ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B‐mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women. Multivariate analysis identified 6 significant variables (age, hypertension, pack‐years smoked, and inversely, plasma concentrations of high density lipoprotein cholesterol and uric acid, and Framingham Type A score) that together accounted for 35% of the variability in extent of carotid atherosclerosis. In a second multivariate analysis, addition of coronary status (presence or absence of coronary stenosis as evaluated by coronary angiography) to the roster of candidate independent variables produced a new equation that accounted for an additional 5% of the variability in carotid atherosclerosis extent. Although much of the variability in extent of carotid atherosclerosis remains unexplained, these data define an association between coronary and carotid atherosclerosis that depends partly on shared exposure of both arteries to the same risk factors. They are also consistent with the concept that as yet undiscovered risk factors and/or genetic (e.g., arterial wall) factors common to both arterial beds also contribute to the relation between coronary and carotid atherosclerosis in human beings. (Stroke 1987; 18:990–996)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Clinical events following cerebral angiography were prospectively evaluated in 1,002 procedures. The ischemic event rate between 0 and 24 hours was 1.3% (0.1% permanent). This incidence was higher (2.5%) in patients investigated for cerebrovascular disease, but the difference was not significant. In addition, 1.8% of the patients suffered ischemia (0.3% permanent) between 24 and 72 hours after angiography. Cerebral ischemic events occurred as a recurrence or worsening of a preexisting condition twice as often as de novo. All permanent ischemia was a worsening of a preexisting phenomenon. There was a significant increase in the incidence of neurologic events between 0 and 24 hours when the procedure lasted longer than 60 minutes and when there was systolic hypertension. Trends toward higher incidence were noted with the use of increased volume of contrast, with increased serum creatinine, when transient ischemic attacks or stroke were the indications, and when 3 or more catheters were used. The incidence of neurologic events between 24 and 72 hours increased significantly with the increase in the amount of contrast used, with age, and with diabetes. The occurrence of nonneurologic events (mostly hematomas) was significantly increased by multiple factors. This study shows that events can and do occur beyond the usual observation period of 24 hours but confirms the low risk of cerebral angiography when performed judiciously. (Stroke 1987;18:997–1004)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In a 4‐year period, 129 asymptomatic high‐grade (80–99%) internal carotid artery stenoses were identified in 115 patients. Because we previously demonstrated a strong relation between degree of carotid stenosis and subsequent development of ipsilateral related events (stroke, transient ischemic attack, and carotid occlusion), we changed our previous policy and began to offer carotid endarterectomy to good surgical risk patients referred to us with asymptomatic high‐grade carotid stenosis. A total of 56 carotid endarterectomies were performed while 73 lesions were followed nonoperatively. Operated and nonoperated groups were similar with regard to age, prevalence of hypertension, cardiac disease, diabetes, and aspirin use. Life table analysis to 24 months revealed a higher rate of stroke (19 vs. 4%, p = 0.08), transient focal neurologic deficits (28 vs. 5%, p = 0.008), and carotid occlusion (29 vs. 0%, p = 0.003) in the nonoperated group. Eight of the 9 strokes in the nonoperated group occurred within 9 months of diagnosis of the high‐grade lesion; none were preceded by a transient ischemic attack. There was 1 perioperative stroke (1.8%) but no in‐hospital operative deaths and no difference in the late death rates of the two groups. This suggests that the preservation of neurologic status in patients with asymptomatic high‐grade internal carotid artery stenosis can be improved by carotid endarterectomy. (Stroke 1987;18:1005–1010)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To quantify the within‐ and between‐reader agreement of carotid B‐mode ultrasonography and angiography interpretation, images from 117 patients examined by both modalities were read multiple times. Angiographic measurements were more reproducible than those of B‐mode scans for all parameters except lesion width, but variations for B‐mode scan measurements were similar to those for angiographic measurements. Within‐reader agreement on the presence of u Ice rat ion was substantial for both modalities, whereas between‐reader agreement was poor for B‐mode scan and only moderate for angiography. (Stroke 1987;18:1011–1017)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Results from 1,039 combined cervical and transcranial Doppler examinations are reported. Satisfactory transcranial signals were not found in 2.7% of the cases. Compared with angiography, the accuracy of transcranial criteria in assessing collateral flow over the circle of Willis was 94 and 88% for anterior and posterior circulation, respectively. The method also appeared very promising for detection of lesions of the intracranial arteries although the number of such cases with angiographic verification was limited in the present series. Arterial narrowing due to cerebral vasospasm was diagnosed with a sensitivity of 80%. In patients with ruptured intracranial aneurysms, an incidence of 93% arterial narrowing in basal cerebral arteries was found. Patients with subarachnold hemorrhage and no aneurysm on angiography also showed arterial narrowing with an incidence of 56%. It was possible to monitor the time course and severity of cerebral vasospasm. Arteriovenous malformations were characterized by Doppler findings of high velocities and low pulsatilities. These lesions were diagnosed with an accuracy of 95%. (Stroke 1987;18:1018–1024)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Observations on blood velocity in the middle cerebral artery using transcranial Doppler ultrasound and on the ipsilateral internal carotid artery flow volume were obtained during periods of transient, rapid blood flow variations in 7 patients. Five patients were investigated after carotid endarterectomy. A further 2 patients having staged carotid endarterectomy and open heart surgery were investigated during nonpulsatile cardiopulmonary bypass. The patient selection permitted the assumption that middle cerebral artery flow remained proportional to internal carotid artery flow. The integrated time‐mean values from consecutive 5‐second periods were computed. The arithmetic mean internal carotid artery flow varied from 167 to 399 ml/min in individual patients, with individual ranges between ±15% and ±35% of the mean flow. The mean middle cerebral artery blood velocity varied from 32 to 78 cm/sec. The relation between flow volume and blood velocity was nearly linear under these conditions. Normalization of the data as percent of the individual arithmetic means permitted a composite analysis of data from all patients. Linear regression of normalized blood velocity (V') on normalized flow volume (Q') showed V' = 1.05 Q' = 5.08 (r2= 0.898). (Stroke 1987;18:1025–1030)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Recurrent stenosis has not been a primary consideration in the selection of patients for carotid endarterectomy. We have studied the incidence of postoperative restenosis retrospectively in 265 patients following 310 carotid endarterectomies. Two hundred fourteen patients (248 endarterectomies) were examined at 6–12 month intervals using ocular pneumopiethysmography, spectral analysis, and B‐mode imaging. The absolute incidence of recurrent carotid disease was 28% (69 of 248), with a 13% (33 of 248) incidence of hemodynamically significant restenosis and a 15% (36 of 248) incidence of hemodynamically insignificant disease. Life table analysis of the data projected a 32% incidence of hemodynamically significant restenosis after 7 years and a 40% incidence of hemodynamically insignificant recurrence. These data demonstrate a progressively increasing rate of restenosis. The incidence of ipsilateral neurologic events was 8% (24 of 310); 12 occurred in association with noninvasively evident recurrent disease (12 of 69, 17%), whereas 11 occurred in noninvasively determined normal arteries (11 of 179,6%). Noninvasive follow‐up was not available in 1 patient. Of the 12 events associated with recurrent disease, 5 occurred in association with hemodynamically significant restenosis (5 of 33,15%), whereas 7 occurred in association with hemodynamically insignificant disease (7 of 36,19%). Carotid endarterectomy is a durable operative procedure with 92% (286 of 310) of arteries remaining asymptomatic over the period of clinical follow‐up. However, absolute and life table projections of the incidence of asymptomatic restenosis are high, and this factor should be considered in the selection of patients for carotid endarterectomy, particularly in the absence of lateralizing symptoms. (Stroke 1987; 18:1031–1036)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Clinical and radiologic findings in 13 patients (11 women, 2 men) with extracranial vertebral artery dissection are reported. Dissection was spontaneous in 8 patients, occurred after neck manipulation in 2 and after a potential minor injury to the neck in 3. Six had a history of common migraine, 4 were using oral contraceptives at the time of dissection, and 3 had fibromuscular dysplasia. Dissection was bilateral in 8 patients and associated with carotid dissection in 3. It usually presented with neck or occipital pain preceding basilar ischemic symptoms by a few minutes to 1 month. In 3 patients, transient ischemic attacks were the only manifestation of basilar ischemia, and in 1 patient there was no symptom of basilar ischemia despite bilateral vertebral dissection. In 19 of the 21 dissected vertebral arteries, the angiographic appearance was that of an irregular stenosis, which was associated in 6 arteries with pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded but the contraiateral artery showed the typical irregular stenosis. The dissection involved only the third segment in 33%, only the second segment in 24%, and 2 or more segments in 38%. Eleven patients were treated with anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had residual deficit. No recurrence was observed (mean follow‐up 34 months). At control angiography (n= 12) or ultrasonic study (n= 1), 63% of dissected vertebral arteries had returned to normal, 26% showed marked improvement, and 11% were occluded. Our patient characteristics are compared with those of previously published cases. The validity of the distinction between spontaneous dissection and dissection associated with minor trauma is discussed. (Stroke 1987; 18:1037–1047)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID