Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2007
ReviewCurrent status of carotid endarterectomy and stenting for symptomatic carotid stenosis.
There is still considerable uncertainty about the place of carotid stenting in patients with recently symptomatic carotid bifurcation stenosis. Most reviews of carotid endarterectomy versus carotid stenting concentrate on technical aspects and advances in stenting, but the techniques involved in both carotid endarterectomy and stenting are evolving. In addition to reviewing the results of the various randomised controlled trials of carotid endarterectomy versus stenting for symptomatic carotid stenosis, this review considers recent advances and current best practice for endarterectomy. Ongoing randomized trials will determine whether or not the procedural risk of stroke and death is definitely lower with endarterectomy than with stenting, but the key issue that remains to be determined reliably is how the procedural risks of stenting vary with patient characteristics - perhaps the most important question being not whether endarterectomy is better than stenting or vice versa, but for whom is one technique likely to be better than the other.
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Brain stimulation techniques provide a powerful means to modulate the function of specific neural structures, and show potential for future applications in the rehabilitation of stroke patients. Recent studies have started to translate to the bedside the body of data gathered over the last few years on mechanisms underlying brain plasticity and stroke recovery. ⋯ Nonetheless, we are still at an early stage in the field and further evidence is needed to assess the clinical impact of this new approach. In this review, we provide readers with a basic introduction to the field, summarize preliminary studies and discuss future directions.
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Cerebrovascular diseases · Jan 2007
Review Biography Historical ArticleChances and battles in stroke research.
Here I have reviewed how good luck, bad luck and barriers determined my research directions in stroke over the last 30 or so years. Good luck should be exploited, and very often barriers can be not just overcome but put to good use as well. It is crucial for the young researcher to find mentors as good as I have had, and to move around to gain a broad experience, and for the experienced researchers to bring on the younger generation as I have tried to do.
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Ischemia-modified albumin (IMA)is a new biological marker of ischemia. Previous studies have found increased serum IMA levels after myocardial ischemia, but no study has investigated the possibility that stroke modifies IMA blood levels. ⋯ IMA blood levels may be a biomarker for early identification of acute stroke. Further studies are required to investigate the role of IMA in the early detection of acute stroke.
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Cerebrovascular diseases · Jan 2007
Comparative StudyDevelopment of a conversion factor to facilitate comparison of National Institute of Health Stroke Scale scores with Scandinavian Stroke Scale scores.
The National Institute of Health Stroke Scale (NIHSS) and the Scandinavian Stroke Scale (SSS) are commonly used in clinical stroke trials. Use of different scales in trials makes comparison of outcomes difficult. ⋯ A total of 144 patients were included (46% males, mean age = 73 years). At presentation the median SSS score was 38 (2-58), and a week later 40 (4-58), the median NIHSS score at presentation was 5 (0-29) and a week later 3 (0-27). Changes in both scales were strongly correlated, r = 0.76, p < 0.001. Both were good predictors of mortality. Linear regression analysis produced an equation relating the two: SSS = 50 - 2 x NIHSS.