ISSN:1015-9770    

DOI:10.1159/000108542

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Noninvasive methods for the diagnosis of large artery disease include ultrasound and magnetic resonance tests. The combined use of magnetic resonance angiography and duplex sonography, which are becoming increasingly available, promises to reduce the number of necessary conventional angiographies. Three examples considering important issues of cerebrovascular diseases demonstrate this hypothesis.

ISSN:1015-9770    

DOI:10.1159/000108543

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Atherosclerotic lesions are responsible for about 10% of ischemic strokes. However, the evolving thrombotic and embolic potential of these lesions remains difficult to evaluate. Pathology studies and ultrasonography have contributed to the study of the complications of atherosclerotic plaques at the origin of the internal carotid artery (hemorrhage, ulceration, necrosis, and the degree of stenosis). Moreover, improvement of ultrasound examination of intracranial arteries allows the detection of emboli which could be markers of ulceration. Considering pathologic, angiographic, ultrasonographic and clinical studies, only tight stenoses have been shown to have a high thromboembolic potential. The risk is further increased when the stenosis is ulcerated, progressive, has an intraluminal thrombus, or when it is the source of emboli detected by transcranial Doppler. Apart from this stroke risk, an increased general risk of vascular mortality and heart morbidity is present in this population. Increased intima plus media thickness of the common carotid artery, quantified by B-mode sonography, has been shown to be a good predictor of ischemic events. Further improvements in noninvasive methods will more precisely define the evolution of atherosclerotic plaques and their link with the risk of stroke, especially for low-degree stenosis.

ISSN:1015-9770    

DOI:10.1159/000108544

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The clinical markers for carotid endarterectomy (CE) have traditionally been transient ischemic attack (TIA) or minor stroke. Whether CE should be restricted to this symptomatic category of carotid stenosis has become a public health issue, particularly in recent years when cost-effectiveness has become such a major consideration. With rare exceptions, all patients, whether they have had a TIA or nondisabling infarction, are asymptomatic at the time of CE. Therefore, how long after such an event a patient should be termed symptomatic is not a theoretical issue because, traditionally, once a TIA has occurred, the patient is classified as symptomatic no matter how much time has elapsed. CE is safer for truly asymptomatic patients with carotid stenosis because they are usually younger, have fewer associated risk factors, and the artery in these patients may be a better tissue for surgical repair. Whether asymptomatic patients with carotid stenosis should be treated only medically with risk factor reduction and antiplatelet agents or with CE as well has been addressed only partially. The US Veterans Administration Trial demonstrated a statistically significant reduction in the occurrence of combined end points of TIA, infarction and vascular death but not for stroke alone. The CASANOVA Trial was flawed and cannot be used. The Asymptomatic Carotid Atherosclerosis Study closed case acquisition at 1,662 patients in December 1993, and will provide definitive answers to this very important question.

ISSN:1015-9770    

DOI:10.1159/000108545

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108546

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The effort to develop therapies that improve outcome after acute ischemic stroke should bear fruit in the near future. The availability of effective, safe and economical neuroprotectants as a spin-off from this effort will lead to the evaluation of prophylactic neuroprotection in selectively targeted populations. We propose three types of prophylactic neuroprotection and patient groups that might be evaluated in appropriate clinical trials. We anticipate the identification of other patient groups and more effective neuroprotectants. The medical community which directs its efforts at stroke prevention and acute therapy will have to consider and evaluate prophylactic neuroprotection along with the other two therapeutic approaches of prevention and acute therapy. This prophylactic-neuroprotection hypothesis should be testable in the near future. We welcome further debate and suggestions.

ISSN:1015-9770    

DOI:10.1159/000108547

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Antiplatelet agents have been studied extensively in clinical stroke prevention trials for 25 years. Only two have proven effective, aspirin and ticlopidine. Current data suggest that antiplatelets have a limited role in the primary prevention of stroke, and that ticlopidine is superior to aspirin in most settings. Ticlopidine may have special advantages in women, aspirin failure and in patients with vertebrobasilar insufficiency, hypertension and diabetes. Many unanswered questions require further study.

ISSN:1015-9770    

DOI:10.1159/000108548

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

About 15–25% of all ischemic strokes are attributed to cardiogenic emboli, and the majority are associated with atrial fibrillation. In valvular heart disease including prosthetic heart valves, anticoagulation is of proven benefit and addition of low-dose aspirin further improves the antithrombotic effect. Following acute myocardial infarction, aspirin or anticoagulation reduce the risk of cerebrovascular events. In nonvalvular atrial fibrillation (NVAF), pooled analysis of data from randomized trials of anticoagulation confirmed a risk reduction for ischemic stroke of 68% corresponding to avoidance of 3.1 strokes per 100 patient years in both sexes, and 4.9 in women. In patients younger than 65 years without risk factors, the rate of stroke was about 1% per year with no effect of antithrombotic therapy. In older patients and in patients with risk factors, the rate of stroke ranged from 4 to 8% per year, and anticoagulation provided a significant protective effect. Aspirin, when tested, reduced the risk by 36% (p < 0.001). Secondary prevention in NVAF with anticoagulation resulted in a similar risk reduction to primary prevention with avoidance of about 8 strokes per 100 patient years. Aspirin resulted in avoidance of about 2 strokes per 100 patient year

ISSN:1015-9770    

DOI:10.1159/000108569

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108570

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108571

出版商:S. Karger AG    

年代:1994

数据来源: Karger