Cervical artery dissection: emerging risk factors.

Cervical artery dissection (CAD) represents an increasingly recognized cause of stroke and the most common cause of ischemic stroke in young adults. Many factors have been identified in association with CAD such as primary disease of arterial wall (fibrodysplasia) and other non-specific diseases related to CAD like Ehlers Danlos-syndrome IV, Marfan's syndrome, vessel tortuosity. Moreover, an underlying arteriopathy which could be in part genetically determined, has been suspected.

Risk of recurrent cerebrovascular events in patients with cryptogenic stroke or transient ischemic attack and patent foramen ovale: the FORI (Foramen Ovale Registro Italiano) study.

Background: The optimal management of patients with cryptogenic ischemic stroke found to have a patent foramen ovale (PFO) at diagnostic workup remains unclear. The aims of this observational multicenter study were to evaluate: (1) the risk of recurrent cerebrovascular events in patients with cryptogenic minor ischemic stroke or transient ischemic attack (TIA) and PFO who either underwent percutaneous PFO closure or received only medical treatment, and (2) the risk factors associated with recurrent events.

Methods: Consecutive patients (aged 55 years or less) with first-ever cryptogenic minor ischemic stroke or TIA and PFO were recruited in 13 Italian hospitals between January 2006 and September 2007 and followed up for 2 years.

Effects of statins on early and late results of carotid stenting.

Objectives: Increasing data suggest that statins can significantly decrease cardiovascular and cerebrovascular events due to a plaque stabilization effect. However, the benefit of statins in patients undergoing carotid angioplasty and stenting (CAS) for carotid stenosis is not well defined. The aim of this study was to investigate whether statins use was associated with decreased perioperative and late risks of stroke, mortality, and restenosis in patients undergoing CAS.

Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review.

Objectives: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.

Methods: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language.

Risk factors for cerebral ischemic events in patients with atrial fibrillation on warfarin for stroke prevention.

Background And Purposes: Patients with atrial fibrillation (AF) on treatment with oral anticoagulants may still suffer ischemic cerebrovascular events. The aim of this study was to evaluate the risk factors for cerebral ischemic events in warfarin-treated AF patients with an International Normalized Ratios (INR) above 1.8 on admission.

Gender differences in patients with acute ischemic stroke.

Stroke has a greater effect on women than men owing to the fact that women have more stroke events and are less likely to recover. Age-specific stroke rates are higher in men; however, because of women's longer life expectancy and the much higher incidence of stroke at older ages, women have more stroke events than men overall. The aims of this prospective study in consecutive patients were to assess whether there are gender differences in stroke risk factors, treatment or outcome.

A comparative analysis of the outcomes of carotid stenting and carotid endarterectomy in women.

Objective: Randomized controlled trials (RCTs) of carotid endarterectomy (CEA) advised little benefit from surgery in women because of high operative risk. Whether these findings are also applicable to carotid angioplasty and stenting (CAS) is subject of investigation. Our aim was to determine the risk of perioperative and late complications related to CAS and CEA in women.

Stroke pharmacogenomics.

Circulatory disease accounts for fifteen million deaths each year, of which stroke accounts for four and a half million- with an estimated nine million stroke survivors annually. The overall incidence rate of stroke is 2 to 2.5 per thousand adults with an approximate prevalence of 5 per thousand and an estimated 5-year risk of stroke recurrence of 15 to 40 percent.

CADISP-genetics: an International project searching for genetic risk factors of cervical artery dissections.

Background: Cervical artery dissection (CAD) is a frequent cause of ischemic stroke, and occasionally death, in young adults. Several lines of evidence suggest a genetic predisposition to CAD. However, previous genetic studies have been inconclusive mainly due to insufficient numbers of patients.

Acute hyperglycemia and early hemorrhagic transformation in ischemic stroke.

Background: Hyperglycemia has been claimed to be associated with hemorrhagic transformation (HT) in patients with acute ischemic stroke treated with thrombolysis. The aim of this study was to assess whether the admission blood glucose level is related to HT in a prospective study in consecutive patients with acute ischemic stroke.

Methods: Consecutive patients admitted for ischemic stroke to 4 Italian hospitals were included in this prospective cohort study.

Effect of carotid stenosis on the prognostic value of admission blood pressure in patients with acute ischemic stroke.

Background: Data on the correlation between blood pressure (BP) on admission and clinical outcome in patients with acute stroke are conflicting. The aims of the present study in consecutive patients with acute ischemic stroke were to evaluate: (a) the relationship between systolic or diastolic BP on admission and mortality at 3 months; (b) the role of carotid artery disease ipsilateral to the index stroke on this relationship.

Methods: Consecutive patients admitted to four Italian hospitals with objectively diagnosed ischemic stroke were included in this prospective study.

The concept of ischemic penumbra in acute stroke and therapeutic opportunities.

Ischemic penumbra was first defined by Astrup in 1981 as perfused brain tissue at a level within the thresholds of functional impairment and morphological integrity, which has the capacity to recover if perfusion is improved. It exists, even for a short period of time in the center of ischemia, from which irreversible necrosis propagates to the neighboring tissues over time. Penumbra has become the focus of intense imaging research to differentiate it from infarction.

Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome.

Background: Early seizure (ES) may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the rate of and the predictive factors for ES as well the effects of ES on the clinical outcome at hospital discharge in patients with first-ever stroke.

Patients And Methods: A total of 638 consecutive patients with first-ever stroke (543 ischemic, 95 hemorrhagic), admitted to our Stroke Unit, were included in this prospective study.

The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review.

Background And Purpose: Change in cognition is being increasingly recognized as an important outcome measure; however, the role of carotid revascularization on this issue remains to be determined. It is still under debate whether carotid artery stenting and carotid endarterectomy have the same influence on neuropsychological functions.

Summary Of Review: This article systematically reviews recent literature in an attempt to clarify this issue.

Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study.

Background And Purpose: Early hemorrhagic transformation (HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT.

Methods: Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers.

Hormone replacement therapy and stroke.

Unlabelled: Stroke is the third most common cause of death in women and a major cause of disability. Stroke occurs in older age in women compared with men. High premenopausal estrogen concentrations in women are thought to be protective against stroke and cardiovascular disease.

Clinical benefit of early anticoagulation in cardioembolic stroke.

Background: Nonvalvular atrial fibrillation is the most common source of cardiac embolism with a high reported risk of stroke and a high stroke-related mortality. A common clinical dilemma in patients with acute stroke is whether the detection of one of the major cardiac sources of emboli requires an early anticoagulation to reduce early stroke recurrence and mortality.

Methods: In this review, we report on the results of clinical trials that have investigated the efficacy of early treatment for acute cardioembolic stroke.

Need for extensive diagnostic work-up for patients with lacunar stroke.

Objective: Small-vessel disease is the most frequent cause of lacunar stroke. The aims of this study were to evaluate: 1) alternative causes of lacunar stroke other than small-vessel disease; 2) functional outcome of lacunar strokes due to small vessel disease compared to lacunar strokes due to alternative causes.

Methods: Consecutive patients with first-ever ischemic lacunar stroke were prospectively followed-up for at least 3 months.

Is haemodynamic depression during carotid stenting a predictor of peri-procedural complications?

Objective: The clinical significance of Haemodynamic Depression (HD) during carotid stenting (CAS) remains unclear. The aim of this study was to analyze the frequency and predictors of HD during CAS in a single centre experience.

Methods: A prospective protocol for CAS was applied in a 15-month interval.

Determinants of outcome in patients eligible for thrombolysis for ischemic stroke.

Objectives: Eligibility criteria for thrombolysis in ischemic stroke have been clearly defined. However, not all eligible patients benefit from this treatment. This study aimed to assess the determinants for clinical outcome in consecutive, eligible patients with ischemic stroke treated with thrombolysis in a single-center study.

Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.

Background: Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke.

Interventional neuroradiology in the treatment of cerebral venous thrombosis.

Heparin is the standard of care in cerebral venous thrombosis. Local thrombolysis is believed to better restore venous blood flow than heparin. Thrombolysis is also used when the patient's condition worsens despite heparin and symptomatic treatment.

Hormone-replacement therapy, dementia and stroke.

Hormone-replacement therapy (HRT) has been used for more than 40 years to reduce perimenopausal symptoms. Estrogens may protect brain structures and functional systems affected by Alzheimer's disease, which suggests that maintaining high levels of hormones with HRT can protect against Alzheimer's disease. Moreover, high premenopausal estrogen concentrations are thought to be protective against stroke and, consequently, in the past, HRT was considered to be a potential protective agent against stroke.