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[PMID]:29247032
[Au] Autor:Miyazaki S; Watanabe T; Kajiyama T; Iwasawa J; Ichijo S; Nakamura H; Taniguchi H; Hirao K; Iesaka Y
[Ad] Endereço:From the Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki (S.M., T.W., T.K., J.I., S.I., H.N., H.T., Y.I.); and Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan (K.H.). mshinsuke@k3.dion.ne.jp.
[Ti] Título:Thromboembolic Risks of the Procedural Process in Second-Generation Cryoballoon Ablation Procedures: Analysis From Real-Time Transcranial Doppler Monitoring.
[So] Source:Circ Arrhythm Electrophysiol;10(12), 2017 Dec.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426-626). Left atrial access and Flexcath sheath insertion generated 25 (11-44) and 34 (24-53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 [81-157]), especially after balloon stretch/deflations (43 [21-81]). Pre- and post-pulmonary vein potential mapping with Lasso catheters generated 57 (21-88) and 61 (36-88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156-310) MESs. Touch-up ablation generated 32 (19-62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs. CONCLUSIONS: A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a high probability of gaseous emboli.
[Mh] Termos MeSH primário: Fibrilação Atrial/complicações
Fibrilação Atrial/cirurgia
Ablação por Cateter/métodos
Criocirurgia/métodos
Embolia Intracraniana/diagnóstico por imagem
Embolia Intracraniana/etiologia
Veias Pulmonares/cirurgia
Ultrassonografia Doppler Transcraniana
[Mh] Termos MeSH secundário: Fibrilação Atrial/fisiopatologia
Feminino
Fluoroscopia
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE


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[PMID]:28916665
[Au] Autor:Cui LL; Nitzsche F; Pryazhnikov E; Tibeykina M; Tolppanen L; Rytkönen J; Huhtala T; Mu JW; Khiroug L; Boltze J; Jolkkonen J
[Ad] Endereço:From the Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland (L.-l.C., J.-w.M., J.J.); Department of Cell Therapy, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany (F.N.); McGowan Institute for Regenerative Medicine, University of Pittsburgh
[Ti] Título:Integrin α4 Overexpression on Rat Mesenchymal Stem Cells Enhances Transmigration and Reduces Cerebral Embolism After Intracarotid Injection.
[So] Source:Stroke;48(10):2895-2900, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Very late antigen-4 (integrin α4ß1)/vascular cell adhesion molecule-1 mediates leukocyte trafficking and transendothelial migration after stroke. Mesenchymal stem cells (MSCs) typically express integrin ß1 but insufficient ITGA4 (integrin α4), which limits their homing after intravascular transplantation. We tested whether ITGA4 overexpression on MSCs increases cerebral homing after intracarotid transplantation and reduces MSC-borne cerebral embolism. METHODS: Rat MSCs were lentivirally transduced to overexpress ITGA4. In vitro transendothelial migration was assessed using a Boyden chamber assay. Male Wistar rats intracarotidly received 0.5×10 control or modified MSCs 24 hours after sham or stroke surgery. In vivo behavior of MSCs in the cerebral vasculature was observed by intravital microscopy and single-photon emission computed tomography for up to 72 hours. RESULTS: Transendothelial migration of ITGA4-overexpressing MSCs was increased in vitro. MSCs were passively entrapped in microvessels in vivo and occasionally formed large cell aggregates causing local blood flow interruptions. MSCs were rarely found in perivascular niches or parenchyma at 72 hours post-transplantation, but ITGA4 overexpression significantly decreased cell aggregation and ameliorated the evoked cerebral embolism in stroke rats. CONCLUSIONS: ITGA4 overexpression on MSCs enhances transendothelial migration in vitro, but not in vivo, although it improves safety after intracarotid transplantation into stroke rats.
[Mh] Termos MeSH primário: Integrina alfa4/administração & dosagem
Integrina alfa4/biossíntese
Embolia Intracraniana/terapia
Células Mesenquimais Estromais/metabolismo
Transplante de Células-Tronco/métodos
Migração Transendotelial e Transepitelial/fisiologia
[Mh] Termos MeSH secundário: Animais
Células Cultivadas
Expressão Gênica
Injeções Intra-Arteriais
Integrina alfa4/genética
Embolia Intracraniana/diagnóstico por imagem
Masculino
Ratos
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
143198-26-9 (Integrin alpha4)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170917
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017809


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[PMID]:28830976
[Au] Autor:Saber H; Yakoob MY; Shi P; Longstreth WT; Lemaitre RN; Siscovick D; Rexrode KM; Willett WC; Mozaffarian D
[Ad] Endereço:From the Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.); Department of Epidemiology (H.S., M.Y.Y., W.C.W.) and Department of Nutrition (W.C.W.), Harvard T.H. Chan School of Public Health, Boston, MA; Tufts Friedman School of Nutrition Science and Policy, Bosto
[Ti] Título:Omega-3 Fatty Acids and Incident Ischemic Stroke and Its Atherothrombotic and Cardioembolic Subtypes in 3 US Cohorts.
[So] Source:Stroke;48(10):2678-2685, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The associations of individual long-chain n-3 polyunsaturated fatty acids with incident ischemic stroke and its main subtypes are not well established. We aimed to investigate prospectively the relationship of circulating eicosapentaenoic acid, docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with risk of total ischemic, atherothrombotic, and cardioembolic stroke. METHODS: We measured circulating phospholipid fatty acids at baseline in 3 separate US cohorts: CHS (Cardiovascular Health Study), NHS (Nurses' Health Study), and HPFS (Health Professionals Follow-Up Study). Ischemic strokes were prospectively adjudicated and classified into atherothrombotic (large- and small-vessel infarctions) or cardioembolic by imaging studies and medical records. Risk according to fatty acid levels was assessed using Cox proportional hazards (CHS) or conditional logistic regression (NHS, HPFS) according to study design. Cohort findings were pooled using fixed-effects meta-analysis. RESULTS: A total of 953 incident ischemic strokes were identified (408 atherothrombotic, 256 cardioembolic, and 289 undetermined subtypes) during median follow-up of 11.2 years (CHS) and 8.3 years (pooled, NHS and HPFS). After multivariable adjustment, lower risk of total ischemic stroke was seen with higher DPA (highest versus lowest quartiles; pooled hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.58-0.92) and DHA (HR, 0.80; 95% CI, 0.64-1.00) but not eicosapentaenoic acid (HR, 0.94; 95% CI, 0.77-1.19). DHA was associated with lower risk of atherothrombotic stroke (HR, 0.53; 95% CI, 0.34-0.83) and DPA with lower risk of cardioembolic stroke (HR, 0.58; 95% CI, 0.37-0.92). Findings in each individual cohort were consistent with pooled results. CONCLUSIONS: In 3 large US cohorts, higher circulating levels of DHA were inversely associated with incident atherothrombotic stroke and DPA with cardioembolic stroke. These novel findings suggest differential pathways of benefit for DHA, DPA, and eicosapentaenoic acid.
[Mh] Termos MeSH primário: Isquemia Encefálica/sangue
Doenças Cardiovasculares/sangue
Ácidos Graxos Ômega-3/sangue
Embolia Intracraniana/sangue
Trombose Intracraniana/sangue
Acidente Vascular Cerebral/sangue
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Biomarcadores/sangue
Isquemia Encefálica/diagnóstico
Isquemia Encefálica/epidemiologia
Doenças Cardiovasculares/diagnóstico
Doenças Cardiovasculares/epidemiologia
Estudos de Casos e Controles
Estudos de Coortes
Feminino
Seguimentos
Seres Humanos
Incidência
Arteriosclerose Intracraniana/sangue
Arteriosclerose Intracraniana/diagnóstico
Arteriosclerose Intracraniana/epidemiologia
Embolia Intracraniana/diagnóstico
Embolia Intracraniana/epidemiologia
Trombose Intracraniana/diagnóstico
Trombose Intracraniana/epidemiologia
Masculino
Meia-Idade
Estudos Prospectivos
Distribuição Aleatória
Fatores de Risco
Acidente Vascular Cerebral/diagnóstico
Acidente Vascular Cerebral/epidemiologia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Biomarkers); 0 (Fatty Acids, Omega-3)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018235


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[PMID]:28818863
[Au] Autor:Takasugi J; Yamagami H; Noguchi T; Morita Y; Tanaka T; Okuno Y; Yasuda S; Toyoda K; Gon Y; Todo K; Sakaguchi M; Nagatsuka K
[Ad] Endereço:From the Departments of Neurology (J.T., H.Y., T.T., Y.O., K.N.), Cerebrovascular Medicine (K.T.), Cardiovascular Medicine (T.N., S.Y.), and Radiology (Y.M.), National Cerebral and Cardiovascular Center, Osaka, Japan; and Department of Neurology, Osaka University Graduate School of Medicine, Japan (
[Ti] Título:Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source.
[So] Source:Stroke;48(9):2434-2440, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: We aimed to use contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging to elucidate the prevalence of left ventricular (LV) thrombus in patients suspected of embolic stroke of undetermined source (ESUS) with previous myocardial infarction or LV dysfunction (LV ejection fraction [LVEF] <50%). METHODS: We prospectively investigated 797 consecutive patients who presented to our hospital with acute ischemic stroke between 2014 and 2015. Patients with myocardial infarction or LVEF<50% underwent CE-CMR imaging. ESUS was diagnosed according to proposal criteria based on transthoracic echocardiography findings. RESULTS: The prevalence of ESUS was 22% (178 of 797) on initial diagnosis. Among 60 patients with myocardial infarction or LVEF<50%, the stroke subtypes were as follows: small artery disease, 17% (10 of 60); large artery atherosclerosis, 5% (3 of 60); cardioembolic stroke, 49% (29 of 60); ESUS, 23% (14 of 60); and undetermined causes other than ESUS, 6% (4 of 60). Of 60 patients examined via CE-CMR, LV thrombus was confirmed in 12 patients, whereas only 1 had been detected on transthoracic echocardiography ( =0.04). Importantly, 29% (4 of 14) of patients with ESUS had LV thrombus. A prediction model based on CE-CMR findings showed higher performance in LV thrombus detection, permitting a net improvement of 0.46 (95% confidence interval, 0.08-0.82; =0.016) in cardioembolic stroke reclassification. Compared with patients without LV thrombus, those with LV thrombus had lower LVEF (median: 26% versus 40%; =0.003). Notably, 42% (5 of 12) of patients with LV thrombus had LVEF≥30%. CONCLUSIONS: When ESUS-suspected patients have myocardial infarction or LV dysfunction, CE-CMR may help improve detection of cardioembolic stroke and provide relevant information for anticoagulation therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02251665.
[Mh] Termos MeSH primário: Ventrículos do Coração/diagnóstico por imagem
Embolia Intracraniana/epidemiologia
Infarto do Miocárdio/epidemiologia
Acidente Vascular Cerebral/epidemiologia
Trombose/diagnóstico por imagem
Disfunção Ventricular Esquerda/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Meios de Contraste
Ecocardiografia
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Imagem Cinética por Ressonância Magnética
Masculino
Meia-Idade
Volume Sistólico
Trombose/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.018263


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[PMID]:28818260
[Au] Autor:Spence JD
[Ad] Endereço:Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, Ontario, Canada N6G 2V4. Electronic address: dspence@robarts.ca.
[Ti] Título:Transcranial Doppler monitoring for microemboli: a marker of a high-risk carotid plaque.
[So] Source:Semin Vasc Surg;30(1):62-66, 2017 Mar.
[Is] ISSN:1558-4518
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid. Even though the two most recent papers comparing carotid endarterectomy with CAS reported that the long-term risk (after first deducting periprocedural risks) is similar to that with medical therapy (approximately 0.5% per year), when the periprocedural risks are considered (approximately 3% with stenting v 1.5% with CAS), most patients would be better treated with intensive medical therapy. Furthermore, it must be recognized that the low risks observed in clinical trials with highly selected surgeons and interventionalists are much lower than in real-world practice. It is therefore necessary to have ways to identify, among patients with asymptomatic carotid stenosis, the few (approximately 10% to 15%) who could benefit from intervention. Indicators of vulnerable plaque, such as ulceration, juxtaluminal lucent plaque, intraplaque hemorrhage on magnetic resonance imaging, and plaque inflammation on positron emission tomography/computed tomography are in development for that purpose. The best-validated approach is detection of microemboli on transcranial Doppler. A prospective single-center study of 468 patients showed that microemboli identified high-risk asymptomatic stenosis; this was validated by a prospective multicenter international study in 467 patients. Increased risk with microemboli persisted in the era of lower risks with intensive medical therapy. Patients with asymptomatic carotid stenosis should not be offered CAS or carotid endarterectomy without first being identified as high risk; percent stenosis does not do so. Currently, the best way to improve the risk to benefit ratio for intervention is transcranial Doppler embolus detection.
[Mh] Termos MeSH primário: Artérias Carótidas/diagnóstico por imagem
Estenose das Carótidas/diagnóstico por imagem
Embolia Intracraniana/diagnóstico por imagem
Placa Aterosclerótica
Ultrassonografia Doppler Transcraniana
[Mh] Termos MeSH secundário: Angioplastia/instrumentação
Doenças Assintomáticas
Artérias Carótidas/patologia
Estenose das Carótidas/complicações
Estenose das Carótidas/patologia
Estenose das Carótidas/terapia
Progressão da Doença
Endarterectomia das Carótidas
Seres Humanos
Embolia Intracraniana/etiologia
Seleção de Pacientes
Valor Preditivo dos Testes
Prognóstico
Medição de Risco
Fatores de Risco
Ruptura Espontânea
Stents
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE


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[PMID]:28818256
[Au] Autor:Richards CN; Schneider PA
[Ad] Endereço:Division of Vascular Therapy, Kaiser Foundation Hospital and Department of Surgery, Tripler Army Medical Center, 3288 Moanalua Road, Honolulu, HI 96819.
[Ti] Título:Will mesh-covered stents help reduce stroke associated with carotid stent angioplasty?
[So] Source:Semin Vasc Surg;30(1):25-30, 2017 Mar.
[Is] ISSN:1558-4518
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur. It appears that this embolic risk can be reduced by use of specific carotid stent designs that include a mesh covering to minimize the open struts areas and thus embolization through the carotid stent. Improvements in stent design that eliminate post-procedural debris embolization will expand the application of CAS for severe internal carotid artery atherosclerotic stenosis.
[Mh] Termos MeSH primário: Angioplastia/instrumentação
Artéria Carótida Interna
Estenose das Carótidas/terapia
Dispositivos de Proteção Embólica
Embolia Intracraniana/prevenção & controle
Stents
Acidente Vascular Cerebral/prevenção & controle
Telas Cirúrgicas
[Mh] Termos MeSH secundário: Angioplastia/efeitos adversos
Estenose das Carótidas/complicações
Seres Humanos
Embolia Intracraniana/etiologia
Desenho de Prótese
Fatores de Proteção
Fatores de Risco
Índice de Gravidade de Doença
Acidente Vascular Cerebral/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE


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[PMID]:28720658
[Au] Autor:Amarenco P; Albers GW; Denison H; Easton JD; Evans SR; Held P; Hill MD; Jonasson J; Kasner SE; Ladenvall P; Minematsu K; Molina CA; Wang Y; Wong KSL; Johnston SC; SOCRATES Steering Committee and Investigators
[Ad] Endereço:From the Department of Neurology and Stroke Center, Bichat University Hospital and Paris-Diderot, Sorbonne University, Paris, France (P.A.); Stanford University Medical Center, Stanford Stroke Center, Palo Alto, CA (G.W.A.); AstraZeneca, Gothenburg, Sweden (H.D., P.H., J.J., P.L.); Department of Neu
[Ti] Título:Ticagrelor Versus Aspirin in Acute Embolic Stroke of Undetermined Source.
[So] Source:Stroke;48(9):2480-2487, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Ticagrelor is an effective antiplatelet therapy among patients with atherosclerotic disease and, therefore, could be more effective than aspirin in preventing recurrent stroke and cardiovascular events among patients with embolic stroke of unknown source (ESUS), which includes patients with ipsilateral stenosis <50% and aortic arch atherosclerosis. METHODS: We randomized 13 199 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2-90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2-90) within 24 hours of symptom onset. In all patients, investigators informed on the presence of ipsilateral stenosis ≥50%, small deep infarct <15 mm, and on cardiac source of embolism detected after enrollment or rare causes, which allowed to construct an ESUS category in all other patients with documented brain infarction. The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. RESULTS: ESUS was identified in 4329 (32.8%) patients. There was no treatment-by-ESUS category interaction ( =0.83). Hazard ratio in ESUS patients was 0.87 (95% confidence interval, 0.68-1.10; =0.24). However, hazard ratio was 0.51 (95% confidence interval, 0.29-0.90; =0.02) in ESUS patients with ipsilateral stenosis <50% or aortic arch atherosclerosis (n=961) and 0.98 (95% confidence interval, 0.76-1.27; =0.89) in the remaining ESUS patients (n=3368; for heterogeneity =0.04). CONCLUSIONS: In this post hoc, exploratory analysis, we found no treatment-by-ESUS category interaction. ESUS subgroups have heterogeneous response to treatment (Funded by AstraZeneca). CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.
[Mh] Termos MeSH primário: Adenosina/análogos & derivados
Aspirina/uso terapêutico
Embolia Intracraniana/tratamento farmacológico
Ataque Isquêmico Transitório/tratamento farmacológico
Inibidores da Agregação de Plaquetas/uso terapêutico
Acidente Vascular Cerebral/tratamento farmacológico
[Mh] Termos MeSH secundário: Adenosina/uso terapêutico
Idoso
Doenças da Aorta/epidemiologia
Aterosclerose/epidemiologia
Estenose das Carótidas/epidemiologia
Feminino
Seres Humanos
Embolia Intracraniana/epidemiologia
Masculino
Meia-Idade
Mortalidade
Infarto do Miocárdio/epidemiologia
Recidiva
Acidente Vascular Cerebral/epidemiologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Platelet Aggregation Inhibitors); GLH0314RVC (Ticagrelor); K72T3FS567 (Adenosine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017217


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[PMID]:28712815
[Au] Autor:Lal BK; Dux MC; Sikdar S; Goldstein C; Khan AA; Yokemick J; Zhao L
[Ad] Endereço:Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md. Electronic address: blal@som.umaryland.edu.
[Ti] Título:Asymptomatic carotid stenosis is associated with cognitive impairment.
[So] Source:J Vasc Surg;66(4):1083-1092, 2017 Oct.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cerebrovascular risk factors (eg, hypertension, coronary artery disease) and stroke can lead to vascular cognitive impairment. The Asymptomatic Carotid Stenosis and Cognitive Function study evaluated the isolated impact of asymptomatic carotid stenosis (no prior ipsilateral or contralateral stroke or transient ischemic attack) on cognitive function. Cerebrovascular hemodynamic and carotid plaque characteristics were analyzed to elucidate potential mechanisms affecting cognition. METHODS: There were 82 patients with ≥50% asymptomatic carotid stenosis and 62 controls without stenosis but matched for vascular comorbidities who underwent neurologic, National Institutes of Health Stroke Scale, and comprehensive neuropsychological examination. Overall cognitive function and five domain-specific scores were computed. Duplex ultrasound with Doppler waveform and B-mode imaging defined the degree of stenosis, least luminal diameter, plaque area, and plaque gray-scale median. Breath-holding index (BHI) and microembolization were measured using transcranial Doppler. We assessed cognitive differences between stenosis patients and control patients and of stenosis patients with low vs high BHI and correlated cognitive function with microembolic counts and plaque characteristics. RESULTS: Stenosis and control patients did not differ in vascular risk factors, education, estimated intelligence, or depressive symptoms. Stenosis patients had worse composite cognitive scores (P = .02; Cohen's d = 0.43) and domain-specific scores for learning/memory (P = .02; d = 0.42) and motor/processing speed (P = .01; d = 0.65), whereas scores for executive function were numerically lower (P = .08). Approximately 49.4% of all stenosis patients were impaired in at least two cognitive domains. Precisely 50% of stenosis patients demonstrated a reduced BHI. Stenosis patients with reduced BHI performed worse on the overall composite cognitive score (t = -2.1; P = .02; d = 0.53) and tests for learning/memory (t = -2.7; P = .01; d = 0.66). Cognitive function did not correlate with measures of plaque burden (degree of stenosis, least luminal diameter, and plaque area) or with plaque gray-scale median. CONCLUSIONS: Asymptomatic carotid stenosis is associated with cognitive impairment independent of known vascular risk factors for vascular cognitive impairment. Approximately 49.4% of these patients demonstrate impairment in at least two neuropsychological domains. The deficit is driven primarily by reduced motor/processing speed and learning/memory and is mild to moderate in severity. The mechanism for impairment is likely to be hemodynamic as evidenced by reduced cerebrovascular reserve and the likely result of hypoperfusion from a pressure drop across the stenosis in the presence of inadequate collateralization.
[Mh] Termos MeSH primário: Artérias Carótidas
Estenose das Carótidas/complicações
Transtornos Cognitivos/etiologia
Cognição
Embolia Intracraniana/etiologia
[Mh] Termos MeSH secundário: Idoso
Doenças Assintomáticas
Atenção
Artérias Carótidas/diagnóstico por imagem
Artérias Carótidas/fisiopatologia
Estenose das Carótidas/diagnóstico por imagem
Estenose das Carótidas/fisiopatologia
Estenose das Carótidas/psicologia
Estudos de Casos e Controles
Circulação Cerebrovascular
Transtornos Cognitivos/diagnóstico
Transtornos Cognitivos/fisiopatologia
Transtornos Cognitivos/psicologia
Função Executiva
Feminino
Seres Humanos
Embolia Intracraniana/diagnóstico por imagem
Embolia Intracraniana/fisiopatologia
Embolia Intracraniana/psicologia
Masculino
Memória
Meia-Idade
Atividade Motora
Exame Neurológico
Testes Neuropsicológicos
Placa Aterosclerótica
Estudos Prospectivos
Fatores de Risco
Índice de Gravidade de Doença
Ultrassonografia Doppler Dupla
Ultrassonografia Doppler Transcraniana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170718
[St] Status:MEDLINE


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[PMID]:28687720
[Au] Autor:Ntaios G; Lip GYH; Vemmos K; Koroboki E; Manios E; Vemmou A; Rodríguez-Campello A; Cuadrado-Godia E; Roquer J; Arnao V; Caso V; Paciaroni M; Diez-Tejedor E; Fuentes B; Pérez Lucas J; Arauz A; Ameriso SF; Pertierra L; Gómez-Schneider M; Hawkes MA; Bandini F; Chavarria Cano B; Iglesias Mohedano AM; García Pastor A; Gil-Núñez A; Putaala J; Tatlisumak T; Barboza MA; Athanasakis G; Gioulekas F; Makaritsis K; Papavasileiou V
[Ad] Endereço:From the Department of Medicine (G.N., G.A., K.M., V.P.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Institute of Cardiovascular Sciences (G.Y.H.L.), City Hospital, UK; Department of Clinical Therapeutics (K.V., E.K., E.M., A.V.
[Ti] Título:Age- and sex-specific analysis of patients with embolic stroke of undetermined source.
[So] Source:Neurology;89(6):532-539, 2017 Aug 08.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS). METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death. RESULTS: Ischemic stroke/TIA recurrences and deaths per 100 patient-years were 2.46 and 1.01 in patients <60 years old, 5.76 and 5.23 in patients 60 to 80 years old, 7.88 and 11.58 in those >80 years old, 3.53 and 3.48 in women, and 4.49 and 3.98 in men, respectively. Female sex was not associated with increased risk for recurrent ischemic stroke/TIA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84-1.58) or death (HR 1.35, 95% CI 0.97-1.86). Compared with the group <60 years old, the 60- to 80- and >80-year groups had higher 10-year cumulative probability of recurrent ischemic stroke/TIA (14.0%, 47.9%, and 37.0%, respectively, < 0.001) and death (6.4%, 40.6%, and 100%, respectively, < 0.001) and higher risk for recurrent ischemic stroke/TIA (HR 1.90, 95% CI 1.21-2.98 and HR 2.71, 95% CI 1.57-4.70, respectively) and death (HR 4.43, 95% CI 2.32-8.44 and HR 8.01, 95% CI 3.98-16.10, respectively). CONCLUSIONS: Age, but not sex, is a strong predictor of stroke recurrence and death in ESUS. The risk is ≈3- and 8-fold higher in patients >80 years compared with those <60 years of age, respectively. The age distribution in the ongoing ESUS trials may potentially influence their power to detect a significant treatment association.
[Mh] Termos MeSH primário: Isquemia Encefálica/epidemiologia
Embolia Intracraniana/epidemiologia
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Europa (Continente)
Feminino
Seguimentos
Seres Humanos
Estimativa de Kaplan-Meier
América Latina
Masculino
Meia-Idade
Análise Multivariada
Modelos de Riscos Proporcionais
Recidiva
Sistema de Registros
Fatores de Risco
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004199


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[PMID]:28658027
[Au] Autor:Bonow RH; Witt CE; Mosher BP; Mossa-Basha M; Vavilala MS; Rivara FP; Cuschieri J; Arbabi S; Chesnut RM
[Ad] Endereço:1Harborview Injury Prevention Research Center, University of Washington, Seattle, WA. 2Department of Neurological Surgery, University of Washington, Seattle, WA. 3Department of Surgery, University of Washington, Seattle, WA. 4University of Washington School of Medicine, Seattle, WA. 5Department of Radiology, University of Washington, Seattle, WA. 6Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 7Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, WA.
[Ti] Título:Transcranial Doppler Microemboli Monitoring for Stroke Risk Stratification in Blunt Cerebrovascular Injury.
[So] Source:Crit Care Med;45(10):e1011-e1017, 2017 Oct.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess whether microemboli burden, assessed noninvasively by bedside transcranial Doppler ultrasonography, correlates with risk of subsequent stroke greater than 24 hours after hospital arrival among patients with blunt cerebrovascular injury. The greater than 24-hour time frame provides a window for transcranial Doppler examinations and therapeutic interventions to prevent stroke. DESIGN: Retrospective cohort study. SETTING: Level I trauma center. PATIENTS: One thousand one hundred forty-six blunt cerebrovascular injury patients over 10 years. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 1,146 blunt cerebrovascular injury patients; 54 (4.7%) experienced stroke detected greater than 24 hours after arrival. Among those with isolated internal carotid artery injuries, five of nine with delayed stroke had positive transcranial Dopplers (at least one microembolus detected with transcranial Dopplers) before stroke, compared with 46 of 248 without (risk ratio, 5.05; 95% CI, 1.41-18.13). Stroke risk increased with the number of microemboli (adjusted risk ratio, 1.03/microembolus/hr; 95% CI, 1.01-1.05) and with persistently positive transcranial Dopplers over multiple days (risk ratio, 16.0; 95% CI, 2.00-127.93). Among patients who sustained an internal carotid artery injury with or without additional vessel injuries, positive transcranial Dopplers predicted stroke after adjusting for ipsilateral and contralateral internal carotid artery injury grade (adjusted risk ratio, 2.91; 95% CI, 1.42-5.97). No patients with isolated vertebral artery injuries had positive transcranial Dopplers before stroke, and positive transcranial Dopplers were not associated with delayed stroke among patients who sustained a vertebral artery injury with or without additional vessel injuries (risk ratio, 0.90; 95% CI, 0.21-3.83). CONCLUSIONS: Microemboli burden is associated with higher risk of stroke due to internal carotid artery injuries, but monitoring was not useful for vertebral artery injuries.
[Mh] Termos MeSH primário: Lesões das Artérias Carótidas/complicações
Embolia Intracraniana/diagnóstico por imagem
Acidente Vascular Cerebral/diagnóstico por imagem
Ultrassonografia Doppler Transcraniana
Artéria Vertebral/lesões
Ferimentos não Penetrantes/complicações
[Mh] Termos MeSH secundário: Adulto
Lesões das Artérias Carótidas/diagnóstico por imagem
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Meia-Idade
Sistemas Automatizados de Assistência Junto ao Leito
Estudos Retrospectivos
Medição de Risco
Acidente Vascular Cerebral/etiologia
Artéria Vertebral/diagnóstico por imagem
Ferimentos não Penetrantes/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002549



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