Cerebrovascular diseases
-
Cerebrovascular diseases · Jan 2008
Review Historical ArticleIs counterpulsation a potential therapy for ischemic stroke?
Despite the rapid progress in stroke prevention, effective acute stroke treatment except for thrombolysis is still lacking. Hypoperfusion is related to unfavorable functional outcome, further strokes and long-term mortality. Therefore, the need for a safe and effective way of increasing the cerebral blood flow seems obvious. Currently, there is a growing body of evidence to suggest that external counterpulsation (ECP) may enhance the blood supply to the brain and thus may be beneficial to patients with ischemic stroke. ⋯ Randomized-controlled trials with a large sample size are needed to further define the efficacy and safety of ECP in acute stroke management. Future studies should provide insight into the value of ECP in ischemic stroke as well as its possible mechanisms.
-
Cerebrovascular diseases · Jan 2008
Comparative StudyMajor vascular events after transient ischaemic attack and minor ischaemic stroke: post hoc modelling of incidence dynamics.
Only few follow-up studies have compared the long-term risk of such major vascular events (MVE) as myocardial infarction (MI) and/or stroke following transient ischaemic attack (TIA) or minor ischaemic stroke (MIS). Estimates of relative risk and cumulative long-term occurrence of MVE may provide better information and contribute to the optimization of treatment decisions. ⋯ The age- and sex-adjusted cumulative 36-month hazard of MVE is higher after MIS than after TIA, but MVE fatality was higher after TIA than after MIS. Although stroke incidence was higher (up to 3 times that of MI), with the highest difference between months 8 and 18, MI fatality was always higher in absolute, relative or adjusted terms. The above alarming patterns and increasing, diverging tendencies for MVE indicate a higher long-term cumulative risk after MIS compared with TIA. These results confirm our hypothesis of a differential risk of TIA versus MIS and, at least, point toward equal importance of therapies aimed at preventing MVE in both types of preceding conditions (TIA or MIS) and the increased fatality after MI, in particular in patients with TIA.
-
Cerebrovascular diseases · Jan 2008
Comparative Study Controlled Clinical TrialDiagnosing cerebral collateral flow patterns: accuracy of non-invasive testing.
With routine use of non-invasive methods to assess the internal carotid artery, it becomes increasingly important to clarify the diagnostic accuracy of transcranial Doppler (TCD) ultrasound and magnetic resonance angiography (MRA) compared with intra-arterial digital subtraction angiography (iaDSA) for the detection of collateral flow via the major intracerebral collateral branches. ⋯ As compared with iaDSA, combined MRA and TCD has a moderate to good diagnostic value for the examination of intracranial collateral flow in patients with symptomatic carotid occlusion.
-
Cerebrovascular diseases · Jan 2008
Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome.
Serious cardiac arrhythmias have been described in approximately 5% of patients after subarachnoid hemorrhage (SAH). The aim of this study was to identify the frequency, risk factors and clinical impact of cardiac arrhythmia after SAH. ⋯ Clinically important arrhythmias, most often atrial fibrillation or flutter, occurred in 4% of SAH patients. Arrhythmias are associated with an increased risk of cardiovascular comorbidity, prolonged hospital stay and poor outcome or death after SAH, after adjusting for other predictors of poor outcome.
-
Cerebrovascular diseases · Jan 2008
Comparative StudyDisplay of dural sinuses with time-resolved, contrast-enhanced three-dimensional MR venography.
Time-resolved (TR) contrast-enhanced 3D MR angiography has recently received considerable attention for the workup of cerebrovascular diseases, foremost dural arteriovenous fistula and arteriovenous malformation, and potentially for the evaluation of dural sinus thrombosis. Thereby, the dynamic visualization of cerebral vessels is enabled similar to the principle of digital subtraction angiography. Yet, its voxel size is relatively large due to an inherent trade-off between the desired spatial and temporal resolutions. The goal of this study was to evaluate whether the limited spatial resolution of TR MR venography (MRV) is sufficient to visualize dural venous sinuses. ⋯ Despite the inferior spatial resolution, TR MRV depicted some large dural sinuses more clearly than TOF MRV. To overcome the visualization of smaller venous structures, TR MRV can be applied complementarily with high-resolution steady-state contrast-enhanced MRV.