Trials of IV recombinant tissue plasminogen activator (rt-PA) have demonstrated that longer times from ischemic stroke symptom onset to initiation of treatment are associated with progressively lower likelihoods of clinical benefit, and likely no benefit beyond 4.5 hours. How the timing of IV rt-PA initiation relates to timing of restoration ...

To evaluate early and late results of carotid endarterectomy (CEA) in female patients in a large single center experience. Over a 12-year period ending in December 2007, 4009 consecutive primary and secondary CEAs in 3324 patients were performed at our institution. All patients were prospectively enrolled in a dedicated database ...

BACKGROUND AND PURPOSE: The purpose of this study was to compare the long-term effect of five daily sessions of 1 vs. 3 Hz repetitive transcranial magnetic stimulation (rTMS) on motor recovery in acute stroke. METHODS: A total of 36 patients with acute ischaemic stroke participated in the study. The patients ...

BACKGROUND AND PURPOSE: Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. METHODS: Consecutive patients with two different indications were included. ...

BACKGROUND AND PURPOSE: We aimed to delineate prognostic variables in Israeli patients with anterior circulation strokes treated with endovascular multi-modal reperfusion therapy (MMRT). METHODS: Clinical and radiological data from consecutive tpa-ineligible stroke patients with large anterior circulation infarcts involving either the entire internal carotid artery or the proximal middle cerebral ...

BACKGROUND: We evaluated retrospectively early and midterm results of conventional redo surgery and carotid stent-assisted angioplasty (CAS) in the treatment of carotis restenosis (CR) after carotid endarterectomy (CEA). METHODS: From January 1989 to April 2007, 79 consecutive patients (61 male, median age 65 years, range 51-82) were treated for CR. ...

BACKGROUND: We analyzed the risk of adverse events following carotid angioplasty and stenting (CAS) in patients <80 years (group I) compared with those > or = 80 years of age (group II). METHODS: Prospective data from 224 patients who underwent 235 consecutive CAS procedures at three participating institutions were reviewed ...

BACKGROUND: Although ultrasound-activated microbubbles (MB) accelerate clot lysis, MB activation has shown to promote blood barrier disruption and bleeding in animal models. We conducted a case-control study aimed to investigate the risk of hemorrhagic transformation (HT) after MB-enhanced sonothrombolysis in acute stroke. METHODS: We evaluated a total of 296 patients ...

BACKGROUND: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard of care for symptomatic and asymptomatic extracranial carotid stenosis. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients; however, long-term follow-up of this technique has not been reported. ...

BACKGROUND AND OBJECTIVE: Botulinum toxin type A (BtxA) injection and modified constraint-induced movement therapy (mCIMT) are both promising approaches to enhance recovery after stroke. The combined application of these 2 promising modalities has rarely been studied. The aim was to investigate whether combined BtxA and mCIMT would improve spasticity and ...

BACKGROUND: In several animal studies of young and aged rats with ischemic stroke, treatment with sildenafil improved functional outcomes compared with placebo. We conducted a safety study of sildenafil (25 mg daily for 2 weeks) shortly after ischemic stroke onset. METHODS: We recruited patients aged 18 to 80 years with ...

BACKGROUND: The Joint Commission (JC) certifies primary stroke centers in the United States. Whether certification promotes enrollment of study subjects into stroke research studies is not known. We examined whether enrollment performance of centers was related to JC certification status. METHODS: The 51 US Siblings with Ischemic Stroke Study (SWISS) ...

The role of a patent foramen ovale (PFO) as a risk factor for ischemic stroke has been established in recent years. However, the best therapeutic option to prevent recurrent events is still controversial, with antithrombotic treatment or transcatheter PFO closure being favored by different clinicians. Also, associated conditions that may ...

Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular ...

: The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery ...

The abrupt occurrence of a devastating stroke has been referred to as "super death." It has long been realized that ischemic cerebral vascular disease may become symptomatic with a wide variety of clinical patterns. A robust circle of Willis has been recognized for its major protective function in many cases. ...

INTRODUCTION: Systemic and local intra-arterial thrombolysis in patients with large vessel ischaemic stroke is hampered by poor re-canalisation rates and risk of haemorrhage. The Merci Retrieval System is an endovascular device for removal of acute intracranial thrombus. We present our initial experience using this device in conjunction with existing thrombolytic ...

BACKGROUND: Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). METHODS: Between March, 1992, ...

BACKGROUND: In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of ...

BACKGROUND AND PURPOSE: Intravenous (IV) thrombolysis often fails to achieve recanalization of occluded cerebral arteries, especially in patients with proximal large arterial occlusions. The goal of this study was to assess the feasibility, safety, and efficacy of low-dose intra-arterial (IA) urokinase and aggressive mechanical clot disruption (AMCD) after failure of ...

Carotid artery stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in high-risk surgical patients, including stenosis after CEA. This study compared early and midterm clinical outcomes for primary CAS vs CAS for post-CEA stenosis. This study analyzed 180 high-risk surgical patients: 68 had primary CAS (group ...

BACKGROUND AND PURPOSE: Data on patient-specific recovery after stroke are lacking and the effects of complex healthcare interventions on the course of recovery were not reported. To quantify the recovery pattern up to 1 year post-stroke and assess effects of evidence-based treatments on the patient-specific course of recovery allowing its ...

OBJECTIVE: Although there is evidence for short term benefits of rTMS in stroke, longer term effects have not been reported. The aim of the study was to evaluate the effect of two different frequencies of rTMS on motor recovery and on cortical excitability up to 1 year post-treatment. METHODS: Forty-eight ...

BACKGROUND: Conventional treatment of stenosis at the common carotid artery origin has involved extra-anatomic bypass using an open cervical approach or median sternotomy. The goal of this study is to determine the procedural feasibility and safety of angioplasty and stenting at the common carotid origin as a less invasive alternative. ...

Reduced maximal hyoid excursion has been suspected as one of the primary physiologic causes of aspiration after a stroke. Vertical and anterior displacement of hyoid excursion is critical to epiglottic closure for airway protection and the opening of the upper esophageal sphincter (UES). Without these carefully timed and well-executed components, ...

There are still some vascular surgeons who do not use carotid patching routinely in all patients undergoing CEA, however, based on the data presented in this review, there is Level 1 evidence to support the routine use of carotid patching. Meanwhile, there is no Level 1 evidence to support selective ...

PURPOSE: To examine the 4-year outcomes from Carotid Revascularization using Endarterectomy or Stenting Systems (CaRESS) in light of the current reimbursement guidelines for carotid artery stenting (CAS) from the Centers for Medicare and Medicaid Services (CMS). METHODS:CaRESS was designed as a prospective, nonrandomized comparative cohort study of a broad-risk population ...

BACKGROUND: This retrospective study determined whether leukoaraiosis and hippocampal atrophy seen in preoperative magnetic resonance imaging (MRI) predict neurologic outcome after total aortic arch replacement. METHODS: From August 2001 to November 2007, 131 consecutive patients (22% women) who underwent elective total arch replacement with selective cerebral perfusion were enrolled. Mean ...

PURPOSE:To compare through a systematic review of published literature the stroke outcomes in protected and unprotected carotid artery stenting (CAS). METHODS:PubMed and Cochrane electronic databases were queried to identify peer-reviewed publications from 1995 to 2007 meeting our pre-defined criteria for inclusion (English language, human only, at least 20 patients reported) ...

Approximately 25% of patients with carotid artery stenosis treated with carotid endarterectomy develop cognitive dysfunction (CD) between 1 day and 1 month after surgery compared with a control group. We hypothesized that patients with carotid artery stenosis treated with carotid artery stenting (CAS) performed under cerebral embolic protection also develop ...

BACKGROUND: Fluid management guided by oesophageal Doppler monitor has been reported to improve perioperative outcome. Stroke volume variation (SVV) is considered a reliable clinical predictor of fluid responsiveness. Consequently, the aim of the present trial was to evaluate the accuracy of SVV determined by arterial pulse contour (APCO) analysis, using ...

The General Anesthesia vs. Local Anesthesia for Carotid Surgery (GALA) trial did not show a difference in 30-day postoperative stroke, myocardial infarction and death rates between patients undergoing carotid endarterectomy (CEA) under local vs. general anesthesia. The present article discusses some limitations of the GALA trial. Firstly, the expected stroke ...

BACKGROUND AND PURPOSE: This is a retrospective review of patients who underwent endovascular recanalization > or = 8 hours after acute ischemic stroke symptom onset, including wake-up strokes, between June 2005 and June 2008. METHODS: Thirty patients with a premorbid modified Rankin score < or = 1 and NIHSS between ...

BACKGROUND: admission hyperglycaemia (HG) is associated with worse prognosis and higher mortality within 3 months after stroke. Reports on long-term mortality are inconsistent. OBJECTIVE: to evaluate the influence of admission HG [blood glucose (BG) levels >8 mmol/L] on long-term mortality after ischaemic stroke (IS) and transient ischaemic attack (TIA). METHODS: ...

This study compared transcranial Doppler (TCD) imaging and outcomes of carotid angioplasty and stenting (CAS) in stenosis after carotid endarterectomy (CEA) vs primary atherosclerotic stenoses. A prospectively accumulated database of 812 CAS procedures was analyzed retrospectively. Two groups were created. Group 1 had 72 restenoses at a mean of 71 ...

BACKGROUND: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in ...

INTRODUCTION: Stroke is a debilitating complication of cardiac surgery. Many intraoperative and postoperative factors predict the likelihood of post-cardiac surgery stroke. We evaluated preoperative parameters, seeking correlations with adverse neurological outcome following cardiac surgery. We investigated the possibility of preoperative carotid ultrasonography to select patients for carotid endarterectomy pre- or ...

BACKGROUND: The aim of this study was to compare the influence of either general (GA) or local (LA) anesthesia on the postoperative neurocognitive outcome in patients undergoing carotid endarterectomy (CEA) in a randomized study. Therefore, we performed a subgroup analysis of the multicenter GALA study. METHODS: A total of 40 ...

BACKGROUND AND AIM: We sought to study the frequency and predictors of stroke in tuberculous meningitis (TBM) and its prognostic significance. DESIGN: This was an observational study in a tertiary care teaching hospital. METHODS: In all, 122 patients with TBM aged 4 to 82 years diagnosed on the basis of ...

BACKGROUND: The retrojugular approach is promoted as an alternative to traditional antejugular carotid endarterectomy. Absence of named posterior venous branches and ease of distal internal carotid dissection reduce time for carotid exposure together with improved distal exposure. However, a higher incidence of local nerve injury and persistent hoarse voice has ...

To determine the prevalence, risk factors, and the clinical outcome of patients undergone coronary artery bypass grafting who progressed with Acute Renal Failure (ARF). A retrospective cohort prospective study was performed from data of 186 patients undergone surgery from January 2003 through June 2006. The stored data were analyzed using ...

OBJECTIVE: To investigate the outcomes of magnetic resonance imaging (MRI)-based thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute middle cerebral artery (MCA) occlusion in 3-6 hours. MATERIALS AND METHODS: MRI-selected patients (n=15) with acute ischemic stroke in MCA divided into two groups (<or=3 h and 3-6 h) ...

BACKGROUND AND PURPOSE: The intravenous t-PA thrombolysis is not thought to be effective in most patients with internal carotid artery (ICA) occlusion. However, we have sometimes observed dramatic recovery in patients with ICA occlusion after t-PA therapy. The aim of the present study was to investigate the mechanism of dramatic ...

We report the 5-year experience with thrombolysis in acute ischemic stroke from a tertiary care hospital in the Malabar region of South India. All stroke patients thrombolyzed with intravenous recombinant tissue plasminogen activator (rt-PA) from May 2003 to May 2008 were studied in an open, non-randomized, prospective study. Of 2,308 ...

BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy for preventing recurrent stroke is maximal when surgery is performed within 2 weeks after ischemic stroke or transient ischemic attack; the benefit is reduced when surgery is delayed >2 weeks and essentially lost if delayed >3 months. Guidelines recommend endarterectomy within 2 ...

Endothelial dysfunction and vascular inflammation may be associated with variant angina (VA). Flow-mediated vasodilation (FMD), carotid artery intima-media thickness (IMT), and pulse wave velocity (PWV) are widely used as non-invasive modalities for evaluating atherosclerosis. A total of 254 patients with chest pain were divided into three groups according to coronary ...

In patients with severe carotid artery stenosis, cognitive decline and changes in cognitive function before to after treatment have been noted, though the true effects of treatment in such patients remain unclear. A convenient and repeatable neuropsychological test battery is needed for such patients. In 26 patients with severe carotid ...

BACKGROUND: Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region. METHODS: We prospectively collected data of 116 ...

OBJECTIVE: To determine whether there are non-motor regions of cerebellum in which sizeable infarcts have little or no impact on motor control. EXPERIMENTAL PROCEDURES: We evaluated motor deficits in patients following cerebellar stroke using a modified version of the International Cooperative Ataxia Rating Scale (MICARS). Lesion location was determined using ...

PURPOSE: The purpose of the study is to investigate the embolic potential as well as ultrasonic characteristics of plaques in patients presenting with severe unilateral restenosis at least 1 year after carotid endarterectomy (CEA), compared with patients with severe unilateral primary carotid stenosis. METHODS: We used transcranial Doppler (TCD) to ...