ABSTRACT
BACKGROUND AND PURPOSE: To compare safety and efficacy of bridging approach with intravenous (IV) thrombolysis in patients with acute anterior strokes and proximal occlusions. PATIENTS AND METHODS: Consecutive patients with ischemic anterior strokes admitted within a 4 h 30 min window in two different centers were included. The first center performed IV therapy (alteplase 0.6 mg/kg) during 30 min and, in absence of clinical improvement, mechanical thrombectomy with flow restoration using a Solitaire stent (StS); the second carried out IV thrombolysis (alteplase 0.9 mg/kg) alone. Only T, M1 or M2 occlusions present on CT angiography were considered. Endpoints were clinical outcome and mortality at 3 months. RESULTS: There were 63 patients in the bridging and 163 in the IV group. No significant differences regarding baseline characteristics were observed. At 3 months, 46% (n = 29) of the patients treated in the combined and 23% (n = 38) of those treated in the IV group had a modified Rankin scale (mRS) of 0-1 (P < 0.001). A statistical significant difference was observed for all sites of occlusion. In a logistic regression model, National Institute of Health Stroke Scale (NIHSS) and bridging therapy were independent predictors of good outcome (respectively, P = 0.001 and P = 0.0018). Symptomatic hemorrhage was documented in 6.3% vs 3.7% in the bridging and in the IV group, respectively (P = 0.32). There was no difference in mortality. CONCLUSIONS: Our results suggest that patients treated with a bridging approach were more likely to have minimal or no deficit at all at 3 months as compared to the IV treated group.
Subject(s)
Fibrinolytic Agents/administration & dosage , Mechanical Thrombolysis/methods , Stroke/therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Administration, Intravenous , Aged , Female , Humans , Male , Middle Aged , StentsABSTRACT
All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.
Subject(s)
Aphrodisiacs/pharmacology , Cacao/chemistry , Candy , Sexuality/psychology , Aphrodisiacs/chemistry , Female , Flavonoids/isolation & purification , Flavonoids/pharmacology , Humans , Male , Reproductive Health , Sexuality/drug effectsABSTRACT
BACKGROUND: Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO). OBJECTIVE: The safety of IVT in SAO-patients is addressed in this study. METHODS: We used the Swiss IVT databank to compare outcome and complications of IVT-treated SAO-patients with IVT-treated patients with other etiologies (non-SAO-patients). Main outcome and complication measures were independence (modified Rankin scale
Subject(s)
Arterial Occlusive Diseases/complications , Brain Ischemia/etiology , Brain Ischemia/therapy , Stroke/etiology , Stroke/therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Aged , Aged, 80 and over , Chi-Square Distribution , Databases, Factual , Female , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Odds Ratio , Recurrence , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the prognostic accuracy of combining perfusion CT (PCT) and thrombolysis in brain ischemia (TIBI) ultrasonographic grade in the triage of stroke patients who will benefit from thrombolysis and in predicting the clinical outcome. METHODS: We conducted a prospective study of all consecutive stroke patients admitted to our hospital from March 2003 to July 2007, presenting with signs of acute stroke within the therapeutic window, who had undergone either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated by a complete stroke CT protocol, transcranial color-coded duplex sonographic monitoring, follow-up imaging (CT or MRI) and clinical outcome at 3 months, as assessed by the modified Rankin scale (mRS). RESULTS: A total of 34 patients were included with a mean NIHSS on admission of 14.2. This study revealed that PCT had 95% sensitivity and 71% specificity in the evaluation of therapy benefit as well as 75% sensitivity and 39% specificity in predicting clinical outcome. The extent of ischemic tissue according to PCT and TIBI grade were significantly correlated (p<0.05). Using the MTT-TTP approach was an alternative to the classical MTT-CBV approach for determining tissue at risk. The clinical outcome assessed by the mRS was considered favorable (mRS 0-2) in 16 patients and unfavorable (mRS>2) in 18 patients. CONCLUSION: PCT was the most accurate predictor of both thrombolytic therapy benefit and clinical outcome. The TIBI score was useful for determining whether or not to perform intravenous therapy alone or as a combined therapy.
Subject(s)
Brain Ischemia/diagnosis , Brain Ischemia/therapy , Perfusion Imaging , Stroke/diagnosis , Thrombolytic Therapy , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Brain Ischemia/complications , Cerebrovascular Circulation , Cohort Studies , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Stroke/etiology , Stroke/therapy , Treatment Outcome , Ultrasonography, Doppler, TranscranialABSTRACT
Major progress has recently been made in the neuro-imaging of stroke as a result of improvements in imaging hardware and software. Imaging may be based on either magnetic resonance imaging (MRI) or computed tomography (CT) techniques. Imaging should provide information on the entire vascular cervical and intracranial network, from the aortic arch to the circle of Willis. Equally, it should also give information on the viability of brain tissue and brain hemodynamics. CT has the advantage in the detection of acute hemorrhage whereas MRI offers more accurate pathophysiological information in the follow-up of patients.
Subject(s)
Brain Ischemia/diagnosis , Diagnostic Imaging/methods , Stroke/diagnosis , Cerebral Angiography/methods , Humans , Magnetic Resonance Imaging/methods , Spin Labels , Tomography, X-Ray Computed/methodsABSTRACT
Most patients with chronic heart failure (CHF) can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active coronary ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements for sexual activity and the impact chronic heart failure has on sexual performance. Fear of cardiac events during intercourse can interfere with patients' ability to perform and enjoy sex, and thus, it is important that the physician be able to counsel patients with chronic heart failure about sexual activity.
Subject(s)
Erectile Dysfunction/etiology , Heart Failure/complications , Erectile Dysfunction/therapy , Humans , MaleABSTRACT
Stroke represents the third leading cause of death, ranking behind heart disease and cancer and it is the major cause of worldwide long-term disability after the age of 65. Stroke has an important psychological and emotional impact on the patient and his environment. Some trials show the substantial lowering of libido, of the frequency of sexual intercourse, the presence of erectile dysfunction and reduced sexual satisfaction. After stroke it is important to evaluate the relational and sexual aspects of the patient and his sexual partner. A specialized consultation should be proposed when necessary to optimise the patient's post-stroke rehabilitation.
Subject(s)
Sexual Dysfunction, Physiological/etiology , Sexual Dysfunctions, Psychological/etiology , Stroke/complications , Humans , MaleABSTRACT
Erectile dysfunction is defined as the inability to achieve and/or maintain an erection sufficient to permit satisfactory sexual intercourse. Most cases of erectile dysfunction have a vascular etiology and, in patients with known cardiovascular disease, the degree of erectile dysfunction correlates with severity of that disease. In addition, cardiovascular disease and erectile dysfunction share the same risk factors for atherosclerosis and have a common pathophysiology (endothelial dysfunction); thus, erectile dysfunction appears as an early and sentinel symptom in patients with occult vascular disease, of the coronary or carotid arteries.
Subject(s)
Cardiovascular Diseases/physiopathology , Erectile Dysfunction/physiopathology , Biomarkers , Endothelium, Vascular/physiopathology , Humans , Male , Risk FactorsABSTRACT
Even with the help of modern pharmacology, treatment of erectile dysfunction often remains complex, and requires taking into account the social, psychological, and behavioral dimensions of the disorder. This brief report presents a case study highlighting this complexity.
Subject(s)
Erectile Dysfunction/drug therapy , Erectile Dysfunction/psychology , Piperazines/administration & dosage , Psychotherapy , Vasodilator Agents/administration & dosage , Adult , Combined Modality Therapy , Family Health , Humans , Male , Purines , Sildenafil Citrate , SulfonesABSTRACT
We report the use of transmyocardial laser revascularization in combination with partial left ventriculectomy for treatment of end-stage dilated ischemic cardiomyopathy. The disappearance of the reversible perfusion defects in the treated left ventricular territories and improvement of the systolic function led us to believe that the simultaneous use of these two techniques was complementary in our patient.
Subject(s)
Cardiomyopathy, Dilated/surgery , Heart Ventricles/surgery , Laser Therapy , Myocardial Ischemia/surgery , Myocardial Revascularization , Adult , Angiography , Cardiomyopathy, Dilated/diagnostic imaging , Combined Modality Therapy , Humans , Male , Myocardial Ischemia/diagnostic imaging , Systole/physiologySubject(s)
Brain/pathology , Carotid Arteries/pathology , Cerebral Angiography , Magnetic Resonance Imaging , Spin Labels , Stroke/diagnosis , Carotid Arteries/diagnostic imaging , Humans , Language Disorders/etiology , Middle Aged , Stroke/complications , Stroke/diagnostic imaging , Stroke/pathology , Stroke/therapy , Thrombolytic Therapy/methodsABSTRACT
Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions.
Subject(s)
Atherosclerosis/diagnostic imaging , Atherosclerosis/pathology , Brain/blood supply , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/pathology , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Atherosclerosis/complications , Brain/diagnostic imaging , Brain/pathology , Capillaries/diagnostic imaging , Capillaries/pathology , Cerebrovascular Disorders/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective StudiesABSTRACT
This databank-based, multicenter study compared all stroke patients with IV tissue plasminogen activator aged > or = 80 years (n = 38) and those < 80 years old (n = 287). Three-month mortality was higher in older patients. Favorable outcome (modified Rankin scale < or = 1) and intracranial hemorrhage (asymptomatic/symptomatic/fatal) were similarly frequent in both groups. Logistic regression showed that stroke severity, time to thrombolysis, glucose level, and history of coronary heart disease independently predicted outcome, whereas age did not.