Increased common carotid artery wall thickness is associated with rapid progression of asymptomatic carotid stenosis.

Background And Purposes: This study aimed to identify clinical and ultrasound imaging predictors of progression of carotid luminal narrowing in subjects with asymptomatic moderate internal carotid artery (ICA) stenosis.

Methods: A total of 571 subjects with asymptomatic moderate (50-69%) ICA stenoses were enrolled. They underwent ultrasound examination at baseline and after 12 months.

Efficacy of systemic thrombolysis within 4.5 h from stroke symptom onset: a single-centre clinical and diffusion-perfusion 3T MRI study.

Purpose: The efficacy of thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) within 3 h from stroke onset has been extensively supported by randomised placebo-controlled multicentre trials. In our single-centre study, we investigated the efficacy of intravenous (IV) administration of rt-PA within 4.5 h of stroke onset, in terms of clinical and radiological outcome, using a 3T magnetic resonance (MR) scanner in a cohort of patients similar to that of multicentre clinical trials.

Intra-arterial thrombectomy versus standard intravenous thrombolysis in patients with anterior circulation stroke caused by intracranial arterial occlusions: a single-center experience.

Background: Severely impaired patients with persisting intracranial occlusion despite standard treatment with intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) or presenting beyond the therapeutic window for IV rtPA may be candidates for interventional neurothrombectomy (NT). The safety and efficacy of NT by the Penumbra System (PS) were compared with standard IV rtPA treatment in patients with severe acute ischemic stroke (AIS) caused by large intracranial vessel occlusion in the anterior circulation.

Methods: Consecutive AIS patients underwent a predefined treatment algorithm based on arrival time, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on computed tomographic angiography (CTA).

Stroke prevention: managing modifiable risk factors.

Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events.

Safety of early carotid artery stenting after systemic thrombolysis: a single center experience.

Background. Patients with acute ischemic stroke due to internal carotid artery (ICA) disease are at high risk of early stroke recurrence. A combination of IV thrombolysis and early carotid artery stenting (CAS) may result in more effective secondary stroke prevention.

Cryptogenic cerebral ischemia: clinical usefulness of a flexible ultrasound diagnostic algorithm for detection of patent foramen ovale.

Objectives: Paradoxical thromboembolism across a patent foramen ovale (PFO) may be involved in the pathogenesis of cryptogenic strokes. We tested the feasibility and the clinical usefulness of an early screening for PFO combining different ultrasound techniques in patients with acute cerebral ischemia of undetermined cause.

Methods: Consecutive patients with acute ischemic stroke or transient ischemic attack with undetermined cause were selected.

Short-Term and Two-Year Rate of Recurrent Cerebrovascular Events in Patients with Acute Cerebral Ischemia of Undetermined Aetiology, with and without a Patent Foramen Ovale.

Purpose. We investigated stroke recurrence in patients with acute ischemic stroke of undetermined aetiology, with or without a patent foramen ovale (PFO). Methods.

Floating carotid thrombus treated by intravenous heparin and endarterectomy.

Among different subtypes of ischemic stroke, atherosclerotic stroke carries the greatest risk (30%) of worsening and recurrence during the acute phase of hospitalization with a 7.9% risk ≤ 30 days. Causes of this high risk include plaque rupture leading to thrombus formation, thrombus propagation with consequent vessel occlusion, and distal embolism.

Is stroke history reliably reported by elderly with cognitive impairment? A community-based study.

Background/aims: Self-reported history of stroke has been questioned in the elderly due to the high prevalence of cognitive impairment. We tested the validity of response to a stroke questionnaire versus clinical diagnosis of stroke among elderly people with and without cognitive impairment.

Methods: Community-dwelling participants to the phase 1 Canadian Study of Health and Aging were screened for self-reported stroke.

Changes in cerebrovascular reactivity following low-frequency repetitive transcranial magnetic stimulation.

Objectives: Repetitive Transcranial Magnetic Stimulation (rTMS) potential therapeutic uses have been explored in many conditions including stroke. However, its potential effects on cerebral hemodynamics have not been deeply considered. Transcranial Doppler ultrasonography (TCD) is a promising tool in detecting focal changes of cerebral blood flow velocity (CBFV) and cerebrovascular reactivity (CRV) induced by rTMS.

The Canadian Neurological Scale and the NIHSS: development and validation of a simple conversion model.

Background: The Canadian Neurological Scale (CNS) and the National Institutes of Health Stroke Scale (NIHSS) are among the most reliable stroke severity assessment scales. The CNS requires less extensive neurological evaluation and is quicker and simpler to administer.

Objective: Our aim was to develop and validate a simple conversion model from the CNS to the NIHSS.

Ultrasound evaluation of early changes in arterial dissection.

We show magnetic resonance imaging, computed tomography-angiography, and ultrasound images of internal carotid artery dissection in a patient with acute ischemic stroke. Arterial changes occurring during the first few days were detected by serial ultrasound examinations. Neurologic and functional outcome are provided and therapeutic options discussed.

Cilostazol in the management of atherosclerosis.

The burden of atherosclerosis is particularly high in western countries in terms of mortality and disability. The cerebral arteries (stroke or transient ischemic attack [TIA]), coronary arteries (myocardial infarction [MI]) and peripheral arteries (intermittent claudication [IC], ischemic limb) can be affected. Atherosclerosis may involve different mechanisms such as inflammation, platelet activation, endothelial damage, balance between proliferation and apoptosis of smooth muscle cells and oxidative stress.

Vascular cognitive impairment (VCI): Progress towards knowledge and treatment.

Until recently, the study of cognitive impairment as a manifestation of cerebrovascular disease (CVD) has been hampered by the lack of common standards for assessment. The term vascular cognitive impairment (VCI) encompasses all levels of cognitive decline associated with CVD from mild deficits in one or more cognitive domains to crude dementia syndrome. VCI incorporates the complex interactions among classic vascular risk factors (i.

The reciprocal risks of stroke and cognitive impairment in an elderly population.

Background: Stroke, dementia, and cognitive impairment no dementia (CIND) pose major threats to the elderly but have rarely been studied together in the same population. We aimed to compare the relative frequencies of stroke, CIND, and dementia in an elderly population and to examine whether cognitive impairment poses a risk for stroke.

Methods: Prevalences of stroke, CIND, and dementia were estimated among participants in the first clinical examination of the Canadian Study of Health and Aging (CSHA-1, n = 2,914).

Neglecting the difference: does right or left matter in stroke outcome after thrombolysis?

Background And Purpose: Patients with right hemispheric strokes (RHSs) present later to an emergency department, have a lower chance to receive intravenous recombinant tissue plasminogen activator (IV rt-PA), and have worse clinical outcomes than do patients with left hemispheric strokes (LHSs). We analyzed outcomes after IV rt-PA with respect to the side of the affected hemisphere.

Methods: A prospective cohort of acute stroke patients was treated with IV rt-PA at the London Health Sciences Centre (December 1998 to March 2003).

Predictors of major neurologic improvement after thrombolysis in acute stroke.

Background: Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months.

Objective: To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months.

Methods: The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003.