Journal of the neurological sciences
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Cerebrovascular reactivity (CVR) testing with CO2 challenge is used clinically as a measure of cerebrovascular reserve. However it is not known whether CVR measures the same physiological process as spontaneous cerebral autoregulation (CA). ⋯ We showed a decrease in spontaneous CA after vasodilatation. However, the lack of correlation between baseline CA and degree of CVR suggests that cerebrovascular reserve and CA are based in part on distinct physiological mechanisms. Further studies are needed to determine which of these parameters is most useful to guide treatment decisions in pathological states.
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The purpose of the study is to investigate the embolic potential as well as ultrasonic characteristics of plaques in patients presenting with severe unilateral restenosis at least 1 year after carotid endarterectomy (CEA), compared with patients with severe unilateral primary carotid stenosis. ⋯ Carotid plaques in patients with severe unilateral carotid restenosis at least 1 year after surgery and in patients with primary lesions are similar in their embolic potential and ultrasonic characteristics.
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Antiplatelet therapy is an integral component of effective secondary prevention after non-cardioembolic ischemic stroke. Numerous clinical trials have tested the efficacy and safety of different antiplatelet regimens, including aspirin monotherapy, clopidogrel monotherapy, the combination of aspirin plus clopidogrel, and the combination of aspirin plus dipyridamole, in patients with a history of arterial ischemic stroke and transient ischemic attack (TIA). Although competing, head-to-head comparisons between aspirin plus dipyridamole and clopidogrel were not previously available, various professional societies have outlined evidence-based recommendations for antiplatelet therapy in patients with ischemic stroke or TIA. ⋯ The results of PRoFESS thus highlight the pitfalls of making conclusions of relative therapy efficacy in the absence of head-to-head comparisons. This article presents an overview of the factors that differ between clinical trials and "real-world" patient populations, as well as factors that differ among clinical trials themselves. The article also addresses the potential impact these differences may have on clinical trial results and subsequent clinical decision making.
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To date, pre-treatment with anti-platelet agents does not constitute a contraindication for thrombolysis in acute ischemic stroke. We tested the hypothesis that combined pre-treatment with aspirin and clopidogrel is a risk factor for thrombolysis-related symptomatic intracerebral hemorrhage (sICH). ⋯ In our retrospective study, only pre-treatment with aspirin and clopidogrel was associated with thrombolysis-related intracerebral hemorrhage. This finding should be further validated in large prospective databases like the SITS-MOST registry.