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Stroke Prevention: Little-Known and Neglected Aspects
Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoidi...
Source: Cerebrovascular Diseases - May 27, 2021 Category: Neurology Source Type: research

CYP2C19 Loss-of-Function Associated with First-Time Ischemic Stroke in Non-surgical Asymptomatic Carotid Artery Stenosis During Clopidogrel Therapy
This study measures effect ofCYP2C19 genotype on ischemic stroke risk during clopidogrel therapy for asymptomatic, extracranial carotid stenosis patients. Using deidentified electronic health records, patients were selected for retrospective cohort using administrative code for carotid stenosis, availability ofCYP2C19 genotype result, clopidogrel exposure, and established patient care. Patients with intracranial atherosclerosis, aneurysm, arteriovenous malformation, prior ischemic stroke, or observation time<1 month were excluded. Dual antiplatelet therapy patients were included. Patients with carotid endarterectomy or ...
Source: Translational Stroke Research - February 21, 2021 Category: Neurology Source Type: research

Cerebrovacular Reserve Predicts the Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy
Cerebral hyperperfusion syndrome is a rare but potentially severe complication of carotid artery revascularisation that develops under conditions of resistant postoperative hypertension and impaired cerebrovascular autoregulation.
Source: Journal of Stroke and Cerebrovascular Diseases - September 22, 2020 Category: Neurology Authors: Vladimir Manojlovic, Nebojsa Budakov, Slavko Budinski, Djordje Milosevic, Dragan Nikolic, Vladimir Manojlovic Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Intra-operative Video Characterization of Carotid Artery Pulsation Patterns in Case Series with Post-endarterectomy Hypertension and Hyperperfusion Syndrome
AbstractCerebral hyperperfusion syndrome (CHS) is a complication that can occur after carotid endarterectomy (CEA), the treatment of choice to decrease the subsequent risk of fatal or disabling stroke for patients with symptomatic severe stenosis of the carotid artery. Because of its rarity and complexity, the mechanism of the condition is still unclear, making its prevention via prediction and monitoring challenging. This is especially true during surgery, when multiple factors can induce physiological changes, including blood pressure and baroreceptor functions, which are crucial factors for post-CEA hypertension and CHS...
Source: Translational Stroke Research - October 1, 2018 Category: Neurology Source Type: research

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update
Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking.Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe...
Source: Cerebrovascular Diseases - January 9, 2018 Category: Neurology Source Type: research

Early Carotid Revascularization Reduces Readmission for Recurrent Ischemic Stroke in Acute Ischemic Stroke Patients: Analysis of United States Nationwide Readmissions Database (P4.294)
Conclusions:Patients with ischemic stroke undergoing carotid revascularization during the initial hospitalization have significantly lower risk of readmission related to another ischemic strokeDisclosure: Dr. Chaudhry has nothing to disclose. Dr. Gheith has nothing to disclose. Dr. Gu has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Rahman has nothing to disclose. Dr. Riaz has nothing to disclose. Dr. Sachdeva has nothing to disclose. Dr. Sattar has nothing to disclose. Dr. Razak has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Chaudhry, S., Gheith, T., Gu, S., Afzal, M.-R., Rahman, H., Riaz, A., Sachdeva, G., Sattar, A., Razak, A., Qureshi, A. Tags: In-Hospital Stroke Care Source Type: research

Utilization of Carotid Revascularization for Ischemic Stroke/TIA: A Canadian Perspective (P5.276)
Conclusions:Use of CEA/CAS in patients with acute ischemic stroke/TIA admitted to hospitals in Canada has doubled over the last decade. Differences in utilization by age, sex and across provinces are seen.Disclosure: Dr. Najm has nothing to disclose. Dr. Lindsay has nothing to disclose. Dr. Hill has nothing to disclose. Dr. Demchuk has nothing to disclose. Dr. Menon has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Najm, M., Lindsay, P., Hill, M. D., Demchuk, A., Menon, B. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting
AbstractCerebral hyperperfusion is a relatively rare syndrome with significant and potentially preventable clinical consequences. The pathophysiology of cerebral hyperperfusion syndrome (CHS) may involve dysregulation of the cerebral vascular system and hypertension, in the setting of increase in cerebral blood flow. The early recognition of CHS is important to prevent complications such as intracerebral hemorrhage. This review will focus on CHS following carotid endarterectomy and carotid artery stenting. We will discuss the typical clinical features of CHS, risk factors, pathophysiology, diagnostic modalities for detecti...
Source: Experimental and Translational Stroke Medicine - September 6, 2016 Category: Neurology Source Type: research

Unusual Intersection: Elucidating the Role of Erdheim Chester Disease in Stroke (P4.366)
Conclusion:A unifying diagnosis of ECD was identified for this gentleman presenting with a stroke in the setting of critical ICA stenosis. Pathology from his CEA suggests that while ECD involves multisystem inflammation, it did not appear to play a direct role in his stroke.Disclosure: Dr. Sheikhi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Sheikhi, L. Tags: Cerebrovascular Case Reports Source Type: research

Natural History of Extracranial Carotid Stenosis in Asian Stroke Patients- A Retrospective Study (P1.182)
Conclusions- Symptomatic steno-occlusive disease of cervical carotid artery carries a high risk of subsequent vascular events and mortality despite best medical therapy. Perhaps, better methods of risk stratification and an aggressive approach towards revascularisation in eligible cases are warranted.Disclosure: Dr. Chandra has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Kulkarni has nothing to disclose. Dr. Sharma has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Chandra, B., Woo, J. W., Woo, R. W., Liu, R. J., Kulkarni, A., Sharma, V. Tags: Cerebrovascular Disease: Risk Factors and Prevention Source Type: research

Prevalence, Risk Factors, and Clinical Significance of Asymptomatic Extracranial Vertebral Artery Disease in Patients with Symptomatic Internal Carotid Artery Stenosis: Analysis of Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) Trial (S42.002)
Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis. Key words: Extracranial vertebral artery; carotid stenosis; vertebral artery stenosis; vertebral artery occlusion; stroke; death.Disclosure: Dr. Qureshi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Jansen has nothing to disclose. Dr. Eckstein has nothing to disclose. Dr. Ringleb has nothing to disclose.
Source: Neurology - February 7, 2016 Category: Neurology Authors: Qureshi, A., Chaudhry, S., Jansen, O., Eckstein, H.-H., Ringleb, P. Tags: Stroke Mechanism and Modifiers Source Type: research

Periprocedural Myocardial Infarction After Carotid Endarterectomy and Stenting: Systematic Review and Meta-Analysis Clinical Sciences
Conclusions— The risk of MI after CEA and CAS did not significantly differ. Risk factors for MI are overall similar in both techniques except that men are at lower risk of MI after CAS but not after CEA.
Source: Stroke - September 28, 2015 Category: Neurology Authors: Boulanger, M., Cameliere, L., Felgueiras, R., Berger, L., Rerkasem, K., Rothwell, P. M., Touze, E. Tags: Acute myocardial infarction, Carotid Stenosis, Primary and Secondary Stroke Prevention, Carotid endarterectomy, Angioplasty and Stenting Clinical Sciences Source Type: research

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