Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2008
Multicenter StudyPredictors of carotid clamping intolerance during endarterectomy that would be wise to apply to stenting procedures.
Carotid artery stenting procedures are increasingly being performed with devices such as the MO.MA or the Parodi system that involve endovascular clamping of the common carotid artery, thus exposing the ipsilateral hemisphere to the risk of hypoperfusion. The aim of the present study was to look for predictors of carotid clamping intolerance by means of transcranial Doppler. ⋯ The preoperative assessment of recruitable collaterals and of maximal decrement in MCA mean flow velocity after carotid compression are useful predictors of carotid clamping intolerance. The criteria derived from carotid endarterectomy need to be applied and validated in a prospective series of patients undergoing carotid artery stenting procedures.
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Cerebrovascular diseases · Jan 2008
Multicenter Study Comparative Study Controlled Clinical TrialInitiation of oral anticoagulation after acute ischaemic stroke or transient ischaemic attack: timing and complications of overlapping heparin or conventional treatment.
Oral anticoagulation is highly effective for secondary prevention of cardioembolic strokes in patients with atrial fibrillation (AF). There are no studies investigating timing and complications of different strategies for initiation of oral anticoagulation after acute stroke or transient ischaemic attack (TIA). ⋯ Initiation of oral anticoagulation after acute ischaemic stroke yielded low complication rates independent of antithrombotic co-medication. Heparin bridging was associated with a longer stay in acute care hospitals.
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Cerebrovascular diseases · Jan 2008
Multicenter Study Comparative StudyGeographic differences in acute stroke care in Catalunya: impact of a regional interhospital network.
Limited resources prevent specialized care in community hospitals (CH) challenging geographical equity. We studied the impact of a regional interhospital network based on urgent transfer from 4 CH to a referral stroke center (RSC). ⋯ An interhospital network based on transfers to an RSC does not warrant geographical equity: equal access to best therapeutic interventions is only partially achieved at the expense of a high proportion of unnecessary transfers.
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Cerebrovascular diseases · Jan 2008
Functional outcome 3 months after stroke predicts long-term survival.
When reporting stroke survival and prognostic factors with a possible effect on outcome, the starting point for the observation of a clinical cohort usually is the onset of stroke or the acute admission of a patient. Thus, acute and early mortality inflict prognosis on long-term outcome. In order to give a more robust analysis of long-term survival after the acute period we chose to start our observation with 3-month survivors. ⋯ The influence of disability on survival is stronger than that of several other well-known prognostic factors. This finding indicates that any intervention in the acute phase that may improve functional status at 3 months will also have favourable secondary effects on survival in the long term.
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Cerebrovascular diseases · Jan 2008
Multicenter StudyInfluence of antiplatelet pre-treatment on the risk of symptomatic intracranial haemorrhage after intravenous thrombolysis.
The influence of antiplatelet agents (AP) in the development of a symptomatic intracranial haemorrhage (SICH) after intravenous rt-PA is not well known. We assessed the hypothesis that pre-treatment with AP may increase that risk. ⋯ Pre-treatment with AP non-significantly increases the risk of SICH and therefore this antecedent should not be a contraindication for intravenous thrombolysis.