Stroke; a journal of cerebral circulation
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Clinical Trial Controlled Clinical Trial
Transcranial Doppler and near-infrared spectroscopy can evaluate the hemodynamic effect of carotid artery occlusion.
Cerebral hemodynamic and metabolic changes can compensate for the decrease in cerebral blood flow occurring in patients with carotid occlusive disease. At present, a complete assessment of the cerebral adaptive status is only possible with positron-emission tomography. Near-infrared spectroscopy (NIRS) is a noninvasive technique that, providing a real time assessment of fluctuations in cerebral hemoglobin, has been used to estimate the cerebral blood volume and to measure cerebral vasomotor reactivity (VMR). Moreover, NIRS technology, by allowing the absolute measurement of absorption and scattering coefficients of brain, can determine the oxyhemoglobin and deoxyhemoglobin concentrations in situ in the blood stream. ⋯ The opportunity to perform NIRS and TCD simultaneously provides useful information about both hemodynamic and metabolic cerebral adaptive status in patients with occlusive disease in a simple, noninvasive, and reliable way.
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Clinical Trial Controlled Clinical Trial
Direction of flow in posterior communicating artery on magnetic resonance angiography in patients with occipital lobe infarcts.
In some people the blood supply to the posterior cerebral artery occurs partly or even exclusively via the carotid system. This anatomic configuration may influence the risk of occipital lobe infarction. We studied the presence and direction of flow in the posterior communicating artery (PCoA) in patients with an occipital lobe infarct and in healthy controls. ⋯ Supply of the posterior cerebral artery by the carotid system occurs less often in patients with an occipital lobe infarct than in healthy controls. The same was true for the unaffected hemisphere of patients, which suggests that the anatomic difference represents a causal factor (fewer collateral pathways after occlusion of the posterior cerebral artery or its branches) rather than a consequence (redistribution of blood flow after occipital infarction).
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The present study was performed to determine whether antisense inhibition of intercellular adhesion molecule-1 (ICAM-1) protein expression decreases focal ischemic brain damage. ⋯ Increased ICAM-1 expression is implicated in the pathogenesis of focal ischemia since ICAM-1 protein knockdown decreased ischemic brain damage. The mechanism by which ICAM-1 inhibition offers neuroprotection is independent of blood pressure modulation.
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Multicenter Study Clinical Trial
Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator.
Although early recanalization is a powerful predictor of stroke outcome after thrombolysis, some stroke patients remain disabled despite tissue plasminogen activator (tPA)-induced recanalization. Therefore, we sought to investigate whether the predictive accuracy of early recanalization on stroke outcome is improved when combined with clinical and radiological information. ⋯ The combination of clinical, radiological, and hemodynamic information predicts with a high accuracy long-term stroke outcome during or shortly after intravenous tPA administration.
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Clinical Trial
Detection of reversed basilar flow with power-motion Doppler after acute occlusion predicts favorable outcome.
Power-motion transcranial Doppler PMD-TCD is a new method for simultaneous display of flow at multiple depths. We aimed to determine clinical significance of PMD-TCD demonstration of reversed basilar flow in patients with basilar artery (BA) occlusion. ⋯ Detection of reversed flow in the distal BA with PMD-TCD is associated with lower stroke severity and better outcome after acute basilar artery occlusion.