Cerebrovascular Diseases

BEJING -- The degree of stenosis does not affect outcomes in elective stenting of intracranial arteries, but the procedure should probably be reserved for major lesions, researchers here reported.

SEATTLE -- Fine-particulate air pollution over time significantly increased the risk of a first heart attack or stroke, as well as cardiac mortality, in postmenopausal women, researchers here reported.

DALLAS -- Serious symptoms of sickle cell disease in childhood don't imply a greater risk of premature stroke or death for patients as they grow up, according to researchers here.

BETHESDA, Md. -- Nearly three million Americans are living after a stroke, reported government researchers. There are more than two million patients with epilepsy, and migraine affects more than 35 million lives.

SOUTH SAN FRANCISCO -- The 0.5 mg dose of Lucentis (ranibizumab injection), the targeted therapy for neovascular age-related macular degeneration, is associated with a significantly higher risk of stroke than the 0.3 mg dose (P=0.02), according to Genentech.

SAN FRANCISCO -- A new prognostic tool called ABCD2 for predicting the early risk of a major stroke after a transient ischemic attack (TIA) may help physicians determine which patients need emergency care, researchers said.

BETHESDA, Md. -- MRI is better than CT for detecting acute strokes of any kind, and should be the diagnostic imager of choice in the ER, according to NIH researchers.

STOCKHOLM -- Activase (alteplase), the thrombolytic agent, appears as safe in real-world use for acute stroke as it was in the clinical trials that led regulators to okay it, according to a large European study.

KANSAS CITY, Kan. -- When carotid endarterectomies and coronary artery bypass grafts are combined, the risk of postoperative stroke or death rises by nearly 40% over CABG alone, investigators here reported.

HOUSTON -- Running counter to the 97-year old patient's expressed wishes, surgeons here repaired a dissecting aortic aneurysm in Michael DeBakey, M.D., the legendary heart surgeon. The case stimulated questions about patients' rights, end-of-life care, and costs.

Lately I have heard that "tissue ACE" properties are important in endothelial remodelingand in the prevention of myocardial infarction and stroke.

Each year about 700,000 Americans suffer a stroke. It is the third leading cause of deathin the United States, ranking behind heart disease and cancer.1 For survivors, stroke canresult in serious, long-term disability.

What is the risk of dementia in patients who have had an ischemic stroke?

In his "Consultations & Comments" response to a reader’scomments about statins and cancer risk in elderly patients(CONSULTANT, October 2003, page 1389), Dr David Nashnotes that the increased number of deaths from cancer thatoccurred in the second year of the Pravastatin in Elderly Individualsat Risk of Vascular Disease (PROSPER) study canprobably be attributed to disease that was already present beforethe start of the trial.

What is the recommended treatment of a patient who has anasymptomatic splenic aneurysm that is 4 cm in diameter?

On her eighth day in the hospital for acute pulmonaryembolism, an 88-year-old woman complains of nauseaand abdominal pain and fullness of 12 hours’ duration.The pain is localized to the mid epigastric area and radiatesinto the right lower quadrant. The patient deniesvomiting, melena, and dysuria; she has refused to eat allday.

Q:Based on the latest evidence, what constitutesoptimal management and follow-up for patientswith asymptomatic carotid stenosis?

Twenty-four-hour ambulatory blood pressure (BP) monitoringis a more accurate predictor of stroke and myocardialinfarction than office BP measurement, according tothe results of the recent Office Versus Ambulatory BloodPressure Study. This prospective trial followed 1963 patientswith treated hypertension for 5 years.

A 70-year-old man complains of a sudden, painless loss ofvision in the left eye that occurred several hours earlier. He denies traumaand previous visual disturbances. His history is significant for peripheralvascular disease and type 2 diabetes mellitus.

In their “Photoclinic” case of a patient with acute pulmonary embolism(CONSULTANT, December 2003, page 1741), Drs Tapas Bandyopadhyay andIsmael Martin state that the patient’s 12-lead ECG (which accompanies the casediscussion) exhibits right axis deviation.

IRVINE, Calif.-- Methamphetamine users may develop carotid artery dissections, leading to a severe stroke, an effect also seen in cocaine users, according to researchers here.

BOSTON -- Despite improved treatment of stroke risk factors, and a decline in age-adjusted annual incidence, the lifetime risk of a stroke has not fallen significantly over the past half century, according to the Framingham Study.

OXFORD, England -- More women than men inherit a propensity for ischemic stroke, irrespective of traditional vascular risk factors, researchers here found.

ORLANDO -- In patients with acute ischemic stroke, Lovenox (enoxaparin) was superior to unfractionated heparin every 12 hours for reducing the risk of venous thromboembolism, reported investigators from the PREVAIL trial.

ORLANDO -- In patients with acute ischemic stroke, Lovenox (enoxaparin) was superior to unfractionated heparin every 12 hours for reducing the risk of venous thromboembolism, reported investigators from the PREVAIL trial.