Pub Date : 2004-08-01DOI: 10.1161/01.STR.0000133321.00456.00
H. Eyre, R. Kahn, R. Robertson
Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about $700 billion in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity—the major risk factors for these diseases—and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the ACS, ADA, and AHA review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.
{"title":"Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association","authors":"H. Eyre, R. Kahn, R. Robertson","doi":"10.1161/01.STR.0000133321.00456.00","DOIUrl":"https://doi.org/10.1161/01.STR.0000133321.00456.00","url":null,"abstract":"Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about $700 billion in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity—the major risk factors for these diseases—and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the ACS, ADA, and AHA review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"16 14 1","pages":"1999-2010"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87077420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-06-01DOI: 10.1161/STR.00000000128697.52150.75
D. Rutgers, C. Klijn, L. Kappelle, J. van der Grond
Background and Purpose— To investigate whether the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic carotid artery occlusion (CAO) is related to (1) volume flow in the contralateral internal carotid artery (ICA), basilar artery (BA), and middle cerebral arteries (MCAs), and (2) intracranial collateral flow to the symptomatic side, measured in the first 6 months after the qualifying symptoms occurred. Methods— We prospectively studied 112 patients with symptomatic CAO. Quantitative volume flow was measured with magnetic resonance angiography (MRA) and collateral flow via the circle of Willis with MRA, via the ophthalmic artery (OA) with transcranial Doppler sonography, and via leptomeningeal anastomoses with conventional angiography. Results— During 49±14 months of follow-up (mean±SD), 7 patients had recurrent ipsilateral ischemic stroke. Compared with patients without recurrent stroke, these patients had significantly higher total flow to the brain, ie, ICA+BA flow (mean 536 mL/min versus 410 mL/min; P<0.05), and significantly higher contralateral ICA flow (355 mL/min versus 209 mL/min; P<0.001), whereas BA and MCA flow showed no significant differences. Also, they more often had Willisian collateral flow (P<0.05), mainly caused by increased collateral flow via the posterior communicating artery (PCoA; 71% versus 28%; P<0.05), whereas collateral flow via the OA and leptomeningeal anastomoses did not differ significantly. Conclusions— Recurrent ipsilateral ischemic stroke in patients with symptomatic CAO is associated with high volume flow to the brain and increased collateral PCoA flow.
背景与目的:探讨症状性颈动脉闭塞(CAO)患者同侧缺血性卒中复发的风险是否与(1)对侧颈内动脉(ICA)、基底动脉(BA)和大脑中动脉(MCAs)的容积流量，以及(2)症状出现后6个月内测量的症状侧颅内侧支血流有关。方法:前瞻性研究112例有症状性曹操患者。磁共振血管造影(MRA)测量定量体积流量，MRA测量威氏圈侧支血流，经颅多普勒超声测量眼动脉(OA)侧支血流，常规血管造影测量小脑膜吻合口侧支血流。结果-在49±14个月的随访期间(平均±SD)， 7例患者复发同侧缺血性卒中。与没有卒中复发的患者相比，这些患者的脑总流量明显更高，即ICA+BA流量(平均536 mL/min vs 410 mL/min;P<0.05)，且对侧ICA血流显著增加(355 mL/min vs 209 mL/min;P<0.001)，而BA和MCA流量无显著差异。Willisian侧枝血流较多(P<0.05)，主要是由于后交通动脉(PCoA)侧枝血流增加所致;71%对28%;P<0.05)，而经OA和小脑膜吻合口侧支血流无显著差异。结论:症状性CAO患者复发性同侧缺血性卒中与大容量脑血流和侧支PCoA血流增加有关。
{"title":"Recurrent Stroke in Patients With Symptomatic Carotid Artery Occlusion Is Associated With High-Volume Flow to the Brain and Increased Collateral Circulation","authors":"D. Rutgers, C. Klijn, L. Kappelle, J. van der Grond","doi":"10.1161/STR.00000000128697.52150.75","DOIUrl":"https://doi.org/10.1161/STR.00000000128697.52150.75","url":null,"abstract":"Background and Purpose— To investigate whether the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic carotid artery occlusion (CAO) is related to (1) volume flow in the contralateral internal carotid artery (ICA), basilar artery (BA), and middle cerebral arteries (MCAs), and (2) intracranial collateral flow to the symptomatic side, measured in the first 6 months after the qualifying symptoms occurred. Methods— We prospectively studied 112 patients with symptomatic CAO. Quantitative volume flow was measured with magnetic resonance angiography (MRA) and collateral flow via the circle of Willis with MRA, via the ophthalmic artery (OA) with transcranial Doppler sonography, and via leptomeningeal anastomoses with conventional angiography. Results— During 49±14 months of follow-up (mean±SD), 7 patients had recurrent ipsilateral ischemic stroke. Compared with patients without recurrent stroke, these patients had significantly higher total flow to the brain, ie, ICA+BA flow (mean 536 mL/min versus 410 mL/min; P<0.05), and significantly higher contralateral ICA flow (355 mL/min versus 209 mL/min; P<0.001), whereas BA and MCA flow showed no significant differences. Also, they more often had Willisian collateral flow (P<0.05), mainly caused by increased collateral flow via the posterior communicating artery (PCoA; 71% versus 28%; P<0.05), whereas collateral flow via the OA and leptomeningeal anastomoses did not differ significantly. Conclusions— Recurrent ipsilateral ischemic stroke in patients with symptomatic CAO is associated with high volume flow to the brain and increased collateral PCoA flow.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"34 1","pages":"1345-1349"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83783025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-02-01DOI: 10.1161/01.STR.0000053444.00582.B7
Sarah E Lamb, Luigi Ferrucci, S. Volapto, Linda P. Fried, J. Guralnik, Y. Gustafson
Background and Purpose— Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population. Methods— This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments. Results— Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling. Conclusions— Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.
{"title":"Risk Factors for Falling in Home-Dwelling Older Women With Stroke: The Women’s Health and Aging Study","authors":"Sarah E Lamb, Luigi Ferrucci, S. Volapto, Linda P. Fried, J. Guralnik, Y. Gustafson","doi":"10.1161/01.STR.0000053444.00582.B7","DOIUrl":"https://doi.org/10.1161/01.STR.0000053444.00582.B7","url":null,"abstract":"Background and Purpose— Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population. Methods— This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments. Results— Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling. Conclusions— Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"7 1","pages":"494-501"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88083345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-02-01DOI: 10.1161/01.STR.0000053029.45352.A0
S. Bak, M. Andersen, I. Tsiropoulos, L. G. García Rodríguez, J. Hallas, K. Christensen, D. Gaist
Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs. Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates. Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.
{"title":"Risk of Stroke Associated With Nonsteroidal Anti-Inflammatory Drugs: A Nested Case-Control Study","authors":"S. Bak, M. Andersen, I. Tsiropoulos, L. G. García Rodríguez, J. Hallas, K. Christensen, D. Gaist","doi":"10.1161/01.STR.0000053029.45352.A0","DOIUrl":"https://doi.org/10.1161/01.STR.0000053029.45352.A0","url":null,"abstract":"Background and Purpose— Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs. Methods— We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results— The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates. Conclusions— Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"121 1","pages":"379-386"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77738594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-02-01DOI: 10.1161/01.STR.0000051504.10095.9C
P. Schellinger, J. Fiebach, W. Hacke
Background— Thrombolysis is the treatment of choice for acute stroke within 3 hours after symptom onset. Treatment beyond the 3-hour time window has not been shown to be effective in any single trial; however, meta-analyses suggest a somewhat lesser but still significant effect within 3 to 6 hours after stroke. It seems reasonable to apply improved selection criteria that allow differentiation between patients with and without a relevant indication for thrombolytic therapy. Summary of Review— The present literature on imaging in stroke has been thoroughly reviewed, covering Doppler ultrasound (DU), arteriography, CT, and MRI and including modern techniques such as perfusion CT, diffusion- and perfusion-weighted MRI (DWI, PWI), CT angiography and MR angiography (CTA, MRA), and CTA source image analysis (CTA-SI). The authors present their view of a comprehensive diagnostic approach to acute stroke, which challenges the concept of a rigid therapeutic time window. Conclusions— Information about the presence or absence of a vessel occlusion, whether by means of DU, CTA, or MRA, is essential before recombinant tissue plasminogen activator is given in the 3- to 6-hour time window. Clear demarcation of the irreversibly damaged infarct core and the ischemic but still viable and thus salvageable tissue at risk of infarction as seen on DWI/PWI/MRA or alternatively CT/CTA/CTA-SI should be obtained before thrombolysis is initiated within 3 to 6 hours. Once these advanced techniques are used, the therapeutic time window can be extended with acceptable safety. However, comprehensive informed consent is mandatory, especially when thrombolytic therapy is considered beyond established time windows.
{"title":"Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status","authors":"P. Schellinger, J. Fiebach, W. Hacke","doi":"10.1161/01.STR.0000051504.10095.9C","DOIUrl":"https://doi.org/10.1161/01.STR.0000051504.10095.9C","url":null,"abstract":"Background— Thrombolysis is the treatment of choice for acute stroke within 3 hours after symptom onset. Treatment beyond the 3-hour time window has not been shown to be effective in any single trial; however, meta-analyses suggest a somewhat lesser but still significant effect within 3 to 6 hours after stroke. It seems reasonable to apply improved selection criteria that allow differentiation between patients with and without a relevant indication for thrombolytic therapy. Summary of Review— The present literature on imaging in stroke has been thoroughly reviewed, covering Doppler ultrasound (DU), arteriography, CT, and MRI and including modern techniques such as perfusion CT, diffusion- and perfusion-weighted MRI (DWI, PWI), CT angiography and MR angiography (CTA, MRA), and CTA source image analysis (CTA-SI). The authors present their view of a comprehensive diagnostic approach to acute stroke, which challenges the concept of a rigid therapeutic time window. Conclusions— Information about the presence or absence of a vessel occlusion, whether by means of DU, CTA, or MRA, is essential before recombinant tissue plasminogen activator is given in the 3- to 6-hour time window. Clear demarcation of the irreversibly damaged infarct core and the ischemic but still viable and thus salvageable tissue at risk of infarction as seen on DWI/PWI/MRA or alternatively CT/CTA/CTA-SI should be obtained before thrombolysis is initiated within 3 to 6 hours. Once these advanced techniques are used, the therapeutic time window can be extended with acceptable safety. However, comprehensive informed consent is mandatory, especially when thrombolytic therapy is considered beyond established time windows.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"298 1","pages":"575-583"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79671861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1161/01.STR.0000046764.57344.31
M. Castellanos, R. Leira, J. Serena, J. Pumar, I. Lizasoaín, J. Castillo, A. Dávalos
Background and Purpose— Matrix metalloproteinase-9 (MMP-9) activity has been associated with hemorrhagic transformation (HT) in experimental models of cerebral ischemia. Our aim was to investigate the relationship between MMP-9 concentrations in blood within 24 hours of stroke onset and subsequent HT of cerebral infarction. Methods— We studied 250 patients with a hemispheric ischemic stroke of 7.8±4.5 hours’ duration. Early CT signs of cerebral infarction were evaluated on admission. The HT and infarct volume were analyzed from the CT performed on days 4 through 7. MMP-9 levels were determined by enzyme-linked immunosorbent assay in blood samples obtained on admission. Results— HT was observed in 38 patients (15.2%): 24 (63.2%) had a hemorrhagic infarction, and 14 (36.8%) had a parenchymal hematoma. A total of 108 patients (43%) received anticoagulants before the second CT scan. Systolic and diastolic blood pressures, body temperature, frequency of early CT signs of ischemia (92% versus 22%), and treatment with anticoagulants (79% versus 37%) were significantly higher in the group with HT (P <0.001). Mean infarct volume was 126±60 cm3 in the HT group and 90±68 cm3 in the group without HT (P =0.003). Median (quartiles) plasma MMP-9 concentrations were higher in the HT group (193 [163, 213] versus 62 [40, 93] ng/mL, P <0.001), even in the 24 patients seen within 3 hours of symptom onset (P =0.014). MMP-9 levels ≥140 ng/mL had a positive and negative predictive value of HT of 61% and 97%, respectively. MMP-9 ≥140 ng/mL was associated with HT (odds ratio, 12; 95% confidence interval, 3 to 51;P <0.001) after adjustment for potential confounders and final infarct volume. Conclusions— High plasma MMP-9 concentration in the acute phase of a cerebral infarct is an independent biochemical predictor of HT in all stroke subtypes.
{"title":"Plasma Metalloproteinase-9 Concentration Predicts Hemorrhagic Transformation in Acute Ischemic Stroke","authors":"M. Castellanos, R. Leira, J. Serena, J. Pumar, I. Lizasoaín, J. Castillo, A. Dávalos","doi":"10.1161/01.STR.0000046764.57344.31","DOIUrl":"https://doi.org/10.1161/01.STR.0000046764.57344.31","url":null,"abstract":"Background and Purpose— Matrix metalloproteinase-9 (MMP-9) activity has been associated with hemorrhagic transformation (HT) in experimental models of cerebral ischemia. Our aim was to investigate the relationship between MMP-9 concentrations in blood within 24 hours of stroke onset and subsequent HT of cerebral infarction. Methods— We studied 250 patients with a hemispheric ischemic stroke of 7.8±4.5 hours’ duration. Early CT signs of cerebral infarction were evaluated on admission. The HT and infarct volume were analyzed from the CT performed on days 4 through 7. MMP-9 levels were determined by enzyme-linked immunosorbent assay in blood samples obtained on admission. Results— HT was observed in 38 patients (15.2%): 24 (63.2%) had a hemorrhagic infarction, and 14 (36.8%) had a parenchymal hematoma. A total of 108 patients (43%) received anticoagulants before the second CT scan. Systolic and diastolic blood pressures, body temperature, frequency of early CT signs of ischemia (92% versus 22%), and treatment with anticoagulants (79% versus 37%) were significantly higher in the group with HT (P <0.001). Mean infarct volume was 126±60 cm3 in the HT group and 90±68 cm3 in the group without HT (P =0.003). Median (quartiles) plasma MMP-9 concentrations were higher in the HT group (193 [163, 213] versus 62 [40, 93] ng/mL, P <0.001), even in the 24 patients seen within 3 hours of symptom onset (P =0.014). MMP-9 levels ≥140 ng/mL had a positive and negative predictive value of HT of 61% and 97%, respectively. MMP-9 ≥140 ng/mL was associated with HT (odds ratio, 12; 95% confidence interval, 3 to 51;P <0.001) after adjustment for potential confounders and final infarct volume. Conclusions— High plasma MMP-9 concentration in the acute phase of a cerebral infarct is an independent biochemical predictor of HT in all stroke subtypes.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"18 1","pages":"40-46"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81842909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1161/01.STR.0000022809.46400.4B
D. Russell, R. Brucher
Background and Purpose— The aim of this study was to assess the first multifrequency transcranial Doppler system that was specially developed to automatically detect and discriminate between solid and gaseous cerebral microemboli. Methods— The multifrequency transcranial Doppler instrumentation insonates simultaneously with 2.5 and 2.0 MHz. Differentiation between solid and gaseous microemboli is based on the principle that solid microemboli reflect more ultrasound at the higher than at the lower frequency, whereas the opposite is the case for gaseous microemboli. In the in vitro studies, 159 plastic spheres (50 or 80 &mgr;m in diameter) and 105 gas bubbles (8 to 25 &mgr;m) were studied in a pulsatile closed-loop system containing irodinium or pig blood. In vivo studies were carried out for 1 hour in 15 patients with mechanical heart valves and in 45 patients with carotid stenosis. This gave a total of 60 hours of online automatic monitoring in patients. Results— In the in vitro studies, 152 of the 159 (95.6%) plastic spheres were classified as solid, and 7 (4.4%) were classified as uncertain solid. Of the 105 gas bubbles, 99 (94.3%) were classified as gaseous and 6 (5.7%) as uncertain gaseous. Thus, correct classification was made for 251 (95.1%) of the 264 embolic events studied. A comparison between the automatic multifrequency discrimination and the known embolic classification gave a &kgr; value of 0.897 (P <0.0001). The multifrequency Doppler classified 433 (84.2%) of the 514 emboli detected in the mechanical heart valve patients as gaseous, 74 (14.4%) as solid, and 7 (1.4%) as uncertain (3 uncertain solid, 4 uncertain gas). Thirty-two emboli were detected in 17 (38%) of the 45 carotid stenosis patients; 30 (93.7%) were classified as solid and 2 (6.3%) as uncertain solid. Conclusions— This study has shown that multifrequency transcranial Doppler can be used to automatically differentiate between solid and gaseous microemboli online. Most detected microemboli in this initial study of mechanical heart valves were classified as gaseous, whereas most were classified as solid in the patients with carotid stenosis.
{"title":"Online Automatic Discrimination Between Solid and Gaseous Cerebral Microemboli With the First Multifrequency Transcranial Doppler","authors":"D. Russell, R. Brucher","doi":"10.1161/01.STR.0000022809.46400.4B","DOIUrl":"https://doi.org/10.1161/01.STR.0000022809.46400.4B","url":null,"abstract":"Background and Purpose— The aim of this study was to assess the first multifrequency transcranial Doppler system that was specially developed to automatically detect and discriminate between solid and gaseous cerebral microemboli. Methods— The multifrequency transcranial Doppler instrumentation insonates simultaneously with 2.5 and 2.0 MHz. Differentiation between solid and gaseous microemboli is based on the principle that solid microemboli reflect more ultrasound at the higher than at the lower frequency, whereas the opposite is the case for gaseous microemboli. In the in vitro studies, 159 plastic spheres (50 or 80 &mgr;m in diameter) and 105 gas bubbles (8 to 25 &mgr;m) were studied in a pulsatile closed-loop system containing irodinium or pig blood. In vivo studies were carried out for 1 hour in 15 patients with mechanical heart valves and in 45 patients with carotid stenosis. This gave a total of 60 hours of online automatic monitoring in patients. Results— In the in vitro studies, 152 of the 159 (95.6%) plastic spheres were classified as solid, and 7 (4.4%) were classified as uncertain solid. Of the 105 gas bubbles, 99 (94.3%) were classified as gaseous and 6 (5.7%) as uncertain gaseous. Thus, correct classification was made for 251 (95.1%) of the 264 embolic events studied. A comparison between the automatic multifrequency discrimination and the known embolic classification gave a &kgr; value of 0.897 (P <0.0001). The multifrequency Doppler classified 433 (84.2%) of the 514 emboli detected in the mechanical heart valve patients as gaseous, 74 (14.4%) as solid, and 7 (1.4%) as uncertain (3 uncertain solid, 4 uncertain gas). Thirty-two emboli were detected in 17 (38%) of the 45 carotid stenosis patients; 30 (93.7%) were classified as solid and 2 (6.3%) as uncertain solid. Conclusions— This study has shown that multifrequency transcranial Doppler can be used to automatically differentiate between solid and gaseous microemboli online. Most detected microemboli in this initial study of mechanical heart valves were classified as gaseous, whereas most were classified as solid in the patients with carotid stenosis.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"46 1","pages":"1975-1980"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73517652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1161/01.STR.0000021409.16314.16
Tsong-Hai Lee, W. Hsu, Chi‐Jen Chen, Sien‐Tsong Chen
Background and Purpose— The etiologic mechanisms of young ischemic stroke in Chinese are largely unknown. This work thus studied the etiologies of young ischemic stroke in Taiwan Chinese and made a comparison with previous reports. Methods— From January 1997 to October 2001, a total of 264 consecutive young ischemic stroke patients (18 to 45 years old) were admitted to the Department of Neurology in our hospital. The risk factors for stroke and the distribution of stroke subtype were studied. The vascular ultrasound and angiographic findings of these patients were also studied. Results— The sample contained 188 men and 76 women. Cerebral infarction was diagnosed in 241 patients and transient ischemic attack in 23 (8.7%). Regarding stroke subtype, stroke of small-vessel occlusion was diagnosed in 20.5% of cases, large-artery atherosclerosis in 7.2%, cardioembolism in 17.8%, other determined etiology in 22.3%, and undetermined etiology in 23.5%. The 4 most common risk factors were hyperlipidemia (53.1%), smoking (49.8%), hypertension (45.8%), and family history of stroke (29.3%). Twenty-three patients (9.6%) had significant stenosis (≥50%) of the carotid (7.5%) and vertebral arteries (2.1%), the most common cause of which was dissection (60.9%). Forty-five patients (26.5%) had significant intracranial stenosis with 18.8% in the carotid and 10.6% in the vertebrobasilar system, and 5 (2.9%) had stenosis in both systems. Premature atherosclerosis (33.3%) was the most common cause of intracranial stenosis. Conclusions— Our study found that strokes of other determined etiology and undetermined etiology were most common among the sample group, and a battery of extensive examinations is indicated to elucidate the etiology for further stroke prevention. Intracranial stenosis is more common than extracranial stenosis in both the carotid and vertebrobasilar systems.
{"title":"Etiologic Study of Young Ischemic Stroke in Taiwan","authors":"Tsong-Hai Lee, W. Hsu, Chi‐Jen Chen, Sien‐Tsong Chen","doi":"10.1161/01.STR.0000021409.16314.16","DOIUrl":"https://doi.org/10.1161/01.STR.0000021409.16314.16","url":null,"abstract":"Background and Purpose— The etiologic mechanisms of young ischemic stroke in Chinese are largely unknown. This work thus studied the etiologies of young ischemic stroke in Taiwan Chinese and made a comparison with previous reports. Methods— From January 1997 to October 2001, a total of 264 consecutive young ischemic stroke patients (18 to 45 years old) were admitted to the Department of Neurology in our hospital. The risk factors for stroke and the distribution of stroke subtype were studied. The vascular ultrasound and angiographic findings of these patients were also studied. Results— The sample contained 188 men and 76 women. Cerebral infarction was diagnosed in 241 patients and transient ischemic attack in 23 (8.7%). Regarding stroke subtype, stroke of small-vessel occlusion was diagnosed in 20.5% of cases, large-artery atherosclerosis in 7.2%, cardioembolism in 17.8%, other determined etiology in 22.3%, and undetermined etiology in 23.5%. The 4 most common risk factors were hyperlipidemia (53.1%), smoking (49.8%), hypertension (45.8%), and family history of stroke (29.3%). Twenty-three patients (9.6%) had significant stenosis (≥50%) of the carotid (7.5%) and vertebral arteries (2.1%), the most common cause of which was dissection (60.9%). Forty-five patients (26.5%) had significant intracranial stenosis with 18.8% in the carotid and 10.6% in the vertebrobasilar system, and 5 (2.9%) had stenosis in both systems. Premature atherosclerosis (33.3%) was the most common cause of intracranial stenosis. Conclusions— Our study found that strokes of other determined etiology and undetermined etiology were most common among the sample group, and a battery of extensive examinations is indicated to elucidate the etiology for further stroke prevention. Intracranial stenosis is more common than extracranial stenosis in both the carotid and vertebrobasilar systems.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"204 1","pages":"1950-1955"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80307601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1161/01.STR.0000022811.46115.70
R. Brucher, D. Russell
Background and Purpose— The goal of this study was to assess the first multifrequency transcranial Doppler system specially developed for online automatic detection of cerebral microemboli. Methods— The multifrequency Doppler instrumentation insonates simultaneously with 2.0- and 2.5-MHz frequencies. The detection threshold for embolus detection used in this study was a relative Doppler energy increase of >20 dB · ms, at which point the Doppler power increase was at least 5 dB and lasted >4 ms above the background energy. Four parameters were used in an optimized binary decision tree to recognize emboli: quarter Doppler shift, maximum duration limit, reference gate, and bidirectional enhancement. In in vitro studies, 200 plastic microspheres (80 &mgr;m), 200 gas bubbles (8 to 25 &mgr;m), and 600 artifacts were studied in a pulsatile closed-loop system. In vivo studies were carried out for 1 hour in 15 patients with mechanical heart valves and in 45 patients with carotid stenosis. This gave a total of 60 hours of online automatic monitoring in patients. Results— All 400 plastic spheres and microbubbles were automatically detected and correctly classified. Of the 600 artifacts, 596 (99.3%) were correctly classified as artifacts, and 4 (0.7%) were incorrectly identified as emboli (&kgr;=0.992, P <0.001). The experienced observer detected a total of 554 emboli and 800 artifacts in the heart valve (521 emboli, 400 artifacts) and carotid stenosis (33 emboli, 400 artifacts) patients. With multifrequency Doppler, 546 of these emboli (98.6%) and 791 of these artifacts (98.9%) were automatically detected and correctly classified as embolus or artifact (&kgr;=0.953, P <0.0001). Conclusions— We found that multifrequency transcranial Doppler had a relatively high sensitivity and specificity when used to automatically detect cerebral microemboli and reject artifacts online.
背景和目的:本研究的目的是评估首个专门用于在线自动检测脑微栓塞的多频经颅多普勒系统。方法:多频多普勒仪器同时对2.0和2.5 mhz频率进行超声检测。本研究中栓子检测的检测阈值为相对多普勒能量增加bbb20 dB·ms，此时多普勒能量增加至少5 dB，并持续>4ms以上的背景能量。在优化的二叉决策树中使用四个参数来识别栓塞:四分之一多普勒频移，最大持续时间限制，参考门和双向增强。在体外研究中，在脉冲闭环系统中研究了200个塑料微球(80 &mgr;m)， 200个气泡(8至25 &mgr;m)和600个人工制品。在15例机械心脏瓣膜患者和45例颈动脉狭窄患者中进行了1小时的体内研究。这给患者提供了总共60小时的在线自动监测。结果:所有400个塑料球和微泡均被自动检测并正确分类。600例伪象中，596例(99.3%)被正确分类为伪象，4例(0.7%)被错误识别为栓子(&kgr;=0.992, P <0.001)。经验丰富的观察者在心脏瓣膜共发现554个栓子和800个伪影(521个栓子，400个伪影)和颈动脉狭窄(33个栓子，400个伪影)患者。多频多普勒自动检测栓塞546例(98.6%)，伪象791例(98.9%)，并正确分类为栓子或伪象(&kgr;=0.953, P <0.0001)。结论-我们发现多频经颅多普勒在在线自动检测脑微栓塞和排斥伪像时具有相对较高的灵敏度和特异性。
{"title":"Automatic Online Embolus Detection and Artifact Rejection With the First Multifrequency Transcranial Doppler","authors":"R. Brucher, D. Russell","doi":"10.1161/01.STR.0000022811.46115.70","DOIUrl":"https://doi.org/10.1161/01.STR.0000022811.46115.70","url":null,"abstract":"Background and Purpose— The goal of this study was to assess the first multifrequency transcranial Doppler system specially developed for online automatic detection of cerebral microemboli. Methods— The multifrequency Doppler instrumentation insonates simultaneously with 2.0- and 2.5-MHz frequencies. The detection threshold for embolus detection used in this study was a relative Doppler energy increase of >20 dB · ms, at which point the Doppler power increase was at least 5 dB and lasted >4 ms above the background energy. Four parameters were used in an optimized binary decision tree to recognize emboli: quarter Doppler shift, maximum duration limit, reference gate, and bidirectional enhancement. In in vitro studies, 200 plastic microspheres (80 &mgr;m), 200 gas bubbles (8 to 25 &mgr;m), and 600 artifacts were studied in a pulsatile closed-loop system. In vivo studies were carried out for 1 hour in 15 patients with mechanical heart valves and in 45 patients with carotid stenosis. This gave a total of 60 hours of online automatic monitoring in patients. Results— All 400 plastic spheres and microbubbles were automatically detected and correctly classified. Of the 600 artifacts, 596 (99.3%) were correctly classified as artifacts, and 4 (0.7%) were incorrectly identified as emboli (&kgr;=0.992, P <0.001). The experienced observer detected a total of 554 emboli and 800 artifacts in the heart valve (521 emboli, 400 artifacts) and carotid stenosis (33 emboli, 400 artifacts) patients. With multifrequency Doppler, 546 of these emboli (98.6%) and 791 of these artifacts (98.9%) were automatically detected and correctly classified as embolus or artifact (&kgr;=0.953, P <0.0001). Conclusions— We found that multifrequency transcranial Doppler had a relatively high sensitivity and specificity when used to automatically detect cerebral microemboli and reject artifacts online.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"20 1","pages":"1969-1974"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86040733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-08-01DOI: 10.1161/01.STR.0000025226.95834.7D
J. L. Stork, C. Levi, B. Chambers, A. Abbott, G. Donnan
Background and Purpose— High numbers of microembolic signals (MES) have been associated with increased risk of postoperative stroke after carotid endarterectomy (CEA). We sought to identify factors predictive of postoperative MES. Methods— Transcranial Doppler monitoring of the ipsilateral middle cerebral artery for MES was performed for 30 minutes during the first postoperative hour in sequential patients undergoing CEA. Stepwise binomial logistic regression analysis was performed to identify preoperative and intraoperative variables that predicted the occurrence of postoperative MES. Results— We studied 141 patients (mean age, 69 years); 102 (72%) were male, and 69 (49%) had at least 1 MES (range, 1 to 118) detected in the first postoperative hour. The risk of postoperative MES was greater in women (P =0.027), patients not receiving antiplatelet therapy (P =0.033), and patients undergoing left-sided CEA (P =0.049). Other variables such as residual stenosis seen on completion angiography and operative technique were not associated with postoperative MES. Conclusions— Postoperative MES were most likely in women, patients not receiving preoperative antiplatelet therapy, and patients who had a left CEA. Microembolism might explain why these same factors are associated with higher rates of perioperative stroke.
{"title":"Possible Determinants of Early Microembolism After Carotid Endarterectomy","authors":"J. L. Stork, C. Levi, B. Chambers, A. Abbott, G. Donnan","doi":"10.1161/01.STR.0000025226.95834.7D","DOIUrl":"https://doi.org/10.1161/01.STR.0000025226.95834.7D","url":null,"abstract":"Background and Purpose— High numbers of microembolic signals (MES) have been associated with increased risk of postoperative stroke after carotid endarterectomy (CEA). We sought to identify factors predictive of postoperative MES. Methods— Transcranial Doppler monitoring of the ipsilateral middle cerebral artery for MES was performed for 30 minutes during the first postoperative hour in sequential patients undergoing CEA. Stepwise binomial logistic regression analysis was performed to identify preoperative and intraoperative variables that predicted the occurrence of postoperative MES. Results— We studied 141 patients (mean age, 69 years); 102 (72%) were male, and 69 (49%) had at least 1 MES (range, 1 to 118) detected in the first postoperative hour. The risk of postoperative MES was greater in women (P =0.027), patients not receiving antiplatelet therapy (P =0.033), and patients undergoing left-sided CEA (P =0.049). Other variables such as residual stenosis seen on completion angiography and operative technique were not associated with postoperative MES. Conclusions— Postoperative MES were most likely in women, patients not receiving preoperative antiplatelet therapy, and patients who had a left CEA. Microembolism might explain why these same factors are associated with higher rates of perioperative stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"1 1","pages":"2082-2085"},"PeriodicalIF":0.0,"publicationDate":"2002-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88312958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：