ABSTRACT
Mediante la práctica adquirida en la aplicación de técnicas de angioplastia endovascular cerebral, cada vez se tienen más casos exitosos, con menos reportes de complicaciones. En la práctica clínica es frecuente encontrar pacientes con estenosis de múltiples vasos extracraneanos o intracraneanos, así que no es inusual enfrentarse a la necesidad de realizar simultáneamente angioplastia de dos o más vasos cerebrales. En este artículo se describen dos casos de pacientes con estenosis de los cuatro vasos cerebrales. El primero fue llevado a angioplastia más colocación de endoprótesis (stent) en la arteria carótida interna izquierda y en la arteria vertebral izquierda. Posteriormente, en un segundo procedimiento se practicó angioplastia de la arteria carótida interna derecha. El segundo requirió angioplastia y colocación de stent en la arteria carótida interna derecha y a arteria vertebral izquierda. Aunque un caso presentó isquemia transitoria debida a vasoespasmo, éste se resolvió completamente; ambos casos se llevaron a término exitosamente.
Subject(s)
Humans , Stroke , Angioplasty , Constriction, PathologicABSTRACT
BACKGROUND: A substantial portion of the general population has clinically silent stroke on brain imaging. These lesions may cause symptoms. This study assessed the prevalence of stroke symptoms in a stroke- and transient ischemic attack (TIA)-free population and the association of symptoms with risk factors indexed by the Framingham Stroke Risk Score. METHODS: We performed a cross-sectional analysis from a randomly sampled national cohort enrolled from January 25, 2003, through November 30, 2005, with oversampling from the southeastern stroke belt and African American populations. The main outcome measure was stroke symptoms assessed by validated questionnaire. RESULTS: The study included 18 462 (41% African American; 51% female; mean age, 65.8 years) participants who reported no stroke or TIA. The prevalence of stroke symptoms was 5.8% for sudden painless hemibody weakness, 8.5% for sudden hemibody numbness, 4.6% for sudden painless loss of vision in one or both eyes, 3.1% for sudden hemifield visual loss, 2.7% for sudden inability to understand speech, and 3.8% for sudden inability of linguistic expression. The prevalence of 1 or more symptoms was 17.8%. Relative to the first quartile of the Framingham Stroke Risk Score, the adjusted odds ratio for 1 or more stroke symptoms increased from 1.0 (95% confidence interval [CI], 0.90-1.2) in the second quartile to 1.2 (95% CI, 1.1-1.5) and 1.5 (95% CI, 1.3-1.6) in successive quartiles. Symptoms were more prevalent among African American compared with white participants and among those with lower income, lower educational level, and fair to poor perceived health status. CONCLUSIONS: The general population without prior diagnosed stroke or TIA has a high prevalence of stroke symptoms. The relationship between symptoms and risk factors suggests that some symptomatic individuals may have had clinically undetected cerebrovascular events and may benefit from aggressive stroke prophylaxis.
Subject(s)
Ischemic Attack, Transient/complications , Stroke/complications , Aged , Aged, 80 and over , Black People , Blindness/epidemiology , Cohort Studies , Cross-Sectional Studies , Educational Status , Female , Health Status , Humans , Hypesthesia/epidemiology , Ischemic Attack, Transient/diagnosis , Male , Middle Aged , Multivariate Analysis , Muscle Weakness/epidemiology , Prevalence , Risk Factors , Socioeconomic Factors , Speech Intelligibility , Stroke/diagnosis , Surveys and Questionnaires , United States/epidemiology , White PeopleABSTRACT
We discuss the case of a patient with stroke in whom severe stenosis at the origin of the left vertebral artery was identified by transesophageal echocardiography and subsequently confirmed with conventional angiography.
Subject(s)
Echocardiography, Transesophageal , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Vertebrobasilar Insufficiency/diagnosis , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Stenosis/diagnosis , Cerebral Infarction/diagnosis , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Stroke continues to be a major health problem for our society. Despite the proven effectiveness of intravenous tissue plasminogen activator (t-PA) for the treatment of acute ischemic stroke, only a minority of patients qualify for this type of therapy. Furthermore, the existing literature has demonstrated that t-PA is not as effective in the treatment of occlusion of large cerebral arteries. The benefit-to-risk assessment of this subpopulation of stroke patients makes them the best candidates for neuroendovascular rescue. This term refers to the intra-arterial application of techniques designed to promote arterial recanalization, and includes intra-arterial thrombolysis and antithrombotic agents, direct mechanical disruption, angioplasty, stenting, embolectomy, and vasoactive pharmacologic intervention. The timing and choice of these procedures, as well as the care of the patient prior to, during, and after the intervention, requires a highly focused and expert approach.
