High total serum homocysteine (tHcy) concentrations are associated with an increased risk of carotid artery disease in the general population. Since patients with peripheral arterial disease (PAD) have a threefold risk of cerebrovascular morbidity compared to individuals free of PAD, and since the total neurological event rate is associated with a > or = 50% lumen reduction in extracranial carotid arteries, it was tested whether tHcy is a predictor of internal carotid artery stenosis in patients with symptomatic PAD. A total of 443 consecutive male PAD patients without previous carotid surgery/stenting were studied. In all, 100 patients with PAD had an internal carotid artery stenosis > or = 50%. Of the remaining 343 patients, 100 individuals matched for age (+/- 2 years) and diabetes served as controls. The extent of carotid stenosis was evaluated with color duplex measurement; tHcy was determined by high-performance liquid chromatography. Cases displayed a significantly higher median fasting tHcy level (17.0 micromol/l) than controls (13.7 micromol/l, p=0.001). Multivariate analysis showed that tHcy (p=0.036) was an independent predictor of internal carotid artery stenosis > or = 50% in PAD patients, representing an odds ratio of 1.32 (95% CI, 1.02-1.72) for an increment of 5 micromol/l. In the present study, high tHcy was an independent risk factor for an internal carotid artery stenosis > or = 50% in patients with PAD. Since PAD patients suffer a threefold risk of stroke compared to healthy individuals, a simple vitamin substitution in PAD patients may reduce the occurrence of internal carotid artery stenosis and therefore diminish the relatively high rate of cerebrovascular events in this population.
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http://dx.doi.org/10.1177/1358836x0100600307 | DOI Listing |
Alzheimers Dement
December 2024
Tulane University, New Orleans, LA, USA.
Background: Vascular dementia (VaD), the second most common cause of dementia, is characterized by cognitive decline due to reduced cerebral blood flow and blood-brain barrier disruption. Current evidence demonstrates that not only are VaD patients at higher risk of severe COVID-19 illness and mortality, but also that pre-existing cognitive dysfunction/dementia is associated with increased COVID-19 incidence. Conversely, SARS-CoV-2 infection alone worsens dementia-related mild cognitive impairment (MCI) and increases risk of cognitive decline, supported by similar fMRI findings demonstrating hypoperfusion.
View Article and Find Full Text PDFDynamic carotid compression arising from a change in patient position is a rare complication of goitre, with the potential for cerebral ischaemia and infarction. In this report, a 37-year-old woman presented with a multi-nodular goitre with clinical features concerning for transient cerebral ischaemia. The anaesthetic management and neurological monitoring used to mitigate the risk of cerebral ischaemia during thyroidectomy is described and the literature surrounding this rare complication is explored.
View Article and Find Full Text PDFMed Sci Sports Exerc
January 2025
Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, Guangzhou Sport University, Guangzhou, Guangdong, CHINA.
Purpose: The present study aimed to compare the impacts of different exercise types on cardiovascular health and executive function in sedentary young individuals, and to determine the associations between cardiovascular function and executive function (EF) after exercise.
Methods: Sixty-three sedentary participants were randomly divided into high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), resistance exercise (RE), and control groups. Macro- and microvascular endothelial function were assessed using brachial artery flow-mediated dilation and fingertip reactive hyperemia index, respectively.
JACC Cardiovasc Imaging
January 2025
Division of Vascular Surgery, Stanford University Medical Center, Stanford, California, USA. Electronic address:
J Neurointerv Surg
January 2025
Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
Background: Studies have described a first pass effect (FPE) where patients with successful recanalization after one pass experience better outcomes. Few studies have evaluated this in patients with large core infarctions.
Objective: To determine whether patients with large core infarcts undergoing mechanical thrombectomy in which first pass reperfusion is achieved experience improved outcomes compared with those who undergo more than one pass.
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