Recanalization therapies in acute ischemic stroke: pharmacological agents, devices, and combinations.

The primary aim of thrombolysis in acute ischemic stroke is recanalization of an occluded intracranial artery. Recanalization is an important predictor of stroke outcome as timely restoration of regional cerebral perfusion helps salvage threatened ischemic tissue. At present, intravenously administered tissue plasminogen activator (IV-TPA) remains the only FDA-approved therapeutic agent for the treatment of ischemic stroke within 3 hours of symptom onset.

Adiponectin primes human monocytes into alternative anti-inflammatory M2 macrophages.

Altered macrophage kinetics is a pivotal mechanism of visceral obesity-induced inflammation and cardiometabolic risk. Because monocytes can differentiate into either proatherogenic M1 macrophages or anti-inflammatory M2 macrophages, approaches that limit M1 while promoting M2 differentiation represent a unique therapeutic strategy. We hypothesized that adiponectin may prime human monocytes toward the M2 phenotype.

Chronic brainstem ischemia in subclavian steal syndrome.

Subclavian steal syndrome is usually an incidental finding and rarely causes vertebrobasilar ischemia. We present a 58-year-old man who, over six months, experienced progressive slowing in both talking and walking. Cervical duplex sonography revealed severe stenosis of the right subclavian artery; fixed retrograde flow was noted in the right vertebral artery on transcranial Doppler.

Feasibility and safety of intravenous thrombolysis in multiethnic Asian stroke patients in Singapore.

Treatment rates with intravenously administered tissue plasminogen activator (IV-tPA) in acute ischemic stroke (IS) remain low in Asian populations. Various logistic obstacles and higher anticipated bleeding risk in Asians are major concerns. We report on the feasibility and safety of IV-tPA therapy at our tertiary care center.

Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada.

Objectives: To evaluate vascular protection treatment patterns and attainment of the 2003 Canadian Diabetes Association's recommended targets in ambulatory patients with type 2 diabetes.

Methods: Between 2005 and 2006, 3002 outpatients with type 2 diabetes were enrolled by 229 primary health care settings across Canada. Baseline characteristics, therapeutic regimens and treatment success - defined as the achievement of a blood pressure (BP) of 13080 mmHg or lower, glycosylated hemoglobin (A1C) of 7% or lower, low-density lipoprotein cholesterol (LDL-C) lower than 2.

Effects of ezetimibe add-on to statin therapy on adipokine production in patients with metabolic syndrome and stable vascular disease.

The aim of this study was to determine whether the addition of ezetimibe to ongoing statin therapy in patients with atherosclerosis and metabolic syndrome would favorably affect levels of inflammatory markers and adipokines. Individuals with the metabolic syndrome exhibit higher levels of inflammatory biomarkers and adipokines, which have been implicated in the pathobiology of cardiovascular risk. The impact of the addition of ezetimibe to statin therapy on these proinflammatory mediators is unclear.

Multicenter external validation of the ABCD2 score in triaging TIA patients.

Objectives: A simple clinical score (ABCD(2) score) has been introduced to triage TIA patients with a high early risk of stroke. External validation studies have yielded inconsistent results regarding the predictive ability of the ABCD(2) score. We aimed to prospectively validate the former score in a multicenter case series study.

Bilateral thalamic infarctions due to occlusion of artery of Percheron.

The artery of Percheron is an uncommon anatomic variant in which a solitary trunk originates from either posterior cerebral artery and provides arterial supply to bilateral paramedian thalami and the rostral midbrain (Fig. 1). Recognition of this anatomical variant is essential in establishing the stroke mechanism in bilateral paramedian thalamic infarcts.

DNA damage repair and cardiovascular diseases.

DNA turnover through damage and repair is normal homeostatic process in viable cells. DNA damage induces sequential responses to either repair the damage or activate a programmed cell death process. Defects in this critical response to DNA damage underpin a wide array of human pathologies that include cancer predisposition, immune dysfunction, radiosensitivity, and neurodegeneration.

Fragmentation of the classical magnetic resonance mismatch "penumbral" pattern with time.

Background And Purpose: The classical mismatch pattern in the middle cerebral artery territory stroke on MR is defined by a central diffusion-weighted image core with surrounding mismatch tissue. Because of variable rates of tissue salvage, we hypothesized that this pattern may fragment over time and may be influenced by vessel patency, mismatch volume, and infarct core location.

Methods: Patients were recruited with MR studies performed within 48 hours of ischemic stroke.

Usefulness of statin-ezetimibe combination to reduce the care gap in dyslipidemia management in patients with a high risk of atherosclerotic disease.

Lowering of low-density lipoprotein (LDL) cholesterol is a fundamental step in the comprehensive management of patients at high risk for cardiovascular events. The combination of a statin with ezetimibe usually provides additional LDL cholesterol lowering compared to statin monotherapy. This open-label observational study evaluated the impact of a 26-week treatment program with uptitration of statin dosages and incorporation of ezetimibe 10 mg therapy in 2,577 men and women (median age 64 years) with hypercholesterolemia and an LDL cholesterol level >2.

Reversed flow in the basilar artery in acute vertebrobasilar ischemia.

Acute vertebrobasilar ischemia is a potentially sinister pathology with high mortality and poor functional outcome in survivors. We report the findings of multi-modal assessment (MRI and cerebrovascular ultrasonography) of cerebral hemodynamics in a patient who suffered from acute brainstem infarction with National Institute of Health Stroke Scale (NIHSS) score of 16 points. Our patient demonstrated reversal of blood flow in the basilar artery on the second day of his stroke and this was associated with significant and rapid clinical recovery over the following 2 days (NIHSS score dropped to 4 points).

Retrospective review of prognostic factors, including 1p19q deletion, in low-grade oligodendrogliomas and a review of recent published works.

The purpose of the present study was to investigate potential prognostic factors in low-grade oligodendrogliomas (LGOs), particularly 1p19q deletion, due to its proven prognostic significance in anaplastic oligodendrogliomas. We carried out a retrospective review of patients with a histological diagnosis of LGO between 1990 and 2000 in Auckland and Wellington, New Zealand. All cases underwent central histopathological review and FISH testing for 1p19q status.

Sonography as an aid to neurophysiological studies in diagnosing tarsal tunnel syndrome.

Diagnosing tarsal tunnel syndrome can be difficult because of varying clinical diagnostic criteria and equivocal physical signs. We present a case of tarsal tunnel syndrome where nerve conduction identified distal tibial neuropathy and high-resolution sonography was able to show nerve swelling within the tarsal tunnel.

Statin effects on LDL and HDL cholesterol in South Asian and white populations.

Inasmuch as statins appear to exhibit altered efficacy in some Asian populations (predominantly East Asian), current lipid guidelines recommend the use of lower statin doses in all Asians. Whether this should also apply to South Asians, a population at high risk for coronary heart disease, remains unclear. The authors evaluated the lipid-modifying effects of statins in South Asian and white patients with established coronary heart disease.

Penumbral mismatch is underestimated using standard volumetric methods and this is exacerbated with time.

Background And Aims: The mismatch between perfusion weighted images (PWI) and diffusion weighted images (DWI) using MR is increasingly being applied in patient selection for therapeutic trials. Two approaches to the calculation of the mismatch volume exist--the commonly used volumetric and the more precise co-registration method, the latter of which considers lesion topography. That there are differences in the mismatch volume analysed by each method and that these are time dependent was hypothesised.

Visfatin activates eNOS via Akt and MAP kinases and improves endothelial cell function and angiogenesis in vitro and in vivo: translational implications for atherosclerosis.

Improving endothelial nitric oxide synthase (eNOS) bioactivity and endothelial function is important to limit native, vein graft, and transplant atherosclerosis. Visfatin, a NAD biosynthetic enzyme, regulates the activity of the cellular survival factor, Sirt1. We hypothesized that visfatin may improve eNOS expression, endothelial function, and postnatal angiogenesis.