How effective is endovascular intracranial revascularization in stroke prevention? Results from Borgess Medical Center Intracranial Revascularization Registry.

BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%-99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%-99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%-99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results.

Predictors of unfavorable outcome in intracranial angioplasty and stenting in a single-center comparison: results from the Borgess Medical Center-Intracranial Revascularization Registry.

BACKGROUND AND PURPOSE: Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared. MATERIALS AND METHODS: This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked. RESULTS: From April 2002 to January 2009, 140 subjects with 159 lesions (50%-100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; P = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days (P = .0439) and restenosis (P = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days (P = .008). Eccentric lesions were more likely to have stroke than concentric lesions (P = .0726). CONCLUSIONS: In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.

Responses to occupational hazards: exit and participation.

The authors developed and tested a model linking subjective risk perceptions to both turnover intentions and employees' willingness to participate in health and safety programs. On the basis of data from 130 employees of a manufacturing firm, the model was supported. Risk perceptions were predicted by employees' accident history and perceptions of others' commitment to health and safety. In turn, risk perceptions predicted both turnover intentions and willingness to participate. These effects emerged after controlling for monomethod bias.

Effect of a carbohydrate-restricted, calorie-reduced diet on the growth of young rats and on serum growth hormone, somatomedins, total thyroxine and triiodothyronine, free T4 index, and total corticosterone.

We have studied the effect of a carbohydrate-restricted, calorie-reduced diet on the growth of young rats and on serum levels of GH, somatomedins [insulin-like growth factors (IGFs) I and II], total T4 and T3, free T4 index, and total corticosterone. Experimental animals consumed the same quantities of protein and fat as controls, but only 50.3% as much carbohydrate and 76% as many calories. While the experimental group grew at 69.4% of the control rate, their mean (+/- SEM) GH level (175.7 +/- 36.9 ng/mL) was not significantly different from that in the control group (180 +/- 30 ng/mL). In contrast, serum total IGF and IGF-I, while not correlated with serum GH levels, were significantly correlated in all animals with body weight (r = .87 and r = .82, respectively, P less than .01) and tail length (r = .61 and r = .62, respectively, P less than .01). The somatomedin levels of the carbohydrate-restricted rats were significantly lower than those of their age-matched, but not weight-matched, controls by the eighth day of study. Serum T4, T3, and free T4 index were not significantly different in these two groups, while total corticosterone in the experimental group (245 +/- 73 ng/mL) was slightly lower than in controls (292 +/- 80 ng/mL, P less than .05). These data indicate that by restricting carbohydrate intake we have compromised the anabolic use of dietary protein by growing rats, resulting in a retardation of growth and a reduction in serum total IGF and IGF-I levels.

Effect of preventing coprophagy in the rat on neutral detergent fiber digestibility and apparent calcium absorption.

The effect of coprophagy on apparent neutral detergent fiber (NDF) digestibility, and calcium absorption was evaluated by housing rats in four types of cages: regular, metabolic, and two anticoprophagy cages: a short linear tube cage which allowed the rat forward and backward movement of about one-half a body length and a long tube cage assembled to form a square which allowed the rat to move in one direction through the tube but not turn around. Three-day weight gains of animals in the regular or metabolism cages were greater than those of rats housed in either anticoprophagy cage. In contrast, average food intake did not differ among the four housing conditions. Wet, but not dry, fecal weights were greater in the two groups of rats in the anticoprophagy cages. Neither fecal NDF (% dry wt) nor apparent NDF digestibility was affected by housing conditions. Apparent calcium absorption was decreased by the anticoprophagy housing. The differences in body weight and apparent calcium absorption suggest that prevention of coprophagy in the rats produces significant changes in the efficiency of food and nutrient utilization. The failure to detect differences in NDF digestibility indicates that coprophagy has little impact on the study of fiber digestibility.

Protein utilization in growth: effect of calorie deficiency on serum growth hormone, somatomedins, total thyroxine (T4) and triiodothyronine, free T4 index, and total corticosterone.

We have studied the effect of a calorie-restricted diet on the growth of young rats and on serum levels of GH, somatomedins (insulin-like growth factors I and II), total T4 and T3, free T4 index, and total corticosterone. Experimental rats consumed the same quantities of protein and carbohydrate as control animals, but less fat, so that their calorie intake was approximately 76% that of controls. The mean (+/- SEM) GH level in the experimental group (78 +/- 21 ng/ml) was not significantly different from that in the control group (89 +/- 31 ng/ml). In contrast, serum total insulin-like growth factor and insulin-like growth factor IGF-I, while not correlated with serum GH, were significantly correlated with age and body weight (r = 0.93 and r = 0.69, respectively; P less than 0.01). The levels of these somatomedins in the calorie-restricted rats were significantly lower than those in their age-matched, but not weight-matched, controls after approximately 2 weeks of study. Serum T4, T3, and free T4 index were all significantly reduced in the experimental animals and may represent an adaptive response to calorie restriction. Serum corticosterone levels in the experimental and control rats were essentially identical. In this study, by restricting calorie intake we have compromised the ability of growing rats to use dietary protein anabolically, creating a useful model to examine in some detail nutritional influences on growth and the growth-promoting endocrine system.

Protein utilization in growth: effect of lysine deficiency on serum growth hormone, somatomedins, insulin, total thyroxine (T4) and triiodothyronine, free T4 index, and total corticosterone.

We have studied the effect of a lysine-deficient diet on the growth of young rats and on serum levels of GH, somatomedins [insulin-like growth factors (IGFs) I and II], insulin, total T4 and T3, free T4 index, and total corticosterone. Rats eating a wheat gluten diet consumed about one third as much lysine as controls eating an isocaloric and isonitrogenous casein diet and grew at approximately 56% of the control rate. The mean (+/- SEM) GH level in the experimental group (68 +/- 9 ng/ml) was significantly lower (P less than 0.01) than that in the controls (106 +/- 17 ng/ml), but was not correlated with age or body weight and was only weakly correlated with total IGF. In contrast, total IGF and IGF-I were significantly correlated with age and body weight (r = 0.86 and r = 0.84, respectively; P less than 0.01). The levels of these somatomedins in the wheat gluten-fed animals were consistently and significantly lower than those in their age-matched controls, but not significantly different from those in their weight-matched controls, throughout the study. Serum total T4 and T3 (but not the free T4 index) and corticosterone were significantly elevated in the experimental rats, perhaps representing a serum binding globulin adaptation to lysine deficiency that is not clearly understood. In this study, we have compromised the ability of growing rats to use dietary protein anabolically to examine the nutritional effects of qualitative protein deficiency on growth and the growth-promoting endocrine system.