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1.
Eur J Neurol ; 27(5): 849-855, 2020 05.
Article in English | MEDLINE | ID: mdl-32065457

ABSTRACT

BACKGROUND AND PURPOSE: The aim was to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anaesthesia. METHODS: All consecutive ischaemic stroke patients who had been treated at our centre with MT for anterior circulation large vessel occlusion under general anaesthesia were identified over an 8-year period. Ventilation time was analysed as a continuous variable and patients were grouped into extubation within 6 h ('early'), 6-24 h ('delayed') and >24 h ('late'). Favourable outcome was defined as modified Rankin Scale scores of 0-2 at 3 months post-stroke. Pneumonia rate and reasons for prolonged ventilation were also assessed. RESULTS: Amongst 447 MT patients (mean age 69.1 ± 13.3 years, 50.1% female), the median ventilation time was 3 h. 188 (42.6%) patients had a favourable 3-month outcome, which correlated with shorter ventilation time (Spearman's rho 0.39, P < 0.001). In patients extubated within 24 h, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% confidence interval 1.53-3.76, P < 0.001). This was confirmed in multivariable analysis (P = 0.01). A longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, P < 0.01). Whilst stroke-associated complications represented the most common reasons for late extubation (>24 h), delayed extubation (6-24 h) was associated with admission outside of core working hours (P < 0.001). CONCLUSIONS: Prolonged ventilation time after stroke thrombectomy independently predicts unfavourable outcome at 3 months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.


Subject(s)
Brain Ischemia , Endovascular Procedures , Stroke , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/surgery , Female , Humans , Male , Middle Aged , Prognosis , Stroke/surgery , Thrombectomy , Treatment Outcome
2.
Eur J Neurol ; 26(5): 727-732, 2019 05.
Article in English | MEDLINE | ID: mdl-30489673

ABSTRACT

BACKGROUND AND PURPOSE: Information on the prevalence and course of post-stroke cognitive impairment in young stroke patients is limited. The aim was to assess a consecutive sample of acute young ischaemic stroke patients (18-55 years) for the presence and development of neuropsychological deficits. METHODS: Patients prospectively underwent a comprehensive clinical and cognitive assessment, examining general cognitive function, processing speed, attention, flexibility/executive function and word fluency within the first 3 weeks after hospital admission (median assessment at day 6) and at a 3 months' follow-up (FU). Cognitive dysfunction was defined in comparison to age-standardized published norms. RESULTS: At baseline (N = 114), deficits were highly prevalent in processing speed (56.0%), flexibility/executive function (49.5%), attention (46.4%) and general cognitive function (42.1%). These frequencies were comparable for those with FU assessment (N = 87). In most domains, cognitive performance improved within 3 months, except for word fluency. However, in about one-third of patients, cognitive deficits (as defined by 1.5 standard deviations below the standardized mean) were still present 3 months after stroke. At FU, 44.0% were impaired in the domain flexibility/executive function, 35.0% in processing speed and 30.0% in attention. CONCLUSIONS: The high prevalence of cognitive deficits in acute young patients with ischaemic stroke highlights the importance of early post-stroke cognitive assessment to capture a patient's dysfunction in a comprehensive manner and to offer adequate rehabilitation. The role of factors which promote neuropsychological deficits needs further exploration.


Subject(s)
Brain Ischemia/epidemiology , Brain Ischemia/psychology , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/psychology , Stroke/epidemiology , Stroke/psychology , Adolescent , Adult , Age Factors , Attention , Brain Ischemia/complications , Cognition , Cognitive Dysfunction/complications , Disease Progression , Executive Function , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Prevalence , Prospective Studies , Speech , Stroke/complications , Young Adult
3.
Eur J Neurol ; 23(5): 906-11, 2016 May.
Article in English | MEDLINE | ID: mdl-26843095

ABSTRACT

BACKGROUND AND PURPOSE: Based on a tight network of stroke units (SUs) and interventional centres, endovascular treatment of acute major intracranial vessel occlusion has been widely implemented in Austria. Documentation of all patients in the nationwide SU registry has thereby become mandatory. METHODS: Demographic, clinical and interventional characteristics of patients who underwent endovascular treatment for acute ischaemic stroke in 11 Austrian interventional centres between 1 October 2013 and 30 September 2014 were analysed. RESULTS: In total, 301 patients (50.5% women; median age 70.5 years; median National Institutes of Health Stroke Scale score 17) were identified.193 patients (64.1%) additionally received intravenous thrombolysis. The most frequent vessel occlusion sites were the M1 segment of the middle cerebral artery (n = 161, 53.5%), the intracranial internal carotid artery (n = 60, 19.9%) and the basilar artery (n = 40, 13.3%). Stent retrievers were used in 235 patients (78.1%) and adequate reperfusion (modified Thrombolysis in Cerebral Infarction scores 2b and 3, median onset to reperfusion time 254 min) was achieved in 242 patients (81.4%). Symptomatic intracranial haemorrhage occurred in 7%. 43.8% of patients (n = 132) had good functional outcome (modified Rankin Scale score 0-2) and the mortality rate was 20.9% (n = 63) after 3 months. Compared to the anterior circulation, vertebrobasilar stroke patients had higher mortality. Patients with secondary hospital transportation had better outcomes after 3 months than in-house treated patients. CONCLUSION: Our results document nationwide favourable outcome and safety rates of endovascular stroke treatment comparable to recent randomized trials. The ability to provide such data and the need to further optimize such an approach also underscore the contribution of respective registries.


Subject(s)
Brain Ischemia/therapy , Endovascular Procedures/methods , Stroke/therapy , Thrombectomy/methods , Thrombolytic Therapy/methods , Administration, Intravenous , Aged , Austria , Brain Ischemia/drug therapy , Female , Humans , Male , Middle Aged , Registries , Stents , Stroke/drug therapy , Stroke/etiology , Treatment Outcome , United States
4.
AJNR Am J Neuroradiol ; 33(3): 481-6, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22158922

ABSTRACT

BACKGROUND AND PURPOSE: Stent-like, self-expandable devices, the so-called flow diverters, are increasingly used for the treatment of wide-neck cerebral aneurysms. The immediate and short-term results are promising, but no long-term results are available. The purpose of our research was to report the long-term angiographic and cross-sectional imaging results after placement of a PED in 12 patients with wide-neck intracranial aneurysms. MATERIALS AND METHODS: Twelve wide-neck or otherwise untreatable cerebral aneurysms in 12 patients were treated with the PED. Angiography was performed at 6 and 24 months after treatment. Additional MR and CT angiograms were acquired. RESULTS: In all patients, angiographic or cross-sectional imaging follow-up of at least 27 months demonstrated complete occlusion of the aneurysms treated with the PED. There were no cases of aneurysm recurrence. Angiography at around 6 months showed complete occlusion in all cases, except 1 that showed complete occlusion at the 29-month follow-up. In 1 patient, a clinically asymptomatic 75% in-stent stenosis was seen on the angiography at 6 months but was resolved completely by balloon dilation. Device placement was successful in all patients. Distal embolization had occurred in 1 patient, but the clot was resolved completely without clinical sequelae. Almost immediate angiographic occlusion was achieved in 2 aneurysms and flow reduction in 10 aneurysms. CONCLUSIONS: Treatment of wide-neck intracranial aneurysms by PED placement led to successful and durable occlusion in all cases, without severe complications. Endovascular treatment for in-stent stenosis should be considered cautiously, because the underlying stenosis may be transient and disappear within 12 months after treatment.


Subject(s)
Embolization, Therapeutic/instrumentation , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome
5.
Interv Neuroradiol ; 17(2): 235-40, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21696665

ABSTRACT

We report the immediate technical and clinical outcome of a new self-expanding fully retrievable stent in the treatment of acute ischemic stroke. Eleven consecutive patients with acute intracerebral artery occlusions were treated with a self-expandable fully retrievable intracranial stent (Solitaire AB). Four patients had an occlusion of the basilar artery, five had a middle cerebral artery occlusion and two had terminal carotid artery occlusions. Recanalization results were assessed by follow-up angiography immediately after the procedure. Neurologic status was evaluated before and after treatment (90-day follow-up) according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRS).Successful revascularization (TICI 2a/b and 3) was achieved in 11 of 11 (100%) patients, a TICI 3 state was accomplished in two (18%) patients, and partial recanalization or slow distal branch filling with filling of more than two-thirds of the vessel territory (TICI 2a/2b) was achieved in nine (82%) patients. The stent was removed in all patients. The mean time from stroke symptom onset to recanalization was 339 minutes (+/- 114.3 minutes). NIHSS on admission was 16.09 (+/- 4.7). Almost two-thirds of the patients (61.2%) improved by >6 points on the NIHSS at discharge, and 30% showed a mRS of <2 at 90 days. Mortality was 9%. One patient with a BA occlusion had a massive brain stem infarction and died two days after the procedure. There were no intracranial hemorrhages.The use of the Solitaire in ischemic stroke patients shows encouraging results. However, further prospective large randomized trials are mandatory to confirm these early results.


Subject(s)
Brain Ischemia/therapy , Cerebral Revascularization/instrumentation , Stents , Stroke/therapy , Thrombectomy/instrumentation , Acute Disease , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Brain Ischemia/pathology , Cerebral Angiography , Cerebral Revascularization/methods , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Stroke/diagnostic imaging , Stroke/pathology , Thrombectomy/methods , Treatment Outcome
6.
Eur J Neurol ; 16(1): 31-6, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19049506

ABSTRACT

BACKGROUND AND PURPOSE: About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. METHODS: Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. RESULTS: When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis >/=50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. CONCLUSIONS: We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis.


Subject(s)
Angioplasty/instrumentation , Stents/statistics & numerical data , Vertebrobasilar Insufficiency/physiopathology , Vertebrobasilar Insufficiency/therapy , Adult , Aged , Angioplasty/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Vertebrobasilar Insufficiency/etiology , Vertebrobasilar Insufficiency/mortality , Young Adult
8.
Lancet Neurol ; 7(3): 216-22, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18242141

ABSTRACT

BACKGROUND: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are used to prevent ischaemic stroke in patients with stenosis of the internal carotid artery. Better knowledge of risk factors could improve assignment of patients to these procedures and reduce overall risk. We aimed to assess the risk of stroke or death associated with CEA and CAS in patients with different risk factors. METHODS: We analysed data from 1196 patients randomised to CAS or CEA in the Stent-Protected Angioplasty versus Carotid Endarterectomy in Symptomatic Patients (SPACE) trial. The primary outcome event was death or ipsilateral stroke (ischaemic or haemorrhagic) with symptoms that lasted more than 24 h between randomisation and 30 days after therapy. Six predefined variables were assessed as potential risk factors for this outcome: age, sex, type of qualifying event, side of intervention, degree of stenosis, and presence of high-grade contralateral stenosis or occlusion. The SPACE trial is registered at Current Controlled Trials, with the international standard randomised controlled trial number ISRCTN57874028. FINDINGS: Risk of ipsilateral stroke or death increased significantly with age in the CAS group (p=0.001) but not in the CEA group (p=0.534). Classification and regression tree analysis showed that the age that gave the greatest separation between high-risk and low-risk populations who had CAS was 68 years: the rate of primary outcome events was 2.7% (8/293) in patients who were 68 years old or younger and 10.8% (34/314) in older patients. Other variables did not differ between the CEA and CAS groups. INTERPRETATION: Of the predefined covariates, only age was significantly associated with the risk of stroke and death. The lower risk after CAS versus CEA in patients up to 68 years of age was not detectable in older patients. This finding should be interpreted with caution because of the drawbacks of post-hoc analyses.


Subject(s)
Angioplasty/methods , Carotid Artery, Internal/surgery , Carotid Stenosis/surgery , Endarterectomy, Carotid/methods , Stroke/surgery , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Risk Factors , Severity of Illness Index , Stroke/epidemiology , Stroke/mortality , Survival Analysis , Treatment Outcome
10.
Eur J Neurol ; 13(12): 1271-83, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17116208

ABSTRACT

Neuroimaging techniques are necessary for the evaluation of stroke, one of the leading causes of death and neurological impairment in developed countries. The multiplicity of techniques available has increased the complexity of decision making for physicians. We performed a comprehensive review of the literature in English for the period 1965-2005 and critically assessed the relevant publications. The members of the panel reviewed and corrected an initial draft, until a consensus was reached on recommendations stratified according to the European Federation of Neurological Societies (EFNS) criteria. Non-contrast computed tomography (CT) scan is the established imaging procedure for the initial evaluation of stroke patients. However, magnetic resonance imaging (MRI) has a higher sensitivity than CT for the demonstration of infarcted or ischemic areas and depicts well acute and chronic intracerebral hemorrhage. Perfusion and diffusion MRI together with MR angiography (MRA) are very helpful for the acute evaluation of patients with ischemic stroke. MRI and MRA are the recommended techniques for screening cerebral aneurysms and for the diagnosis of cerebral venous thrombosis and arterial dissection. For the non-invasive study of extracranial vessels, MRA is less portable and more expensive than ultrasonography but it has higher sensitivity and specificity for carotid stenosis. Transcranial Doppler is very useful for monitoring arterial reperfusion after thrombolysis, for the diagnosis of intracranial stenosis and of right-to-left shunts, and for monitoring vasospasm after subarachnoid hemorrhage. Currently, single photon emission computed tomography and positron emission tomography have a more limited role in the evaluation of the acute stroke patient.


Subject(s)
Image Processing, Computer-Assisted/standards , Magnetic Resonance Imaging/standards , Stroke/diagnosis , Humans , Practice Guidelines as Topic , Radiography , Stroke/diagnostic imaging
11.
Lancet ; 368(9543): 1239-47, 2006 Oct 07.
Article in English | MEDLINE | ID: mdl-17027729

ABSTRACT

BACKGROUND: Carotid endarterectomy is effective in stroke prevention for patients with severe symptomatic carotid-artery stenosis, and carotid-artery stenting has been widely used as alternative treatment. Since equivalence or superiority has not been convincingly shown for either treatment, we aimed to compare the two. METHODS: 1200 patients with symptomatic carotid-artery stenosis were randomly assigned within 180 days of transient ischaemic attack or moderate stroke (modified Rankin scale score of < or =3) carotid-artery stenting (n=605) or carotid endarterectomy (n=595). The primary endpoint of this hospital-based study was ipsilateral ischaemic stroke or death from time of randomisation to 30 days after the procedure. The non-inferiority margin was defined as less than 2.5% on the basis of an expected event rate of 5%. Analyses were on an intention-to-treat basis. This trial is registered at Current Controlled Trials with the international standard randomised controlled trial number ISRCTN57874028. FINDINGS: 1183 patients were included in the analysis. The rate of death or ipsilateral ischaemic stroke from randomisation to 30 days after the procedure was 6.84% with carotid-artery stenting and 6.34% with carotid endarterectomy (absolute difference 0.51%, 90% CI -1.89% to 2.91%). The one-sided p value for non-inferiority is 0.09. INTERPRETATION: SPACE failed to prove non-inferiority of carotid-artery stenting compared with carotid endarterectomy for the periprocedural complication rate. The results of this trial do not justify the widespread use in the short-term of carotid-artery stenting for treatment of carotid-artery stenoses. Results at 6-24 months are awaited.


Subject(s)
Angioplasty, Balloon , Carotid Stenosis/therapy , Endarterectomy, Carotid , Stents , Aged , Aged, 80 and over , Carotid Stenosis/complications , Carotid Stenosis/surgery , Female , Humans , Male , Stroke/etiology , Stroke/prevention & control
12.
J Neurol Neurosurg Psychiatry ; 76(11): 1520-4, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16227543

ABSTRACT

OBJECTIVE: To determine the clinical presentation and aetiology of small subcortical infarctions as found on diffusion weighted magnetic resonance imaging (DWI). DWI is both sensitive and specific in the early detection of acute ischaemic brain lesions irrespective of pre-existing vascular damage. METHODS: Ninety three patients were identified showing subcortical or brainstem DWI lesions <1.5 cm in diameter within a maximum of 7 days from the onset of stroke symptoms. The patients' clinical status on admission was reviewed according to the Oxfordshire Community Stroke Project (OCSP). The results of procedures searching for cerebrovascular risk factors, large artery disease, and potential sources of cardiac embolism were included to determine stroke aetiology. Magnetic resonance imaging scans were also reviewed for concomitant changes that could support the aetiologic classification. RESULTS: Only 41 (44.1%) patients presented clinically with a lacunar syndrome according to OCSP criteria. The nine (9.7%) patients who showed two or more DWI lesions in different vascular territories were also significantly more likely to have potential sources of cardiac embolism (5/9, 55.6% v 20/84, 23.8%). Hypertension was significantly more prevalent in the group of patients who showed a microangiopathy related imaging pattern, but this pattern did not exclude the presence of large artery disease or a possible cardioembolic source of stroke. CONCLUSION: Identification of small subcortical infarctions as the cause of stroke appears quite uncertain based on clinical characteristics only. DWI adds significant aetiologic information but does not obviate the search for other potentially causative mechanisms.


Subject(s)
Brain Infarction/etiology , Brain Infarction/pathology , Brain Stem/pathology , Diffusion Magnetic Resonance Imaging , Hypertension/complications , Acute Disease , Adult , Aged , Aged, 80 and over , Brain Infarction/epidemiology , Brain Stem/blood supply , Carotid Artery, Internal/physiopathology , Carotid Stenosis/complications , Carotid Stenosis/epidemiology , Carotid Stenosis/physiopathology , Cerebrovascular Circulation/physiology , Electrocardiography , Embolism/complications , Embolism/epidemiology , Female , Heart Diseases/complications , Heart Diseases/epidemiology , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/epidemiology , Humans , Hypertension/epidemiology , Male , Middle Aged , Prevalence , Risk Factors
13.
Hypertension ; 38(1): 110-5, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11463770

ABSTRACT

The angiotensinogen M235T polymorphism has been linked to hypertension and cardiovascular disease. We studied the role of this polymorphism as a risk factor for carotid atherosclerosis and small-vessel disease-related brain abnormalities. A total of 431 randomly selected community-dwelling subjects without clinical evidence for strokes underwent angiotensinogen genotyping and carotid Duplex scanning; 1.5-T brain magnetic resonance imaging (MRI) was done in 396 individuals. At 3-year follow-up, we reexamined 343 and 267 study participants by ultrasound and brain MRI, respectively. Carotid atherosclerosis was graded on a 5-point scale. Small-vessel disease-related brain abnormalities were deep or subcortical white matter lesions or lacunes. Progression of carotid atherosclerosis and MRI findings was rated by direct imaging comparison by 3 independent raters. The M/M, M/T, and T/T genotypes were seen in 20.9%, 52.9%, and 18.1% of subjects, respectively. The M235T polymorphism was neither associated with baseline carotid findings nor with progression of carotid atherosclerosis. There was a trend toward more frequent small-vessel disease-related MRI abnormalities in the T/T than in the other genotypes at the baseline examination. Progression of brain lesions occurred significantly more commonly in T/T than in M/M and M/T carriers (P<0.001). Logistic regression analysis identified the T/T genotype (odds ratio, 3.19; P=0.002) and arterial hypertension (odds ratio, 3.06; P=0.03) as significant independent predictors of lesion progression. These data suggest that the angiotensinogen T/T genotype at position 235 is a genetic marker for brain lesions from and progression of small vessel disease but not for extracranial carotid atherosclerosis.


Subject(s)
Angiotensinogen/genetics , Carotid Artery Diseases/genetics , Blood Vessels , Female , Gene Frequency , Genotype , Humans , Male , Middle Aged , Polymorphism, Genetic , Risk Factors , Telencephalon
14.
Stroke ; 29(10): 2043-8, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9756579

ABSTRACT

BACKGROUND AND PURPOSE: Genetic polymorphism at the paraoxonase locus is associated with serum concentration and activity of paraoxonase and with increased risk for coronary heart disease. Two frequent polymorphisms present at the paraoxonase gene are the methionine (M allele) leucine (L allele) interchange at position 54 and the arginine (B allele) glutamine (A allele) interchange at position 191. This is the first study to determine the effect of these polymorphisms on carotid atherosclerosis. METHODS: The paraoxonase genotypes at positions 54 and 191 of 316 randomly selected individuals aged 44 to 75 years were determined by polymerase chain reaction-based restriction enzyme digestion. Carotid atherosclerosis was assessed by color-coded Duplex scanning and was graded on a 5-point scale ranging from 0 (normal) to 5 (complete luminal obstruction). RESULTS: The LL, LM, and MM genotypes at position 54 were noted in 137 (43.4%), 132 (41.8%), and 47 (14.9%) subjects; the AA, AB, and BB genotypes at position 191 occurred in 172 (54.4%), 124 (39.2%), and 20 (6.3%) individuals. The LL genotype was significantly associated with the presence and severity of carotid disease (P=0.022), whereas the 191 polymorphism had no effect. Logistic regression analysis with age and sex forced into the model demonstrated plasma fibrinogen (odds ratio [OR], 1.005 per mg/dL), LDL cholesterol (OR, 1.01 per mg/dL), cardiac disease (OR, 1.75), and the paraoxonase LL genotype to be significant predictors of carotid atherosclerosis. The ORs for the associations with age and sex were 1.09 (P=0.0003) and 1.66 (P=0.052) per year. CONCLUSIONS: These data suggest that the paraoxonase LL genotype may represent a genetic risk factor for carotid atherosclerosis.


Subject(s)
Arteriosclerosis/genetics , Carotid Artery Diseases/genetics , Cerebrovascular Disorders/prevention & control , Esterases/genetics , Polymorphism, Genetic/genetics , Aged , Alleles , Amino Acid Sequence , Arteriosclerosis/diagnostic imaging , Aryldialkylphosphatase , Austria , Carotid Artery Diseases/diagnostic imaging , Female , Genotype , Humans , Male , Middle Aged , Polymerase Chain Reaction , Risk Factors , Ultrasonography, Doppler, Duplex
15.
Arterioscler Thromb Vasc Biol ; 18(3): 487-92, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9514419

ABSTRACT

Polymorphisms at the beta-fibrinogen locus have been shown to be associated with plasma concentration of fibrinogen and coronary heart disease. The effect of the genetic heterogeneity of fibrinogen on carotid atherosclerosis has not been determined so far. We examined the influence of the C148 --> T polymorphism on carotid disease in a large cohort of middle-aged to elderly subjects without evidence of neuropsychiatric disease. This polymorphism is located close to the consensus sequence of the interleukin-6 element and may represent a functional sequence variant. The genotype of 399 randomly selected, neurologically asymptomatic individuals, aged 45 to 75 years, was determined by denaturing gradient gel electrophoresis. Carotid atherosclerosis was assessed by color-coded duplex scanning and was graded on a five-point scale ranging from 0 (=normal) to 5 (=complete luminal obstruction). The C/C, C/T, and T/T genotypes were noted in 226 (56.6%), 148 (37.1 %), and 25 (6.3%) individuals, respectively. The T/T genotype group demonstrated higher grades of carotid atherosclerosis than did the C/C and C/T genotypes (P=.003). Logistic regression analysis created a model of independent predictors of carotid atherosclerosis that included apolipoprotein B (odds ratio [OR], 1.17/10 mg/dL), age (OR, 2.46/10 years), lifetime tobacco consumption (OR, 1.03/1000 g), presence of the beta-fibrinogen promoter T/T genotype (OR, 6.17), plasma fibrinogen concentration (OR, 1.05/10 mg/dL), and cardiac disease (OR, 1.80). These data suggest that the beta-fibrinogen promoter T/T148 genotype represents a genetic risk factor for carotid atherosclerosis in the middle-aged to elderly.


Subject(s)
Arteriosclerosis/genetics , Carotid Artery Diseases/genetics , Fibrinogen/genetics , Polymorphism, Genetic/genetics , Aged , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/etiology , Base Sequence , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Cerebrovascular Disorders/prevention & control , Cohort Studies , Female , Follow-Up Studies , Forecasting , Genotype , Humans , Male , Middle Aged , Prospective Studies , Regression Analysis , Risk Factors , Ultrasonography
16.
J Neurol Sci ; 150(1): 49-57, 1997 Sep 01.
Article in English | MEDLINE | ID: mdl-9260857

ABSTRACT

The prevalence of a right-to-left intracardiac shunt, demonstrated by echocardiography and transcranial Doppler sonography has been shown to be higher in stroke patients than in normal controls. The aim of this study was to assess the sensitivity and specificity of contrast transcranial Doppler sonography in comparison to transesophageal echocardiography in the detection and differentiation of intracardiac and intrapulmonary shunts and to correlate the transcranial Doppler findings with clinical outcome and morphological findings. Forty five consecutive stroke patients with suspected paradoxical embolism were entered into the study. In all 25 patients with middle cerebral artery stroke of the left (56%) or right (44%) territory and echocardiographic demonstrated patent foramen ovale (80%) or intrapulmonary shunt (20%), simultaneous bilateral transcranial Doppler sonography of the middle cerebral arteries was performed after contrast medium injection during rest and valsalva straining under standardized and optimized conditions. Overall sensitivity for the detection of a right-to-left shunt by contrast transcranial Doppler sonography was 97% and overall specificity was 70%. Bilateral appearance of microbubbles, microbubble count and time delay of microbubble appearance significantly increased after valsalva straining. In patients with intracardiac shunts, a significantly higher microbubble count (32 vs. 13 in patients with an intrapulmonary shunt) and a shorter time interval of microbubble appearance (11 vs. 14 s in patients with intrapulmonary shunts) was observed. There was no correlation between the side and numerical distribution of microbubble count and the location and severity of the current clinical symptoms, as well as between microbubble count and presence and hemispherical distribution of brain infarcts. Transcranial Doppler sonography is a highly sensitive method for the detection of right-to-left shunts, whether of cardiac or pulmonary location. However. no correlation was found between the side and number of microbubbles counted and the clinical symptomatology.


Subject(s)
Cerebrovascular Disorders/physiopathology , Coronary Circulation , Embolism, Paradoxical/diagnostic imaging , Pulmonary Circulation , Ultrasonography, Doppler, Transcranial , Adolescent , Adult , Cerebral Arteries/diagnostic imaging , Cerebrovascular Disorders/diagnostic imaging , Echocardiography, Transesophageal , Embolism, Paradoxical/physiopathology , Female , Functional Laterality , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Male , Middle Aged , Sensitivity and Specificity , Valsalva Maneuver
17.
Stroke ; 28(5): 951-6, 1997 May.
Article in English | MEDLINE | ID: mdl-9158631

ABSTRACT

BACKGROUND AND PURPOSE: Microangiopathy-related cerebral damage (MARCD) includes white matter abnormalities and lacunar infarctions and represents a common MRI observation in subjects above 50 years of age. The risk factors of such brain abnormalities are not fully determined. The goal of this study was to determine whether the genetic heterogeneity of apolipoprotein E (apoE) contributes to the occurrence of MARCD. METHODS: Brain MRI (1.5 T) was performed in 280 individuals (ages 50 to 75 years) without neuropsychiatric disease randomly selected from the official register of residents of the city of Graz, Austria. All study participants underwent apoE genotyping, carotid Doppler sonography, electrocardiography, echocardiography, and a complete blood chemistry panel. MARCD was defined as evidence of early confluent and confluent white matter hyperintensities or lacunes. Carotid atherosclerosis was graded on a five-point scale ranging from not present (0) to complete occlusion (5). RESULTS: MARCD occurred in 61 individuals (21%). The distribution of apoE genotypes differed significantly between subjects with and without MARCD (P = .036). Subjects with such findings more commonly had the epsilon 2/epsilon 3 genotype (24.6% versus 10%) at similar frequencies of genotypes containing the epsilon 4 allele. The epsilon 2/epsilon 3 genotype was associated with lower levels of total cholesterol (P = .0009), LDL cholesterol (P = .00001), and apolipoprotein B (P = .00001). Also, there was a nonsignificant trend toward less cardiac disease. Other major vascular risk factors and carotid abnormalities were similar among the various genotypes. Multiple logistic regression analysis created a model of significant MARCD predictors, including age (odds ratio [OR], 1.1 per year), hypertension (OR, 3.4), and the apoE epsilon 2/epsilon 3 genotype (OR, 3.0). CONCLUSIONS: These data suggest an association between the apoE epsilon 2/epsilon 3 genotype and MARCD despite favorable effects on the lipid profile and cardiac disease.


Subject(s)
Apolipoproteins E/genetics , Brain Damage, Chronic/genetics , Cerebrovascular Disorders/pathology , Cerebrovascular Disorders/prevention & control , Polymorphism, Genetic , Aged , Alleles , Brain/pathology , Female , Genotype , Humans , Magnetic Resonance Imaging , Male , Microcirculation , Middle Aged
18.
Wien Med Wochenschr ; 147(2): 36-40, 1997.
Article in German | MEDLINE | ID: mdl-9139470

ABSTRACT

The Austrian Stroke Prevention Study recruited 1960 randomly selected subjects aged 50 to 75 years during a 3-year period of enrollment. The response rate of the study was 32.4%. A telephone interview with 200 randomly selected non-responders yielded no differences to responders regarding the frequency of major vascular risk factors known to the subjects. Besides demographics, the study assessed arterial hypertension, diabetes mellitus, cardiac disease, smoking, a complete lipid status including the apolipoprotein-E genotype, serum fibrinogen and anticardiolipin antibodies as well as various natural antioxidants such as vitamins A, C, E and beta-carotene. Arterial hypertension, diabetes mellitus, cardiac disease and hypercholesterolemia > 200 mg/dl were strikingly common and occurred in 38%, 7.6%, 32% and 76%, respectively. Suboptimal plasma concentrations of vitamin A, E, and beta-carotene were noted in 77.2%, 56.1% and in 53.2% of study participants. The rate of treatment of major risk factors known to the subjects prior to study entry were 60.3% and 70% for arterial hypertension and diabetes mellitus, but only 37.1% and 6.3% for cardiac disease and hypercholesterolemia > 250 mg/dl. Diet was commonly used to treat diabetes but was almost neglected in the treatment of other vascular risk factors. These data provide an orientation on the prevalence of risk factors and the use of primary preventive measures for stroke treatment in our community.


Subject(s)
Cerebrovascular Disorders/prevention & control , Urban Population , Adult , Aged , Austria/epidemiology , Cerebrovascular Disorders/etiology , Cross-Sectional Studies , Female , Health Surveys , Humans , Incidence , Life Style , Male , Middle Aged , Risk Factors , Sampling Studies
19.
Nervenarzt ; 68(12): 967-71, 1997 Dec.
Article in German | MEDLINE | ID: mdl-9465339

ABSTRACT

A vascular etiology of Parkinson's disease (PD) has been long debated. In order to search for an ischemic basis of PD we assessed the clinical symptomatology of a consecutive group of 60 PD patients and compared their frequency of cerebrovascular risk factors, carotid atherosclerosis and ischemic brain lesions with age-matched groups of stroke patients and normals. There were 16 (27%) subjects with PD who also had symptoms of cerebrovascular disease. The frequencies of carotid stenoses, ischemic brain lesions and most of cerebrovascular risk factors seen in the latter group was comparable with those of stroke patients and significantly higher than in the investigational subsets of patients with "pure" PD and normals. Only one (1.6%) individual with PD presented signs suggestive of an ischemic etiology of parkinsonism. These findings suggest that cerebrovascular disease occurs in approximately one fourth of patients with PD, but seldomly is causally related.


Subject(s)
Brain Ischemia/complications , Parkinson Disease/etiology , Aged , Aged, 80 and over , Brain Ischemia/diagnosis , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Cerebral Infarction/complications , Cerebral Infarction/diagnosis , Female , Humans , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis/diagnosis , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/diagnosis , Male , Middle Aged , Parkinson Disease/diagnosis , Risk Factors , Vertebrobasilar Insufficiency/complications , Vertebrobasilar Insufficiency/diagnosis
20.
J Neurol Sci ; 132(1): 57-60, 1995 Sep.
Article in English | MEDLINE | ID: mdl-8523031

ABSTRACT

Seventy-two patients with postischemic seizures were evaluated with electroencephalography (EEG), computerized tomography (CT) and neurosonography. There were 24% early-onset and 76% late-onset initial seizures. Early-onset seizure was more likely to be simple partial (53%), whereas late-onset seizure was more likely to be primarily generalized (56%). 76% early-onset and 80% late-onset seizures were single. Status epilepticus was more frequent in early-onset that late-onset seizures (p = 0.023). The possibility of recurrence was greater in late-onset than early-onset seizures (p < 0.001). 88% patients had EEG abnormalities, and the most common finding was focal slowing. 75% patients had cerebral infarctions on CT scan, and the majority of them involved cortex. 89% postischemic seizures had carotid lesions which mostly were carotid plaques < 50%. We failed to find these data to be useful in predicting the time of onset of initial seizures after acute ischemic stroke and recurrence.


Subject(s)
Brain Ischemia/diagnosis , Electrocardiography , Electroencephalography , Epilepsy/diagnosis , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Epilepsy/diagnostic imaging , Epilepsy/etiology , Female , Humans , Male , Middle Aged , Ultrasonography
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