ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We review carotid artery hemodynamics in hypertensive men, with particular reference to common carotid artery diameter and blood flow, and emphasize the changes in artery diameter and compliance implied by antihypertensive therapy. (Stroke1988; 19:1198–1202)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Canadian American Ticlopidine Study is a randomized, placebo‐controlled, double‐blind, multicenter study to assess the efficacy and safety of ticlopidine hydrochloride in patients who have suffered a thromboembolic stroke no less than 1 week and no more than 4 months before entry into the study. The primary assessment of efficacy will be based on the cluster of outcome events recurrent stroke, myocardial infarction, or vascular death. Twenty‐five clinical centers, 12 in Canada and 13 in the United States, entered a total of 1,072 patients during a 3‐year recruitment period; these patients were randomly allocated to receive either 250 mg ticlopidine or identical‐appearing placebo tablets twice daily for up to 3 years. Patient recruitment was completed in December 1986. Patients were followed for a maximum of 3 years or until the close of the study in December 1987; at that time an average follow‐up of 25 months had been achieved. We summarize the protocol and organization of the study and document the methods of execution and analysis, with corresponding criteria, before disclosure of the treatment code to any of the study investigators. We also provide a clinical description of the patients at entry into the study. (Stroke1988;19:1203–1210)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effect of very‐low‐dose aspirin as an antithrombotic agent was evaluated blindly in 301 patients who had recently undergone carotid endarterectomy. After randomization, 150 patients received aspirin and 151 received placebo. The two groups were comparable with regard to age, sex, blood pressure, previous cerebrovascular events, and smoking habits. The effect of the study medication on platelet aggregation was measured twice in each patient during the first 2 months and at each follow‐up visit; the dose was individually adjusted. In 76% of the patients receiving aspirin, 50 mg/day gave satisfactory platelet inhibition, 13% needed 60 mg/day, 8% needed 70 mg/day, and 3% needed 100 mg/day. Platelet aggregation was found to be inhibited in only 1.2% of the measurements in the patients receiving placebo. Observation during treatment averaged 21 months; total intention‐to‐treat follow‐up averaged 25 months. For the combined outcome events of transient ischemic attack, stroke, acute myocardial infarction, and vascular death, aspirin reduced risk by 11% (95% confidence limits: −38% to 48%,p>0.1). Thus, there was no significant effect of very‐low‐dose aspirin in our trial. (Stroke1988;19:1211–1215)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In this retrospective analysis we report our treatment experience in 65 consecutive patients with clinical signs of severe brainstem ischemia with angiographically demonstrated thrombotic vertebrobasilar artery occlusions who received either local intra‐arterial thrombolytic therapy (urokinase or streptokinase) (43 patients) or conventional therapy (antiplatelet agents or anticoagulants) (22 patients). We analyzed the data with respect to cerebral artery occlusion patterns, posttreatment arterial recanalization, and the clinical categories of favorable/unfavorable outcome and survival/death. In subgroup analyses, recanalization in patients who received thrombolytic therapy correlated significantly with clinical outcome; in 19 of 43 patients, recanalization was demonstrated angiographically, while in 24 patients the occlusion persisted. All patients without recanalization died, but 14 of the 19 patients displaying recanalization survived (p= 0.000007), 10 with a favorable clinical outcome. Only three of the 22 patients who received conventional therapy survived, all with a moderate clinical deficit. When we compared the treatment groups, highly significant differences in both outcome quality (p= 0.017) and survival (p= 0.0005) were found to depend on establishing recanalization. Our data support the concept that technically successful thrombolysis of vertebrobasilar artery occlusions is associated with beneficial clinical outcome.Stroke1988;19:1216–1222)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine the outcome of patients with carotid transient ischemic attacks (TIAs) and normal cerebral angiograms, we assessed 68 patients (40 men, 28 women) aged 24–72 (mean 53.5) years for recurrent TIAs and strokes and for the development of cardiac disease over 2–6 (mean 4.4) years. All but one patient had a follow‐up interview in early 1987; that patient had died of an unrelated cause (lung cancer) 18 months after the presenting TIA. The diagnosis was changed at the follow‐up interview in three patients (multiple sclerosis, meningioma, migraine). Among the 64 remaining patients, at admission cranial computed tomography had shown cerebral infarction in 11 of 64, two‐dimensional echocardiography had been abnormal in nine of 61, Holter monitoring had been abnormal in eight of 45, and twelve‐lead electrocardiography had been abnormal in three of 64. Two patients had abnormalities on both echocardiography and Holter monitoring. At the follow‐up interview of the 64 remaining patients, TIAs had recurred in nine and three had developed a completed stroke; cardiac disease (angina in seven, myocardial infarction in four) was noted in 11 patients. Findings from cardiac investigations on admission in the nine patients with recurrent TIAs had been abnormal in six and normal in three; all three patients who developed a stroke had had abnormal cardiac findings. Overall, further neurologic or cardiac events occurred in 12 of 46 patients (26%) with normal and in 10 of 18 patients (55.5%) with abnormal findings on admission (p< 0.01). In the presence of normal angiograms, extensive cardiac investigations may help predict the outcome of patients with TIAs. (Stroke1988;19:1223–1228)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A total of 72 ocular bruits in 50 patients with symptoms of atherothrombotic ischemic cerebrovascular disease were studied with continuous‐wave Doppler ultrasonography with spectrum analysis (Dopscan). Fourteen patients also had conventional angiography, and 14 had digital subtraction angiography. Ocular bruits by augmentation flow due to occlusion (seven bruits, 9.7%) or tight stenosis (17 bruits, 23.6%) of the contralateral internal carotid artery accounted for only 24 ocular bruits (33.3%). In contrast, siphon stenosis ipsilateral to the ocular bruit was a very common finding. All 14 patients studied with conventional angiography had variable degrees of siphon stenosis ipsilateral to the ocular bruits; there was one angiography failure. We conclude that siphon stenosis can cause ocular bruit alone or can act in combination with augmentation flow by contralateral carotid occlusion or tight stenosis. The difference in their relative occurrence in our patients compared with previous reports probably reflects racial differences in the distribution of stenotic or occluded lesions of the carotid artery between our patients and Caucasian patients. The ocular bruit was the only auscultatory finding in more than a quarter of our patients (14 of 50, 28%). (Stroke1988;19:1229–1233)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We measured cytoplasmic ionized calcium concentrations ([Cai2+]) in aequorin‐loaded gel‐filtered platelets from 38 patients with acute occlusive stroke (12 treated with aspirin, 26 untreated) and 25 healthy controls. Compared with controls, baseline [Cai2+] was higher in untreated patients (p< 0.002), maximal 36–72 hours after the onset of neurologic dysfunction (p< 0.0001), in those patients with as well as those without major stroke risk factors. The increase in [Cai2+] after stimulation with 0.5 and 1.0 unit/ml thrombin (p< 0.05), 2 and 4 μg/ml collagen (p< 0.02), and 0.5 and 1.0 mM platelet activating factor (p< 0.05) were also greater in untreated patients, but the profiles of these changes were parallel to those in controls. Even though the platelets of stroke patients are more sensitive to activation, they are functionally similar to those of controls. Aspirin treatment reduced baseline [Cai2+] as well as thrombin‐ and collagen‐induced [Cai2+] changes. Platelet activating factor‐induced increase in [Cai2+] was not altered by aspirin treatment. Our results suggest that the usefulness of aspirin in stroke is limited because aspirin does not suppress platelet responsiveness to all in vivo thrombogenic stimuli. Specific platelet activating factor antagonists may prove to be useful therapeutic agents in stroke. (Stroke1988;19:1234–1238)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We retrospectively studied 46 patients with symptomatic retinal artery occlusion and assessed the pattern and extent of carotid artery disease ipsilateral to the retinal artery occlusion. Ipsilateral internal carotid artery atherosclerotic lesions were virtually limited to the cervical arterial segment; 50% of such lesions were plaques or stenoses of ⩽60%, whereas 15% of the angiograms were normal. No clinical features were significantly associated with a flow‐limiting carotid stenosis of >60%. Contrary to previous reports, the type of retinal artery occlusion, whether branch or central artery occlusion, was not predictive of severe underlying carotid stenosis or occlusion. Likely mechanisms of retinal artery occlusion include in situ thrombosis and emboli from carotid, and possibly cardiac, sources. Extension of thrombus from an occluded carotid artery into the ophthalmic artery did not appear to be a mechanism of retinal artery occlusion. (Stroke1988; 19:1239–1242)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Two interventions for improving stroke caregiver knowledge, stabilizing family function, promoting patient adjustment, and enlisting the use of social resources after stroke were compared with routine medical and nursing care of stroke patients (n= 61) at a 440‐bed Veterans Administration Medical Center. The education intervention (n= 64) consisted of classroom instruction for caregivers about basic stroke care principles. The counseling condition (n= 63) consisted of education plus seven follow‐up problem‐solving sessions with a social worker (for the caregiver). Six months and 1 year after the stroke, both interventions significantly improved caregiver knowledge and stabilized some aspects of family function better than routine care. Counseling was consistently more effective than education alone and resulted in better patient adjustment at 1 year. Neither intervention influenced the use of social resources. (Stroke1988; 19:1243–1249)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID