Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study.

BACKGROUND AND PURPOSE: Although the latest recommendations suggest that carotid endarterectomy (CEA) should be performed in symptomatic carotid artery stenosis (sCAS) patients within 2 weeks of the index event, only a minority of patients undergo surgery within the recommended time-frame. The aim of this international multicenter study was to prospectively evaluate the safety of early CEA in patients with sCAS in everyday clinical practice settings. METHODS: Consecutive patients with non-disabling acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) due to sCAS (≥ 70%) underwent early (≤ 14 days) CEA at five tertiary-care stroke centers during a 2-year period. Primary outcome events included stroke, myocardial infarction (MI) or death occurring during the 30-day follow-up period and were defined according to the International Carotid Stenting Study criteria. RESULTS: A total of 165 patients with sCAS [mean age 69 ± 10 years; 69% men; 70% AIS; 6% crescendo TIA; 8% with contralateral internal carotid artery (ICA) occlusion] underwent early CEA (median elapsed time from symptom onset 8 days). Urgent CEA (≤ 2 days) was performed in 20 cases (12%). The primary outcomes of stroke and MI were 4.8% [95% confidence interval (CI) 1.5%-8.1%] and 0.6% (95% CI 0%-1.8%). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (95% CI 2.0%-9.0%). Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (P > 0.2) with a higher 30-day stroke rate. CONCLUSIONS: Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling AIS or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks (or even within 2 days) from symptom onset.

Adult age differences in memory in relation to availability and accessibility of knowledge-based schemas.

Three experiments investigated whether, over adulthood, the use of schemas to process and remember new information increases (developmental shift hypothesis), decreases (production deficiency hypothesis) or remains constant (age-invariance hypothesis). Effects of schema access were studied by having young, middle-aged, and old music experts and nonexperts recall information that was relevant or irrelevant to music (Experiment 1) and by comparing young and old participants' memory for prose passages when they knew or did not know the subject of the passage (Experiments 2 and 3). In each case, schema access facilitated memory equally across age levels, supporting the age-invariance hypothesis and implying that the basic structures and operations of memory do not necessarily change with age. Possible limits on the independence of age and schema utilization were considered in relation to the conditions under which each of the two alternative hypotheses might hold.

Adult age differences in recall of a moral dilemma under intentional, incidental and dual task instructions.

Age changes in memory discourse were examined under conditions where participants were asked to listen to a passage about a moral dilemma: (a) for later recall of main ideas and details (Intentional Recall); (b) to propose solutions for it (Incidental Recall), or (c) to do both (Dual Task). Sixty young (19-32 years) and 60 old (60-76 years) adults participated, 20 of each age in each condition. Older adults gave fewer verbatim responses but more inferences, elaborations and overgeneralizations, an outcome which contrasted with earlier findings that older adults cannot process implied meanings. Verbatim recall was lower with Dual Task than with Intentional Recall instructions, suggesting that doing two tasks required more processing capacity, but there were no age x condition interactions with any measure. The results were discussed in relation to possible age decrements in processing capacity and possible age differences in interpreting the recall instructions.