patients with and without acute ischemic lesions. We also assessed the number, location, and topographic distribution of DWI bright lesions. Acute ischemic lesions were detected in 15 of 86 patients (17.4%); the lesions had a small, dot-like appearance in 13 patients (87%) and were located in an arterial territory separate from the incident ICH in 12 patients (80%). Patients with acute ischemic lesions had higher admission systolic, diastolic, and mean arterial blood pressure levels; greater periventricular leukoaraiosis burden; more microbleeds, and lower admission Glasgow Coma Scale score. In multivariate analyses, admission mean arterial blood pressure (P trend toward an increased burden of leukoaraiosis and microbleeds in patients with acute ischemic lesions, suggest an underlying dysfunctional cerebral microvasculature in the etiology of these lesions. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Contrast-enhanced cardiovascular magnetic resonance in primary and ischemic dilated cardiomyopathy.

    Science.gov (United States)

    Calore, Chiara; Cacciavillani, Luisa; Boffa, Giovanni Maria; Silva, Caterina; Tiso, Enrico; Marra, Martina Perazzolo; Bacchiega, Enrico; Corbetti, Francesco; Iliceto, Sabino

    2007-10-01

    Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy has an important clinical significance. Contrast-enhanced cardiovascular magnetic resonance can play a role in this task, identifying myocardial scarring or fibrosis as presence of delayed enhancement. The aim of the present study was to evaluate the diagnostic potential of contrast-enhanced cardiovascular magnetic resonance in differentiating dilated cardiomyopathy from ischemic cardiomyopathy. Contrast-enhanced cardiovascular magnetic resonance was performed in 100 patients with left ventricular dilatation and reduced systolic function: 24 had normal coronary arteries (dilated cardiomyopathy group) and 76 had significant coronary artery disease (ischemic cardiomyopathy group), with or without previous myocardial infarction. In the dilated cardiomyopathy group, only seven (29%) patients showed delayed enhancement and its pattern was characterized by mid-wall, patchy or diffuse location. All patients with ischemic cardiomyopathy and prior myocardial infarction (54 subjects) showed delayed enhancement with subendocardial (n = 4) or transmural (n = 50) extension. Among the 22 patients with ischemic cardiomyopathy but without previous myocardial infarction, 13 (59%) showed either subendocardial (n = 4) or transmural (n = 9) delayed enhancement. Patterns of delayed enhancement are different in dilated cardiomyopathy and ischemic cardiomyopathy, reflecting the presence of scarring or various degrees of fibrosis in left ventricular myocardium. The presence of subendocardial or transmural delayed enhancement at contrast-enhanced cardiovascular magnetic resonance allowed distinction between dilated cardiomyopathy and ischemic cardiomyopathy with high sensitivity (88%) and specificity (100%). Integration of cardiovascular magnetic resonance results with angiographic information can be useful in the identification of pathogenic mechanisms underlying left ventricular dysfunction.

  6. Mitochondrial adaptations within chronically ischemic swine myocardium.

    Science.gov (United States)

    McFalls, Edward O; Sluiter, Wim; Schoonderwoerd, Kees; Manintveld, Olivier C; Lamers, Jos M J; Bezstarosti, Karel; van Beusekom, Heleen M; Sikora, Joseph; Ward, Herbert B; Merkus, Daphne; Duncker, Dirk J

    2006-12-01

    Experimental evidence has emerged that myocardial ischemic preconditioning can prime the mitochondria into a "stress-resistant state", so that cell death is reduced following prolonged severe ischemia and reperfusion. Using a swine model of chronically ischemic myocardium, we tested the hypothesis that mitochondria within the ischemic territory have also acquired a protective phenotype. Eleven swine underwent a left thoracotomy with placement of an external constrictor around the proximal left anterior descending (LAD) artery. By 10 weeks, a severe stenosis of the LAD artery was documented by quantitative coronary angiography (92 +/- 2%). Animals were sacrificed and myocardium was extracted from the LAD and remote regions. Mitochondria were isolated from subendocardium and subepicardium from LAD and remote regions and state 2 (substrate alone) and state 3 (+ADP) respiration were assessed with a Clark electrode. Within the LAD subendocardium, the respiratory control index was 2.68 +/- 0.17 and was lower than the remote subendocardium (3.64 +/- 0.08; P < 0.05). When exposed to 20 min anoxia with reoxygenation, the LAD region demonstrated a more preserved state 3 respiration compared with the remote region (99 +/- 14 versus 65 +/- 9 nmol O2/mg, respectively; P < 0.05). In parallel mitochondrial experiments, chemiluminescence was detected with the probe coelenterazine and superoxide generation in the LAD region in the presence of antimycin A was 574 +/- 108 RLU/30 s/microg and was nearly 50% lower than the remote region (979 +/- 175 RLU/30 s/microg; P < 0.05). Within the mitochondria, the expression of uncoupling protein (UCP) 2 by western gels was 20% higher in the LAD region compared with the remote region (P < 0.05) with no differences noted in UCP-3. In this swine model of chronic myocardial ischemia, isolated mitochondria from the ischemic tissue demonstrate preserved state 3 respiration following anoxia/reoxygenation, consistent with a stress-resistant state

  7. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... blood clot blocks an artery for a short time. The only difference between a stroke and TIA ... symptoms occur rapidly and last a relatively short time. Unlike a stroke, when a TIA is over, ...

  8. Association between internal carotid artery dissection and arterial tortuosity

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

    2014-10-18

    Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

  9. Rescue Arterial Revascularization Using Cryopreserved Iliac Artery Allograft in Liver Transplant Patients.

    Science.gov (United States)

    Mohkam, Kayvan; Darnis, Benjamin; Rode, Agnès; Hetsch, Nathalie; Balbo, Gregorio; Bourgeot, Jean-Paul; Mezoughi, Salim; Demian, Hassan; Ducerf, Christian; Mabrut, Jean-Yves

    2017-08-01

    Management of hepatic arterial complications after liver transplant remains challenging. The aim of our study was to assess the efficacy of rescue arterial revascularization using cryopreserved iliac artery allografts in this setting. Medical records of patients with liver transplants who underwent rescue arterial revascularization using cryopreserved iliac artery allografts at a single institution were reviewed. From 1992 to 2015, 7 patients underwent rescue arterial revascularization using cryopreserved iliac artery allografts for hepatic artery pseudoaneurysm (3 patients), thrombosis (2 patients), aneurysm (1 patient), or stenosis (1 patient). Two patients developed severe complications, comprising one biliary leakage treated percutaneously, and one acute necrotizing pancreatitis causing death on postoperative day 29. After a median follow-up of 75 months (range, 1-269 mo), 2 patients had an uneventful long-term course, whereas 4 patients developed graft thrombosis after a median period of 120 days (range, 2-488 d). Among the 4 patients who developed graft thrombosis, 1 patient developed ischemic cholangitis, 1 developed acute ischemic hepatic necrosis and was retransplanted, and 2 patients did not develop any further complications. Despite a high rate of allograft thrombosis, rescue arterial revascularization using cryopreserved iliac artery allografts after liver transplant is an effective and readily available approach, with a limited risk of infection and satisfactory long-term graft and patient survival.

  10. Increased expression of vascular endothelin type B and angiotensin type 1 receptors in patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Dimitrijevic, Ivan; Edvinsson, Lars; Chen, Qingwen

    2009-01-01

    expression in subcutaneous arteries from patients with different degrees of ischemic heart disease. METHODS: Subcutaneous arteries were obtained, by biopsy from the abdomen, from patients undergoing coronary artery bypass graft (CABG) surgery because of ischemic heart disease (n = 15), patients with angina...... pectoris without established myocardial infarction (n = 15) and matched cardiovascular healthy controls (n = 15). Endothelin type A (ETA) and type B (ETB), and angiotensin type 1 (AT1) and type 2 (AT2) receptors expression and function were examined using immunohistochemistry, Western blot and in vitro...

  11. Prediction of Recurrent Stroke or Transient Ischemic Attack After Noncardiogenic Posterior Circulation Ischemic Stroke.

    Science.gov (United States)

    Zhang, Changqing; Wang, Yilong; Zhao, Xingquan; Liu, Liping; Wang, ChunXue; Pu, Yuehua; Zou, Xinying; Pan, Yuesong; Wong, Ka Sing; Wang, Yongjun

    2017-07-01

    Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS. A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69-10.2; P =0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55-42.5; P <0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00-62.6; P =0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25-23.3; P =0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09-8.58; P =0.03) as independent predictors of recurrent IS or TIA. Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible. © 2017 American Heart Association, Inc.

  12. Bone Fracture Pre-Ischemic Stroke Exacerbates Ischemic Cerebral Injury in Mice.

    Directory of Open Access Journals (Sweden)

    Liang Wang

    Full Text Available Ischemic stroke is a devastating complication of bone fracture. Bone fracture shortly after stroke enhances stroke injury by augmenting inflammation. We hypothesize that bone fracture shortly before ischemic stroke also exacerbates ischemic cerebral injury. Tibia fracture was performed 6 or 24 hours before permanent middle cerebral artery occlusion (pMCAO on C57BL/6J mice or Ccr2RFP/+Cx3cr1GFP/+ mice that have the RFP gene knocked into one allele of Ccr2 gene and GFP gene knocked into one allele of Cx3cr1 gene. Behavior was tested 3 days after pMCAO. Infarct volume, the number of CD68+ cells, apoptotic neurons, bone marrow-derived macrophages (RFP+, and microgila (GFP+ in the peri-infarct region were quantified. Compared to mice subjected to pMCAO only, bone fracture 6 or 24 hours before pMCAO increased behavioral deficits, the infarct volume, and the number of CD68+ cells and apoptotic neurons in the peri-infarct area. Both bone marrow-derived macrophages (CCR2+ and microglia (CX3CR1+ increased in the peri-infarct regions of mice subjected to bone fracture before pMCAO compared to stroke-only mice. The mice subjected to bone fracture 6 hours before pMCAO had more severe injury than mice that had bone fracture 24 hours before pMCAO. Our data showed that bone fracture shortly before stroke also increases neuroinflammation and exacerbates ischemic cerebral injury. Our findings suggest that inhibition of neuroinflammation or management of stroke risk factors before major bone surgery would be beneficial for patients who are likely to suffer from stroke.

  13. Remnant cholesterol and ischemic heart disease

    DEFF Research Database (Denmark)

    Varbo, Anette; Nordestgaard, Børge G

    2014-01-01

    PURPOSE OF REVIEW: To review recent advances in the field of remnant cholesterol as a contributor to the development of ischemic heart disease (IHD). RECENT FINDINGS: Epidemiologic, mechanistic, and genetic studies all support a role for elevated remnant cholesterol (=cholesterol in triglyceride......-rich lipoproteins) as a contributor to the development of atherosclerosis and IHD. Observational studies show association between elevated remnant cholesterol and IHD, and mechanistic studies show remnant cholesterol accumulation in the arterial wall like LDL-cholesterol (LDL-C) accumulation. Furthermore, large...... genetic studies show evidence of remnant cholesterol as a causal risk factor for IHD independent of HDL-cholesterol levels. Genetic studies also show that elevated remnant cholesterol is associated with low-grade inflammation, whereas elevated LDL-C is not. There are several pharmacologic ways of lowering...

  14. Giant left anterior descending artery aneurysm resulting in sudden death

    Directory of Open Access Journals (Sweden)

    Chan-Hee Lee

    2016-07-01

    Full Text Available Coronary artery aneurysm is a rare congenital or vascular inflammation-based anomaly for which the clinical course and optimal timing of treatment remain unclear. Here, we report a case of sudden death caused by a giant coronary artery aneurysm of the left anterior descending artery that presented with chest pain. This case suggests that urgent interventional or surgical repair is needed when a large coronary aneurysm presents with acute ischemic symptoms.

  15. Stable ischemic heart disease in women: current perspectives

    Directory of Open Access Journals (Sweden)

    Samad F

    2017-09-01

    Full Text Available Fatima Samad,1 Anushree Agarwal,2 Zainab Samad3 1Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, 2Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 3Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA Abstract: Cardiovascular disease is the leading cause of death in women accounting for 1 in every 4 female deaths. Pathophysiology of ischemic heart disease in women includes epicardial coronary artery, endothelial dysfunction, coronary vasospasm, plaque erosion and spontaneous coronary artery dissection. Angina is the most common presentation of stable ischemic heart disease (SIHD in women. Risk factors for SIHD include traditional risks such as older age, obesity (body mass index [BMI] >25 kg/m2, smoking, hypertension, dyslipidemia, cerebrovascular and peripheral vascular disease, sedentary lifestyle, family history of premature coronary artery disease, metabolic syndrome and diabetes mellitus, and nontraditional risk factors, such as gestational diabetes, insulin resistance/polycystic ovarian disease, pregnancy-induced hypertension, pre-eclampsia, eclampsia, menopause, mental stress and autoimmune diseases. Diagnostic testing can be used effectively to risk stratify women. Guidelines-directed medical therapy including aspirin, statins, beta-blocker therapy, calcium channel blockers and ranolazine should be instituted for symptom and ischemia management. Despite robust evidence regarding the adverse outcomes seen in women with ischemic heart disease, knowledge gaps exist in several areas. Future research needs to be directed toward a greater understanding of the role of nontraditional risk factors for SIHD in women, gaining deeper insights into the sex differences in therapeutic effects and formulating a sex-specific algorithm for the

  16. Cortical modulation of cardiac autonomic activity in ischemic stroke patients.

    Science.gov (United States)

    Constantinescu, Victor; Matei, Daniela; Cuciureanu, Dan; Corciova, Calin; Ignat, Bogdan; Popescu, Cristian Dinu

    2016-12-01

    The cardiovascular system is regulated by the autonomic nervous system, under cortical modulation. Stroke can induce cardiac autonomic imbalance, therefore, causing secondary cardiovascular complications. Heart rate variability (HRV) analysis is a simple method to appraise the autonomic nervous function. The purpose of this study was to investigate the cardiac autonomic activity in patients that suffered an ischemic stroke in middle cerebral artery (MCA) territory. Using Biopac Acquisition System, we monitored ECG in rest condition and during Ewing's tests. From these measurements, HRV parameters (using time and frequency domain analysis) were determined in 20 right MCA and 20 left MCA ischemic stroke patients, in the first 6 months after the acute event. Data were compared with 20 age- and sex-matched healthy controls. All the patients were right handed. In ischemic stroke patients, HRV parameters were significantly modified compared to controls (p < 0.05) and we found asymmetric responses to different stimulation autonomic tests between right and left hemisphere. Parameters illustrating the parasympathetic predominance in time domain (RMSSD) and frequency domain (HF) analysis were higher in left hemisphere stroke compared to right hemisphere stroke patients (p < 0.01) in resting state. From Ewing's battery test, patients with left hemisphere ischemic stroke showed predominance of parasympathetic activity to deep breathing (p < 0.01), while HRV parameters in right hemisphere ischemic stroke patients described a reduced cardiac parasympathetic innervation (p < 0.01). Cardiac autonomic imbalance occurs more often after right hemisphere ischemic stroke. HRV study may highlight cardiac dysfunctions that increase the risk of cardiovascular complications and portends a poor long-term outcome.

  17. Coronary artery disease: medical therapy

    African Journals Online (AJOL)

    one in three for women.1 Atherosclerotic coronary artery disease begins in childhood and the risk factors influence the development of atherosclerosis throughout one's lifetime.2. A standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent, demonstrated that nine ...

  18. [New pharmacological approaches to ischemic heart disease].

    Science.gov (United States)

    Raddino, Riccardo; Della Pina, Paolo; Gorga, Elio; Brambilla, Giulio; Regazzoni, Valentina; Gavazzoni, Mara; Dei Cas, Livio

    2012-10-01

    Major steps have been made in the treatment of ischemic heart disease from the discovery of nitrates as antianginal medication to the techniques of percutaneous angioplasty. This incredible therapeutic progress has resulted in a reduced incidence of ischemic heart disease and related mortality and morbidity. However, statistical and epidemiological data indicate that in ischemic heart disease, despite the achievement of great success, there is a necessity for a further step toward treatment, considering the fact that the characteristics of this population are changing (increased prevalence of subendocardial infarction compared with classic transmural infarction, especially in the elderly population). Furthermore, the need for alternative therapeutic approaches to traditional ones is recognized. Ranolazine is a selective inhibitor of Na channels that prevents pathological extension of late Na current developing in the ischemic myocardial cell. This current is responsible for calcium overload, with consequent impairment of diastolic relaxation. Ranolazine reduces Na overload induced by calcium and improves diastolic relaxation and coronary subendocardial flow, without affecting hemodynamic parameters such as blood pressure, heart rate, or inotropic state of the heart, avoiding undesirable side effects. Efficacy of ranolazine has been evaluated in several trials, using clinical and instrumental endpoints (MARISA and CARISA) or, more recently, using endpoints such as mortality and reinfarction (ERICA and MERLIN-TIMI 36). Ivabradine acts through the inhibition of late Na current (also known as If), which controls the spontaneous diastolic depolarization of sinus node cells. The partial inhibition of these channels reduces the frequency of sinus node action potential initiation, resulting in decreased heart rate without effects on contractility, atrio-ventricular conduction, or repolarization. The BEAUTIFUL trial has tested whether the effect of ivabradine in lowering

  19. Aspirin, but not clopidogrel, reduces collateral conductance in a rabbit model of femoral artery occlusion

    NARCIS (Netherlands)

    Hoefer, Imo E.; Grundmann, Sebastian; Schirmer, Stephan; van Royen, Niels; Meder, Benjamin; Bode, Christoph; Piek, Jan J.; Buschmann, Ivo R.

    2005-01-01

    OBJECTIVES The objective of this study was to test the potential of aspirin and clopidogrel to influence collateral artery growth (arteriogenesis). BACKGROUND Aspirin and clopidogrel are antiplatelet agents commonly used in the treatment of ischemic cardiovascular disease. Both inhibit platelet

  20. Ischemic QRS prolongation as a biomarker of severe myocardial ischemia.

    Science.gov (United States)

    Almer, Jakob; Jennings, Robert B; Maan, Arie C; Ringborn, Michael; Maynard, Charles; Pahlm, Olle; Arheden, Håkan; Wagner, Galen S; Engblom, Henrik

    2016-01-01

    Previous studies have shown that QRS prolongation is a sign of depressed collateral flow and increased rate of myocardial cell death during coronary occlusion. The aims of this study were to evaluate ischemic QRS prolongation as a biomarker of severe ischemia by establishing the relationship between prolongation and collateral flow experimentally in a dog model, and test if the same pattern of ischemic QRS prolongation occurs in man. Degree of ischemic QRS prolongation was measured using a novel method in dogs (n=23) and patients (n=52) during coronary occlusion for 5min. Collateral arterial flow was assessed in the dogs. There was a significant correlation between QRS prolongation and collateral flow in dogs (r=0.61, p=0.008). Magnitude and temporal evolution of prolongation during ischemia were similar for dogs and humans (p=0.202 and p=0.911). Quantification of ischemic QRS prolongation could potentially be used as a biomarker for severe myocardial ischemia. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The relationship between history of ischemic heart disease in parents of children with Kawasaki Disease with severity of heart complications and disease recurrence in these children

    Directory of Open Access Journals (Sweden)

    saeid Mojtahedzadeh

    2011-03-01

    Full Text Available Kawasaki disease (KD, also called mucocutaneous lymph node syndrome is one of the most common childhood vasculitis. Although the etiology of the disease is unknown infectious, genetic and immunologic factors have been supposed to be responsible for KD occurrence. Complications such as coronary artery aneurysm, cardiomyopathy and heart failure, may occur, which can cause significant morbidity and mortality in children. KD is the common cause of acquired heart disease in children in the United States and Japan. Materials and Methods: 61 patients with approved KD admitted in the Mofid Children’s Hospital (from December 2004 to January 2008 and their parents were studied in this cross-sectional survey. 11 patients were omitted according to exclusion criteria, 50 patients were divided into two groups: Mild (n=26 and severe (n=24. Data was analyzed via Fisher’s exact test and student’s t-test using SPSS software, V. 11,5. p<0.05was taken into account significant. Results: 50 patients (32 males, 18 females with mean age of 43 months were concluded in this survey. All of the patients had fever (100%, coronary artery aneurism was seen in 2% of the patients. No recurrence of KD was seen among these children and there was no history of KD in their parents and siblings. Mitral valve prolaps in mothers and ischemic heart disease in fathers among sever group were significantly higher than mild group (p=0.03 and p=0.001, respectively. Mitral regurgitation and 2-times receiving IVIG was significantly higher in severe group (p=0.02 and p=0.008, respectively. Conclusion: This study showed that mitral valve prolaps in mothers and ischemic heart disease in fathers had significant relation with Kawasaki disease in their children. Also, CRP, ESR, Na, LFT and echocardiography are useful to detect and manage severe Kawasaki disease. To provide more accurate conclusions, prospective and multicentric studies with larger sample sizes are necessary.

  2. Silent Ischemic Heart Disease and Pericardial Fat Volume in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Kristoffersen, Ulrik S; Lebech, Anne-Mette; Wiinberg, Niels

    2013-01-01

    to determine the prevalence of asymptomatic ischemic heart disease (IHD) in HIV patients by myocardial perfusion scintigraphy (MPS) and to determine the value of coronary artery calcium score (CACS), carotid intima-media thickness (cIMT) and pericardial fat volume as screening tools for detection...

  3. Comparative study of mitral valve repair in ischemic and rheumatic mitral regurge

    Directory of Open Access Journals (Sweden)

    M. Adel Al-Adawy

    2017-03-01

    Conclusions: Patients with ischemic MVD were in a worse cardiac condition with higher hospital mortality than patients with combined rheumatic MVD and coronary artery bypass grafting. Patients with rheumatic MVD were usually having very complex pathology and in need modifications of standard repair techniques. Once discharged from hospital, both groups had comparable short and mid-term outcomes.

  4. Silent intracerebral microhemorrhages in patients with ischemic stroke. Amsterdam Vascular Medicine Group

    NARCIS (Netherlands)

    Kwa, V. I.; Franke, C. L.; Verbeeten, B.; Stam, J.

    1998-01-01

    We compared the frequencies of signs of old intracerebral hemorrhages on brain magnetic resonance imaging scans in 66 patients with ischemic stroke, 69 with myocardial infarction, and 86 with peripheral arterial disease (a total of 221 patients). Magnetic resonance imaging scans were independently

  5. Thrombolysis for Acute Ischemic Stroke

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten; De Keyser, J.; Luijckx, G. J.

    2009-01-01

    In the last decennium, thrombolytic therapy has changed the management of acute ischemic stroke. Randomized clinical studies have demonstrated that intravenous thrombolysis with tissue plasminogen activator improves functional outcomes. Recently the time window for intravenous thrombolysis has been

  6. MRI at 3 Tesla detects no evidence for ischemic brain damage in intensively treated patients with homozygous familial hypercholesterolemia

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz, Stephan A.; O' Regan, Declan P.; Fitzpatrick, Julie; Hajnal, Joseph V. [Hammersmith Hospital Campus, Imaging Sciences Department, MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College, London (United Kingdom); Neuwirth, Clare; Potter, Elizabeth; Tosi, Isabella; Naoumova, Rossi P. [MRC Clinical Sciences Centre, Clinical Research Facility, London (United Kingdom); Hammersmith Hospital, Lipid Clinic, London (United Kingdom)

    2007-11-15

    Homozygous familial hypercholesterolemia (FH) is considered a model disease for excessive plasma cholesterol levels. Patients with untreated homozygous FH have a markedly increased risk for premature atherosclerosis. The frequency and extent of ischemic brain damage detectable by high-field magnetic resonance imaging (MRI) after long-term intensive treatment are unknown. In a case control study, five patients with homozygous FH (one male and four females; mean age: 23.6 {+-} 9.2, range: 12-36 years; mean pre-treatment serum total cholesterol level: 26.9 {+-} 3.24 mmol/L; all patients with documented atherosclerotic plaques in the carotid arteries) and five age- and sex-matched healthy controls were studied. All patients had been on maximal lipid-lowering medication since early childhood, and four of them were also on treatment with low-density lipoprotein (LDL) apheresis at bi-weekly intervals. Brain MRI was performed at 3 Tesla field strength with fluid-attenuated T2-weighted inversion recovery and T1-weighted spin-echo MR pulse sequences and subsequently evaluated by two independent readers. The maximal lipid-lowering treatment reduced the total serum cholesterol by more than 50% in the patients, but their serum concentrations were still 3.6-fold higher than those found in the controls (11.9 {+-} 4.2 vs. 4.5 {+-} 0.5 mmol/L; p < 0.0047). No brain abnormality was observed in any of the patients with homozygous FH. Homozygous FH patients on intensive cholesterol-lowering therapy have no evidence of ischemic brain damage at 3 Tesla MRI despite the remaining high cholesterol levels. (orig.)

  7. A standardized definition of ischemic cardiomyopathy for use in clinical research.

    Science.gov (United States)

    Felker, G Michael; Shaw, Linda K; O'Connor, Christopher M

    2002-01-16

    We sought to evaluate the association between the extent of coronary artery disease (CAD) and survival in patients with symptomatic heart failure (HF) and to create the most prognostically powerful clinical definition of ischemic cardiomyopathy. An ischemic etiology of HF is known to be a predictor of adverse outcome; however, there is no uniform definition for ischemic cardiomyopathy. We assessed the clinical history and coronary anatomy of patients with symptomatic HF and ejection fraction definition of ischemic cardiomyopathy for prognostic purposes. A more extensive CAD was independently associated with shorter survival. When the various classification schemes were compared, a modified number-of-diseased-vessels classification, in which patients with single-vessel disease and no prior history of revascularization or myocardial infarction (MI) were classified as nonischemic, provided the most prognostic power. A definition of ischemic cardiomyopathy that incorporated this definition had more prognostic power than the traditional definition. Angiographically diagnosed ischemic HF is associated with shorter survival than nonischemic HF. A more extensive CAD is independently associated with shorter survival, and patients with single-vessel disease and no history of MI or revascularization should be classified as nonischemic for prognostic purposes. Standardization of the definition of ischemic cardiomyopathy will be useful in the conduct and interpretation of clinical research in HF.

  8. Neurorehabilitation in stroke produced by vertebral artery dissection: case presentation

    Directory of Open Access Journals (Sweden)

    Stanescu Ioana

    2018-02-01

    Full Text Available Arterial dissections are a common cause of stroke in the young (mean age 44 to 46 years. Primary lesion is a tear of the arterial intima, which promotes platelet aggregation, thrombus formation, which further produced vessel stenosis / occlusion, distal embolism or vessel wall rupture. Vertebral artery (VA dissection appear most commonly in extracranial segments V2 and V3, and could be spontaneous (with underlying predispositions or triggered by various traumatisms. Clinicaly, VA dissection produces an ischemic stroke or transient ischemic attack , preceded by local symptoms such as neck pain or headache. The diagnosis is confirmed by neurovascular imaging. Treatment of symptomatic VA dissections respect indications of treatment in ischemic strokes. Prognosis is mostly favorable in extracranial dissections. We present the case of a left VA dissection in V2 segment, produced by physical effort (swimming, which causes 2 ischemic lesions, one in the territory of the left posterior cerebral artery and the other in the territory of the left posterolateral chorroidal artery. Patient’s treatment included antiplatelet agents, statines, and an adapted physical rehabilitation program. At three months he showed significant clinical improvement with regain of autonomy and partial recanalisation at angio-MRI of the V2 segment of the dissected artery.

  9. A rating system for prompt clinical diagnosis of ischemic stroke.

    Science.gov (United States)

    Talavera, J O; Wacher, N H; Laredo, F; López, A; Martínez, V; González, J; Lifshitz, A; Feinstein, A R

    2000-01-01

    When a CT scan is not available, an early accurate clinical diagnosis of ischemic stroke is essential to initiate prompt therapy. Our objective was to construct a clinical index that is easy to use when stroke patients are first evaluated at the hospital, to identify those who probably are experiencing an acute ischemic episode. The study was conducted at a university-affiliated medical referral center and two community general hospitals in Mexico. Clinical records were reviewed for 801 patients with sudden onset of a focal or global neurologic dysfunction, presumably of vascular origin lasting more than 24 h. Eligibility criteria for this study were admission to the hospital within the first 24 h after symptomatic onset, CT scan diagnosis between 24 and 72 h, and age >45 years. Ischemic stroke included cases of arterial brain infarction, while nonischemic stroke included subarachnoid or intraparenchymatous hemorrhage, mass lesion, venous infarction, and in cases without a CT scan evidence that could explain the clinical manifestations. Data excerpted for analysis were age, sex, history of diabetes mellitus or previous stroke/transient ischemic attack (TIA), time of onset of symptoms, presence of headache, vomiting, neck stiffness, hemiplegia, leukocytosis or atrial fibrillation, diastolic blood pressure, and Glasgow coma scale (GCS) rating. Two multivariable analyses were used: 1) step-wise multiple logistic regression (SMLR), and 2) conjunctive consolidation (CC). After appropriate exclusions, the study proceeded with 83 ischemic and 42 nonischemic stroke patients. With SMLR, six variables were selected as predictive for ischemic stroke, including neck stiffness, diastolic blood pressure, previous history of stroke/TIA, hemiplegia, GCS, and atrial fibrillation. An appropriate sum of weighted ratings had a positive predictive value (PPV) of 100% for ischemic stroke. With consolidated categories, the PPV was 97% when patients had the following: no neck stiffness

  10. A STUDY ON INTRACRANIAL STENOSIS IN ACUTE ISCHEMIC STROKE

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    Jerrin

    2015-11-01

    Full Text Available BACKGROUND : Acute ischemic stroke is very common cause of significant morbidity and mortality throughout the world. The causes of acute ischemic stroke could be intracranial or extra cranial. Prevention of the acute episode could be decreased by surgically treating ex tra - cranial vascular disease but the prevention of intracranial cause is only medical. Various risk factors are also associated with development of ischemic stroke. However, the association between these and the pattern of vascular involvement is not clear . AIM: The aim of the study was to 1. Identify the location of the vessel involved in different cases of ischemic stroke 2. To study the various risk factors associated with the development of ischemic stroke. MATERIALS AND METHOD S: This was a prospective study conducted between the years 2010 and 2012. All adult patients with acute ischemic stroke which was confirmed by MRI and less than two weeks duration were included in the study. Parameters recorded were presence of pre - existing comorbid conditions, n eurological examination findings, Cardiovascular system examination findings, Blood pressures, blood sugar levels and pattern of vascular involvement. This was assessed using MR angiography or four vessel Doppler. Statistical analysis was done using the SP SS software. RESULTS: Two hundred patients were enrolled in the study. Pure extracranial stenosis was present in 21.5%, extracranial with intracranial stenosis in 34%, and pure intracranial stenosis in 44.5%, which was predominant and resembled other Indi an studies. 15.5% of patients had significant carotid stenosis based on Doppler study and were suitable candidates for carotid endarterectomy. Middle cerebral artery was commonly involved (55%. Hypertension (63.5%, diabetes mellitus (48%, alcoholism (20 .5% and smoking (18.5% were the common risk factors. Prevalence of these risk factors was more in those with intracranial stenosis in our study, elevated total

  11. Serum 25-hydroxyvitamin d deficiency in ischemic stroke and subtypes in Indian patients.

    Science.gov (United States)

    Chaudhuri, Jaydip Ray; Mridula, K Rukmini; Alladi, Suvarna; Anamika, A; Umamahesh, M; Balaraju, Banda; Swath, A; Bandaru, Vcs Srinivasarao

    2014-01-01

    Vitamin D deficiency is common across all age groups and may contribute to cardiovascular diseases. Serum 25-hydroxyvitamin D deficiency causing ischemic stroke has been documented in recent reports. To investigate the association of serum 25-hydroxyvitamin D deficiency with ischemic stroke and subtypes. We recruited 250 consecutive ischemic stroke patients and 250 age and sex matched controls attending the Department of Neurology, at Yashoda hospital, Hyderabad, India, from January 2011 to December 2012. All ischemic stroke patients underwent stroke subtyping. We measured 25-hydroxyvitamin D by chemiluminescence test, serum calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP) in cases and controls. Out of 250 stroke patients, 190 (76%) were men and mean age was 58.4±11.1 years (age range-26-89 years). 25-hydroxyvitamin D deficiency was observed in 122 (48.8%) stroke patients and 79 (31.6%) controls (P=0.001). Among stroke patients, serum 25-hydroxyvitamin D deficiency was found in 54.9% (50/91) of patients with large artery atherosclerosis, 54% (20/37) in cardioembolic stroke, 44.4% (20/45) in small artery diseases, 42.8% (15/35) in stroke of other determined etiology and 40.4% (17/42) in stroke of un-determined etiology. Multiple logistic regression analysis showed an independent association of 25-hydroxyvitamin D deficiency with ischemic stroke (odds ratio: 1.6; 95% CI 1.2-2.8). The association was strongest with large artery atherosclerosis (odds ratio: 2.4; 95% CI 1.6-3.5) and cardioembolic stroke (odds ratio: 2.0; 95% CI 1.0-3.2). We found that 25-hydroxyvitamin D deficiency had an independent association with ischemic stroke. The association was established in large artery arthrosclerosis and cardioembolic stroke.

  12. Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR.

    Science.gov (United States)

    Nagao, Michinobu; Hatakenaka, Masamitsu; Matsuo, Yoshio; Kamitani, Takeshi; Higuchi, Ko; Shikata, Fumiaki; Nagashima, Mitsugi; Mochizuki, Teruhito; Honda, Hiroshi

    2012-02-02

    The purpose of this study was to quantify myocardial strain on the subendocardial and epicardial layers of the left ventricle (LV) using tagged cardiovascular magnetic resonance (CMR) and to investigate the transmural degree of contractile impairment in the chronic ischemic myocardium. 3T tagged CMR was performed at rest in 12 patients with severe coronary artery disease who had been scheduled for coronary artery bypass grafting. Circumferential strain (C-strain) at end-systole on subendocardial and epicardial layers was measured using the short-axis tagged images of the LV and available software (Intag; Osirix). The myocardial segment was divided into stenotic and non-stenotic segments by invasive coronary angiography, and ischemic and non-ischemic segments by stress myocardial perfusion scintigraphy. The difference in C-strain between the two groups was analyzed using the Mann-Whitney U-test. The diagnostic capability of C-strain was analyzed using receiver operating characteristics analysis. The absolute subendocardial C-strain was significantly lower for stenotic (-7.5 ± 12.6%) than non-stenotic segment (-18.8 ± 10.2%, p subendocardial C-strain differentiated stenotic segments from non-stenotic segments with a sensitivity of 77%, a specificity of 70%, and areas under the curve (AUC) of 0.76. The absolute subendocardial C-strain was significantly lower for ischemic (-6.7 ± 13.1%) than non-ischemic segments (-21.6 ± 7.0%, p subendocardial C-strain differentiated ischemic segments from non-ischemic segments with sensitivities of 86%, specificities of 84%, and AUC of 0.86. Analysis of tagged CMR can non-invasively demonstrate predominant impairment of subendocardial strain in the chronic ischemic myocardium at rest. © 2012 Nagao et al; licensee BioMed Central Ltd.

  13. Neuroprotection of lamotrigine on hypoxic-ischemic brain damage in neonatal rats: Relations to administration time and doses

    OpenAIRE

    Yi, Yong-Hong; Guo, Wen-Chao; Sun, Wei-Wen; Su, Tao; Lin, Han; Chen, Sheng-Qiang; Deng, Wen-Yi; Zhou, Wei; Liao, Wei-Ping

    2008-01-01

    Lamotrigine (LTG), an antiepileptic drug, has been shown to be able to improve cerebral ischemic damage by limiting the presynaptic release of glutamate. The present study investigated further the neuroprotective effect of LTG on hypoxic-ischemic brain damage (HIBD) in neonatal rats and its relations to administration time and doses. The HIBD model was produced in 7-days old SD rats by left common carotid artery ligation followed by 2 h hypoxic exposure (8% oxygen). LTG was administered intra...

  14. Antisense oligonucleotide for tissue factor inhibits hepatic ischemic reperfusion injury.

    Science.gov (United States)

    Nakamura, Kenji; Kadotani, Yayoi; Ushigome, Hidetaka; Akioka, Kiyokazu; Okamoto, Masahiko; Ohmori, Yoshihiro; Yaoi, Takeshi; Fushiki, Shinji; Yoshimura, Rikio; Yoshimura, Norio

    2002-09-27

    Tissue factor (TF) is an initiation factor for blood coagulation and its expression is induced on endothelial cells during inflammatory or immune responses. We designed an antisense oligodeoxynucleotide (AS-1/TF) for rat TF and studied its effect on hepatic ischemic reperfusion injury. AS-1/TF was delivered intravenously to Lewis rats. After 10 h, hepatic artery and portal vein were partially clamped. Livers were reperfused after 180 min and harvested. TF expression was studied using immunohistochemical staining. One of 10 rats survived in a 5-day survival rate and TF was strongly stained on endothelial cells in non-treatment group. However, by treatment with AS-1/TF, six of seven survived and TF staining was significantly reduced. Furthermore, we observed that fluorescein-labeled AS-1/TF was absorbed into endothelial cells. These results suggest that AS-1/TF can strongly suppress the expression of TF and thereby inhibit ischemic reperfusion injury to the rat liver.

  15. [Effect of Chinese drugs for activating blood circulation and removing blood stasis on carotid atherosclerosis and ischemic cerebrovascular events].

    Science.gov (United States)

    Lu, Yan; Li, Tao

    2014-03-01

    To explore the effect of Chinese drugs for activating blood circulation and removing blood stasis (CDABCRBS) on carotid atherosclerotic plaque and long-term ischemic cerebrovascular events. By using open and control method, effect of 4 groups of platelet antagonists, platelet antagonists + CDABCRBS, platelet antagonists +atorvastatin, platelet antagonists +atorvastatin +CDABCRBS on carotid atherosclerotic plaque and long-term ischemic cerebrovascular events of 90 cerebral infarction patients were analyzed. Through survival analysis, there was no statistical difference in the effect of the 4 interventions on the variation of carotid stenosis rates or ischemic cerebrovascular events (P > 0.05). The occurrence of ischemic cerebrovascular events could be postponed by about 4 months in those treated with platelet antagonists + CDABCRBS and platelet antagonists + atorvastatin +CDABCRBS. By multivariate Logistic analysis, age, hypertension, and clopidogrel were associated with stenosis of extracranial carotid arteries (P cerebrovascular accidents (P cerebrovascular events. CDABCRBS could effectively prolong the occurrence time of ischemic cerebrovascular events.

  16. Upregulation of intercellular adhesion molecule 1 (ICAM-1) on brain microvascular endothelial cells in rat ischemic cortex.

    Science.gov (United States)

    Wang, X; Siren, A L; Liu, Y; Yue, T L; Barone, F C; Feuerstein, G Z

    1994-10-01

    The expression of intercellular adhesion molecule 1 (ICAM-1) was studied in rat focal ischemic cortex. A significant increase in ICAM-1 mRNA expression in the ischemic cortex over levels in contralateral (nonischemic) site was observed by means of Northern blot analysis following either permanent or temporary occlusion with reperfusion of the middle cerebral artery (PMCAO or MCAO with reperfusion) in spontaneously hypertensive rats. In the ischemic cortex, levels of ICAM-1 mRNA increased significantly at 3 h (2.6-fold, n = 3, P hypertensive rats than in two normotensive rat strains. Immunostaining using anti-ICAM-1 antibodies indicated that upregulated ICAM-1 expression was localized to endothelial cells of intraparenchymal blood vessels in the ischemic but not contralateral cortex. The data suggest that an upregulation of ICAM-1 mRNA and protein on brain capillary endothelium may play an important role in leukocyte migration into ischemic brain tissue.

  17. Nonischemic Priapism in Childhood: A Case Series and Review of Literature.

    Science.gov (United States)

    Hacker, Hans-Walter; Schwoebel, Marcus G; Szavay, Philipp O

    2017-03-27

    Introduction  Nonischemic priapism (NIP) in childhood is a very rare affection. In the literature, patients with NIP are described mainly incidental after perineal trauma. Many of them underwent embolization of either internal pudendal artery or bulbocavernosal arteries. Patients and Methods  We report on six boys between 4 and 13 years of age with NIP, treated at our institution between 2008 and 2014. Color Doppler ultrasound (CDU) was performed in all patients as emergency diagnostic evaluation. Patients were treated conservatively, including bed rest, local cooling, and perineal compression. History, etiological factors, clinical findings, diagnostics, and follow-up are presented. Results  Out of the six patients, only one boy had a history of perineal injury with subsequent arteriocavernosal fistula, revealed in CDU. Five patients were circumcised, and one of them suffered from thalassemia minor, but no other underlying disease or etiological factors could be found. In all patients, normal to high blood flow velocities were detected in the cavernosal arteries. Detumescence started with nonoperative treatment within 24 hours in five boys and in one patient with recurrent priapism after 1 week. All six patients remained painless without evidence for an ischemic priapism. None of them suffered from relapse and further erections were observed during follow-up from 3 to 87 months. Conclusion  In contrast to the literature, five out of six boys developed NIP without a previous perineal trauma. The etiology of idiopathic NIP in childhood remains unclear; however, circumcision may play a role as a conditional factor. One etiological thesis could be the release of the neurotransmitter nitric oxide after stimulation of the corpora cavernosa. Conservative treatment proved to be successful in all six patients. During a median follow-up of 55 months (3-87 months), none of the patients showed signs of erectile dysfunction. Georg Thieme Verlag KG Stuttgart · New York.

  18. Adolescent ischemic stroke associated with anabolic steroid and cannabis abuse.

    Science.gov (United States)

    El Scheich, Tarik; Weber, Artur-Aron; Klee, Dirk; Schweiger, Daniel; Mayatepek, Ertan; Karenfort, Michael

    2013-01-01

    We report on a 16-year-old body builder who suffered from an acute ischemic stroke. In the urine, cannabis metabolites as well as metabolites of the oral androgenic-anabolic steroid methandrostenolone were detected, both known to be associated with stroke events. This report highlights the role of cannabis and steroid abuse that induce strokes in the absence of arteriopathy, cardioembolism or thrombophilia. Owing to new upcoming socio-behavioral aspects of late childhood and early adolescent life, this formally rare abuse of cannabis and/or anabolic steroids as well as their associations with strokes becomes more current than ever.

  19. Automatic classification of long-term ambulatory ECG records according to type of ischemic heart disease

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    Smrdel Aleš

    2011-12-01

    Full Text Available Abstract Background Elevated transient ischemic ST segment episodes in the ambulatory electrocardiographic (AECG records appear generally in patients with transmural ischemia (e. g. Prinzmetal's angina while depressed ischemic episodes appear in patients with subendocardial ischemia (e. g. unstable or stable angina. Huge amount of AECG data necessitates automatic methods for analysis. We present an algorithm which determines type of transient ischemic episodes in the leads of records (elevations/depressions and classifies AECG records according to type of ischemic heart disease (Prinzmetal's angina; coronary artery diseases excluding patients with Prinzmetal's angina; other heart diseases. Methods The algorithm was developed using 24-hour AECG records of the Long Term ST Database (LTST DB. The algorithm robustly generates ST segment level function in each AECG lead of the records, and tracks time varying non-ischemic ST segment changes such as slow drifts and axis shifts to construct the ST segment reference function. The ST segment reference function is then subtracted from the ST segment level function to obtain the ST segment deviation function. Using the third statistical moment of the histogram of the ST segment deviation function, the algorithm determines deflections of leads according to type of ischemic episodes present (elevations, depressions, and then classifies records according to type of ischemic heart disease. Results Using 74 records of the LTST DB (containing elevated or depressed ischemic episodes, mixed ischemic episodes, or no episodes, the algorithm correctly determined deflections of the majority of the leads of the records and correctly classified majority of the records with Prinzmetal's angina into the Prinzmetal's angina category (7 out of 8; majority of the records with other coronary artery diseases into the coronary artery diseases excluding patients with Prinzmetal's angina category (47 out of 55; and correctly

  20. eNOS Uncoupling, A Therapeutic Target For Ischemic Foot of Diabetic Rat.

    Science.gov (United States)

    Gao, Ling; Yu, Ailin; Liu, Jingcheng; Ma, Lina; Li, Jing

    2018-02-01

    To determine the relationship between eNOS uncoupling and diabetic ischemic foot and whether reversing eNOS uncoupling by Dihydrofolate reductase (DHFR) transfection or folic acid (FA) supplementation can be beneficiary in diabetic ischemic foot. The bilateral common iliac artery of diabetic rats were ligated to establish the diabetic ischemic foot animal model. DHFR transfection was implemented via femoral artery and muscle injection of in vivo transfection reagent mixture (GenEscortIII) every 4 days during the 2 weeks intervention. The color doppler flow imaging (CDFI) of femoral artery for RI measurement, triceps and quadriceps structure and histology, eNOS coupling status, DHFR expression level, superoxide, peroxynitrite (ONOO- ) and nitric oxide (NO) production in the presence or absence of L-NAME (eNOS inhibitor) were examined among wild type rats (WT), diabetic sham rats (DM), rats of diabetic ischemic foot (DF) or DF with DHFR transfection (DFT) or DF with FA supplementation (DFF). Dihydroethidium (DHE) fluorescence, as an index of superoxide production was enhanced in the femoral arteries of diabetic rats and even more in those of ischemic foot from diabetic rats. However, the DHE fluorescence was diminished in the presence of L-NAME suggesting eNOS uncoupling is the source of superoxide overproduction which further led to increased peroxynitrite production and decreased NO . bioavailability. Subsequently, the hind limb muscle became atrophic and the local collateral circulation was defective due to endothelial dysfunction related to eNOS uncoupling. However, all of the above and hemodynamic index (RI) of femoral artery were resumed via restoration of DHFR protein expression by folic acid treatment or DHFR transfection. eNOS uncoupling is involved in diabetic ischemic foot due to DHFR suppression. DHFR restoration can reverse eNOS uncoupling and resume the endothelial dysfunction and pathological changes (increased vasculature resistance, hind limb muscle

  1. Childhood Stress

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Childhood Stress KidsHealth / For Parents / Childhood Stress What's in this ... and feel stress to some degree. Sources of Stress Stress is a function of the demands placed ...

  2. Self-perceived psychological stress and ischemic stroke: a case-control study

    Directory of Open Access Journals (Sweden)

    Blomstrand Christian

    2009-10-01

    Full Text Available Abstract Background A growing body of evidence suggests that psychological stress contributes to coronary artery disease. However, associations between stress and stroke are less clear. In this study, we investigated the possible association between ischemic stroke and self-perceived psychological stress, as measured by a single-item questionnaire, previously reported to be associated with myocardial infarction. Methods In the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS, 600 consecutive patients with acute ischemic stroke (aged 18 to 69 years and 600 age-matched and sex-matched population controls were recruited. Ischemic stroke subtype was determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST criteria. Self-perceived psychological stress preceding stroke was assessed retrospectively using a single-item questionnaire. Results Permanent self-perceived psychological stress during the last year or longer was independently associated with overall ischemic stroke (multivariate adjusted odds ratio (OR 3.49, 95% confidence interval (CI 2.06 to 5.93. Analyses by stroke subtype showed that this association was present for large vessel disease (OR 3.91, 95% CI 1.58 to 9.67, small vessel disease (OR 3.20, 95% CI 1.64 to 6.24, and cryptogenic stroke (OR 4.03, 95% CI 2.34 to 6.95, but not for cardioembolic stroke (OR 1.48, 95% CI 0.64 to 3.39. Conclusion In this case-control study, we found an independent association between self-perceived psychological stress and ischemic stroke. A novel finding was that this association differed by ischemic stroke subtype. Our results emphasize the need for further prospective studies addressing the potential role for psychological stress as a risk factor for ischemic stroke. In such studies ischemic stroke subtypes should be taken into consideration.

  3. Intracoronary Delivery of Mitochondria to the Ischemic Heart for Cardioprotection.

    Science.gov (United States)

    Cowan, Douglas B; Yao, Rouan; Akurathi, Vamsidhar; Snay, Erin R; Thedsanamoorthy, Jerusha K; Zurakowski, David; Ericsson, Maria; Friehs, Ingeborg; Wu, Yaotang; Levitsky, Sidney; Del Nido, Pedro J; Packard, Alan B; McCully, James D

    2016-01-01

    We have previously shown that transplantation of autologously derived, respiration-competent mitochondria by direct injection into the heart following transient ischemia and reperfusion enhances cell viability and contractile function. To increase the therapeutic potential of this approach, we investigated whether exogenous mitochondria can be effectively delivered through the coronary vasculature to protect the ischemic myocardium and studied the fate of these transplanted organelles in the heart. Langendorff-perfused rabbit hearts were subjected to 30 minutes of ischemia and then reperfused for 10 minutes. Mitochondria were labeled with 18F-rhodamine 6G and iron oxide nanoparticles. The labeled mitochondria were either directly injected into the ischemic region or delivered by vascular perfusion through the coronary arteries at the onset of reperfusion. These hearts were used for positron emission tomography, microcomputed tomography, and magnetic resonance imaging with subsequent microscopic analyses of tissue sections to confirm the uptake and distribution of exogenous mitochondria. Injected mitochondria were localized near the site of delivery; while, vascular perfusion of mitochondria resulted in rapid and extensive dispersal throughout the heart. Both injected and perfused mitochondria were observed in interstitial spaces and were associated with blood vessels and cardiomyocytes. To determine the efficacy of vascular perfusion of mitochondria, an additional group of rabbit hearts were subjected to 30 minutes of regional ischemia and reperfused for 120 minutes. Immediately following regional ischemia, the hearts received unlabeled, autologous mitochondria delivered through the coronary arteries. Autologous mitochondria perfused through the coronary vasculature significantly decreased infarct size and significantly enhanced post-ischemic myocardial function. In conclusion, the delivery of mitochondria through the coronary arteries resulted in their rapid

  4. Childhood Obesity

    OpenAIRE

    Ahmad, Qazi Iqbal; Ahmad, Charoo Bashir; Ahmad, Sheikh Mushtaq

    2010-01-01

    Childhood obesity has important consequences for health and wellbeing both during childhood and also in later adult life. The rising prevalence of childhood obesity poses a major public health challenge in both developed and developing countries by increasing the burden of chronic non-communicable diseases. Despite the urgent need for effective preventative strategies, there remains disagreement over its definition due to a lack of evidence on the optimal cut-offs linking childhood BMI to dis...

  5. Protective effects of ischemic postconditioning on intestinal

    Directory of Open Access Journals (Sweden)

    DING Jun-tao

    2011-04-01

    Full Text Available 【Abstract】Objective: To explore the protective effects of two types of ischemic postconditioning (IP on intestinal mucosa barrier in rabbits with crush injury of the hind limb. Methods: This study was conducted between August and December 2008 in the Department of Trauma Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. The model of crush injury to the hind limb of rabbits was firstly developed by a 25 kg object with the right hind limbs fixed by wooden splints, and then two types of IP were established, including occluding/opening the common iliac artery and vein alternatively (traditional IP, IP A and binding/loosening the proximum of the injured hind limb alternatively (modified IP, IP B. Thirty-six male New Zealand white rabbits were randomly divided into three groups: IP A group, IP B group and control group, with 12 rabbits in each group. The serum levels of diamine oxidase (DAO and intestinal fatty acid-binding protein (I-FABP were detected at 2, 6, 12 and 24 hours after injury. Pathological changes of ileum were examined at 24 hours after injury. Results: The serum levels of I-FABP at 2, 6, 12 and 24 hours after injury in both IP A and IP B groups had a significant decrease, compared with control group. DAO levels also showed the same change trend at 2 and 6 hours after injury, but showed no significant difference between two IP groups. No difference in pathological changes of ileum was found among the three groups. Conclusions: IP can protect intestinal mucosa barrier function on the model of hind limb crush injury in rabbits. Meanwhile the modified IP B shows the same protection as the traditional IP A, and is worth applying in clinic. Key words: Ischemic postconditioning; Crush syndrome; Intestinal mucosa

  6. Childhood Cancer

    Science.gov (United States)

    ... Late for the Flu Vaccine? Eating Disorders Arrhythmias Childhood Cancer KidsHealth > For Parents > Childhood Cancer Print A A A What's in this ... in children, but can happen. The most common childhood cancers are leukemia , lymphoma , and brain cancer . As ...

  7. Sudden death as a late sequel of Kawasaki disease: postmortem CT demonstration of coronary artery aneurysm.

    Science.gov (United States)

    Okura, Naoki; Okuda, Takahisa; Shiotani, Seiji; Kohno, Mototsugu; Hayakawa, Hideyuki; Suzuki, Atsuko; Kawasaki, Tomisaku

    2013-02-10

    Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents during childhood. The characteristic coronary arterial lesion of KD is an aneurysm. Ischemic heart disease derived from a CA aneurysm is experienced approximately two decades after the onset of acute KD. In recent years, the primary issue of concern has been asymptomatic adults with a CA aneurysm caused by undiagnosed KD. We present a case of sudden death as a late KD sequel in a young adult. A postmortem CT scan revealed a coarse calcification of a left anterior descending CA aneurysm, which was confirmed at the time of autopsy. A postmortem CT scan is useful in cases of sudden death where the detection of a calcified CA aneurysm would suggest to the forensic pathologist that the deceased suffered from a late sequel of KD. The use of screening postmortem CT scans for young people may detect cases of unsuspected CA aneurysms, raising the possibility of untreated KD. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. The role of aspirin in childhood tuberculous meningitis.

    Science.gov (United States)

    Schoeman, Johan F; Janse van Rensburg, Anita; Laubscher, Jacoba A; Springer, Priscilla

    2011-08-01

    Arterial stroke is the main cause of poor outcome in childhood tuberculous meningitis. Aspirin has an antithrombotic action at low dose and anti-ischemic and anti-inflammatory properties, which are dose-related. The aim of the study was to explore the possible benefits of aspirin in children with tuberculous meningitis. A total of 146 consecutive children with a diagnosis of probable tuberculous meningitis were studied. Patients were randomized into 3 groups: (1) placebo group, (2) low-dose aspirin group, and (3) high-dose aspirin group. Twenty-nine additional patients who received aspirin before admission were excluded from the randomized study, but continued on low-dose aspirin. Aspirin, irrespective of dose, did not show any significant benefit regarding morbidity (hemiparesis and developmental outcome) and mortality. Aspirin was well tolerated, but 1 death was probably related to aspirin. The fact that the outcome of the high-dose aspirin group compared favorably with the other treatment groups despite younger age and more severe neurological involvement at baseline needs further investigation.

  9. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  10. Is there a consistent association between coronary heart disease and ischemic stroke caused by intracranial atherosclerosis?

    Science.gov (United States)

    Conforto, Adriana B; Leite, Claudia da Costa; Nomura, Cesar H; Bor-Seng-Shu, Edson; Santos, Raul D

    2013-05-01

    Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.

  11. Is there a consistent association between coronary heart disease and ischemic stroke caused by intracranial atherosclerosis?

    Directory of Open Access Journals (Sweden)

    Adriana B. Conforto

    2013-05-01

    Full Text Available Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.

  12. Cerebral microbleeds are common in ischemic stroke but rare in TIA.

    Science.gov (United States)

    Werring, D J; Coward, L J; Losseff, N A; Jäger, H R; Brown, M M

    2005-12-27

    In patients with stroke, gradient-echo MRI commonly detects microbleeds, indicating small artery disease with increased risk of macroscopic intracranial bleeding. Antithrombotic treatments are frequently prescribed after TIA and stroke, but there have been no previous studies of microbleeds in TIA. Because microbleeds may predict the hemorrhagic risk of antithrombotic treatments, we studied the prevalence of microbleeds, risk factors, and pathophysiologic mechanisms in patients with ischemic stroke and TIA. One hundred twenty-nine consecutive patients with ischemic stroke or TIA were studied with MRI including T2, fluid-attenuated inversion recovery, and gradient-echo MRI sequences. Blinded observers counted microbleeds and graded white matter T2 hyperintensities throughout the brain. TIA patients with previous ischemic stroke were excluded. Sixty-seven percent of patients had ischemic stroke; 33% had TIA. Microbleeds were found in 23% of ischemic stroke patients but only 2% of TIA patients (p hypertensive (81 vs 59%; p = 0.04) and had more severe MRI white matter disease on T2 MRI (p = 0.003). Microbleeds are common in ischemic stroke but rare in TIA, an observation not explained by differences in vascular risk factors or severity of white matter disease seen on T2 MRI. This finding has implications for the safety of antithrombotic therapy and clinical trial design in the two groups. Microbleeds may also be a new marker for severe microvascular pathology with increased risk of permanent cerebral infarction.

  13. The prevention of ischemic stroke with antithrombotic drugs

    Directory of Open Access Journals (Sweden)

    Denis Perko

    2012-02-01

    Full Text Available Current antithrombotic drugs reduce the risk of stroke, heart attack and death from vascular causes by 25 % in patients with cerebral ischemic events resulting from disease of small or large cerebral arteries. In the primary prevention, Acetylsalicylic acid (ASA reduces the risk of stroke by 19 % in women but not in men. In patients with nonvalvular atrial fibrillation the risk of stroke treating with ASA is reduced by 20 %. Oral anticoagulants significantly reducestroke risk due to nonvalvular atrial fibrillation by 65–70 % compared with placebo and by 40 % compared with ASA alone. At the same time they cause more major bleedings. Recently studied new antiplatelet drugs and anticoagulants might alter the current course of stroke prevention treatment. Research is also needed on the benefits and risks of combination antiplatelets and anticoagulants in patients with non valvular atrial fibrillation in combination with arterial cerebral disease.

  14. [Results of thrombolyses procedures in acute ischemic cerebral stroke realized in Kraków 2004-2007--Grant Ministry of Science and Information].

    Science.gov (United States)

    Popiela, Tadeusz J; Urbanik, Andrzej; Słowik, Agnieszka

    2010-01-01

    To lower the number of complications of acute cerebral ischemic stroke and to reduce the time of rehabilitation in these patients it is necessary to induce treatment within the first 3 hours of the onset of the stroke. Early intervention however, is possible only in cases with the confirm localized ischemic focus visualized in one of the diagnostic imaging methods. The most widespread is CT, hovewer the first symptoms of ischemic stroke can be seen not beforel2 hours of the onset. The study evaluated the effectiveness of early diagnostics of ischemic stroke using perfusion CT (pCT) with subsequent intravenous or intra-arterial thrombolysis. The patients with ischemic stroke confirmed by pCT and qualified to thrombolysis in the first 3 hours of the onset of the stroke were randomly selected to intravenous or intra-arterial thrmobolysis. Those, who were 3 to 6 hours of the onset of the stroke were qualified to intra-arterial thrombolysis. A study group consisted of 377 patients hospitalized due to ischemic stroke. Of these pCT was performed in 76 cases, intravenous thrombolysis in 4 and intra-arterial thrombolysis in 2. Clinical condition substantially improved in 3 patients. Obtained results indicate the necessity to introduce pCT to the routine diagnostics of the acute ischemic stroke. A small number of patients eligible for thrombolysis does not allow to compare the effectiveness of intra-arterial and intravenous thrombolysis, however the project allowed to work out the efficient system of diagnostics and treatment of the acute ischemic stroke in the area of Krakow based on the standards used in the European countries.

  15. Ischemic preconditioning-induced microvascular protection at a distance.

    Science.gov (United States)

    Wang, Wei Z; Stepheson, Linda L; Fang, Xin-Hua; Khiabani, Kayvan T; Zamboni, William A

    2004-02-01

    Ischemic preconditioning-induced microcirculatory protection appears to be a systemic rather than a local phenomenon. This protection induced by remote ischemic preconditioning (RIPC) may be attributed to a humoral rather than a neuronal mechanism. An innervated (Inn, Groups 1 and 4) or denervated (Den, Groups 2 and 3) and vascular isolated right cremaster of the rat was prepared. Left femoral vessels were clamped (Groups 1, 2, and 4) for 45 min or unclamped (Group 3) as a control. After 2 hr of reperfusion in the left lower extremity, 4 hr of ischemia in the right cremaster was applied in Groups 1, 2, and 3. However, in Group 4, 4 hr of ischemia in the cremaster muscle was instituted before reperfusion of the left femoral artery was begun. Microcirculatory responses, including terminal arteriole diameter, capillary perfusion, and endothelium function were evaluated. Four groups (six rats per group) were designed: Group 1: RIPC (Inn); Group 2: RIPC (Den); Group 3: sham RIPC (Den); and Group 4: fake RIPC (Inn). Ischemia of 45 min followed by 2 hr of reperfusion in the left lower extremity of the rat induced a significant microvascular protection against subsequent 4-hr ischemia in both innervated and denervated cremasters. This microvascular protection at a distance was lost in sham RIPC and in fake RIPC groups. The results demonstrated that remote protection induced by ischemic preconditioning is a systemic phenomenon and due to a humoral mechanism.

  16. Anticoagulation in acute ischemic stroke: A systematic search

    Directory of Open Access Journals (Sweden)

    Nayara L. Froio

    Full Text Available Summary Introduction: Stroke is one of the most important diseases worldwide. Several clinical scenarios demand full dose of anticoagulants primary to stroke etiology or to the treatment of comorbidity. However, controversy exists over many issues regarding anticoagulation treatment in stroke such as time for initiation, efficacy according to stroke etiology, the ideal dose of anticoagulants, and whether novel anticoagulants should be used. Method: Computerized search for clinical trials and randomized controlled clinical trials was done to the present date at Medline, Scielo, Embase, PsychInfo, and Cochrane Library using MeSH terms and the keywords stroke, ischemic stroke, anticoagulation, anticoagulants, heparin, low-molecular-weight heparin, warfarin, dabigatran, rivaroxaban, apixaban. The PRISMA statement was used to evaluate clinical trials. Results: Fourteen clinical trials were selected based on inclusion criteria. No evidence was found supporting the early use of heparin, heparinoids or low-molecular-weight heparin (LMWH early after stroke. No consistent evidence for the use of warfarin and the newer oral anticoagulants were found. Argatroban was the only anticoagulant with significant positive results early after large-artery ischemic stroke. Conclusion: The ideal time for initiating anticoagulation remains undefined, requiring further investigation. Early anticoagulation for ischemic stroke is not recommended, with few exceptions, such as that of argatroban.

  17. Risk factors for perioperative ischemic stroke in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mário Augusto Cray da Costa

    2015-09-01

    Full Text Available AbstractObjective:The purpose of this study was to evaluate the risk factors for ischemic stroke in patients undergoing cardiac surgery.Methods:From January 2010 to December 2012, 519 consecutive patients undergoing cardiac surgery were analyzed prospectively. The sample was divided into two groups: patients with stroke per and postoperative were allocated in Group GS (n=22 and the other patients in the group CCONTROL (n=497. The following variables were compared between the groups: gender, age, carotid stenosis > 70%, diabetes on insulin, chronic obstructive pulmonary disease, peripheral arteriopathy, unstable angina, kidney function, left ventricular function, acute myocardial infarction, pulmonary arterial hypertension, use of cardiopulmonary bypass. Ischemic stroke was defined as symptoms lasting over 24 hours associated with changes in brain computed tomography scan. The variables were compared using Fisher’s exact test, Chi square, Student’s t-test and logistic regression.Results:Stroke occurred in 4.2% of patients and the risk factors statistically significant were: carotid stenosis of 70% or more (P=0.03; OR 5.07; IC 95%: 1.35 to 19.02, diabetes on insulin (P=0.04; OR 2.61; IC 95%: 1.10 to 6.21 and peripheral arteriopathy (P=0.03; OR 2.61; 95% CI: 1.08 to 6.28.Conclusion:Risk factors for ischemic stroke were carotid stenosis of 70% or more, diabetes on insulin and peripheral arteriopathy.

  18. Cholinesterase inhibition improves blood flow in the ischemic cerebral cortex.

    Science.gov (United States)

    Scremin, O U; Li, M G; Scremin, A M; Jenden, D J

    1997-01-01

    The ability of central cholinesterase inhibition to improve cerebral blood flow in the ischemic brain was tested in Sprague-Dawley rats with tandem occlusion of left middle cerebral and common carotid arteries. Cerebral blood flow was measured with lodo- 14C-antipyrine autoradiography in 170 regions of cerebral cortex. The regional distribution of blood flow was characterized in normal animals by cerebral blood flow maxima in the temporal regions. After 2 h ischemia, minimum cerebral blood flow values were found in the lateral frontal and parietal areas on the left hemisphere, and a new maximum was found in the right hemisphere in an area approximately symmetrical to the ischemic focus. Heptyl-physostigmine (eptastigmine), a carbamate cholinesterase inhibitor with prolonged time of action improved cerebral blood flow in most regions, with the exception of the ischemic core. The drug also enhanced the ischemia-induced rostral shift of cerebral blood flow maxima in the right hemisphere. The effects of eptastigmine were more marked 24 h after ischemia. Discriminant analysis showed that data from only 22 regions was sufficient to achieve 100% accuracy in classifying all cases into the various experimental conditions. The redistribution of cerebral blood flow to the sensorimotor area of the right hemisphere of animals with cerebral ischemia, a phenomenon possibly related to recovery of function, was also enhanced by eptastigmine.

  19. Spontaneous Bilateral Vertebral Artery Dissection During a Basketball Game

    Science.gov (United States)

    Mas Rodriguez, Manuel F.; Berrios, Rafael Arias; Ramos, Edwardo

    2016-01-01

    Spontaneous vertebral artery dissection accounts for 2% of all ischemic strokes and can occur as a consequence of sports events. We present an unusual case of spontaneous bilateral vertebral artery dissection in a 30-year-old male patient during a basketball game. He developed severe dysphagia, right hemiparesis, and balance dysfunction. We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports. PMID:26733592

  20. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...

  1. Global DNA methylation of ischemic stroke subtypes.

    Directory of Open Access Journals (Sweden)

    Carolina Soriano-Tárraga

    Full Text Available Ischemic stroke (IS, a heterogeneous multifactorial disorder, is among the leading causes of mortality and long-term disability in the western world. Epidemiological data provides evidence for a genetic component to the disease, but its epigenetic involvement is still largely unknown. Epigenetic mechanisms, such as DNA methylation, change over time and may be associated with aging processes and with modulation of the risk of various pathologies, such as cardiovascular disease and stroke. We analyzed 2 independent cohorts of IS patients. Global DNA methylation was measured by luminometric methylation assay (LUMA of DNA blood samples. Univariate and multivariate regression analyses were used to assess the methylation differences between the 3 most common IS subtypes, large-artery atherosclerosis (LAA, small-artery disease (SAD, and cardio-aortic embolism (CE. A total of 485 IS patients from 2 independent hospital cohorts (n = 281 and n = 204 were included, distributed across 3 IS subtypes: LAA (78/281, 59/204, SAD (97/281, 53/204, and CE (106/281, 89/204. In univariate analyses, no statistical differences in LUMA levels were observed between the 3 etiologies in either cohort. Multivariate analysis, adjusted by age, sex, hyperlipidemia, and smoking habit, confirmed the lack of differences in methylation levels between the analyzed IS subtypes in both cohorts. Despite differences in pathogenesis, our results showed no global methylation differences between LAA, SAD, and CE subtypes of IS. Further work is required to establish whether the epigenetic mechanism of methylation might play a role in this complex disease.

  2. Diabetes and ischemic heart disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Holmager, Pernille

    2014-01-01

    The aim of this study was to test i) whether patients having diabetes and ischemic heart disease (IHD), i.e., patients suffering from two chronic diseases, demonstrate a higher degree of chronic stress when compared with patients suffering from IHD alone, and ii) whether suffering from the two...

  3. Olanzapine-induced ischemic colitis

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    Esteban Sáez-González

    Full Text Available Background: Ischemic colitis (IC is an uncommon adverse event associated with antipsychotic agents, more commonly found with phenothiazine drugs and atypical neuroleptics such as clozapine. The risk of developing ischemic colitis increases when anticholinergic drugs are associated. Case report: We report the case of a 38-year-old woman with a history of schizoaffective disorder who had been on chronic quetiapine for 3 years, and presented to the ER because of diarrhea for 5 days. Four months previously, olanzapine had been added to her psychiatric drug regimen. Physical examination revealed abdominal distension with abdominal tympanic sounds and tenderness. Emergency laboratory tests were notable for increased acute phase reagents. Tomography revealed a concentric thickening of the colonic wall in the transverse, descending and sigmoid segments, with no signs of intestinal perforation. Colonoscopy demonstrated severe mucosal involvement from the sigmoid to the hepatic flexure, with ulcerations and fibrinoid exudate. Biopsies confirmed the diagnosis of ischemic colitis. The only relevant finding in her history was the newly added drug to her baseline regimen. An adverse effect was suspected because of its anticholinergic action at the intestinal level, and the drug was withdrawn. After 6 months of follow-up clinical, laboratory and endoscopic recovery was achieved. Discussion: Antipsychotic medication should be considered as a potential cause of ischemic colitis, particularly atypical antipsychotics such as clozapine and olanzapine; despite being uncommon, this adverse event may result in high morbidity and mortality.

  4. [Ischemic stroke in young women

    NARCIS (Netherlands)

    Ekker, M.S.; Wermer, M.J.; Riksen, N.P.; Klijn, C.J.; Leeuw, F.E. de

    2016-01-01

    - In virtually all age groups, the incidence of ischemic stroke is higher in men. However, in women aged between 25-49 years the prevalence is higher than in men. Female-specific risk factors and disorders may explain this peak.- Pregnancy and the post-partum period are associated with physiological

  5. Using coronary calcification to exclude an ischemic etiology for cardiomyopathy: A validation study and systematic review.

    Science.gov (United States)

    Premaratne, Manuja; Shamsaei, Mohabbat; Chow, Jonathan D H; Haddad, Tony; Erthal, Fernanda; Curran, Helen; Yam, Yeung; Szczotka, Agnieszka; Mielniczuk, Lisa; Wells, George A; Beanlands, Rob S; Hossain, Alomgir; Chow, Benjamin J W

    2017-03-01

    Preliminary data suggests the absence of coronary artery calcification (CAC) excludes ischemic etiologies of cardiomyopathy. We prospectively validate and perform a systematic review to determine the utility of an Agatston score=0 to exclude the diagnosis of ischemic cardiomyopathy. Patients with newly diagnosed LV dysfunction were prospectively enrolled. Patients underwent CAC imaging and were followed until an etiologic diagnosis of cardiomyopathy was made. Eighty-two patients were enrolled in the study and underwent CAC imaging with 81.7% patients having non-ischemic cardiomyopathy. An Agatston score=0 successfully excluded an ischemic etiology for cardiomyopathy with a specificity of 100% (CI: 74.7-100%) and a positive predictive value of 100% (CI: 85.0%-100%). A systematic literature review was performed and studies were deemed suitable for inclusion if: 1) patients with CHF, cardiomyopathy or LV dysfunction were enrolled, 2) underwent CAC imaging and patients were assessed for an Agatston score=0 or the absence of CAC, and 3) the final etiologic diagnosis (ischemic or non-ischemic) was provided. Eight studies provided sufficient information to calculate operating characteristics for an Agatston score=0 and were combined with our validation cohort for a total of 754 patients. An Agatston score=0 excluded ischemic cardiomyopathy with specificity and positive predictive values of 98.4% (CI: 95.6-99.5%), and 98.3% (CI: 95.5-99.5%), respectively. In patients with cardiomyopathy of unknown etiology, an Agatston score=0 appears to rule out an ischemic etiology. A screening CAC may be a simple and cost-effective method of triaging patients, identifying those who do and do not need additional CAD investigations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Substitution of Linoleic Acid for Other Macronutrients and the Risk of Ischemic Stroke.

    Science.gov (United States)

    Venø, Stine K; Schmidt, Erik B; Jakobsen, Marianne U; Lundbye-Christensen, Søren; Bach, Flemming W; Overvad, Kim

    2017-10-25

    Ischemic stroke is a major health problem worldwide, but the influence of dietary factors on stroke risk is not well known. This study aimed to investigate the risk of ischemic stroke and its subtypes with a higher intake from linoleic acid and a concomitant lower intake from saturated fatty acids, monounsaturated fatty acids, or glycemic carbohydrates. In the Danish prospective Diet, Cancer, and Health Study of 57 053 participants aged 50 to 64 years at baseline, information on diet was collected using a validated semiquantitative food frequency questionnaire. Information on ischemic stroke was obtained from the Danish National Patient Register, and cases were all validated and subclassified according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Substitution of linoleic acid for saturated fatty acid, monounsaturated fatty acid, or glycemic carbohydrates was investigated in relation to the risk of ischemic stroke and subtypes. Cox proportional hazards regression was used to estimate the associations with ischemic stroke adjusting for appropriate confounders. During 13.5 years of follow-up 1879 participants developed ischemic stroke. A slightly lower risk of ischemic stroke was found with a 5% higher intake of linoleic acid and a concomitant lower intake of saturated fatty acid (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16), monounsaturated fatty acid (hazard ratio, 0.80; 95% confidence interval, 0.63-1.02), and glycemic carbohydrates (hazard ratio, 0.92; 95% confidence interval, 0.78-1.09), although not statistically significant. Similar patterns of association were found for large-artery atherosclerosis and small-vessel occlusions. This study suggests that replacing saturated fatty acid, glycemic carbohydrate, or monounsaturated fatty acid with linoleic acid may be associated with a lower risk of ischemic stroke. © 2017 American Heart Association, Inc.

  7. Posterior auricular artery-middle cerebral artery bypass: a rare superficial temporal artery variant with well-developed posterior auricular artery-case report.

    Science.gov (United States)

    Tokugawa, Joji; Nakao, Yasuaki; Kudo, Kentaro; Iimura, Koji; Esaki, Takanori; Yamamoto, Takuji; Mori, Kentaro

    2014-01-01

    The posterior auricular artery (PAA) is one of the branches of the external carotid artery, but is usually too small for use as a donor artery for middle cerebral artery (MCA) territory revascularization. An extremely unusual case of PAA-MCA anastomosis was performed in a patient requiring MCA territory revascularization because the superficial temporal artery (STA) parietal branch was absent and the PAA was large enough. A 65-year-old man developed mild motor weakness in the right extremities caused by multiple small infarctions. Single photon emission computed tomography (CT) revealed deterioration of the vascular reserve capacity in the left MCA area. Cerebral angiography showed severe stenosis in the C2 portion of the left internal carotid artery, absence of the parietal branch of the left STA, and a well-developed PAA extending to the parietal area. The patient underwent STA (frontal branch)-MCA and PAA-MCA double anastomosis, and has suffered no stroke or transient ischemic attack. The STA with no bifurcation is known as a rare variation. The PAA also occurs with size variations but well-developed PAA is thought to be extremely rare. PAA can be used as a donor artery for MCA territory revascularization if the vessel size is suitable. Preoperative evaluation of the anatomy is mandatory for harvesting the arteries.

  8. The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke.

    Science.gov (United States)

    Dziadkowiak, Edyta; Chojdak-Łukasiewicz, Justyna; Guziński, Maciej; Noga, Leszek; Paradowski, Bogusław

    2016-04-01

    Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions (p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources (p = 0.00094) and with pyramidal signs (p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis.

  9. Hypertension and ischemic heart disease. Role of dipyridamole echocardiography test.

    Science.gov (United States)

    Gulizia, M M; Lo Giudice, P; Doria, G; Valenti, R; Circo, A G

    1994-11-01

    The aim of this study is to try to evaluate the relationship between arterial hypertension and ischemic heart disease (IHD) in the light of the physiopathologic response pattern to the dipyridamole echocardiography test (DET) in hypertensive patients, in pharmacologic washout, without any electrocardiographic ST segment depression during exercise tests or at rest. Sixty patients affected by mild to moderate asymptomatic essential arterial hypertension were studied: the subjects had a sitting diastolic blood pressure > or = 95 1.0 mV during DET, sometimes with the presence of ventricular and/or supraventricular extrasystoles. In this group of patients the left ventricular mass index (LVMI) and duration of hypertension (in months) were higher as compared with those of the other 42 patients (respectively: 160.2 +/- 5.1 vs 129.2 +/- 9.2 g/m2, P < 0.02; and 30 +/- 4.8 vs 9 +/- 5.4 months, P < 0.007). In conclusion it is reasonable to speculate from these data that the ischemic-like" dipyridamole-induced ST segment depression, like that shown by patients affected by Syndrome X, might involve a worse prognosis in hypertensive patients. This may be because of increased coronary resistance due to structural modification or anatomic background.

  10. [Combined operation for ischemic heart diseases and valvular heart diseases].

    Science.gov (United States)

    Inoue, M; Ohba, O; Shichijo, T; Yunoki, K; Suezawa, T; Honjo, O; Kyo, Y

    2000-07-01

    We performed combined operation for patients who have both ischemic heart disease and valvular heart disease in 21 cases from January 1991 to October 1999. This operation was 3.1% of 682 cases of coronary artery bypass grafting and 5.0% of 416 cases of operation for valvular heart disease during that period. The mean age of these patients was 67.9 +/- 9.1 years. The average number of grafts in the coronary artery bypass grafting was 1.5 +/- 0.6. Aortic valve replacement was performed in 6 cases, mitral valve replacement in 10 cases and mitral valve plasty in 5 cases. Together with this combined operation, ascending aorta and aortic arch replacement was done in 1 case and abdominal aortic replacement in 2 cases. Three patients died due to postoperative aortic rupture, cerebral infarction or excessive surgical intervention in ascending aorta and aortic arch replacement. Combined operation for ischemic heart diseases and valvular heart diseases can safely performed, but it appears necessary to pay attention to arteriosclerotic lesions.

  11. Ischemic preconditioning reduces transplanted submandibular gland injury.

    Science.gov (United States)

    Yang, Ning-Yan; Shi, Liang; Zhang, Yan; Ding, Chong; Cong, Xin; Fu, Feng-Ying; Wu, Li-Ling; Yu, Guang-Yan

    2013-01-01

    Ischemic preconditioning (IPC) can reduce ischemia/reperfusion (I/R) injury in multiple organs and species. However, the effect of IPC on transplanted submandibular glands remains unknown. We explored the protection of IPC in transplanted submandibular glands in the rabbit and the underlying mechanism. IPC was performed by clamping the lingual artery for 10 min, with 10 min of reperfusion before transplantation. Male rabbits were randomly divided into control, transplantation, and IPC groups (n = 6 each). Saliva secretion, oxidative stress, pro-inflammatory cytokine levels, and apoptosis-related protein levels were determined at 1, 12, and 24 h after reperfusion. Salivary flow was significantly increased at 12 h and decreased at 24 h in the transplanted glands. IPC treatment prevented the reduced saliva secretion at 24 h after reperfusion (P IPC treatment (all P IPC-treated glands at 1 and 12 h after reperfusion (all P IPC protects the secretory function of transplanted submandibular gland in the rabbit by reducing the inflammatory response, attenuating oxidative stress, and an anti-apoptosis process. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Ischemic Preconditioning in White Matter: Magnitude and Mechanism.

    Science.gov (United States)

    Hamner, Margaret A; Ye, Zucheng; Lee, Richard V; Colman, Jamie R; Le, Thu; Gong, Davin C; Ransom, Bruce R; Weinstein, Jonathan R

    2015-11-25

    Ischemic preconditioning (IPC) is a robust neuroprotective phenomenon whereby brief ischemic exposure confers tolerance to a subsequent ischemic challenge. IPC has not been studied selectively in CNS white matter (WM), although stroke frequently involves WM. We determined whether IPC is present in WM and, if so, its mechanism. We delivered a brief in vivo preconditioning ischemic insult (unilateral common carotid artery ligation) to 12- to 14-week-old mice and determined WM ischemic vulnerability [oxygen-glucose deprivation (OGD)] 72 h later, using acutely isolated optic nerves (CNS WM tracts) from the preconditioned (ipsilateral) and control (contralateral) hemispheres. Functional and structural recovery was assessed by quantitative measurement of compound action potentials (CAPs) and immunofluorescent microscopy. Preconditioned mouse optic nerves (MONs) showed better functional recovery after OGD than the non-preconditioned MONs (31 ± 3 vs 17 ± 3% normalized CAP area, p IFNAR1), key receptors in innate immune response, are implicated in gray matter preconditioning. Strikingly, IPC-mediated WM protection was abolished in both TLR4(-/-) and IFNAR1(-/-) mice. In addition, IPC-mediated protection in WM was also abolished in IFNAR1(fl/fl) LysM(cre), but not in IFNAR1(fl/fl) control, mice. These findings demonstrated for the first time that IPC was robust in WM, the phenomenon being intrinsic to WM itself. Furthermore, WM IPC was dependent on innate immune cell signaling pathways. Finally, these data demonstrated that microglial-specific expression of IFNAR1 plays an indispensable role in WM IPC. Ischemic preconditioning (IPC) has been studied predominantly in gray matter, but stroke in humans frequently involves white matter (WM) as well. Here we describe a novel, combined in vivo/ex vivo mouse model to determine whether IPC occurs in WM. It does. Using genetically altered mice, we identified two innate immune cell receptors, Toll-like receptor 4 and type 1

  13. CURRENT REPERFUSION THERAPY POSSIBILITIES IN MYOCARDIAL INFARCTION AND ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    E. V. Konstantinova

    2015-01-01

    Full Text Available Myocardial infarction and ischemic stroke remain to be of the greatest medical and social importance because of their high prevalence, disability, and mortality rates. Intractable thrombotic occlusion of the respective artery leads to the formation of an ischemic lesion focus in the tissue of the heart or brain. Emergency reperfusion serves to decrease a necrotic focus, makes its formation reversible, and reduces patient death rates. The paper considers main reperfusion therapy lines: medical (with thrombolytic drugs and mechanical (with primary interventions one and their combination in treating patients with acute myocardial and cerebral ischemia. Each reperfusion procedure is discussed in view of its advantages, disadvantages, available guidelines, and possibilities of real clinical practice. Tenecteplase is assessed in terms of its efficacy, safety, and capacities for bolus administration, which allows its use at any hospital and at the pre-hospital stage. Prehospital thrombolysis permits reperfusion therapy to bring much closer to the patient and therefore aids in reducing time to reperfusion and in salvaging as much the myocardial volume as possible. The rapidest recovery of myocardial and cerebral perfusion results in a decreased necrotic area and both improved immediate and late prognosis. The results of randomized clinical trials studying the possibilities of the medical and mechanical methods to restore blood flow are analyzed in the context of evidence-based medicine. The reason why despite the available contraindications, limited efficiency, and the risk of hemorrhagic complications, thrombolytic therapy remains the method of choice for prehospital reperfusion, an alternative to primary percutaneous coronary intervention (PCI if it cannot be carried out in patients with myocardial infarction at the stated time, and the only treatment ischemic stroke treatment that has proven its efficiency and safety in clinical trials is under

  14. Resveratrol regulates autophagy signaling in chronically ischemic myocardium.

    Science.gov (United States)

    Sabe, Ashraf A; Elmadhun, Nassrene Y; Dalal, Rahul S; Robich, Michael P; Sellke, Frank W

    2014-02-01

    Autophagy is a cellular process by which damaged components are removed. Although autophagy can result in cell death, when optimally regulated, it might be cardioprotective. Resveratrol is a naturally occurring polyphenol also believed to be cardioprotective. Using a clinically relevant swine model of metabolic syndrome, we investigated the effects of resveratrol on autophagy in the chronically ischemic myocardium. Yorkshire swine were fed a regular diet (n = 7), a high cholesterol diet (n = 7), or a high cholesterol diet with supplemental resveratrol (n = 6). After 4 weeks, an ameroid constrictor was surgically placed on the left circumflex artery to induce chronic myocardial ischemia. The diets were continued another 7 weeks, and then the ischemic and nonischemic myocardium were harvested for protein analysis. In the ischemic myocardium, a high cholesterol diet partly attenuated the autophagy, as determined by an increase in phosphorylated mammalian target of rapamycin (p-mTOR) and a decrease in p70 S6 kinase (P70S6K), lysosome-associated membrane protein (LAMP)-2, and autophagy-related gene 12-5 conjugate (ATG 12-5; P changes, because the p-mTOR, P70S6K, and LAMP-2 levels were not significantly altered from those of the pigs fed a regular diet. Other autophagy markers were increased with a high cholesterol diet, including light chain 3A-II and beclin 1 (P changes in protein expression were noted among the 3 groups. In the chronically ischemic myocardium, resveratrol partly reversed the effects of a high cholesterol diet on autophagy. This might be a mechanism by which resveratrol exerts its cardioprotective effects. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

    Directory of Open Access Journals (Sweden)

    Charles K Lin

    2014-05-01

    Full Text Available Background: Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA. Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center. Methods: We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis, non-obstructive (<50% stenosis, and no coronary artery disease (no angiographic disease. Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization were obtained. Results: Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13–34 months, the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001. The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001. Conclusion: Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was

  16. Ultrastructural changes in peripheral arteries and nerves in diabetic ...

    African Journals Online (AJOL)

    Mohamed E. Salem

    2017-01-30

    Jan 30, 2017 ... Ultrastructural changes in peripheral arteries and nerves in diabetic ischemic lower limbs, by electron microscope. Mohamed E. Salem a,*. , Abdel-Azzem A. Ismael b, Amr Salem c, Tarek Salem d a Department of Vascular Surgery, Faculty of Medicine, Alexandria University, Egypt b Department of Cell ...

  17. Reversed Robin Hood syndrome in acute ischemic stroke patients.

    Science.gov (United States)

    Alexandrov, Andrei V; Sharma, Vijay K; Lao, Annabelle Y; Tsivgoulis, Georgios; Malkoff, Marc D; Alexandrov, Anne W

    2007-11-01

    Recurrent hemodynamic and neurological changes with persisting arterial occlusions may be attributable to cerebral blood flow steal from ischemic to nonaffected brain. Transcranial Doppler monitoring with voluntary breath-holding and serial NIH Stroke Scale (NIHSS) scores were obtained in patients with acute middle cerebral artery or internal carotid artery occlusions. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. The steal magnitude (%) was calculated as [(MFVm-MFVb)/MFVb]x100, where m=minimum and b=baseline mean flow velocities (MFV) during the 15- to 30-second period of a total 30 second of breath-holding. Six patients had steal phenomenon on transcranial Doppler (53 to 73 years, NIHSS 4 to 15 points). Steal magnitude ranged from -15.0% to -43.2%. All patients also had recurrent neurological worsening (>2 points increase in NIHSS scores) at stable blood pressure. In 3 of 5 patients receiving noninvasive ventilatory correction for snoring/sleep apnea, no further velocity or NIHSS score changes were noted. Our descriptive study suggests possibility to detect and quantify the cerebral steal phenomenon in real-time. If the steal is confirmed as the cause of neurological worsening, reversed Robin Hood syndrome may identify a target group for testing blood pressure augmentation and noninvasive ventilatory correction in stroke patients.

  18. Impact of aspirin according to type of stable coronary artery disease: insights from a large international cohort.

    Science.gov (United States)

    Bavry, Anthony A; Gong, Yan; Handberg, Eileen M; Cooper-DeHoff, Rhonda M; Pepine, Carl J

    2015-02-01

    Aspirin is recommended in stable coronary artery disease based on myocardial infarction and stroke studies. However, benefit among stable coronary artery disease patients who have not suffered an acute ischemic event is uncertain. The objective of this study was to evaluate the impact of aspirin in stable coronary artery disease. We hypothesized that aspirin's benefit would be attenuated among individuals with stable coronary artery disease but no prior ischemic event. An observational study was conducted from the INternational VErapamil-SR/Trandolapril STudy cohort. Ambulatory patients ≥ 50 years of age with clinically stable coronary artery disease requiring antihypertensive drug therapy (n = 22,576) were classified "ischemic" if they had a history of unstable angina, myocardial infarction, transient ischemic attack, or stroke at the baseline visit. All others were classified "non-ischemic." Aspirin use was updated at each clinic visit and considered as a time-varying covariate in a Cox regression model. The primary outcome was first occurrence of all-cause mortality, myocardial infarction, or stroke. At baseline, 56.7% of all participants used aspirin, which increased to 69.3% at study close out. Among the "non-ischemic" group (n = 13,091), aspirin was not associated with a reduction in risk (hazard ratio [HR] 1.11; 95% confidence interval [CI], 0.97-1.28; P = .13); however, among the "ischemic" group (n = 9485), aspirin was associated with a reduction in risk (HR 0.87; 95% CI, 0.77-0.99; P = .033). In patients with stable coronary artery disease and hypertension, aspirin use was associated with reduced risk for adverse cardiovascular outcomes among those with prior ischemic events. Among patients with no prior ischemic events, aspirin use was not associated with a reduction in risk. Published by Elsevier Inc.

  19. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... Health Topics / Coronary Artery Bypass Grafting Coronary Artery Bypass Grafting What Is Coronary artery bypass grafting (CABG) ... multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the ...

  20. Azithromycin protects mice against ischemic stroke injury by promoting macrophage transition towards M2 phenotype.

    Science.gov (United States)

    Amantea, Diana; Certo, Michelangelo; Petrelli, Francesco; Tassorelli, Cristina; Micieli, Giuseppe; Corasaniti, Maria Tiziana; Puccetti, Paolo; Fallarino, Francesca; Bagetta, Giacinto

    2016-01-01

    To develop novel and effective treatments for ischemic stroke, we investigated the neuroprotective effects of the macrolide antibiotic azithromycin in a mouse model system of transient middle cerebral artery occlusion. Intraperitoneal administration of azithromycin significantly reduced blood-brain barrier damage and cerebral infiltration of myeloid cells, including neutrophils and inflammatory macrophages. These effects resulted in a dose-dependent reduction of cerebral ischemic damage, and in a remarkable amelioration of neurological deficits up to 7 days after the insult. Neuroprotection was associated with increased arginase activity in peritoneal exudate cells, which was followed by the detection of Ym1- and arginase I-immunopositive M2 macrophages in the ischemic area at 24-48 h of reperfusion. Pharmacological inhibition of peritoneal arginase activity counteracted azithromycin-induced neuroprotection, pointing to a major role for drug-induced polarization of migratory macrophages towards a protective, non-inflammatory M2 phenotype. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Recovery of Small-Sized Blood Vessels in Ischemic Bone under Static Magnetic Field

    Directory of Open Access Journals (Sweden)

    Shenzhi Xu

    2007-01-01

    Full Text Available Effects of static magnetic field (SMF on the vascularization in bone were evaluated using an ischemic bone model, where rat femoral artery was ligated. Magnetized and unmagnetized samarium–cobalt rods were implanted transcortically into the middle diaphysis of the ischemic femurs. Collateral circulation was evaluated by injection of microspheres into the abdominal aorta at the third week after ligation. It was found that the bone implanted with a magnetized rod showed a larger amount of trapped microspheres than that with an unmagnetized rod at the proximal and the distal region (P < 0.05 proximal region. There were no significant differences at the middle and the distal region. This tendency was similar to that of the bone mineral density in the SMF-exposed ischemic bone.

  2. Modulation of miR29a improves impaired post-ischemic angiogenesis in hyperglycemia.

    Science.gov (United States)

    Chen, Lingdan; Okeke, Emmanuel; Ayalew, Dawit; Wang, Danny; Shahid, Lyeba; Dokun, Ayotunde O

    2017-08-01

    Individuals with diabetes mellitus suffer from impaired angiogenesis and this contributes to poorer peripheral arterial disease outcomes. In experimental peripheral arterial disease, angiogenesis and perfusion recovery are impaired in mice with diabetes. We recently showed that a disintegrin and metalloproteinase domain-containing protein 12 (ADAM12) is upregulated in ischemic endothelial cells and plays a key role in post-ischemic angiogenesis and perfusion recovery following experimental peripheral arterial disease. Here we investigated the role of miR29a in the regulation of endothelial cell ADAM12 expression in ischemia and how hyperglycemia negatively affects this regulation. We also explored whether modulating miR29a can improve impaired post-ischemic angiogenesis associated with hyperglycemia. Additionally, we tested whether miR29a modulation could improve post ischemic angiogenesis in the setting of impaired vascular endothelial growth factor signaling. We forced miR29a expression in ischemic endothelial cells and assessed ADAM12 expression. We also evaluated whether hyperglycemia in vivo and in vitro impair ischemia-induced ADAM12 upregulation and miR29a downregulation. Lastly, we determined whether modulating endothelial cell miR29a expression in ischemia and hyperglycemia could improve impaired endothelial cell functions. We found under ischemic conditions where ADAM12 is upregulated in endothelial cells, miR29a is downregulated. Forced expression of miR29a in ischemic endothelial cell prevented ADAM12 upregulation . In ischemic hind limbs of mice with type 1 diabetes and in endothelial cells exposed to simulated ischemia plus hyperglycemia, ADAM12 upregulation and miR29a downregulation were blunted while angiogenesis was impaired. Knocking down miR29a with an miR29a inhibitor was sufficient to improve ADAM12 upregulation and angiogenesis in simulated ischemia plus hyperglycemia. It was also sufficient to improve perfusion recovery in type 1 diabetes

  3. Delayed reflow of an ischemic infarct after spontaneous thrombolysis studied by CBF tomography using SPECT and Tc-99m HMPAO

    DEFF Research Database (Denmark)

    Companioni, J M; Lassen, N A; Tfelt-Hansen, P

    1991-01-01

    A patient with a large ischemic infarct in the left middle cerebral artery territory was studied six times in the acute/subacute phase by cerebral blood flow (CBF) tomography using Tc-99m-HMPAO. The SPECT instrument used was a brain dedicated highly sensitive four-camera system (TOMOMATIC 232) th...

  4. Collapsin Response Mediator Protein-2-induced Retinal Ischemic Injury in a Novel Mice Model of Ocular Ischemia Syndrome

    Directory of Open Access Journals (Sweden)

    Yu Wang

    2017-01-01

    Conclusions: These results revealed that bilateral ligation of the internal carotid artery causes retinal ischemia in mice. Moreover, CRMP2 might play a pivotal role during the ischemic injury in the retina and inhibit the cleavage of CRMP2 can ameliorate the IH injury.

  5. Ischemic Stroke and Its Risk Factors in a Registry-Based Large Cross-Sectional Diabetic Cohort in a Country Facing a Diabetes Epidemic

    Directory of Open Access Journals (Sweden)

    Khalid Al-Rubeaan

    2016-01-01

    Full Text Available The main aim of this study is to determine the prevalence and risk factors of ischemic stroke among diabetic patients registered in the Saudi National Diabetes Registry (SNDR database. A cross-sectional sample of 62,681 diabetic patients aged ≥25 years was used to calculate ischemic stroke prevalence and its risk factors. Univariate and multivariate logistic regression analyses were used to assess the roles of different risk factors. The prevalence of ischemic stroke was 4.42% and was higher in the older age group with longer diabetes duration. Poor glycemic control and the presence of chronic diabetes complications were associated with a high risk of ischemic stroke. History of smoking and type 2 diabetes were more frequent among stroke patients. Obesity significantly decreased the risk for ischemic stroke. Regression analysis for ischemic stroke risk factors proved that age ≥45 years, male gender, hypertension, coronary artery disease (CAD, diabetes duration ≥10 years, insulin use, and hyperlipidemia were significant independent risk factors for ischemic stroke. We conclude that ischemic stroke is prevalent among diabetic individuals, particularly among those with type 2 diabetes. Good glycemic, hypertension, and hyperlipidemia control, in addition to smoking cessation, are the cornerstones to achieve a significant reduction in ischemic stroke risk.

  6. Coronary Arteries

    Science.gov (United States)

    ... animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other organ or ... the heart by its own vascular system, called coronary circulation. The aorta (the main blood supplier to the ...

  7. Treatment of proximal segment stenoses of vertebral arteries with baloon expandable silicon carbide coated stents

    Directory of Open Access Journals (Sweden)

    Šeruga Tomaž

    2013-01-01

    Conclusions: Stenting of the vertebral arteries can significantly improve hemodynamic conditions in the posterior circulation and prevent recurrent transient ischemic attacks and worsening of vertebro-basilar symptoms. So far, less than twenty studies have been published on the stenting of vertebral arteries worldwide. Randomized larger prospective trials are needed to confirm the benefit of endovascular treatment of vertebral artery stenosis, also by use of drugeluting stents.

  8. Occipital artery to middle cerebral artery bypass in cases of unavailable superficial temporal artery.

    Science.gov (United States)

    Hirano, Tsukasa; Mikami, Takeshi; Suzuki, Hime; Hirano, Toru; Kimura, Yusuke; Komatsu, Katusya; Akiyama, Yukinori; Wanibuchi, Masahiko; Mikuni, Nobuhiro

    2018-01-22

    In neurosurgery, extracranial-to-intracranial (EC-IC) bypass surgery is necessary for patients who have undergone surgery in which the superficial temporal artery (STA) was already used for a different bypass procedure or was damaged. Here, we report our experience with EC-IC bypass using the occipital artery (OA) in cases in which the STA is unavailable, and discuss the technical considerations and pitfalls. Five patients with ischemic-onset moyamoya disease and atherosclerotic disease were included. Two patterns of skin incisions were planned according to the OA pathway and recipient artery location. In one method, a skin incision is made above the OA and a craniotomy is performed under this incision after OA dissection. In the other method, a skin incision is made above the OA to enable its dissection and a craniotomy is performed via a separate skin incision. No major perioperative complications developed in any of the five cases, and bypass patency was confirmed in all patients. There was a significant difference between the pre- and postoperative asymmetry ratio of the mean transit time values. OA-to- middle cerebral artery (MCA) bypass is a simple and effective method in patients in whom the STA was already used or was damaged by previous intracranial revascularization or a craniotomy. This procedure could be an alternative to STA-MCA bypass in patients without an available STA. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Potential humoral mediators of remote ischemic preconditioning in patients undergoing surgical coronary revascularization.

    Science.gov (United States)

    Gedik, Nilgün; Kottenberg, Eva; Thielmann, Matthias; Frey, Ulrich H; Jakob, Heinz; Peters, Jürgen; Heusch, Gerd; Kleinbongard, Petra

    2017-10-04

    Remote ischemic preconditioning (RIPC) by repeated brief cycles of limb ischemia/reperfusion may reduce myocardial ischemia/reperfusion injury and improve patients' prognosis after elective coronary artery bypass graft (CABG) surgery. The signal transducer and activator of transcription (STAT)5 activation in left ventricular myocardium is associated with RIPC´s cardioprotection. Cytokines and growth hormones typically activate STATs and could therefore act as humoral transfer factors of RIPC´s cardioprotection. We here determined arterial plasma concentrations of 25 different cytokines, growth hormones, and other factors which have previously been associated with cardioprotection, before (baseline)/after RIPC or placebo (n = 23/23), respectively, and before/after ischemic cardioplegic arrest in CABG patients. RIPC-induced protection was reflected by a 35% reduction of serum troponin I release. With the exception of interleukin-1α, none of the humoral factors changed in their concentrations after RIPC or placebo, respectively. Interleukin-1α, when normalized to baseline, increased after RIPC (280 ± 56%) but not with placebo (97 ± 15%). The interleukin-1α concentration remained increased until after ischemic cardioplegic arrest and was also higher than with placebo in absolute concentrations (25 ± 6 versus 16 ± 3 pg/mL). Only interleukin-1α possibly fulfills the criteria which would be expected from a substance to be released in response to RIPC and to protect the myocardium during ischemic cardioplegic arrest.

  10. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  11. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Directory of Open Access Journals (Sweden)

    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  12. Redox regulation of ischemic limb neovascularization – What we have learned from animal studies

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    Reiko Matsui

    2017-08-01

    Full Text Available Mouse hindlimb ischemia has been widely used as a model to study peripheral artery disease. Genetic modulation of the enzymatic source of oxidants or components of the antioxidant system reveal that physiological levels of oxidants are essential to promote the process of arteriogenesis and angiogenesis after femoral artery occlusion, although mice with diabetes or atherosclerosis may have higher deleterious levels of oxidants. Therefore, fine control of oxidants is required to stimulate vascularization in the limb muscle. Oxidants transduce cellular signaling through oxidative modifications of redox sensitive cysteine thiols. Of particular importance, the reversible modification with abundant glutathione, called S-glutathionylation (or GSH adducts, is relatively stable and alters protein function including signaling, transcription, and cytoskeletal arrangement. Glutaredoxin-1 (Glrx is an enzyme which catalyzes reversal of GSH adducts, and does not scavenge oxidants itself. Glrx may control redox signaling under fluctuation of oxidants levels. In ischemic muscle increased GSH adducts through Glrx deletion improves in vivo limb revascularization, indicating endogenous Glrx has anti-angiogenic roles. In accordance, Glrx overexpression attenuates VEGF signaling in vitro and ischemic vascularization in vivo. There are several Glrx targets including HIF-1α which may contribute to inhibition of vascularization by reducing GSH adducts. These animal studies provide a caution that excess antioxidants may be counter-productive for treatment of ischemic limbs, and highlights Glrx as a potential therapeutic target to improve ischemic limb vascularization.

  13. Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR

    Directory of Open Access Journals (Sweden)

    Nagao Michinobu

    2012-02-01

    Full Text Available Abstract Background The purpose of this study was to quantify myocardial strain on the subendocardial and epicardial layers of the left ventricle (LV using tagged cardiovascular magnetic resonance (CMR and to investigate the transmural degree of contractile impairment in the chronic ischemic myocardium. Methods 3T tagged CMR was performed at rest in 12 patients with severe coronary artery disease who had been scheduled for coronary artery bypass grafting. Circumferential strain (C-strain at end-systole on subendocardial and epicardial layers was measured using the short-axis tagged images of the LV and available software (Intag; Osirix. The myocardial segment was divided into stenotic and non-stenotic segments by invasive coronary angiography, and ischemic and non-ischemic segments by stress myocardial perfusion scintigraphy. The difference in C-strain between the two groups was analyzed using the Mann-Whitney U-test. The diagnostic capability of C-strain was analyzed using receiver operating characteristics analysis. Results The absolute subendocardial C-strain was significantly lower for stenotic (-7.5 ± 12.6% than non-stenotic segment (-18.8 ± 10.2%, p Conclusions Analysis of tagged CMR can non-invasively demonstrate predominant impairment of subendocardial strain in the chronic ischemic myocardium at rest.

  14. Subendocardial ischemic myocardial lesions associated with severe coronary atherosclerosis.

    Science.gov (United States)

    Geer, J. C.; Crago, C. A.; Little, W. C.; Gardner, L. L.; Bishop, S. P.

    1980-01-01

    Morphologic changes in the subendocardial myocardium that appeared to be caused by severe, chronic subendocardial ischemia were studied in patients with fatal ischemic heart disease admitted to the Specialized Center of Research for Ischemic Heart Disease at the University of Alabama in Birmingham in the period 1970--1977. Thirteen patients were selected for this report on the basis that they had the lesions in the subendocardial myocardium we believe to have been caused by subendocardial ischemia and had no evidence of acute or remote myocardial infarction or other conditions that may have contributed to their terminal illness or death. Clinical findings were unstable angina, congestive heart failure, usually no increase in plasma enzymes indicative of myocardial damage, and electrocardiographic changes consistent with subendocardial ischemia. All 13 patients had 75% or greater stenosis of the three major coronary arteries; none had acute thrombotic or embolic coronary artery occlusion. The left ventricle in all cases was hypertrophied. The subendocardial myocardium showed circumferential pallor, hyperemia, or focal fibrosis without perceptible loss of volume in papillary muscles or trabeculae carneae. Microscopically, acute lesions showed one to two layers of preserved myofibers adjacent to the endocardium, vacuolar change in the deeper fibers, and focal areas of coagulation necrosis of variable size in the myocardium external to the fibers with vacuolar change. Coagulation necrosis was extensive in some cases and usually was not associated with infiltration of neutrophils. The repair reaction involved removal of necrotic sarcoplasm by mononuclear phagocytes, resulting in a reticular-appearing tissue without evidence of stromal collapse. Granulation tissue was not seen. Collagen fibers appeared to be deposited within the area of previous sarcolemmal sheaths. The distribution and morphology of subendocardial myocardial lesions associated with severe coronary

  15. Concomitant use of proton pump inhibitors and clopidogrel in patients with coronary, cerebrovascular, or peripheral artery disease in the factores de Riesgo y ENfermedad Arterial (FRENA) registry.

    Science.gov (United States)

    Muñoz-Torrero, Juan Francisco Sánchez; Escudero, Domingo; Suárez, Carmen; Sanclemente, Carmen; Pascual, Ma Teresa; Zamorano, José; Trujillo-Santos, Javier; Monreal, Manuel

    2011-01-01

    Among patients receiving clopidogrel for coronary artery disease, concomitant therapy with proton pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events. Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicenter, observational registry of consecutive outpatients with coronary artery disease, cerebrovascular disease, or peripheral artery disease. We retrospectively examined the influence of concomitant use of PPIs on outcome in patients receiving clopidogrel. As of March 2009, 1222 patients were using clopidogrel: 595 had coronary artery disease, 329 cerebrovascular disease, and 298 had peripheral artery disease. Of these, 519 (42%) were concomitantly using PPIs. Over a mean follow-up of 15 months, 131 patients (11%) had 139 subsequent ischemic events: myocardial infarction 44, ischemic stroke 40, and critical limb ischemia 55. Seventeen of them (13%) died within 15 days of the subsequent event. PPI users had a higher incidence of myocardial infarction (rate ratio, 2.5; 95% confidence interval [CI], 1.3-4.8), ischemic stroke (rate ratio, 1.9; 95% CI, 1.03-3.7), and a nonsignificantly higher rate of critical limb ischemia (rate ratio, 1.6; 95% CI, 0.95-2.8) than nonusers. On multivariate analysis, concomitant use of clopidogrel and PPIs was independently associated with an increased risk for subsequent ischemic events both in the whole series of patients (hazard ratio, 1.8; 95% CI, 1.1-2.7) and in those with cerebrovascular disease or peripheral artery disease (hazard ratio, 1.5; 95% CI, 1.01-2.4). In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke. This higher incidence persisted after multivariate adjustment.

  16. Left Ventricular Thrombus Formation After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery

    Science.gov (United States)

    Freud, Lindsay R.; Koenig, Peter R.; Russell, Hyde M.; Patel, Angira

    2014-01-01

    Although thrombus formation following myocardial infarction in adults is well known, intracardiac thrombosis in children is uncommon. We report the case of a large left ventricular thrombus in an infant with ischemic cardiomyopathy secondary to anomalous origin of the left coronary artery from the pulmonary artery. Given its mobility and protrusion across the aortic valve, the patient underwent urgent thrombus removal through a transaortic approach. There were no embolic or neurologic complications. This case highlights that thrombectomy may be performed safely and successfully in critically ill pediatric patients. PMID:24668990

  17. Congenital Arteriovenous Fistula with Aneurysm Formation of Ulnar Artery Origin

    Directory of Open Access Journals (Sweden)

    Ming-Chi Yung

    2008-12-01

    Full Text Available Naturally formed arteriovenous fistula (AVF causing local vascular aneurysm dilatation in the forearm ulnar artery region is rare and is exceedingly uncommon in any age group. Presented is a case of AVF in the left ulnar artery of a 39-year-old man in whom there was no history of trauma; the deformity had been noted since childhood. The AVF had become tortuous and enlarged in size as the patient aged. As a result, aneurysm dilatation formed on the base of the AVF and that of the ulnar artery origin. Despite normal preoperative Allen test result and normal preoperative finger pressure measurement with ulnar artery occlusion, arterial duplex imaging showed that the radial artery was the dominant artery of the left arm; the AVF was resected and the base of the aneurismal dilatation, which was directly related to the ulnar artery, was repaired for the sake of the natural continuity of ulnar blood flow.

  18. [An ischemic syndrome of the oculumotor nucleus: associated clinical and anatomical variations on a theme].

    Science.gov (United States)

    Bonnaud, I; Salama, J

    2003-09-01

    Nuclear syndrome of the oculomotor nerve was first described in 1981, it is characterized by the association of an ipsilateral third nerve palsy with a paresis of elevation in the contralateral eye. This syndrome can be caused by vascular or tumoral lesions in the upper midbrain. It is rarely due to ischemic unilateral mesencephalic lesions, because ischemic lesions of the midbrain are usually integrated in a diffuse involvement of the brainstem and the thalamo-sub-thalamic region. In case of nuclear syndrome of the third nerve due to isolated upper midbrain infarct in the paramedian territory, dependent on branches of the basilar artery, oculomotor symptoms are frequently isolated. On the contrary, in fascicular syndromes of the third nerve, resulting from stroke in more lateral territories upon branches of the posterior cerebral artery, many neurological symptoms are associated with the oculomotor signs. We describe 3 patients presenting with a characteristic nuclear syndrome of the third nerve, resulting from a unilateral paramedian ischemic stroke in the upper midbrain, confirmed by cerebral CT scan or MRI examination. Clinical presentation differed in each case, and marked contralateral hemiparesia, cerebellar syndrome and focal asterixis were associated in various ways with the stereotyped oculomotor disorders. In the 3 cases, the nuclear syndrome of the third nerve was associated with fascicular involvement of the nerve, in an unusual clinical picture. The theoretical distinction between nuclear and fascicular syndromes is supported by the anatomical description of the arterial segmentation in the upper midbrain, which remains debated since the first description. According to the variability of clinical presentations, it seems that the arterial territories may be more variable than initially described. Therefore, ischemic lesions of the upper midbrain may involve some vascular borderzones with a high inter-individual variability. Upper midbrain strokes may

  19. Is there a consistent association between coronary heart disease and ischemic stroke caused by intracranial atherosclerosis?

    OpenAIRE

    Conforto, Adriana B.; Claudia da Costa Leite; Cesar H. Nomura; Edson Bor-Seng-Shu; Santos, Raul D

    2013-01-01

    Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke rec...

  20. Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

    OpenAIRE

    Lin, Pei-Jung; Chang, Yu-Tang; Lai, Chiou-Lian

    2006-01-01

    Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic sur...

  1. Update on the Management of Central Retinal Artery Occlusion.

    Science.gov (United States)

    Dattilo, Michael; Biousse, Valérie; Newman, Nancy J

    2017-02-01

    Central retinal artery occlusion (CRAO) is caused by partial or complete occlusion of the central retinal artery, most commonly by an embolus from the ipsilateral carotid artery, aortic arch, or heart, and is the ocular equivalent of an acute cerebral ischemic event. The risk factors for a CRAO and acute cerebral ischemia are very similar, if not identical. Because no current therapeutic intervention has been shown to improve visual outcomes compared with the natural history of CRAO, management of CRAO should be focused on secondary prevention of vascular events, such as cerebral ischemia, myocardial infarction, and cardiovascular death. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Does intravenous administration of recombinant tissue plasminogen activator for ischemic stroke can cause inferior myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Mostafa Almasi

    2016-06-01

    Full Text Available Recombinant tissue plasminogen activator (rTPA is one of the main portions of acute ischemic stroke management, but unfortunately has some complications. Myocardial infarction (MI is a hazardous complication of administration of intravenous rTPA that has been reported recently. A 78-year-old lady was admitted for elective coronary artery bypass graft surgery. On the second day of admission, she developed acute left hemiparesis and intravenous rTPA was administered within 120 minutes. Three hours later, she has had chest pain. Rescue percutaneous coronary intervention was performed on right coronary artery due to diagnosis of inferior MI, and the symptoms were resolved.

  3. An appropriate loading control for western blot analysis in animal models of myocardial ischemic infarction.

    Science.gov (United States)

    Nie, Xin; Li, Chen; Hu, Sheng; Xue, Fulai; Kang, Y James; Zhang, Wenjing

    2017-12-01

    An appropriate loading control is critical for Western blot analysis. Housekeeping proteins (HKPs), such as β-actin, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and β-tubulin, are commonly used to normalize protein expression. But HKP expression can be impacted by certain experimental conditions, such as ischemic myocardial infarction. This study was undertaken to look for an appropriate loading control for western blot analysis of ischemic myocardium. Myocardial ischemic infarction was induced by left anterior descending coronary artery (LAD) ligation in Rhesus monkeys and C57BL/6 mice. The heart tissue samples from different areas and time points after surgery were subjected to western blot or gel staining. The level of β-actin, GAPDH, β-tubulin, and total protein were tested. The total protein level was consistent in all groups, whereas the protein level of β-tubulin and β-actin were different in all groups. However, the protein level of GAPDH was stable in the Rhesus monkey model. We concluded that total protein was the most appropriate internal control in different stages of myocardial ischemic disease of various animal models. GAPDH is a reliable internal control only for ischemic myocardium of Rhesus monkey.

  4. Effects of ischemic preconditioning and cilostazol on muscle ischemia-reperfusion injury in rats.

    Science.gov (United States)

    Frias Neto, Carlos Alberto da Silva; Koike, Márcia Kiyomi; Saad, Karen Ruggeri; Saad, Paulo Fernandes; Montero, Edna Frasson de Souza

    2014-01-01

    To evaluate effects of ischemic preconditioning and Cilostazol on muscle ischemia-reperfusion injury. Male Wistar rats were submitted to muscle ischemic and reperfusion injury (4h of the left common iliac artery occlusion followed by 1h of reperfusion). Five experimental groups were constituted: Control group (n=4); Ischemia-Reperfusion (IR, n=5); Ischemic preconditioning group (IP, n=6); Ischemia-Reperfusion group treated with cilostazol (IRCi, n=6) and Ischemic preconditioning group treated with cilostazol (IPCi, n=6). At the end, left gracile muscle was removed and embedded in paraffin. Histopathology, neutrophil infiltration, myocyte necrosis and edema were analyzed. When compared with the control group, IR group showed increased neutrophil infiltration, severe necrosis and edema. There was significant difference between myocytes necrosis of IR group and IP group. There was no difference between the histopathological changes between IP, IRCi and IPCi groups. The model of IR caused severe muscle injury in the rat hind limb and ischemic preconditioning has a protective effect, reducing myocyte necrosis, however, treatment with cilostazol and also the association between cilostazol and preconditioning has no protective effect on the skeletal muscle subjected to ischemia and reperfusion injury.

  5. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn

    2012-09-01

    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  6. Xenon protects left ventricular diastolic function during acute ischemia, less than ischemic preconditioning

    Directory of Open Access Journals (Sweden)

    Jan H Baumert

    2016-01-01

    Full Text Available Anesthetics modify regional left ventricular (LV dysfunction following ischemia/reperfusion but their effects on global function in this setting are less clear. Aim of this study was to test the hypothesis that xenon would limit global LV dysfunction as caused by acute anterior wall ischemia, comparable to ischemic preconditioning. In an open-chest model under thiopental anesthesia, 30 pigs underwent 60-minute left anterior descending coronary artery occlusion, followed by 120 minutes of reperfusion. A xenon group (constant inhalation from previous to ischemia through end of reperfusion was compared to control and ischemic preconditioning. Load-independent measures of diastolic function (end-diastolic pressure-volume relation, time constant of relaxation and systolic function (end-systolic pressure-volume relation, preload-recruitable stroke work were determined. Heart rate, arterial pressure, cardiac output, and arterial elastance were recorded. Data were compared in 26 pigs. Ischemia impaired global diastolic but not systolic function in control, which recovered during reperfusion. Xenon limited and preconditioning abolished diastolic dysfunction during ischemia. Arterial pressure decreased during reperfusion while arterial elastance increased. Tachycardia and antero-septal wall edema during reperfusion were observed in all groups. In spite of ischemia of 40% of LV mass, global systolic function was preserved. Deterioration in global diastolic function was limited by xenon and prevented by preconditioning.

  7. Xenon protects left ventricular diastolic function during acute ischemia, less than ischemic preconditioning.

    Science.gov (United States)

    Baumert, Jan-H; Roehl, Anna B; Funcke, Sandra; Hein, Marc

    2016-01-01

    Anesthetics modify regional left ventricular (LV) dysfunction following ischemia/reperfusion but their effects on global function in this setting are less clear. Aim of this study was to test the hypothesis that xenon would limit global LV dysfunction as caused by acute anterior wall ischemia, comparable to ischemic preconditioning. In an open-chest model under thiopental anesthesia, 30 pigs underwent 60-minute left anterior descending coronary artery occlusion, followed by 120 minutes of reperfusion. A xenon group (constant inhalation from previous to ischemia through end of reperfusion) was compared to control and ischemic preconditioning. Load-independent measures of diastolic function (end-diastolic pressure-volume relation, time constant of relaxation) and systolic function (end-systolic pressure-volume relation, preload-recruitable stroke work) were determined. Heart rate, arterial pressure, cardiac output, and arterial elastance were recorded. Data were compared in 26 pigs. Ischemia impaired global diastolic but not systolic function in control, which recovered during reperfusion. Xenon limited and preconditioning abolished diastolic dysfunction during ischemia. Arterial pressure decreased during reperfusion while arterial elastance increased. Tachycardia and antero-septal wall edema during reperfusion were observed in all groups. In spite of ischemia of 40% of LV mass, global systolic function was preserved. Deterioration in global diastolic function was limited by xenon and prevented by preconditioning.

  8. Effects Of Ischemic Preconditioning On The Renal Ischemia- Reperfusion Injury

    Directory of Open Access Journals (Sweden)

    Anyamanesh S

    2003-07-01

    Full Text Available  During kidney and other organ transplantation, the organ to be transplanted, must inevitably remain out of the body with little or no blood perfusion at all for a long period of time (ischemia. These events have been suggested to cause the formation of oxygen- derived free radicals (OFR. Reperfusion (reintroduction of blood flow will further exacerbate the initial damage caused by the ischemic insult and may result in the production of free radicals. The aim of this study was to investigate whether induction of brief periods of renal artery occlusion (ischemic pre¬conditioning, IPC can provide protection from the effects of a subsequent period of ischemia and reperfusion (IR in the rat kidney."nMaterials and Methods: In this regard, 28 white, male rats were randomly and equally divided into four groups: Control (sham- operated, IPC alone, IR alone (30 min ischemia followed by 10 min reperfusion, and IPC- IR. Preconditioning involved the sequential clamping of the right renal artery for 5 min and declamping for 5 min for a total of 3 cycles. To demonstrate the effectiveness of IPC regimen, vitamin E as an endogenous antioxidant and an index of lipid peroxidation was measured by HPLC after its extraction from right renal venous plasma and right renal tissue."nResults: Results of this study showed that the amount of vitamin E of renal tissue and venous plasma in the IR group had a significant decrease when compared to the control group (P< 0.0001. Whereas the amount of this vitamin in both renal tissue and venous plasma of the IPC- IR group was significantly higher than that in the IR group (P< 0.0001, but did not show any significant difference with the control group."nConclusion: In this study, preconditioning method prevented the reduction of the endogenous antioxidant (Vit. E in encountering the following sustained ischemic insult. Therefore, we suggest that ischemic preconditioning can be used to protect the Vit. E level of kidney from its

  9. Ischemic preconditioning of the hindlimb or kidney does not attenuate the severity of acute ischemia/reperfusion-induced pancreatitis in rats.

    Science.gov (United States)

    Warzecha, Z; Dembiński, A; Ceranowicz, P; Cieszkowski, J; Konturek, S J; Dembiński, M; Kuśnierz-Cabala, B; Tomaszewska, R; Pawlik, W W

    2008-06-01

    Ischemic preconditioning of several organs, including the pancreas has been shown to protect these organs from injury evoked by subsequent exposure to severe ischemia followed by reperfusion. Moreover, it has been shown that ischemic preconditioning of distant organs such as the kidney, intestine or limb may protect the heart as effectively as cardiac preconditioning itself. This study was designed to determine whether ischemic preconditioning of the kidney or hindlimb protects the pancreas against ischemia/reperfusion-induced pancreatitis. In male Wistar rats, remote ischemic preconditioning of the pancreas was performed by clamping of right femoral or renal artery twice for 5 min with 5 min interval. Direct ischemic preconditioning was performed by clamping of celiac artery. Thirty min after ischemic preconditioning or sham-operation, acute pancreatitis was induced by clamping of inferior splenic artery for 30 min followed by reperfusion. After 6, 12 h or 1, 2, 3, 5 or 9 days of reperfusion the experiment was ended. Secretory studies were performed 2 h after exposure to direct or remote ischemic preconditioning of the pancreas in conscious rats with chronic pancreatic fistula. Direct ischemic preconditioning of the pancreas applied alone reduced pancreatic exocrine secretion; whereas ischemic preconditioning of the hindlimb or kidney was without effect on pancreatic secretion. Direct ischemic preconditioning of the pancreas attenuated the severity of acute pancreatitis. It was found as a reduction in the pancreatitis-evoked increase in serum activity of lipase and amylase, a decrease in serum concentration of pro-inflammatory interleukin-1beta, diminution of histological signs of pancreatic damage, as well as, an improvement of pancreatic blood flow and DNA synthesis. Remote ischemic preconditioning of the pancreas evoked by short-lasting ischemia of the hindlimb or kidney was without any protective effect in ischemia/reperfusion-induced pancreatitis. Moreover

  10. [Migraine and ischemic stroke: possible pathogenic relation].

    Science.gov (United States)

    Galimi, Rocco

    2012-09-01

    Migraine, especially migraine with aura, is an established risk factor for ischemic lesions of the brain. This disorder affects about 15% of people in developed countries and is three times more common in women than in men. The risk of ischemic stroke appears to be higher in migraine with aura than in migraine without aura. An association between migraine and ischemic stroke has been observed for many years but exact mechanisms by which migraine can lead to stroke are currently still under investigation. A significant association between migraine and ischemic stroke has been demonstrated in population and case-control studies. The observation that stroke may occur during migraine attacks prompts to speculation that migraine may directly cause an ischemic event (migrainous infarct). Alternatively, as stroke occurs more frequently during the interictal phase of migraine, an indirect relation between the two diseases might exist. Both ischemic stroke and migraine with aura might be consequences of many underlying vascular disorders. Meta-analysis also demonstrates that subjects with migraine are at higher risk of showing white matter abnormalities on Magnetic Resonance images. Ultimately, it will be important to determine whether migraine with aura is a modifiable risk factor for ischemic stroke and if preventive medications for migraine or antiplatelet therapy might reduce the risk of ischemic stroke in patients with migraine with aura. In the present paper, I will review epidemiological studies, discuss potential mechanisms of migraine-induced stroke and comorbid ischemic stroke.

  11. Genetic variation in WRN and ischemic stroke

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Frikke-Schmidt, Ruth; Nordestgaard, Børge G

    2017-01-01

    BACKGROUND: Werner syndrome, a premature genetic aging syndrome, shares many clinical features reminiscent of normal physiological aging, and ischemic vascular disease is a frequent cause of death. We tested the hypothesis that genetic variation in the WRN gene was associated with risk of ischemic...... for ischemic cerebrovascular disease (P=0.06). In meta-analyses including 59,190 individuals in 5 studies, the hazard ratio for ischemic stroke for C1367R TT homozygotes versus CC/CT was 1.14 (1.04-1.25; P=0.008). CONCLUSIONS: This study suggests that common genetic variation in WRN is associated...

  12. MORPHOLOGY OF ISCHEMIC INJURY OF LIVER ALLOGRAFT

    Directory of Open Access Journals (Sweden)

    L. V. Shkalova

    2010-01-01

    Full Text Available The literature data in modern transplantology concerning morphology of ischemic injury of liver allograft are analyzed in the article. Questions of pathogenesis of liver allograft ischemic injury, histological features that indicate the possibility of donor liver transplantation are discussed in detail, as well as the role of steatosis and its reverse is highlighted. We tried to systematize the morphological changes depending on severity of ischemic injury; also we focused on the questions of persistency of the ischemic injury in the liver allograft. 

  13. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke

    NARCIS (Netherlands)

    Geuskens, R.R.; Borst, J.; Lucas, M.; Boers, A.M.; Berkhemer, O.A.; Roos, Y.B.; Walderveen, M.A. van; Jenniskens, S.F.M.; Zwam, W.H. van; Dippel, D.W.; Majoie, C.B.; Marquering, H.A.; et al.,

    2015-01-01

    BACKGROUND: CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to

  14. Characteristics of misclassified ct perfusion ischemic core in patients with acute ischemic stroke

    NARCIS (Netherlands)

    R.R.E.G. Geuskens (Ralph R.E.G.); J. Borst (Jordi); M. Lucas (Marit); A.M. Boers; O.A. Berkhemer (Olvert); B.W.E.M. Roos Yvo; M.A. van Walderveen (M.); S. Jenniskens (Sjoerd); W.H. van Zwam (Wim); D.W.J. Dippel (Diederik); C.B. Majoie (Charles); H. Marquering (Henk)

    2015-01-01

    textabstractBackground CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT.

  15. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke

    NARCIS (Netherlands)

    Geuskens, Ralph R. E. G.; Borst, Jordi; Lucas, Marit; Boers, A. M. Merel; Berkhemer, Olvert A.; Roos, Yvo B. W. E. M.; van Walderveen, Marianne A. A.; Jenniskens, Sjoerd F. M.; van Zwam, Wim H.; Dippel, Diederik W. J.; Majoie, Charles B. L. M.; Marquering, Henk A.

    2015-01-01

    CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess

  16. Transient Ischemic Right Axis Deviation Tendency of the Frontal Plane QRS Axis in a Case of Inferior Myocardial Ischemia.

    Science.gov (United States)

    Hasegawa, Kohei; Takaya, Tomofumi; Mori, Shumpei; Soga, Fumitaka; Takahashi, Hachidai; Terashita, Daisuke; Otake, Hiromasa; Hirata, Ken-Ichi

    2016-05-25

    A 73-year-old man was admitted to our hospital because of chest pain at rest. Electrocardiography (ECG) showed an ST-segment depression, a negative U-wave in the precordial leads, and a right axis deviation (RAD) tendency. Coronary angiography revealed occlusion of the right coronary artery. Collateral flow from the jeopardized left anterior descending artery to the posterior descending artery (PDA) was fair. After successful revascularization, improvement in the ECG findings was noted. Since blood supply to the left posterior fascicle is dependent on the PDA, the RAD tendency could be explained by the presence of a transient ischemic left posterior hemiblock.

  17. Balancing the risk of spontaneous ischemic and major bleeding events in acute coronary syndromes.

    Science.gov (United States)

    Ducrocq, Gregory; Schulte, Phillip J; Budaj, Andrzej; Cornel, Jan H; Held, Claes; Himmelmann, Anders; Husted, Steen; Storey, Robert F; Cannon, Christopher P; Becker, Richard C; James, Stefan K; Katus, Hugo A; Lopes, Renato D; Sorbets, Emmanuel; Wallentin, Lars; Steg, Philippe Gabriel

    2017-04-01

    Evaluation of antithrombotic treatments for acute coronary syndromes (ACS) requires balancing ischemic and bleeding risks to assess net benefit. We sought to compare the relative effects of ischemic and bleeding events on mortality. In the PLATelet inhibition and patient Outcomes (PLATO) trial, we compared spontaneous ischemic events (myocardial infarction or stroke) with spontaneous major bleeding events (PLATO major, Thrombolysis In Myocardial Infarction [TIMI] major, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] severe) with respect to risk of mortality using time-dependent Cox proportional hazards models. The comparison was performed using ratio of hazard ratios for mortality increase after ischemic vs bleeding events. A total of 822 patients (4.4%) had ≥1 spontaneous ischemic event; 485 patients (2.6%), ≥1 spontaneous PLATO major bleed, 282 (1.5%), ≥1 spontaneous TIMI major bleed; and 207 (1.1%), ≥1 spontaneous severe GUSTO bleed. In patients who had both events, bleeding occurred first in most patients. Regardless of classification, major bleeding events were associated with increased short- and long-term mortality that were not significantly different from the increase associated with spontaneous ischemic events: ratio of hazard ratios (95% CIs) for short- and long-term mortality after spontaneous ischemic vs bleeding events: 1.46 (0.98-2.19) and 0.92 (0.52-1.62) (PLATO major); 1.26 (0.80-1.96) and 1.19 (0.58-2.24) (TIMI major), 0.72 (0.47-1.10) and 0.83 (0.38-1.79) (GUSTO severe) (all P>0.05) CONCLUSIONS: In patients with ACS on dual antiplatelet therapy, spontaneous major bleeding events seem "prognostically equivalent" to spontaneous ischemic complications. This result allows quantitative comparisons between both actual and predicted bleeding and ischemic risks. Our findings help to better define net clinical benefit of antithrombotic treatments and more accurately estimate mortality

  18. Childhood Cancer Statistics

    Science.gov (United States)

    ... Financial Reports Watchdog Ratings Feedback Contact Select Page Childhood Cancer Statistics Home > Cancer Resources > Childhood Cancer Statistics Childhood Cancer Statistics – Graphs and Infographics Number of Diagnoses ...

  19. Childhood Leukemia

    Science.gov (United States)

    Leukemia is cancer of the white blood cells. It is the most common type of childhood cancer. ... blood cells help your body fight infection. In leukemia, the bone marrow produces abnormal white blood cells. ...

  20. Childhood Schizophrenia

    Science.gov (United States)

    ... of onset presents special challenges for diagnosis, treatment, education, and emotional and social development. Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia ...

  1. Rescuing the ischemic penumbra: Our experience

    Directory of Open Access Journals (Sweden)

    Milosavljević Tamara

    2013-12-01

    Full Text Available Objectives: Over one million strokes per year are occurring in Europe. Brain stroke is one of the most important death and disability causes in Europe and USA. The main role of perfusion is to determine the border of insult core and ischemic penumbra. Penumbra can be saved with thrombolytic therapy but core have irreversible injuries and represent death of brain cells. Aim: to determine the role of CT brain perfusion in cases of acute brain stroke and following thrombolytic therapy. Methods: We examined 64 patients with acute brain stroke who received thrombolytic therapy after that. All patients were examining on 16 MDCT with 50 ml of iodine contrast agent following the standard procedure for CT perfusion. Patients were 34 male and 30 female with middle age of 64 years. MRI was made after thrombolytic therapy and compare with perfusion results before therapy. Results: Using an artery and a vein as reference three parameters were measured - blood flow (CBF, blood volume (CBV and mean transit time (MTT, for each patient. Hemorrhagic was find in 9 (14.01% patients after thrombolytic therapy. 4 (6.25% other patients develop new stroke of same but mostly other side of brain. 8 (12.50% more patients finished lethally. From other 42 patients with thrombolytic therapy we can positively say that in 31 (48.44% patients penumbra was rescued. For other 11 (17.19% stroke was same size like firstly involved core and penumbra but not bigger. Conclusion: CT perfusion plays major role by showing a curable parts of tissue in brain strokes.

  2. Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com [Pamukkale University, Department of Radiology, School of Medicine (Turkey); Güney, Bünyamin [Muğla Sıtkı Kocman University, Department of Radiology, School of Medicine (Turkey)

    2016-09-15

    PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

  3. Diabetes and ischemic heart disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Holmager, Pernille

    2014-01-01

    The aim of this study was to test i) whether patients having diabetes and ischemic heart disease (IHD), i.e., patients suffering from two chronic diseases, demonstrate a higher degree of chronic stress when compared with patients suffering from IHD alone, and ii) whether suffering from the two...... chronic diseases results in an elevation in specific elements of the chronic stress concept. A total of 361 participants with IHD were included, of whom 47 suffered from concomitant diabetes. Stress was measured by pressure pain sensitivity (PPS) and by the following questionnaires: the Major Depression...

  4. Ischemic postconditioning: a clinical perspective

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Treiman, Marek; Engstrøm, Thomas

    2010-01-01

    therapy to primary percutaneous coronary intervention, ischemic postconditioning (IPost) has been shown to be safe and to underlie cardioprotection in several clinical trials. However, there remain important issues to be settled before IPost can be used routinely in patients undergoing primary...... percutaneous coronary intervention: first, determining which IPost protocol is the most optimal in humans; second, determining the effect of IPost on clinical outcome; third, determining in which patients should IPost be applied; and fourth, determining the effect on left ventricular function. This article...... discusses these issues with a clinical perspective and looks into alternative pharmacological cardioprotection....

  5. NOC/oFQ and NMDA contribute to piglet hypoxic ischemic hypotensive cerebrovasodilation impairment.

    Science.gov (United States)

    Armstead, William M

    2002-05-01

    Previous studies have observed that hypotensive pial artery dilation was blunted after hypoxia-ischemia. In unrelated studies, the opioid nociceptin/orphanin FQ (NOC/oFQ) was observed to contribute to hypoxic ischemic impairment of N-methyl-D-aspartate (NMDA)-induced pial dilation. This study determined the contribution of NOC/oFQ and NMDA to hypoxic ischemic hypotensive cerebrovasodilation impairment in newborn pigs equipped with a closed cranial window. Global cerebral ischemia was produced via elevated intracranial pressure. Hypoxia decreased PO(2) to 33 +/- 3 mm Hg. Topical NOC/oFQ (10(-10) M), the cerebrospinal fluid concentration after hypoxia-ischemia, had no effect on pial artery diameter by itself but attenuated hypotension (mean arterial blood pressure decrease of 44 +/- 2%) -induced pial artery dilation (35 +/- 2% versus 22 +/- 3%). Hypotensive pial artery dilation was blunted by hypoxia-ischemia, but such dilation was partially protected by pretreatment with the putative NOC/oFQ receptor antagonist, [F/G] NOC/oFQ (1-13) NH(2) (10(-6) M; 29 +/- 2%, sham control; 7 +/- 2%, hypoxia-ischemia; and 13 +/- 2%, hypoxia-ischemia and [F/G] NOC/oFQ (1-13) NH(2)). Coadministration of the NMDA antagonist MK801 (10(-5) M) with NOC/oFQ(10(-10) M) partially prevented hypotensive pial dilation impairment. Similarly, pretreatment with MK801 partially protected hypoxic ischemia impairment of hypotensive pial dilation (35 +/- 2%, sham control; 7 +/- 1%, hypoxia-ischemia; 22 +/- 2%, hypoxia-ischemia + MK801). These data show that NOC/oFQ and NMDA contribute to hypoxic ischemic hypotensive cerebrovasodilation impairment. These data suggest that NOC/oFQ modulation of NMDA vascular activity also contributes to such hypotensive impairment.

  6. Segmental myoclonus and basilar artery giant aneurysm case report

    Directory of Open Access Journals (Sweden)

    J. Pitágoras de Mattos

    1992-12-01

    Full Text Available A 70 years-old man was admitted at our hospital because of unstable angina pectoris. He had essential hypertension and right hemiplegia from a ischemic stroke two years before admission. On neurologic examination, it was found mental disorientation, unstable emotionality, right spastic hemiparesis with right Babinski sign, and segmental myoclonus affecting the superior lip and the palate (palatal nystagmus on the right side. On the CT scan, a giant aneurysm of the basilar artery was detected. We conclude that the segmental myoclonus could be explained by ischemic lesions in the Guillain - Mollaret triangle.

  7. Fibrinogen gene variation and ischemic stroke.

    Science.gov (United States)

    Jood, K; Danielson, J; Ladenvall, C; Blomstrand, C; Jern, C

    2008-06-01

    Plasma fibrinogen level and fibrin clot structure are heritable traits that may be of importance in the pathogenesis of ischemic stroke. To investigate associations between variation in the fibrinogen gamma (FGG), alpha (FGA) and beta (FGB) genes, fibrinogen level, and ischemic stroke. The Sahlgrenska Academy Study on Ischemic Stroke comprises 600 cases and 600 matched population controls. Stroke subtypes were defined according to TOAST criteria. Plasma fibrinogen level was measured by an automated clot-rate assay. Eight tagging single nucleotide polymorphisms (SNPs) were selected to capture genetic variation in the FGA, FGG, and FGB genes. Plasma fibrinogen was independently associated with overall ischemic stroke and all subtypes, both in the acute stage (P FGG and FGA genes. FGB haplotypes were associated with fibrinogen level (P FGG/FGA haplotypes showed independent association to ischemic stroke but not to fibrinogen level. In an additive model with the most common FGG/FGA haplotype (A1) as reference, the adjusted odds ratios of ischemic stroke were 1.4 [95% confidence interval (95% CI) 1.1-1.8], P FGG/FGA haplotypes, respectively. FGG/FGA haplotypes show association to ischemic stroke. This association is independent of fibrinogen level, thus suggesting that the association between ischemic stroke and variation at the FGG/FGA genes is mediated by qualitative rather than quantitative effects on fibrin(ogen).

  8. Mild hypothermia reduces cardiac post-ischemic reactive hyperemia

    Directory of Open Access Journals (Sweden)

    Van der Pals Jesper

    2007-02-01

    Full Text Available Abstract Background In experimentally induced myocardial infarction, mild hypothermia (33–35°C is beneficial if applied prior to ischemia or reperfusion. Hypothermia, when applied after reperfusion seems to confer little or no benefit. The mechanism by which hypothermia exerts its cell-protective effect during cardiac ischemia remains unclear. It has been hypothesized that hypothermia reduces the reperfusion damage; the additional damage incurred upon the myocardium during reperfusion. Reperfusion results in a massive increase in blood flow, reactive hyperemia, which may contribute to reperfusion damage. We postulated that hypothermia could attenuate the post-ischemic reactive hyperemia. Methods Sixteen 25–30 kg pigs, in a closed chest model, were anesthetized and temperature was established in all pigs at 37°C using an intravascular cooling catheter. The 16 pigs were then randomized to hypothermia (34°C or control (37°C. The left main coronary artery was then catheterized with a PCI guiding catheter. A Doppler flow wire was placed in the mid part of the LAD and a PCI balloon was then positioned proximal to the Doppler wire but distal to the first diagonal branch. The LAD was then occluded for ten minutes in all pigs. Coronary blood flow was measured before, during and after ischemia/reperfusion. Results The peak flow seen during post-ischemic reactive hyperemia (during the first minutes of reperfusion was significantly reduced by 43 % (p Conclusion Mild hypothermia significantly reduces post-ischemic hyperemia in a closed chest pig model. The reduction of reactive hyperemia during reperfusion may have an impact on cardiac reperfusion injury.

  9. Relation between reperfusion and hemorrhagic transformation in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, Alexander D. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Dankbaar, Jan Willem; Niesten, Joris M.; Seeters, Tom van; Schaaf, Irene C. van der; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Graaf, Yolanda van der [Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Kappelle, L.J. [University Medical Center, Department of Neurology, Utrecht Stroke Center, Utrecht (Netherlands); Collaboration: DUST investigators

    2015-12-15

    Intravenous recombinant tissue plasminogen activator (IV-rtPA) is given in acute ischemic stroke patients to achieve reperfusion. Hemorrhagic transformation (HT) is a serious complication of IV-rtPA treatment and related to blood-brain barrier (BBB) injury. It is unclear whether HT occurs secondary to reperfusion in combination with ischemic BBB injury or is caused by the negative effect of IV-rtPA on BBB integrity. The aim of this study was to establish the association between reperfusion and the occurrence of HT. From the DUST study, patients were selected with admission and follow-up non-contrast CT (NCCT) and CT perfusion (CTP) imaging, and a perfusion deficit in the middle cerebral artery territory on admission. Reperfusion was categorized qualitatively as reperfusion or no-reperfusion by visual comparison of admission and follow-up CTP. Occurrence of HT was assessed on follow-up NCCT. The association between reperfusion and occurrence of HT on follow-up was estimated by calculating odds ratios (ORs) and 95 % confidence intervals (CIs) with additional stratification for IV-rtPA treatment. Inclusion criteria were met in 299 patients. There was no significant association between reperfusion and HT (OR 1.2 95%CI 0.5-3.1). In patients treated with IV-rtPA (n = 203), the OR was 1.3 (95%CI 0.4-4.0), and in patients not treated with IV-rtPA (n = 96), the OR was 0.8 (95%CI 0.1-4.5). HT occurred in 14 % of the IV-rtPA patients and in 7 % of patients without IV-rtPA (95%CI of difference -1 to 14 %). Our results suggest that the increased risk of HT after acute ischemic stroke treatment is not dependent on the reperfusion status. (orig.)

  10. Incident stroke is associated with common carotid artery diameter and not common carotid artery intima-media thickness.

    Science.gov (United States)

    Polak, Joseph F; Sacco, Ralph L; Post, Wendy S; Vaidya, Dhananjay; Arnan, Martinson Kweku; O'Leary, Daniel H

    2014-05-01

    The common carotid artery interadventitial diameter is measured on ultrasound images as the distance between the media-adventitia interfaces of the near and far walls. It is associated with common carotid intima-media thickness (IMT) and left ventricular mass and might therefore also have an association with incident stroke. We studied 6255 individuals free of coronary heart disease and stroke at baseline with mean age of 62.2 years (47.3% men), members of a multiethnic community-based cohort of whites, blacks, Hispanics, and Chinese. Ischemic stroke events were centrally adjudicated. Common carotid artery interadventitial diameter and IMT were measured. Cases with incident atrial fibrillation (n=385) were excluded. Multivariable Cox proportional hazards models were generated with time to ischemic event as outcome, adjusting for risk factors. There were 115 first-time ischemic strokes at 7.8 years of follow-up. Common carotid artery interadventitial diameter was a significant predictor of ischemic stroke (hazard ratio, 1.86; 95% confidence interval, 1.59-2.17 per millimeter) and remained so after adjustment for risk factors and common carotid IMT with a hazard ratio of 1.52/mm (95% confidence interval, 1.22-1.88). Common carotid IMT was not an independent predictor after adjustment (hazard ratio, 0.14; 95% confidence interval, 0.14-1.19). Although common carotid IMT is not associated with stroke, interadventitial diameter of the common carotid artery is independently associated with first-time incident ischemic stroke even after adjusting for IMT. Our hypothesis that this is in part attributable to the effects of exposure to blood pressure needs confirmation by other studies. http://www.clinicaltrials.gov. Unique identifier: NCT00063440.

  11. Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation.

    Science.gov (United States)

    Frongillo, F; Lirosi, M C; Nure, E; Inchingolo, R; Bianco, G; Silvestrini, N; Avolio, A W; De Gaetano, A M; Cina, A; Di Stasi, C; Sganga, G; Agnes, S

    2015-09-01

    We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation. Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery. We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications. The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. A Case of Double Right Coronary Artery with Separate Ostium

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    Jalal Kheirkhah

    2015-10-01

    Full Text Available Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, and biphasic T wave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs.

  13. Reconsideration of Secondary Risk Management Strategies in Patients with Ischemic Heart Disease.

    Science.gov (United States)

    Kashiyama, Kuninobu; Sonoda, Shinjo; Otsuji, Yutaka

    2017-01-01

    The main risk factors in ischemic heart diseases, including myocardial infarction, are hypertension, dyslipidemia, diabetes, obesity and smoking. The incidence of ischemic heart disease in Japan has been lower than that in Western countries because of differences in lifestyle and the anatomy of the coronary arteries, but the situation has been changing recently because of the westernization of lifestyle. Cardiovascular diseases have become the second most common cause of death in Japan, and 40% of those deaths are attributed to ischemic heart disease. Patients with a history of myocardial infarction, especially, have an increased risk of re-infarction, so strict management of coronary risk factors is important for the prevention of secondary ischemic heart disease. Although there are many guidelines about how to manage the risk factors, there are still many problems. Although lipid management has been demonstrated to have a protective effect against coronary artery disease and arteriosclerotic guidelines have been developed, it is reported that only about one third of patients achieved the low-density lipoprotein (LDL) target value under secondary prevention. Moreover, it is unclear whether the lower target value is required for high-risk patients. Recent research on diabetes has reported increased mortality in patients with intensive glycemic control. We should discuss when to start treatment, which medicine to use, and to what extent we should manage glycemic control. Strict management based on current therapeutic guidelines is effective for secondary prevention of ischemic heart disease, with target values of less than 135/85 mmHg for home blood pressure, less than 100 mg/dl for LDL-C, more than 40 mg/dl for HDL-C, less than 150 mg/dl for TG, and, for diabetic patients, less than 7.0% for HbA1c (NGSP).

  14. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... but also to the worsening of the disease. Obstructive peripheral arterial disease most commonly develops in the arteries of the legs, including the two branches of the aorta (iliac arteries), main arteries of the thighs (femoral arteries), of ... arterial disease may also develop in the part ...

  15. Swallowing disorders after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Gabriela Camargo Remesso

    2011-10-01

    Full Text Available OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7 (p<0.001. Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p<0.001 and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p<0.001. CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

  16. Protective effect of ischemic preconditioning on ischemia/reperfusion-induced acute kidney injury through sympathetic nervous system in rats.

    Science.gov (United States)

    Tsutsui, Hidenobu; Tanaka, Ryosuke; Yamagata, Masayo; Yukimura, Tokihito; Ohkita, Mamoru; Matsumura, Yasuo

    2013-10-15

    We have found that a series of brief renal ischemia and reperfusion (preconditioning), before the time of ischemia significantly attenuated the ischemia/reperfusion-induced acute kidney injury through endothelial nitric oxide synthase. In this study, we examined the effects of ischemic preconditioning on renal sympathetic nervous system and kidney function in ischemia/reperfusion-induced acute kidney injury with or without nitric oxide synthase inhibitor. Ischemia/reperfusion-induced acute kidney injury was made by clamping the left renal artery and vein for 45-min followed by reperfusion, 2 weeks after the contralateral nephrectomy. Ischemic preconditioning, consisting of three cycles of 2-min ischemia followed by 5-min reperfusion, was performed before the 45-min ischemia. Ischemic preconditioning suppressed the enhanced renal sympathetic nerve activity during ischemia and the elevated renal venous plasma norepinephrine level after reperfusion, and attenuated renal dysfunction and histological damage. The renoprotective effect of ischemic preconditioning was diminished by N(G)-nitro-L-arginine methyl ester (0.3 mg/kg, i.v.), a nonselective nitric oxide synthase inhibitor, 5 min before the start of ischemic preconditioning. Thus, ischemic preconditioning decreased renal sympathetic nerve activity and norepinephrine release probably through activating nitric oxide production, thereby improving ischemia/reperfusion-induced acute kidney injury. © 2013 Elsevier B.V. All rights reserved.

  17. Ischemic postconditioning decreases matrix metalloproteinase-2 expression during ischemia-reperfusion of myocardium in a rabbit model: A preliminary report.

    Science.gov (United States)

    Liu, Zhong-Zhi; Kong, Jing-Bo; Li, Feng-Zhi; Ma, Long-Le; Liu, Shu-Qin; Wang, Le-Xin

    2013-01-01

    To investigate the effect of ischemic postconditioning on the expression of matrix metalloproteinase (MMP)-2 during ischemia-reperfusion of myocardium in a rabbit model. Thirty-six male New Zealand white rabbits were randomly divided into sham, ischemia-reperfusion and ischemic postconditioning groups. Myocardial ischemia-reperfusion was created by ligating the left anterior descending coronary artery for 30 min followed by 3 h of reperfusion. Myocardial infarction sizes were determined by dual staining with triphenyltetrazolium chloride and trypan blue. Plasma levels of MMP-2 were measured using ELISA. Myocardial MMP-2 messenger RNA was analyzed by reverse transcription polymerase chain reaction. The mean (± SD) infarct size in the ischemic postconditioning group was significantly smaller compared with the ischemia-reperfusion group (37.1±3.8% versus 57.5±1.9%; P=0.02). The incidence of ventricular tachycardia in the ischemic postconditioning group was also lower than in the ischemia-reperfusion group (8.5% versus 75%; P=0.003). MMP-2 messenger RNA expression in the ischemic postconditioning group was significantly lower compared with the ischemia-reperfusion group (0.4944±0.0476 versus 0.6989±0.0694; P=0.02). Ischemic postconditioning reduces myocardial ischemia-reperfusion injury, possibly by inhibiting the expression of MMP-2.

  18. Hh signaling in regeneration of the ischemic heart.

    Science.gov (United States)

    Dunaeva, Marina; Waltenberger, Johannes

    2017-05-18

    Myocardial infarction (MI) is caused by the occlusion of a coronary artery due to underlying atherosclerosis complicated by localized thrombosis. The blockage of blood flow leads to cardiomyocyte (CM) death in the infarcted area. Adult mammalian cardiomyocytes have little capacity to proliferate in response to injury; however, some pathways active during embryogenesis and silent during adult life are recruited in response to tissue injury. One such example is hedgehog (Hh) signaling. Hh is involved in the embryonic development of the heart and coronary vascular system. Pathological conditions including ischemia activate Hh signaling in adult tissues. This review highlights the involvement of Hh signaling in ischemic tissue regeneration with a particular emphasis on heart regeneration and discusses its potential role as a therapeutic agent.

  19. Radiation-associated ischemic coloproctitis. Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Tomori, Hirofumi; Yasuda, Takashi; Shiraishi, Masayuki; Isa, Tsutomu; Muto, Yoshihiro; Egawa, Haruhiko [Ryukyus Univ., Nishihara, Okinawa (Japan). Faculty of Medicine

    1999-10-01

    Radiation-associated ischemic coloproctitis is a rare clinical entity caused by vascular insufficiency to the rectosigmoid colon. It most commonly occurs after radiotherapy for gynecological cancer. We present herein the cases of two patients who developed radiation-associated coloproctitis with transmural necrosis and eventual perforation. Perforation of the rectosigmoid colon occurred 3.5 years after radiotherapy in case 1, a 46-year-old woman, and presented as a well-defined small area of transmural necrosis. Conversely, in case 2, a 55-year-old woman, it occurred 1.5 years after radiotherapy, and presented as segmental, diffuse transmural necrosis. The lesion in case 1 had been caused by intramural vascular obliteration due to marked fibrosis of the bowel wall, while that in case 2 had been caused by occlusion of the mesenteric artery with thrombosis. Both patients underwent Hartmann's resection without rectal excision, and survived the perforative event. (author)

  20. Remnant cholesterol as a cause of ischemic heart disease

    DEFF Research Database (Denmark)

    Varbo, Anette; Benn, Marianne; Nordestgaard, Børge G

    2014-01-01

    This review focuses on remnant cholesterol as a causal risk factor for ischemic heart disease (IHD), on its definition, measurement, atherogenicity, and levels in high risk patient groups; in addition, present and future pharmacological approaches to lowering remnant cholesterol levels...... are considered. Observational studies show association between elevated levels of remnant cholesterol and increased risk of cardiovascular disease, even when remnant cholesterol levels are defined, measured, or calculated in different ways. In-vitro and animal studies also support the contention that elevated...... levels of remnant cholesterol may cause atherosclerosis same way as elevated levels of low-density lipoprotein (LDL) cholesterol, by cholesterol accumulation in the arterial wall. Genetic studies of variants associated with elevated remnant cholesterol levels show that an increment of 1mmol/L (39mg...

  1. Specific features of reperfusion therapy for vertebrobasilar ischemic stroke

    Directory of Open Access Journals (Sweden)

    K. V. Anisimov

    2015-01-01

    Full Text Available Ischemic stroke in the vertebrobasilar system (VBS is characterized by the high rates of death and disability; reperfusion therapy in patients with a lesion focus in the VBS is safe and effective beyond the 4.5-hour therapeutic window. Actively developed current methods for the endovascular treatment of acute ischemic stroke enable one to increase recanalization rates and hence to improve the degree of functional recovery in this group of patients. Considering that there are no significant differences in the outcomes of systemic and selective thrombolytic therapy in patients with occlusion of the basilar arteries, the urgent problem is to increase the time from the onset of the disease to reperfusion therapy, therefore combined reperfusion therapy may be an optimal option. This approach would make it possible to initiate the therapy in a shorter period of time and to use the advantages of both reperfusion techniques. Intravenous thrombolysis as the rapidest and technically simplest method may be performed in the first step of therapy in the clinics unequipped with an X-ray surgical service, with the patient being further transported to a specialized endovascular center if the intravenous injection of a thrombolytic agent has no effect. Taking into account the fact that reperfusion therapy may be performed in patients with vertebrobasilar stroke in the wider therapeutic window, a similar organizational chart with multistep therapy for this disease might become the treatment of choice.

  2. Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Paul M. Foreman

    2017-04-01

    Full Text Available Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI. The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

  3. Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism.

    Science.gov (United States)

    Chung, Jong-Won; Bang, Oh Young; Ahn, Kangmo; Park, Sang-Soon; Park, Tai Hwan; Kim, Jae Guk; Ko, Youngchai; Lee, SooJoo; Lee, Kyung Bok; Lee, Jun; Kang, Kyusik; Park, Jong-Moo; Cho, Yong-Jin; Hong, Keun-Sik; Nah, Hyun-Wook; Kim, Dae-Hyun; Cha, Jae-Kwan; Ryu, Wi-Sun; Kim, Dong-Eog; Kim, Joon-Tae; Choi, Jay Chol; Oh, Mi-Sun; Yu, Kyung-Ho; Lee, Byung-Chul; Lee, Ji Sung; Lee, Juneyoung; Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon

    2017-01-01

    The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Particulate matter air pollution. Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke. © 2016 American Heart Association, Inc.

  4. Allicin improves carotid artery intima-media thickness in coronary artery disease patients with hyperhomocysteinemia.

    Science.gov (United States)

    Liu, De-Shan; Wang, Shu-Li; Li, Jun-Mei; Liang, Er-Shun; Yan, Ming-Zhong; Gao, Wei

    2017-08-01

    Homocysteine (Hcy) is an important and independent risk factor for atherosclerotic diseases, such as coronary artery disease and ischemic cerebrovascular disease. Increased carotid artery intima-media thickness (IMT) is a non-invasive marker of systemic atherosclerosis. Allicin treatment may decrease serum Hcy levels and improve impaired endothelial function in rats with hyperhomocysteinemia (HHcy). The present study hypothesized that allicin has an anti-atherosclerotic effect in coronary heart disease and tested the effects of allicin treatment on carotid artery IMT and plasma Hcy levels in coronary heart disease patients with HHcy. Sixty-two coronary heart disease patients with HHcy were randomly divided into an allicin group and a control group. All patients underwent diagnostic assessment, plasma Hcy assay, blood lipid measurement and B-mode ultrasound of the carotid artery prior to and after treatment. Plasma Hcy levels were determined by high-performance liquid chromatography and fluorescence detection. Carotid artery IMT was calculated using an automated algorithm based on a validated edge-detection technique. After 12 weeks, significant decreases in carotid artery IMT, plasma Hcy levels, total cholesterol and triglycerides were observed in the allicin group (all Pallicin group were significantly greater than those in the control group (all PAllicin was able to decrease Hcy levels, total cholesterol and triglycerides as well as carotid artery IMT.

  5. Clinical Features of Ocular Ischemic Syndrome and Risk Factors for Neovascular Glaucoma.

    Science.gov (United States)

    Kim, Yung Hui; Sung, Mi Sun; Park, Sang Woo

    2017-08-01

    We aimed to examine the clinical features and prognosis of ocular ischemic syndrome and to investigate the risk factors for the development of neovascular glaucoma (NVG). The medical records from 25 patients (25 eyes) who were diagnosed with ocular ischemic syndrome were retrospectively analyzed. We recorded the length of time between symptom onset and diagnosis, visual acuity, intraocular pressure, clinical findings of the anterior and posterior segments of the eye, fluorescein angiography, systemic diseases, smoking history, and the extent of any ipsilateral carotid artery stenosis. The risk factors for NVG in patients with ocular ischemic syndrome were investigated. The mean age was 67.9 ± 12.5 years, and 21 men and 4 women were included in this study. At initial examination, the mean logarithm of the minimum angle of resolution (logMAR) was 2.02 ± 1.26, and the mean intraocular pressure was 21.0 ± 10.3 mmHg. Among 25 eyes of the 25 patients, NVG occurred in 17 eyes after a mean period of 12.6 ± 14.0 months. The length of time between symptom onset and diagnosis (p = 0.025) and the extent of ipsilateral carotid artery stenosis (p = 0.032) were identified as significant risk factors for NVG. At the final follow-up, the mean logMAR visual acuity was 3.13 ± 1.24, showing a poor prognosis regardless of whether NVG occurred. Overall, the prognosis for ocular ischemic syndrome is very poor. The risk of NVG increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis.

  6. Ischemic cardiomyopathy: lack of clinical applicability of the WHO/ISFC classification of cardiomyopathies.

    Science.gov (United States)

    Boffa, G M; Tarantini, G; Abbasciano, A; Razzolini, R; Chioin, R; Thiene, G

    2001-10-01

    The classification of cardiomyopathies proposed by the WHO/ISFC Task Force defines ischemic cardiomyopathy as "a dilated cardiomyopathy with impaired contractile performance not explained by the extent of coronary disease or ischemic damage". The aim of this study was to verify the clinical applicability of the WHO/ISFC definition of ischemic cardiomyopathy. Retrospective analysis of the clinical characteristics of patients with a left ventricular ejection fraction 50% of a distal portion of a main coronary artery or of a secondary branch. The patients with a clinical diagnosis of previous myocardial infarction were excluded. Fourteen patients with the angiographic characteristics listed above were identified. Twelve patients were males, mean age 59 years. They represented 3.8% of all the patients with left systolic ventricular dysfunction who underwent coronary angiography in the same period. The left ventricular end-diastolic volume was 170 +/- 45 ml/m2 and the ejection fraction was 27 +/- 6%. The cause of systolic left ventricular dysfunction was systemic arterial hypertension in 3 patients, diabetes mellitus in 2, a combination of these diseases in 4, chronic alcohol abuse in 1, a previous clinically silent myocardial infarction in 1, and idiopathic dilated cardiomyopathy in 3. In conclusion, in all our patients with severe left ventricular dysfunction which was not explained by the extent of coronary artery disease, at least one possible cause of impaired contractile performance could be identified. Thus the definition of ischemic cardiomyopathy according to the new WHO/ISFC classification of cardiomyopathies appears to be of scarce utility on clinical grounds and should be redefined and if necessary reclassified.

  7. miR-455 inhibits neuronal cell death by targeting TRAF3 in cerebral ischemic stroke

    Directory of Open Access Journals (Sweden)

    Yao ST

    2016-12-01

    Full Text Available Shengtao Yao,* Bo Tang,* Gang Li, Ruiming Fan, Fang Cao Department of Cerebrovascular Disease, The First Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China *These authors contributed equally to this work Abstract: Ischemic stroke is one of the leading causes of brain disease, with high morbidity, disability, and mortality. MicroRNAs (miRNAs have been identified as vital gene regulators in various types of human diseases. Accumulating evidence has suggested that aberrant expression of miRNAs play critical roles in the pathologies of ischemic stroke. Yet, the precise mechanism by which miRNAs control cerebral ischemic stroke remains unclear. In the present study, we explored whether miR-455 suppresses neuronal death by targeting TRAF3 in cerebral ischemic stroke. The expression levels of miR-455 and TRAF3 were detected by quantitative real-time polymerase chain reaction and Western blot. The role of miR-455 in cell death caused by oxygen–glucose deprivation (OGD was assessed using Cell Counting Kit-8 (CCK-8 assay. The influence of miR-455 on infarct volume was evaluated in mouse brain after middle cerebral artery occlusion (MCAO. Bioinformatics softwares and luciferase analysis were used to find and confirm the targets of miR-455. The results showed that the expression levels of miR-455 significantly decreased in primary neuronal cells subjected to OGD and mouse brain subjected to MCAO. In addition, forced expression of miR-455 inhibited neuronal death and weakened ischemic brain infarction in focal ischemia-stroked mice. Furthermore, TRAF3 was proved to be a direct target of miR-455, and miR-455 could negatively suppress TRAF3 expression. Biological function analysis showed that TRAF3 silencing displayed the neuroprotective effect in ischemic stroke and could enhance miR-455-induced positive impact on ischemic injury both in vitro and in vivo. Taken together, miR-455 played a vital role in protecting neuronal

  8. [Cerebral artery thrombosis in pregnancy].

    Science.gov (United States)

    Charco Roca, L M; Ortiz Sanchez, V E; Hernandez Gutierrez-Manchon, O; Quesada Villar, J; Bonmatí García, L; Rubio Postigo, G

    2015-11-01

    A 28 year old woman, ASA I, who, in the final stages of her pregnancy presented with signs of neural deficit that consisted of distortion of the oral commissure, dysphagia, dysarthria, and weakness on the left side of the body. She was diagnosed with thrombosis in a segment of the right middle cerebral artery which led to an ischemic area in the right frontal lobe. Termination of pregnancy and conservative treatment was decided, with good resolution of the symptoms. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Comparison of the protective effects of direct ischemic preconditioning and remote ischemic preconditioning in a rabbit model of transient spinal cord ischemia.

    Science.gov (United States)

    Fukui, Takehiko; Ishida, Kazuyoshi; Mizukami, Yoichi; Shiramoto, Kiyotaka; Harada, Hidenori; Yamashita, Atsuo; Yamashita, Satoshi; Matsumoto, Mishiya

    2017-11-01

    This study aimed to determine the relative potency of direct ischemic preconditioning (DIPC) and remote ischemic preconditioning (RIPC) for protection against ischemic spinal cord injury in rabbits and to explore the mechanisms involved. In experiment 1, we compared the neurological and histopathological outcomes of DIPC, kidney RIPC, and limb RIPC. The DIPC and kidney RIPC groups received two cycles of 5-min occlusion/15-min reperfusion of the abdominal aorta and left renal artery, respectively. The limb RIPC group received two cycles of 10-min occlusion/10-min reperfusion of the femoral arteries bilaterally. Thirty minutes after the conditioning ischemia, spinal cord ischemia was produced by occluding the abdominal aorta for 15 min. In experiments 2 and 3, we investigated whether pretreatment using a free-radical scavenger, dimethylthiourea (DMTU), an adenosine A1 receptor antagonist, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), or a mitochondrial ATP-sensitive potassium channel antagonist, 5-hydroxydecanoate (5HD), could attenuate the protective effects of DIPC. In experiment 4, comprehensive analysis of phosphorylated proteins in the spinal cord was performed using a Proteome Profiler Array followed by immunoblotting to elucidate the signal pathway activated by DIPC. In experiment 1, DIPC improved the neurological and histopathological outcomes, whereas kidney and limb RIPC had no protective effects. In experiments 2 and 3, strong protective effects of DIPC were reconfirmed but were not attenuated by DMTU, DPCPX, or 5HD. In experiment 4, DIPC induced phosphorylation of Akt2. DIPC, but not kidney or limb RIPC, protected against ischemic spinal cord injury in rabbits. Akt2 might contribute to this protective effect.

  10. Carotid Artery Stenting Successfully Prevents Progressive Stroke Due to Mobile Plaque

    Directory of Open Access Journals (Sweden)

    Masahiro Oomura

    2015-05-01

    Full Text Available We report a case of progressive ischemic stroke due to a mobile plaque, in which carotid artery stenting successfully prevented further infarctions. A 78-year-old man developed acute multiple infarcts in the right hemisphere, and a duplex ultrasound showed a mobile plaque involving the bifurcation of the left common carotid artery. Maximal medical therapy failed to prevent further infarcts, and the number of infarcts increased with his neurological deterioration. Our present case suggests that the deployment of a closed-cell stent is effective to prevent the progression of the ischemic stroke due to the mobile plaque.

  11. Exercise promotes axon regeneration of newborn striatonigral and corticonigral projection neurons in rats after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Qiu-Wan Zhang

    Full Text Available Newborn striatal neurons induced by middle cerebral artery occlusion (MCAO can form functional projections targeting into the substantia nigra, which should be very important for the recovery of motor function. Exercise training post-stroke improves motor recovery in clinic patients and increases striatal neurogenesis in experimental animals. This study aimed to investigate the effects of exercise on axon regeneration of newborn projection neurons in adult rat brains following ischemic stroke. Rats were subjected to a transient MCAO to induce focal cerebral ischemic injury, followed by 30 minutes of exercise training daily from 5 to 28 days after MCAO. Motor function was tested using the rotarod test. We used fluorogold (FG nigral injection to trace striatonigral and corticonigral projection neurons, and green fluorescent protein (GFP-targeting retroviral vectors combined with FG double labeling (GFP(+ -FG(+ to detect newborn projection neurons. The results showed that exercise improved the recovery of motor function of rats after MCAO. Meanwhile, exercise also increased the levels of BDNF and VEGF, and reduced Nogo-A in ischemic brain. On this condition, we further found that exercise significantly increased the number of GFP(+ -FG(+ neurons in the striatum and frontal and parietal cortex ipsilateral to MCAO, suggesting an increase of newborn striatonigral and corticonigral projection neurons by exercise post-stroke. In addition, we found that exercise also increased NeuN(+ and FG(+ cells in the striatum and frontal and parietal cortex, the ischemic territory, and tyrosine hydroxylase (TH immunopositive staining cells in the substantia nigra, a region remote from the ischemic territory. Our results provide the first evidence that exercise can effectively enhance the capacity for regeneration of newborn projection neurons in ischemic injured mammalian brains while improving motor function. Our results provide a very important cellular mechanism

  12. Combination of early and delayed ischemic postconditioning enhances brain-derived neurotrophic factor production by upregulating the ERK-CREB pathway in rats with focal ischemia.

    Science.gov (United States)

    Wu, Hui; Yang, Shao-Feng; Dai, Jiong; Qiu, Yong-Ming; Miao, Yi-Feng; Zhang, Xiao-Hua

    2015-11-01

    Ischemic postconditioning, including early and delayed ischemic postconditioning, has been recognized as a simple and promising strategy in the treatment of stroke. However, the effects of the combination of early and delayed ischemic postconditioning, and the mechanisms underlying these effects, remain unclear. The aim of the present study was to determine whether the combination of early and delayed ischemic postconditioning offers greater protection against stroke, and enhances the production of brain‑derived neurotrophic factor (BDNF). A combination of early and delayed ischemic postconditioning was established by repeated, transient occlusion and reperfusion of the ipsilateral common carotid artery in a rat model of middle cerebral artery occlusion. Infarct size, motor function, cerebral blood flow and brain edema were then evaluated, in order to confirm the effects of combinative ischemic postconditioning. TUNEL staining was used to analyze the rate of apoptosis of cells in the penumbral area. BDNF, extracellular signal‑regulated kinases 1/2 (ERK1/2) and cAMP response element‑binding protein (CREB) expression was detected using immunofluorescence staining and western blot analysis. The results of the present study indicated that the combination of early and delayed ischemic postconditioning further reduced the infarct volume, stabilized cerebral blood disturbance and attenuated neuronal apoptosis, compared with either alone. However, combinative postconditioning exerted the same effect on neurological function and brain edema, compared with early or delayed ischemic postconditioning alone. Further investigation indicated that combinative ischemic postconditioning increased the expression of BDNF, and a significantly higher number of BDNF‑positive cells was observed in neurons and astrocytes from the combined group than in the early or delayed groups. Combinative ischemic postconditioning also induced the phosphorylation of ERK1/2 and CREB in the

  13. Mechanical thrombectomy with snare in patients with acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Alejandro; Mayol, Antonio [Hospital Universitario Virgen del Rocio, Interventional Neuroradiology, Department of Radiology, Seville (Spain); Martinez, Eva; Gonzalez-Marcos, Jose R.; Gil-Peralta, Alberto [Hospital Universitario Virgen del Rocio, Department of Neurology, Seville (Spain)

    2007-04-15

    We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died). According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS. (orig.)

  14. Peculiarities of Ischemic Heart Disease Course and Treatment in Patients with Glucose Metabolism Impairment and Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    O.M. Radchenko

    2015-09-01

    Full Text Available Combination of ischemic heart disease and diabetes mellitus is characterized by certain features of clinical picture and insufficient effectiveness of treatment of ischemic heart disease. With the aim of investigation of pathogenic mechanisms and features of the clinical course of ischemic heart disease associated with glucose homeostasis violation we examined 116 patients (51 women, 65 men, median of age 63 years old with normal regulation of glucose metabolism (NRG, n = 24, changes in fasting glucose (n = 23, violated glucose tolerance (n = 21, combined violation (n = 24 and diabetes mellitus (n = 24. We also conducted their prospective observation for 40 months with the following endpoints — hospitalization because of cardiovascular complications, death from them and the emergence of diabetes. It was established that ischemic heart disease associated with prediabetic disorders and diabetes mellitus has the following peculiarities: earlier clinical manifestation in women; more frequent and severe heart failure; lower tolerance to physical load in patients with angina pectoris; atypical manifestation of ischemic pain: longer attacks, atypical localization or absent pain; frequent combination with arrhythmias and conduction disorders; frequent affection of multiple coronary arteries, which leads to myocardial infarction with complicated course; eccentric type of left ventricle remodeling; significant calcification of mitral and aortic valves of heart. The main principles of treatment of ischemic heart disease: weight loss; active correction of glucose metabolism violations using medications (metformin even at the stage of prediabetes, because in chronic stable forms of ischemic heart disease metformin significantly improves glucose metabolism, decreases insulin resistance and does not increase the incidence of cardiovascular complications and decompensations of heart failure; the basic drugs for treatment of ischemic heart disease should be

  15. The iron-regulatory peptide hepcidin is upregulated in the ischemic and in the remote myocardium after myocardial infarction.

    Science.gov (United States)

    Simonis, Gregor; Mueller, Katrin; Schwarz, Peggy; Wiedemann, Stephan; Adler, Guido; Strasser, Ruth H; Kulaksiz, Hasan

    2010-09-01

    Recent evidence suggests that iron metabolism contributes to the ischemic damage after myocardial infarction. Hepcidin, a recently discovered peptide hormone, regulates iron uptake and metabolism, protecting the body from iron overload. In this study we analyzed the regulation of hepcidin in the heart and blood of rats after myocardial infarction. To induce a myocardial infarction in the rats, left anterior descending coronary artery ligation was performed. After 1-24h, biopsies from the ischemic and the non-ischemic myocardium were taken. In these biopsies, the mRNA levels and the protein expression of hepcidin were analyzed by quantitative RT-PCR and immunoblot analysis, respectively. In parallel, the serum levels of prohepcidin were measured by ELISA. Six hours after myocardial infarction, the hepcidin mRNA expression was temporally upregulated in the ischemic and in the non-ischemic myocardium. The upregulation was specific for hepcidin, since other iron-related genes (hemojuvelin, IREG-1) remained unchanged. Furthermore, the alteration of the hepcidin protein expression in the ischemic area was connected to the level of hepcidin in the serum of the infarcted rats, where hepcidin also raised up. Angiotensin receptor blockade with candesartan did not influence the mRNA regulation of hepcidin. Together, these data show a particular upregulation of the iron-regulatory peptide hepcidin in the ischemic and the non-ischemic myocardium after myocardial infarction. It is speculated that upregulation of hepcidin may reduce iron toxicity and thus infarct size expansion in an infarcted heart. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Roles of the Microsurgeon and Anesthesiologist in the Treatment of Neonatal Upper Extremity Arterial Thrombosis: A Case Report.

    Science.gov (United States)

    Keane, Alexandra M; Santosa, Katherine B; Shahrawat, Sonia M; Snyder-Warwick, Alison K

    2017-10-17

    We present a rare case of a newborn with spontaneous, noniatrogenic arterial thromboembolism in the right brachial artery and accompanying ischemic changes to the right upper extremity, who was successfully treated with microsurgical intervention and ultrasound-guided infraclavicular brachial plexus block with a continuous infusion of ropivacaine for 48 hours. This case report highlights the emerging role of both the microsurgeon and anesthesiologist in management of spontaneous neonatal arterial thromboembolism.

  17. Childhood obesity

    DEFF Research Database (Denmark)

    Heitmann, Berit L; Koplan, Jeffrey; Lissner, Lauren

    2009-01-01

    Despite progress toward assuring the health of today's young population, the 21(st) century began with an epidemic of childhood obesity. There is general agreement that the situation must be addressed by means of primary prevention, but relatively little is known about how to intervene effectively....... The evidence behind the assumption that childhood obesity can be prevented was discussed critically in this roundtable symposium. Overall, there was general agreement that action is needed and that the worldwide epidemic itself is sufficient evidence for action. As the poet, writer, and scholar Wittner Bynner...

  18. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

    Science.gov (United States)

    Easton, J Donald; Aunes, Maria; Albers, Gregory W; Amarenco, Pierre; Bokelund-Singh, Sara; Denison, Hans; Evans, Scott R; Held, Peter; Jahreskog, Marianne; Jonasson, Jenny; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

    2017-09-05

    Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2

  19. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Ralph R E G Geuskens

    Full Text Available CT perfusion (CTP is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up.This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0. Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT regions. False discovery ratio (FDR, defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests.Median total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml; median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml. Median FDR between patients was 62% (IQR:49%-80%. Median relative mean transit time was 243% (IQR:198%-289% and 342% (IQR:249%-432% for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43-1.79 ml/100g (P<0.01 and 1.38 (IQR:1.15-1.49 ml/100g (P<0.01 for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly.For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly

  20. Repeated Intra-Arterial Thrombectomy within 72 Hours in a Patient with a Clear Contraindication for Intravenous Thrombolysis

    Directory of Open Access Journals (Sweden)

    Mona Laible

    2015-01-01

    Full Text Available Introduction. Treating patients with acute ischemic stroke, proximal arterial vessel occlusion, and absolute contraindication for administering intravenous recombinant tissue plasminogen activator (rtPA poses a therapeutic challenge. Intra-arterial thrombectomy constitutes an alternative treatment option. Materials and Methods. We report a case of a 57-year-old patient with concomitant gastric adenocarcinoma, who received three intra-arterial thrombectomies in 72 hours due to repeated occlusion of the left medial cerebral artery (MCA. Findings. Intra-arterial recanalization of the left medial cerebral artery was performed three times with initially good success. However, two days later, the right medial cerebral artery became occluded. Owing to the overall poor prognosis at that time and knowing the wishes of the patient, we decided not to perform another intra-arterial recanalization procedure. Conclusion. To our knowledge, this is the first case illustrating the use of repeated intra-arterial recanalization in early reocclusion of intracranial vessels.

  1. Intraoperative Evaluation of Reverse Bypass Using a Naturally Formed "Bonnet" Superficial Temporal Artery: Technical Note.

    Science.gov (United States)

    Nagm, Alhusain; Horiuchi, Tetsuyoshi; Hasegawa, Takatoshi; Hongo, Kazuhiro

    2016-04-01

    In reverse bypass that used a naturally formed "bonnet" superficial temporal artery, intraoperative volume flow measurement quantifies flow augmentation after revascularization, confirms flow preservation, and identifies inadvertent vessel compromise. A 75-year-old man presented with transient ischemic attacks attributed to right internal carotid artery stenosis. He underwent successful reverse bypass via a naturally formed "bonnet" superficial temporal artery middle cerebral artery bypass. As the result of proper intraoperative volume flow evaluation, a successful reverse bypass was achieved. Modification of the intraoperative stroke risk and prediction of the long-term patency after reverse bypass can be achieved by meticulous intraoperative blood flow evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [Ischemic stroke related to spontaneous].

    Science.gov (United States)

    Benamer, H; Bouzid, M A; Dufay, A; Akodad, M; Russel, S; Halna du Fretay, X; Haziza, F

    2017-12-01

    Cardiovascular disease in women is a particularly complex pathology especially in the youngest population. The clinical presentation of acute coronary syndromes is sometimes misleading and does not necessarily point to the potential presence of cardiac disease given the frequent absence of cardiovascular risks. Such complexity results in delayed diagnosis, which worsens the outcome of myocardial infarction and generates complications related to the absence of coronary revascularization. We report the case of a patient who suffered an (undiagnosed) apical myocardial infarction that went undetected and was complicated by a voluminous intraventricular thrombus with embolus migration in the cerebral circulation resulting in an ischemic accident. The combination of these two pathologies make their therapeutic management particularly difficult. As widely reported in the literature, the outcome of myocardial infarction in women is poorer than in their male counterparts for a number of reasons. We can assume that in the youngest patients, another physiopathological mechanism is often involved, namely, the occurrence of hematoma and spontaneous coronary dissection. Diagnosis is often difficult even with coronary angiography diagnosis. As shown in the case reported here, initial examination results, if not thoroughly analyzed, may be erroneously interpreted as normal. It is also likely that the presence of hematoma or coronary wall dissection without any plaque rupture may negatively influence the outcome owing to the implementation of inappropriate treatments. In conclusion, in patients presenting with an ischemic cerebral accident, meticulous cardiac examination must be performed even in young women with no cardiovascular risk factors given that the occurrence of hematoma or coronary dissection may contribute to the formation of mural thrombi in the setting of myocardial infarction. Cardiac MRI seems to be particularly effective in the diagnosis of myocardial infarction

  3. Acute hemiplegia in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Takehiko; Takao, Tatsuo; Itoh, Masatoshi; Konishi, Yukuo; Nakano, Shozo (Kyoto Univ. (Japan). Faculty of Medicine)

    1983-04-01

    The results of CT in 100 patients with acute hemiplegia in childhood are reported here. The etiology was various: 2 patients had infratentorial brain tumors, 56 had cerebral vascular diseases, 3 had head injuries, 16 had intracranial infectious diseases, one had postinfectious encephalomyelitis, one had multiple sclerosis, 2 had epilepsy, and the diagnosis of 19 were unknown. Eleven patients had a normal CT and a good prognosis. As for the type of onset, there were patients of type 1 with fever and 42 with convulsions and unconsciousness; those of type 2 with convulsions and unconsciousness were 12, and those of type 3 without fever and convulsions were 46. This classification is assumed to be useful, as the type of onset is characteristic of the etiology. Six patients were diagnosed correctly by repeated examinations, although the first CT did not reveal any remarkable findings. Capsular infarction, occlusion of the posterior cerebral artery in acute hemiplegia in childhood, abnormal findings of the internal capsule, thalamus, and midbrain in a patient with postinfectious encephalomyelitis, and a diffuse low density in the CT of the unilateral hemisphere in the patients with acute encephalopathy and acute hemiplegia of an obscure origin have been found after the introduction of computerized tomography.

  4. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Layton, Kennith F.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); White, J. Bradley [Mayo Clinic, Department of Neurosurgery, Rochester, MN, (United States); Manno, Edward M. [Mayo Clinic, Department of Neurology, Rochester, MN, (United States)

    2006-06-15

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  5. Effect of rosuvastatin on inflammatory factors and carotid atherosclerotic plaque in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    YAN Jun

    2013-10-01

    Full Text Available Carotid atherosclerosis is closely related with ischemic stroke occurrence, development and recurrence. This study aims to make an evaluation of the effects of rosuvastatin on inflammatory factors, serum lipid and carotid atherosclerotic plaque in patients with acute ischemic stroke. In this study, 98 patients with acute ischemic stroke and carotid atherosclerosis were given oral administration of rosuvastatin calcium (10 mg once every night, and the course of treatment was 6 months. After treatment, the changes of serum high-sensitivity C-reactive protein (hs-CRP, tumor necrosis factor-alpha (TNF-α and blood lipid were measured, as well as carotid atherosclerotic intima-media thickness (IMT and the calculation of carotid atherosclerotic plaque score. According to the examination results, after 6 months' treatment with rosuvastatin, serum hs-CRP, TNF-α, total cholesterol (TC, triglyceride (TG and low-density lipoprotein cholestrol (LDL-C decreased significantly (P < 0.01, for all, while high-density lipoprotein cholestrol (HDL-C increased significantly (P < 0.01; the total number of plaque reduced, while the number of stable plaque increased (P < 0.05; carotid artery IMT and carotid artery plaque score decreased significantly (P < 0.05. There were significant differences between before and after treatment. The results of this study show that rosuvastatin plays a role in anti-inflammation and alleviates the degree of carotid atherosclerotic plaque.

  6. Childhood obesity.

    Science.gov (United States)

    Strauss, R

    1999-01-01

    Approximately 10% of children are obese. Twin and adoption studies demonstrate a large genetic component to obesity, especially in adults. However, the increasing prevalence of obesity over the last 20 years can only be explained by environmental factors. In most obese individuals, no measurable differences in metabolism can be detected. Few children engage in regular physical activity. Obese children and adults uniformly underreport the amount of food they eat. Obesity is particularly related to increased consumption of high-fat foods. BMI is a quick and easy way to screen for childhood obesity. Treating childhood obesity relies on positive family support and lifestyle changes involving the whole family. Food preferences are influenced early by parental eating habits, and when developed in childhood, they tend to remain fairly constant into adulthood. Children learn to be active or inactive from their parents. In addition, physical activity (or more commonly, physical inactivity) habits that are established in childhood tend to persist into adulthood. Weight loss is usually followed by changes in appetite and metabolism, predisposing individuals to regain their weight. However, when the right family dynamics exist--a motivated child with supportive parents--long-term success is possible.

  7. Childhood Obesity

    Science.gov (United States)

    Yuca, Sevil Ari, Ed.

    2012-01-01

    This book aims to provide readers with a general as well as an advanced overview of the key trends in childhood obesity. Obesity is an illness that occurs due to a combination of genetic, environmental, psychosocial, metabolic and hormonal factors. The prevalence of obesity has shown a great rise both in adults and children in the last 30 years.…

  8. Therapeutic angiogenesis in ischemic muscles after local injection of fragmented fibers with loaded traditional Chinese medicine

    Science.gov (United States)

    Li, Huiyan; Wan, Huiying; Xia, Tian; Chen, Maohua; Zhang, Yun; Luo, Xiaoming; Li, Xiaohong

    2015-07-01

    Therapeutic angiogenesis remains the most effective method to re-establish a proper blood flow in ischemic tissues. There is a great clinical need to identify an injectable format to achieve a well accumulation following local administration and a sustained delivery of biological factors at the ischemic sites. In the current study, fragmented nanofibers with loaded traditional Chinese medicines, astragaloside IV (AT), the main active ingredient of astragalus, and ferulic acid (FA), the main ingredient of angelica, were proposed to promote the microvessel formation after intramuscular injection into ischemic hindlimbs. Fragmented fibers with average lengths of 5 (FF-5), 20 (FF-20) and 80 μm (FF-80) were constructed by the cryocutting of aligned electrospun fibers. Their dispersion in sodium alginate solution (0.2%) indicated good injectability. After injection into the quadriceps muscles of the hindlimbs, FF-20 and FF-80 fiber fragments showed higher tissue retentions than FF-5, and around 90% of the injected doses were determined after 7 days. On a hindlimb ischemia model established by ligating the femoral arteries, intramuscular injection of the mixtures of FA-loaded and AT-loaded FF-20 fiber fragments substantially reduced the muscle degeneration with minimal fibrosis formation, significantly enhanced the neovessel formation and hindlimb perfusion in the ischemic tissues, and efficiently promoted the limb salvage with few limb losses. Along with the easy manipulation and lower invasiveness for in vivo administration, fragmented fibers should become potential drug carriers for disease treatment, wound recovery and tissue repair after local injection.

  9. Severe hypertriglyceridemia does not protect from ischemic brain injury in gene-modified hypertriglyceridemic mice.

    Science.gov (United States)

    Chen, Yong; Liu, Ping; Qi, Rong; Wang, Yu-Hui; Liu, George; Wang, Chun

    2016-05-15

    Hypertriglyceridemia (HTG) is a weak risk factor in primary ischemic stroke prevention. However, clinical studies have found a counterintuitive association between a good prognosis after ischemic stroke and HTG. This "HTG paradox" requires confirmation and further explanation. The aim of this study was to experimentally assess this paradox relationship using the gene-modified mice model of extreme HTG. We first used the human Apolipoprotein CIII transgenic (Tg-ApoCIII) mice and non-transgenic (Non-Tg) littermates to examine the effect of HTG on stroke. To our surprise, infarct size, neurological deficits, brain edema, BBB permeability, neuron density and lipid peroxidation were the same in Tg-ApoCIII mice and Non-Tg mice after temporary middle cerebral artery occlusion (tMCAO). In the late phase (21 days after surgery), no differences were found in brain atrophy, neurological dysfunctions, weight and mortality between the two groups. To confirm the results in Tg-ApoCIII mice, Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1(GPIHBP1) knockout mice, another severe HTG mouse model, were used and yielded similar results. Our study demonstrates for the first time that extreme HTG does not affect ischemic brain injuries in the tMCAO mouse model, indicating that the association between HTG and good outcomes after ischemic stroke probably represents residual unmeasured confounding. Further clinical and prospective population-based studies are needed to explore variables that contribute to the paradox. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Is beta-thalassemia trait a protective factor against ischemic cerebrovascular accidents?

    Science.gov (United States)

    Karimi, Mehran; Borhani Haghighi, Afshin; Yazdani, Maryam; Raisi, Hamideh; Giti, Rahil; Namazee, Mohammad Reza

    2008-01-01

    In this research, we sought to determine the association between beta-thalassemia trait and ischemic cerebrovascular accident (CVA). In acase-control study, 148 patients with thromboembolic cerebrovascular events were evaluated for the presence of hypertension, diabetes mellitus, hyperlipidemia, and beta-thalassemia trait. A total of 156 age- and sex-matched patients with no cardiac or cerebrovascular diseases, serving as the control group, were also investigated for the above-mentioned risk factors. We found that 6.1% of patients with ischemic CVA and 12.2% of the control group had beta-thalassemia trait (P = .066). In male patients, the negative association between ischemic CVA and presence of beta-thalassemia trait was significant (P = .008). In patients, the prevalence of hypertension was also significantly different between those with and without beta-thalassemia trait (P = .01); those with beta-thalassemia trait had a lower mean blood pressure than those without the trait. beta-Thalassemia trait may have a protective effect against ischemic CVA that might be caused by the lower arterial blood pressure observed in those with this trait.

  11. Cardioembolism and Involvement of the Insular Cortex in Patients with Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Jihoon Kang

    Full Text Available To evaluate whether topographical characteristics of insular involvement in ischemic stroke are associated with cardioembolism.A consecutive series of patients hospitalized for ischemic stroke within 7 days of symptom onset were identified. Based on diffusion-weighted imaging, we included those who had ischemic lesions in the middle cerebral artery (MCA territory. Each patient was assigned to one of two groups based on the presence or absence of insular involvement. The primary outcome was the frequency of cardioembolism, which was compared based on insular involvement. Of 1,311 patients with ischemic stroke in the MCA territory, 112 had insular involvement (8.5%. The frequency of cardioembolism in patients with insular involvement (52.7% was significantly higher than that in patients without insular involvement (30.4%, P < 0.001. Although insular involvement was associated with a severe baseline National Institutes of Health Stroke Scale score (13 vs. 4, it did not independently affect the 3-month functional outcome.In cases of stroke in the MCA territory, involvement of the insular cortex may be associated with a risk of cardioembolism.

  12. Long Course Hyperbaric Oxygen Stimulates Neurogenesis and Attenuates Inflammation after Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Ying-Sheng Lee

    2013-01-01

    Full Text Available Several studies have provided evidence with regard to the neuroprotection benefits of hyperbaric oxygen (HBO therapy in cases of stroke, and HBO also promotes bone marrow stem cells (BMSCs proliferation and mobilization. This study investigates the influence of HBO therapy on the migration of BMSCs, neurogenesis, gliosis, and inflammation after stroke. Rats that sustained transient middle cerebral artery occlusion (MCAO were treated with HBO three weeks or two days. The results were examined using a behavior test (modified neurological severity score, mNSS and immunostaining to evaluate the effects of HBO therapy on migration of BMSCs, neurogenesis, and gliosis, and expression of neurotrophic factors was also evaluated. There was a lower mNSS score in the three-week HBO group when compared with the two-day HBO group. Mobilization of BMSCs to an ischemic area was more improved in long course HBO treatments, suggesting the duration of therapy is crucial for promoting the homing of BMSCs to ischemic brain by HBO therapies. HBO also can stimulate expression of trophic factors and improve neurogenesis and gliosis. These effects may help in neuronal repair after ischemic stroke, and increasing the course of HBO therapy might enhance therapeutic effects on ischemic stroke.

  13. Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2017-02-01

    Full Text Available Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technology has revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, …. regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.

  14. Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2017-02-01

    Full Text Available Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technologyhas revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, …. regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.

  15. Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2014-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers. METHODS: A total of 100 patients with acute is...... ischemic stroke. The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01560520....

  16. Posterior Auricular Artery-Middle Cerebral Artery Bypass: A Rare Superficial Temporal Artery Variant with Well-developed Posterior Auricular Artery—Case Report

    Science.gov (United States)

    TOKUGAWA, Joji; NAKAO, Yasuaki; KUDO, Kentaro; IIMURA, Koji; ESAKI, Takanori; YAMAMOTO, Takuji; MORI, Kentaro

    2014-01-01

    The posterior auricular artery (PAA) is one of the branches of the external carotid artery, but is usually too small for use as a donor artery for middle cerebral artery (MCA) territory revascularization. An extremely unusual case of PAA-MCA anastomosis was performed in a patient requiring MCA territory revascularization because the superficial temporal artery (STA) parietal branch was absent and the PAA was large enough. A 65-year-old man developed mild motor weakness in the right extremities caused by multiple small infarctions. Single photon emission computed tomography (CT) revealed deterioration of the vascular reserve capacity in the left MCA area. Cerebral angiography showed severe stenosis in the C2 portion of the left internal carotid artery, absence of the parietal branch of the left STA, and a well-developed PAA extending to the parietal area. The patient underwent STA (frontal branch)-MCA and PAA-MCA double anastomosis, and has suffered no stroke or transient ischemic attack. The STA with no bifurcation is known as a rare variation. The PAA also occurs with size variations but well-developed PAA is thought to be extremely rare. PAA can be used as a donor artery for MCA territory revascularization if the vessel size is suitable. Preoperative evaluation of the anatomy is mandatory for harvesting the arteries. PMID:24140773

  17. Burn-induced subepicardial injury in frog heart: a simple model mimicking ST segment changes in ischemic heart disease.

    Science.gov (United States)

    Kazama, Itsuro

    2016-02-01

    To mimic ischemic heart disease in humans, several animal models have been created, mainly in rodents by surgically ligating their coronary arteries. In the present study, by simply inducing burn injuries on the bullfrog heart, we reproduced abnormal ST segment changes in the electrocardiogram (ECG), mimicking those observed in ischemic heart disease, such as acute myocardial infarction and angina pectoris. The "currents of injury" created by a voltage gradient between the intact and damaged areas of the myocardium, negatively deflected the ECG vector during the diastolic phase, making the ST segment appear elevated during the systolic phase. This frog model of heart injury would be suitable to explain the mechanisms of ST segment changes observed in ischemic heart disease.

  18. Outcome Factors in Hypoxic Ischemic Encephalopathy

    OpenAIRE

    J Gordon Millichap

    2002-01-01

    The predictive value of history, examination, Glasgow Coma Scale (GCS) scores, EEG and sensory evoked potentials (SEP) in the prognosis of children with acute hypoxic-ischemic encephalopathy (HIE) was evaluated at the University Hospital of Lille, France.

  19. Molecular Mechanisms of Renal Ischemic Conditioning Strategies

    DEFF Research Database (Denmark)

    Kierulf-Lassen, Casper; Nieuwenhuijs-Moeke, Gertrude J; Krogstrup, Nicoline V

    2015-01-01

    Ischemia-reperfusion injury is the leading cause of acute kidney injury in a variety of clinical settings such as renal transplantation and hypovolemic and/or septic shock. Strategies to reduce ischemia-reperfusion injury are obviously clinically relevant. Ischemic conditioning is an inherent part...... of the renal defense mechanism against ischemia and can be triggered by short periods of intermittent ischemia and reperfusion. Understanding the signaling transduction pathways of renal ischemic conditioning can promote further clinical translation and pharmacological advancements in this era. This review...... summarizes research on the molecular mechanisms underlying both local and remote ischemic pre-, per- and postconditioning of the kidney. The different types of conditioning strategies in the kidney recruit similar powerful pro-survival mechanisms. Likewise, renal ischemic conditioning mobilizes many...

  20. Transient ischemic attack: definition and natural history.

    Science.gov (United States)

    Caplan, Louis R

    2006-07-01

    The standard definition of a transient ischemic attack--"a cerebral dysfunction of an ischemic nature lasting no longer than 24 hours with a tendency to recur"--was arrived at arbitrarily and is no longer tenable. Experience shows that attacks are much briefer, usually less than an hour, and many are associated with brain infarction. A newer definition, more consonant with the data, is preferred--"transient ischemic attack is a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction." Patients with transient ischemic attacks require urgent evaluation that includes brain and vascular imaging, blood tests, and often cardiac investigations. Treatment will depend on the nature of the causative cervico-cranial vascular, cardiac, and hematologic abnormalities found on investigation.

  1. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  2. Bilateral internal carotid artery occlusion. Comparison among MRI, hemodynamics and clinical feature

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Yasumasa; Tsuda, Harumi; Nabatame, Hidehiko; Akiguchi, Ichiro; Kameyama, Masakuni

    1987-10-01

    Four cases of bilateral internal carotid occlusion are reported with respect to clinical features, hemodynamics and various image diagnosis. MRI is applied to three cases. The patients comprised 2.08 % of all cerebral occlusive diseases treated during the past five years at our clinic. One case is of abrupt onset and three cases are progressing profiles. In one of these cases, collateral circulation is supplied mainly by leptomeningeal anastomosis of the posterior cerebral artery and posterior pericallosal artery branching from the basilar artery. In two of them, they are supplied through the circle of Willis. Middle cerebral artery occlusion, occlusion supra occlusionem, however, causes decisive ischemic lesion in its teritory. Applying MRI, complicated ischemic lesions, such as lacunar infarction, paraventricular lesion, deep white matter lesion and border zone infarction can clearly be identified. In the case of total aphasia, the lesions responsible are demonstrated clearly by MRI, but only vaguely by X-ray CT.

  3. Chronic ischemic mitral regurgitation – adiagnostic and therapeutic challenge

    Directory of Open Access Journals (Sweden)

    Jana Ambrožič

    2014-02-01

    Full Text Available Chronic ischemic mitral regurgitation (IMR is a valvular disorder caused by left ventricular dysfunction due to chronic coronary artery disease. It represents a valvular consequence of left ventricular contractile dysfunction and/or pathologic remodeling that indirectly impairs appropriate closing of the mitral valve. IMR is not caused by a structural change of the mitral valve. Acute postinfarction mitral regurgitation is also differentiated from chronic IMR. Chronic IMR occurs in the chronic stage of myocardial infarction in 20–50 % of the patients; its prevalence in the population is increasing. In patients after myocardial infarction, impaired contractility and mitral regurgitation are the most important negative prognostic factors. Furthermore, regurgitation that would be considered mild in patients with organic mitral valve disease already has a negative prognostic implication in patients with IMR.Echocardiogram is the fundamental tool for diagnostic evaluation and treatment planning in patients with IMR. The key parameters that have to be assessed include left ventricular contractile dysfunction, degree of left ventricular remodeling, pathologic changes in mitral valve geometry and quantification of regurgitation severity. In some patients, significant IMR can only be identified by stress echocardiography.Although IMR has an important negative impact on prognosis, indications for treatment and best treatment options have still not been well defined. According to the European and American guidelines, significant IMR should be treated, particularly in patients who are candidates for surgical coronary artery revascularisation. However, there is still no conclusive evidence that any surgical or percutaneous treatment of IMR improves patients’ prognosis.

  4. COGNITIVE DYSFUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    O. V. Yeremina

    2014-01-01

    Full Text Available Coronary artery bypass graft surgery (CABG is one of the most effective methods of surgical treatment of ischemic heart disease (IHD. However, even improvement of life quality is evident in patients underwent CABG, some neuropsychological, cognitive alterations may appear. Therefore, the problem of neurological complications in cardiac surgery is still of current interest. Prevalence of cognitive dysfunction after CABG varies from 12 to 79%. One third of the patients have alterations of cognitive functions for 1 year and more after the operation. In this review, we will discuss the current understandings on etiology, pathogenesis and prevalence of cognitive dysfunction in patients with IHD after CABG. The following factors determine development of long-lasting cognitive deficiency: lower educational level, advanced age, significant alterations of cognitive functions in preoperative period. At present, age, comorbid pathology (arterial hypertension, diabetes mellitus, vascular diseases, lung diseases, heart fai­lure, alcohol and drug abuse, preoperative cognitive dysfunction are considered as major risk factors for CABG-induced neurological complications. Importance of timely diagnostics and early beginning of treatment of cognitive dysfunction will be discussed.

  5. Electroacupuncture acutely improves cerebral blood flow and attenuates moderate ischemic injury via an endothelial mechanism in mice.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Kim

    Full Text Available Electroacupuncture (EA is a novel therapy based on traditional acupuncture combined with modern eletrotherapy that is currently being investigated as a treatment for acute ischemic stroke. Here, we studied whether acute EA stimulation improves tissue and functional outcome following experimentally induced cerebral ischemia in mice. We hypothesized that endothelial nitric oxide synthase (eNOS-mediated perfusion augmentation was related to the beneficial effects of EA by interventions in acute ischemic injury. EA stimulation at Baihui (GV20 and Dazhui (GV14 increased cerebral perfusion in the cerebral cortex, which was suppressed in eNOS KO, but there was no mean arterial blood pressure (MABP response. The increased perfusion elicited by EA were completely abolished by a muscarinic acetylcholine receptor (mAChR blocker (atropine, but not a β-adrenergic receptor blocker (propranolol, an α-adrenergic receptor blocker (phentolamine, or a nicotinic acetylcholine receptor (nAChR blocker (mecamylamine. In addition, EA increased acetylcholine (ACh release and mAChR M3 expression in the cerebral cortex. Acute EA stimulation after occlusion significantly reduced infarct volume by 34.5% when compared to a control group of mice at 24 h after 60 min-middle cerebral artery occlusion (MCAO (moderate ischemic injury, but not 90-min MCAO (severe ischemic injury. Furthermore, the impact of EA on moderate ischemic injury was totally abolished in eNOS KO. Consistent with a smaller infarct size, acute EA stimulation led to prominent improvement of neurological function and vestibule-motor function. Our results suggest that acute EA stimulation after moderate focal cerebral ischemia, but not severe ischemia improves tissue and functional recovery and ACh/eNOS-mediated perfusion augmentation might be related to these beneficial effects of EA by interventions in acute ischemic injury.

  6. Intraoperative evaluation of revascularization effect on ischemic muscle hemodynamics using near-infrared diffuse optical spectroscopies

    Science.gov (United States)

    Yu, Guoqiang; Shang, Yu; Zhao, Youquan; Cheng, Ran; Dong, Lixin; Saha, Sibu P.

    2011-02-01

    Arterial revascularization in patients with peripheral arterial disease (PAD) reestablishes large arterial blood supply to the ischemic muscles in lower extremities via bypass grafts or percutaneous transluminal angioplasty (PTA). Currently no gold standard is available for assessment of revascularization effects in lower extremity muscles. This study tests a novel near-infrared diffuse correlation spectroscopy flow-oximeter for monitoring of blood flow and oxygenation changes in medial gastrocnemius (calf) muscles during arterial revascularization. Twelve limbs with PAD undergoing revascularization were measured using a sterilized fiber-optic probe taped on top of the calf muscle. The optical measurement demonstrated sensitivity to dynamic physiological events, such as arterial clamping/releasing during bypass graft and balloon inflation/deflation during PTA. Significant elevations in calf muscle blood flow were observed after revascularization in patients with bypass graft (+48.1 +/- 17.5%) and patients with PTA (+43.2 +/- 11.0%), whereas acute post-revascularization effects in muscle oxygenation were not evident. The decoupling of flow and oxygenation after revascularization emphasizes the need for simultaneous measurement of both parameters. The acute elevations/improvements in calf muscle blood flow were associated with significant improvements in symptoms and functions. In total, the investigation corroborates potential of the optical methods for objectively assessing the success of arterial revascularization.

  7. Transient central diabetes insipidus following ischemic stroke

    Directory of Open Access Journals (Sweden)

    Muthukrishnan Jayaraman

    2013-01-01

    Full Text Available Central Diabetes Insipidus (CDI following ischemic infarction of the brain has been described as a rare presentation. Posterior pituitary ischemia has also been postulated as a possible cause of idiopathic CDI. We encountered a young male with bilateral extensive ischemic infarction sustained at high altitude, who had transient polyuria due to central diabetes insipidus, requiring desmopressin therapy. DI completely resolved during the course of his neurological recovery.

  8. Case report: MRI of decubital ischemic fasciitis

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    Ozden Sila Ulus

    2011-01-01

    Full Text Available The MRI findings in a case of decubital ischemic fasciitis located posterolateral to the right greater trochanter, in a 72-year-old woman, are presented. Decubital ischemic fasciitis is an uncommon entity encountered mostly in debilitated, elderly patients, in the deep subcutaneous tissue, at pressure points or bony prominences. It can simulate soft-tissue sarcomas. Recognition of this lesion radiologically is important to prevent unnecessary interventions.

  9. Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-10-01

    Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

  10. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

    Energy Technology Data Exchange (ETDEWEB)

    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

    2017-06-15

    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  11. The Ischemic Stroke Genetics Study (ISGS Protocol

    Directory of Open Access Journals (Sweden)

    Rich Stephen S

    2003-07-01

    Full Text Available Abstract Background The molecular basis for the genetic risk of ischemic stroke is likely to be multigenic and influenced by environmental factors. Several small case-control studies have suggested associations between ischemic stroke and polymorphisms of genes that code for coagulation cascade proteins and platelet receptors. Our aim is to investigate potential associations between hemostatic gene polymorphisms and ischemic stroke, with particular emphasis on detailed characterization of the phenotype. Methods/Design The Ischemic Stroke Genetic Study is a prospective, multicenter genetic association study in adults with recent first-ever ischemic stroke confirmed with computed tomography or magnetic resonance imaging. Patients are evaluated at academic medical centers in the United States and compared with sex- and age-matched controls. Stroke subtypes are determined by central blinded adjudication using standardized, validated mechanistic and syndromic classification systems. The panel of genes to be tested for polymorphisms includes β-fibrinogen and platelet glycoprotein Ia, Iba, and IIb/IIIa. Immortalized cell lines are created to allow for time- and cost-efficient testing of additional candidate genes in the future. Discussion The study is designed to minimize survival bias and to allow for exploring associations between specific polymorphisms and individual subtypes of ischemic stroke. The data set will also permit the study of genetic determinants of stroke outcome. Having cell lines will permit testing of future candidate risk factor genes.

  12. Challenges associated with peripheral arterial disease in women

    OpenAIRE

    Barochiner, Jessica; Aparicio, Lucas S; Waisman, Gabriel D

    2014-01-01

    Jessica Barochiner, Lucas S Aparicio, Gabriel D Waisman Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Abstract: Peripheral arterial disease (PAD) is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common ...

  13. Substitution of Linoleic Acid for Other Macronutrients and the Risk of Ischemic Stroke

    DEFF Research Database (Denmark)

    Venø, Stine K; Schmidt, Erik B; Jakobsen, Marianne U

    2017-01-01

    from saturated fatty acids, monounsaturated fatty acids, or glycemic carbohydrates. METHODS: In the Danish prospective Diet, Cancer, and Health Study of 57 053 participants aged 50 to 64 years at baseline, information on diet was collected using a validated semiquantitative food frequency questionnaire......BACKGROUND AND PURPOSE: Ischemic stroke is a major health problem worldwide, but the influence of dietary factors on stroke risk is not well known. This study aimed to investigate the risk of ischemic stroke and its subtypes with a higher intake from linoleic acid and a concomitant lower intake.......63-1.02), and glycemic carbohydrates (hazard ratio, 0.92; 95% confidence interval, 0.78-1.09), although not statistically significant. Similar patterns of association were found for large-artery atherosclerosis and small-vessel occlusions. CONCLUSIONS: This study suggests that replacing saturated fatty acid, glycemic...

  14. Cardiac magnetic resonance imaging and computed tomography in ischemic cardiomyopathy: an update

    Energy Technology Data Exchange (ETDEWEB)

    Assuncao, Fernanda Boldrini; Oliveira, Diogo Costa Leandro de; Nacif, Marcelo Souto, E-mail: msnacif@gmail.com [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Escola de Medicina; Souza, Vitor Frauches [Complexo Hospitalar de Niteroi (CHN), Niteroi, RJ (Brazil)

    2016-01-15

    Ischemic cardiomyopathy is one of the major health problems worldwide, representing a significant part of mortality in the general population nowadays. Cardiac magnetic resonance imaging (CMRI) and cardiac computed tomography (CCT) are noninvasive imaging methods that serve as useful tools in the diagnosis of coronary artery disease and may also help in screening individuals with risk factors for developing this illness. Technological developments of CMRI and CCT have contributed to the rise of several clinical indications of these imaging methods complimentarily to other investigation methods, particularly in cases where they are inconclusive. In terms of accuracy, CMRI and CCT are similar to the other imaging methods, with few absolute contraindications and minimal risks of adverse side-effects. This fact strengthens these methods as powerful and safe tools in the management of patients. The present study is aimed at describing the role played by CMRI and CCT in the diagnosis of ischemic cardiomyopathies. (author)

  15. Role of Epinephrine and Extracorporeal Membrane Oxygenation in the Management of Ischemic Refractory Ventricular Fibrillation

    Directory of Open Access Journals (Sweden)

    Jason A. Bartos, MD, PhD

    2017-06-01

    Full Text Available Summary: Extracorporeal membrane oxygenation (ECMO is used in cardiopulmonary resuscitation (CPR of refractory cardiac arrest. The authors used a 2 × 2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF. Pigs underwent 5 min of untreated VF and 10 min of CPR, and were randomized to receive epinephrine versus placebo for another 35 min. Animals were further randomized to left anterior descending artery (LAD reperfusion at minute 45 with ongoing CPR versus venoarterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion. Four-hour survival was improved with ECMO whereas epinephrine showed no effect. Key Words: advanced cardiopulmonary life support, cardiac arrest, cardiopulmonary resuscitation, ECMO, extracorporeal membrane oxygenation, ischemic refractory ventricular fibrillation, ST-segment elevation myocardial infarction, ventricular fibrillation

  16. Cardiac magnetic resonance imaging and computed tomography in ischemic cardiomyopathy: an update

    Directory of Open Access Journals (Sweden)

    Fernanda Boldrini Assunção

    2016-02-01

    Full Text Available Abstract Ischemic cardiomyopathy is one of the major health problems worldwide, representing a significant part of mortality in the general population nowadays. Cardiac magnetic resonance imaging (CMRI and cardiac computed tomography (CCT are noninvasive imaging methods that serve as useful tools in the diagnosis of coronary artery disease and may also help in screening individuals with risk factors for developing this illness. Technological developments of CMRI and CCT have contributed to the rise of several clinical indications of these imaging methods complementarily to other investigation methods, particularly in cases where they are inconclusive. In terms of accuracy, CMRI and CCT are similar to the other imaging methods, with few absolute contraindications and minimal risks of adverse side-effects. This fact strengthens these methods as powerful and safe tools in the management of patients. The present study is aimed at describing the role played by CMRI and CCT in the diagnosis of ischemic cardiomyopathies.

  17. Detection of Early Ischemic Changes in Noncontrast CT Head Improved with "Stroke Windows".

    Science.gov (United States)

    Mainali, Shraddha; Wahba, Mervat; Elijovich, Lucas

    2014-01-01

    Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P Windows (14% and 36%; P Windows (6% and 46%; P Windows significantly improved detection of EIC.

  18. Diagnostic and prognostic significance of ischemic electrocardiographic changes with regadenoson-stress myocardial perfusion imaging.

    Science.gov (United States)

    Doukky, Rami; Olusanya, Adebayo; Vashistha, Raj; Saini, Abhimanyu; Fughhi, Ibtihaj; Mansour, Khaled; Nigatu, Abiy; Confer, Kara; Sims, Shannon A

    2015-08-01

    The diagnostic and prognostic value of regadenoson-induced ST-segment depression (ST↓) is not defined. Due to the low incidence of ST↓ ≥1.0 mm with vasodilator stress, a lower threshold to define ischemic ECG response may provide improved clinical utility. We conducted a retrospective cohort study of patients who underwent regadenoson-stress SPECT myocardial perfusion imaging (MPI) followed by coronary angiography within 6 months. Ischemic ST↓ was defined as ≥0.5 mm. The prevalence of angiographically severe coronary artery disease (CAD) and the rates of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and coronary revascularization were determined. In a diagnostic cohort of 629 subjects, 117 (18.6%) had ST↓ ≥0.5 mm. Severe CAD was more prevalent in the ST↓ ≥0.5 vs ST regadenoson-induced ST↓ ≥0.5 mm was associated with higher rates of severe CAD and MACE, irrespective of MPI finding.

  19. Density of thrombus on admission CT predicts revascularization efficacy in large vessel occlusion acute ischemic stroke.

    Science.gov (United States)

    Moftakhar, Parham; English, Joey D; Cooke, Daniel L; Kim, Warren T; Stout, Charles; Smith, Wade S; Dowd, Christopher F; Higashida, Randall T; Halbach, Van V; Hetts, Steven W

    2013-01-01

    Can lysability of large vessel thrombi in acute ischemic stroke be predicted by measuring clot density on admission nonenhanced CT (NECT), postcontrast enhanced CT, or CT angiogram (CTA)? We retrospectively studied 90 patients with acute large vessel ischemic strokes treated with intravenous (IV) tPA, intra-arterial (IA) tPA, and/or mechanical thrombectomy devices. Clot density [in Hounsfield unit (HU)] was measured on NECT, postcontrast enhanced CT, and CTA. Recanalization was assessed by the Thrombolysis in Cerebral Infarction grading system (TICI) on digital subtraction angiography. Thrombus density on preintervention NECT correlated with postintervention TICI grade regardless of pharmacological (IV tPA r=0.69, IA tPA r=0.72, Padmission NECT provides a rapid method to analyze clot composition, a potentially useful discriminator in selecting the most appropriate reperfusion strategy for an individual patient.

  20. Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian

    2015-01-01

    independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p ...Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously....... Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater...

  1. Adjustment and Characterization of an Original Model of Chronic Ischemic Heart Failure in Pig

    Directory of Open Access Journals (Sweden)

    Laurent Barandon

    2010-01-01

    Full Text Available We present and characterize an original experimental model to create a chronic ischemic heart failure in pig. Two ameroid constrictors were placed around the LAD and the circumflex artery. Two months after surgery, pigs presented a poor LV function associated with a severe mitral valve insufficiency. Echocardiography analysis showed substantial anomalies in radial and circumferential deformations, both on the anterior and lateral surface of the heart. These anomalies in function were coupled with anomalies of perfusion observed in echocardiography after injection of contrast medium. No demonstration of myocardial infarction was observed with histological analysis. Our findings suggest that we were able to create and to stabilize a chronic ischemic heart failure model in the pig. This model represents a useful tool for the development of new medical or surgical treatment in this field.

  2. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging.

    Science.gov (United States)

    Chung, Jong-Won; Park, Su Hyun; Kim, Nayoung; Kim, Wook-Joo; Park, Jung Hyun; Ko, Youngchai; Yang, Mi Hwa; Jang, Myung Suk; Han, Moon-Ku; Jung, Cheolkyu; Kim, Jae Hyoung; Oh, Chang Wan; Bae, Hee-Joon

    2014-08-11

    The association between the location and the mechanism of a stroke lesion remains unclear. A diffusion-weighted imaging study may help resolve this lack of clarity. We studied a consecutive series of 2702 acute ischemic stroke patients whose stroke lesions were confirmed by diffusion-weighted imaging and who underwent a thorough etiological investigation. The vascular territory in which an ischemic lesion was situated was identified using standard anatomic maps of the dominant arterial territories. Stroke subtype was based on the Trial of ORG 10172 in Acute Stroke Treatment, or TOAST, classification. Large-artery atherosclerosis (37.3%) was the most common stroke subtype, and middle cerebral artery (49.6%) was the most frequently involved territory. Large-artery atherosclerosis was the most common subtype for anterior cerebral, middle cerebral, vertebral, and anterior and posterior inferior cerebellar artery territory infarctions. Small vessel occlusion was the leading subtype in basilar and posterior cerebral artery territories. Cardioembolism was the leading cause in superior cerebellar artery territory. Compared with carotid territory stroke, vertebrobasilar territory stroke was more likely to be caused by small vessel occlusion (21.4% versus 30.1%, Pterritory infarction was frequently caused by cardioembolism (44.2%) in carotid territory and by large-artery atherosclerosis (52.1%) in vertebrobasilar territory. Information on vascular territory of a stroke lesion may be helpful in timely investigation and accurate diagnosis of stroke etiology. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  3. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Classification and Vascular Territory of Ischemic Stroke Lesions Diagnosed by Diffusion‐Weighted Imaging

    Science.gov (United States)

    Chung, Jong‐Won; Park, Su Hyun; Kim, Nayoung; Kim, Wook‐Joo; Park, Jung Hyun; Ko, Youngchai; Yang, Mi Hwa; Jang, Myung Suk; Han, Moon‐Ku; Jung, Cheolkyu; Kim, Jae Hyoung; Oh, Chang Wan; Bae, Hee‐Joon

    2014-01-01

    Background The association between the location and the mechanism of a stroke lesion remains unclear. A diffusion‐weighted imaging study may help resolve this lack of clarity. Methods and Results We studied a consecutive series of 2702 acute ischemic stroke patients whose stroke lesions were confirmed by diffusion‐weighted imaging and who underwent a thorough etiological investigation. The vascular territory in which an ischemic lesion was situated was identified using standard anatomic maps of the dominant arterial territories. Stroke subtype was based on the Trial of ORG 10172 in Acute Stroke Treatment, or TOAST, classification. Large‐artery atherosclerosis (37.3%) was the most common stroke subtype, and middle cerebral artery (49.6%) was the most frequently involved territory. Large‐artery atherosclerosis was the most common subtype for anterior cerebral, middle cerebral, vertebral, and anterior and posterior inferior cerebellar artery territory infarctions. Small vessel occlusion was the leading subtype in basilar and posterior cerebral artery territories. Cardioembolism was the leading cause in superior cerebellar artery territory. Compared with carotid territory stroke, vertebrobasilar territory stroke was more likely to be caused by small vessel occlusion (21.4% versus 30.1%, Pterritory infarction was frequently caused by cardioembolism (44.2%) in carotid territory and by large‐artery atherosclerosis (52.1%) in vertebrobasilar territory. Conclusions Information on vascular territory of a stroke lesion may be helpful in timely investigation and accurate diagnosis of stroke etiology. PMID:25112556

  4. Childhood obesity.

    Science.gov (United States)

    Ahmad, Qazi Iqbal; Ahmad, Charoo Bashir; Ahmad, Sheikh Mushtaq

    2010-01-01

    Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people world-wide. Obesity is a condition of excess body fat often associated with a large number of debilitating and life-threatening disorders. It is still a matter of debate as to how to define obesity in young people. Overweight children have an increased risk of being overweight as adults. Genetics, behavior, and family environment play a role in childhood overweight. Childhood overweight increases the risk for certain medical and psychological conditions. Encourage overweight children to expand high energy activity, minimize low energy activity (screen watching), and develop healthful eating habits. Breast feeding is protective against obesity. Diet restriction is not recommended in very young children. Children are to be watched for gain in height rather than reduction in weight. Weight reduction of less than 10% is a normal variation, not significant in obesity.

  5. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med . 2016;374(11):1021- ...

  6. Carotid Artery Disease

    Science.gov (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  7. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  8. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of blood pressure ...

  9. Impact of intracranial artery calcification on cerebral hemodynamic changes.

    Science.gov (United States)

    Wu, Xiaohong; Wang, Li; Zhong, Jingxin; Ko, Jacky; Shi, Lin; Soo, Yannie; Leung, Thomas; Wong, Ka Sing; Abrigo, Jill; Chen, Xiangyan

    2018-02-09

    Intracranial artery calcification (IAC) has been demonstrated