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Anterior Circulation (anterior + circulation)

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Medical Sciences	100%

Selected Abstracts

Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat

EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010
V. Parkhutik
Background and purpose:, Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. Methods:, Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. Results:, Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. Conclusions:, Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. [source]

Post-stroke depression, executive dysfunction and functional outcome

EUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2002
T. Pohjasvaara
The early diagnosis of vascular cognitive impairment has been challenged and executive control function has been suggested to be a rational basis for the diagnosis of vascular dementia. We sought to examine the correlates of executive dysfunction in a well-defined stroke cohort. A group of 256 patients from a consecutive cohort of 486 patients with ischaemic stroke, aged 55,85 years, was subjected to a comprehensive neuropsychological examination 3,4 months after ischaemic stroke and 188 of them in addition to detailed psychiatric examination. Basic and complex activities of daily living (ADLs) (bADLs and cADLs) post-stroke were assessed. The DSM-III-R criteria were used for the diagnosis of the depressive disorders. Altogether 40.6% (n=104) of the patients had executive dysfunction. The patients with executive dysfunction were older, had lower level of education, were more often dependent, did worse in bADLs and cADLs, had more often DSM-III dementia, had worse cognition as measured by Mini Mental State Examination (MMSE) and were more depressed as measured by the BECK depression scale, but not with the more detailed psychiatric evaluation. They had more often stroke in the anterior circulation and less often in the posterior circulation. The independent correlates of executive dysfunction were cADLs (OR 1.1, 95% CI 1.03,1.16), each point of worsening in cognition by MMSE (OR 1.7, 95% CI 1.42,1.97) and stroke in the posterior circulation area (OR 0.4, 95% CI 0.18,0.84). Clinically significant executive dysfunction is frequent after ischaemic stroke and is closely connected with cADLs and to overall cognitive status but could be distinguished from depression by detailed neuropsychological examination. Executive measures may detect patients at risk of dementia and disability post-stroke. [source]

Patterns of stroke recurrence according to subtype of first stroke event: the North East Melbourne Stroke Incidence Study (NEMESIS)

INTERNATIONAL JOURNAL OF STROKE, Issue 3 2008
Mahmoud Reza Azarpazhooh
Background Specific information about the nature of recurrent events that occur after each subtype of index stroke may be useful for refining preventive therapies. We aimed to determine whether stroke recurrence rates, the pattern of subtype recurrence, and prescription of secondary prevention agents differed according to initial stroke subtype. Methods Multiple overlapping sources were used to recruit all first-ever stroke patients from a geographically defined region of Melbourne, Australia over a 3-year period from 1996 to 1999. Potential stroke recurrences (fatal and nonfatal) occurring within 2 years of the initial event were identified following patient interview and follow up of death records. Subjects were classified into the different Oxfordshire groups and the type of first-ever stroke was compared with recurrent stroke events. Results One thousand, three hundred and sixteen first-ever strokes were registered during the 3-year period (mean age 74.4 years). A total of 103 first recurrent stroke events (fatal and nonfatal) occurred among those with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) during the 2-year follow-up period. The recurrent stroke subtype was different to the index stroke subtype in most (78%) patients. People with partial anterior circulation infarct had the greatest proportion of recurrences (13%), with a third of these being the more severe total anterior circulation infarct subgroup. The relative risk of ICH after an index lacunar infarct (LACI) compared with an index non-LACI was 4.06 (95% CI 1.10,14.97, P=0.038). Prescription of secondary prevention agents was greater at 2 years after stroke than at hospital discharge, and was similar between ischemic stroke subtypes. Conclusion Approximately 9% of people with first-ever stroke suffered a recurrent event, despite many being prescribed secondary prevention agents. This has implications for the uptake of current preventive strategies and the development of new strategies. The possibility that ICH is greater among index LACI cases needs to be confirmed. [source]

The recovery of walking ability and subclassification of stroke

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2001
Gillian Baer MSc, MCSP
Abstract Background and Purpose The recovery of walking after a stroke is a key functional goal for many patients. Reports vary, but approximately 50,80% of patients will regain some degree of walking ability following stroke (Skilbeck et al., 1983). There are few data available to show whether different subclassifications of stroke have distinct patterns of gait recovery. The present paper describes the pattern of walking recovery in a population of stroke patients classified according to the Oxfordshire Community Stroke Project classification (Bamford et al., 1991). Method A prospective observational study. Stroke patients (n=238) admitted to the inpatient Stroke Rehabilitation Unit at the Western General Hospital, Edinburgh were initially included, with data for 185 patients ultimately available for analysis. Standardized measures of recovery of 10 steps and a 10-metre walk were used routinely to examine recovery time of walking ability. The main outcome measures consisted of days taken to achieve a 10-step walk, days to achieve a 10-metre walk, and initial and discharge gait velocity over 10 metres. Results Eighty-nine per cent of the sample (n=164) achieved a 10-step walk in a median time of five days and a 10-metre walk in eight days. The median initial gait velocity was 0.45 m/s which improved by discharge to 0.55 m/s. Further analysis by subgroup revealed that subjects sustaining a partial anterior circulation infarct, lacunar infarct or posterior circulation infarct recovered significantly more quickly than those subjects with a total anterior circulation infarct (Kruskal Wallis test for days to achieve 10 steps (H = 22.524, N = 164, df = 3) p<0.001; Kruskal Wallis test for days to achieve a 10-metre walk (H = 22.586, N = 164, df = 3) p<0.001. Conclusions An hierarchical pattern of recovery of gait was observed with definite variation between the subclassifications of stroke. It is suggested that further work needs to be undertaken to identify more accurately the factors that may influence the recovery of walking following stroke. Copyright © 2001 Whurr Publishers Ltd. [source]