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  • S. Karger AG  (5)
  • Naritomi, Hiroaki  (5)
  • 1
    Online Resource
    Online Resource
    Moderate Atheroma of the Aortic Arch and the Risk of Stroke
    S. Karger AG ; 2006
    In:  Cerebrovascular Diseases Vol. 21, No. 1-2 ( 2006), p. 26-31
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 21, No. 1-2 ( 2006), p. 26-31
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Severe atheroma ≧4 or 5 mm of the aortic arch is a risk factor for stroke. We investigated the most predictive characteristics of arch atheroma, including maximal plaque thickness, for subsequent cardiovascular events, and also examined whether moderate atheroma 〈 4 mm is a risk of cerebral emboli. 〈 i 〉 Methods: 〈 /i 〉 The maximal plaque thickness (MPT) and plaque morphologies of the aortic arch were evaluated by transesophageal echocardiography in 236 patients with ischemic stroke. We assessed the relationship between the incidence of cardiovascular events, recurrent stroke or myocardial infarction, and the characteristics of the atheroma. We also investigated the thickness of atheroma in patients with known causes of stroke (n = 148) and in patients with undetermined causes (n = 19). 〈 i 〉 Results: 〈 /i 〉 Cardiovascular events occurred in 47 patients in the follow-up period with a mean of 3.5 years. MPT was a significant risk factor of the cardiovascular events, although plaque morphologies were not. For the receiver operator characteristics curve analysis, the suitable cutoff point of MPT associated with the cardiovascular events was 3.5 mm. Patients with MPT ≧3.5 mm had a higher risk of cardiovascular events than did those with MPT 〈 3.5 mm. In addition, aortic atheroma with MPT ≧3.5 mm was more frequently observed in patients with undetermined causes of stroke than those with known causes at 68 vs. 39% (p = 0.024). 〈 i 〉 Conclusions: 〈 /i 〉 MPT ≧3.5 mm is the best predictor of subsequent cardiovascular events and a possible cause of embolic stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000089590
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2006
    detail.hit.zdb_id: 1482069-9
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  • 2
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    Online Resource
    Quantitative Evaluation of Carotid Plaque Echogenicity by Integrated Backscatter Analysis: Correlation with Symptomatic History and Histologic Findings
    S. Karger AG ; 2008
    In:  Cerebrovascular Diseases Vol. 26, No. 6 ( 2008), p. 578-583
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 26, No. 6 ( 2008), p. 578-583
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Echogenicity of carotid plaque well reflects the risk of ischemic stroke and may be predictive of the histologic content of the plaque. However, objective evaluation of plaque echogenicity has been hampered by a lack of established quantitative measures. This study examined the relation between echogenicity assessed by integrated backscatter (IBS) analysis and (1) symptomatic history and (2) histologic features of carotid plaques. 〈 i 〉 Methods: 〈 /i 〉 We used acoustic densitometry to quantify by IBS analysis the echogenicity of 31 carotid plaques of 26 patients undergoing carotid endarterectomy or stenting. IBS was subsequently compared with histologic findings of the respective tissue in 10 patients who underwent endarterectomy. The IBS value was calibrated with 2 reference structures (vessel lumen and adventitia) as the IBS index. 〈 i 〉 Results: 〈 /i 〉 The IBS index of symptomatic plaques was lower than that of asymptomatic plaques (23.1 ± 12.5 vs. 36.5 ± 18.2, p 〈 0.05). The IBS index in fatty/necrotic atheromatous sites (n = 20, 16.6 ± 10.7) was lower than that in fibrous (n = 26, 42.4 ± 13.6, p 〈 0.01) or calcified (n = 11, 87.7 ± 17.4, p 〈 0.01) sites and the same as that in intraplaque hemorrhagic sites (n = 50, 23.6 ± 16.9). 〈 i 〉 Conclusions: 〈 /i 〉 Carotid plaque echogenicity, as quantitatively assessed by IBS analysis, correlates well with the presence or absence of prior symptoms and histologic contents of the plaques. IBS analysis may aid in the assessment of carotid plaque-related risk of stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000165110
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2008
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  • 3
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    Online Resource
    Brain Embolism Caused by a Mobile Aortic Thrombus with Iron Deficiency Anemia
    S. Karger AG ; 2005
    In:  Cerebrovascular Diseases Vol. 20, No. 6 ( 2005), p. 475-478
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 20, No. 6 ( 2005), p. 475-478
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000089335
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2005
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  • 4
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    Enlargement of Acute Intracerebral Hematomas in Patients on Long-Term Warfarin Treatment
    S. Karger AG ; 2010
    In:  Cerebrovascular Diseases Vol. 29, No. 5 ( 2010), p. 446-453
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 29, No. 5 ( 2010), p. 446-453
    Abstract: 〈 i 〉 Background: 〈 /i 〉 The relationship between warfarin administration and the frequent development of enlarged hematomas in patients with acute intracerebral hemorrhage (ICH) is controversial. The present study was carried out to examine this issue. 〈 i 〉 Methods: 〈 /i 〉 This study reviewed 41 patients with nontraumatic ICH within 24 h after stroke onset from 1999 to 2003 who received long-term warfarin treatment (29 men and 12 women, 70 ± 12 years old) and 323 patients who had not been on warfarin (177 men and 146 women, 66 ± 13 years old). The hematoma volume (HV) on admission, final HV, frequency of hematoma enlargement (HE) and other background characteristics were investigated. 〈 i 〉 Results: 〈 /i 〉 Both the HV on admission (p = 0.031) and final HV (p = 0.001) were larger in patients on warfarin than in those not receiving warfarin. HE occurred more frequently (p 〈 0.001), and mortality at 30 days or at discharge was higher (p = 0.003) in the warfarin group than in the control group. A multivariate adjusted logistic regression analysis showed that warfarin treatment (OR = 5.75, 95% CI = 2.41–13.8, p 〈 0.001), liver disease (OR = 2.59, 95% CI = 1.12–5.99, p = 0.026), and the National Institutes of Health Stroke Scale score (OR = 1.10, 95% CI = 1.04–1.15, p 〈 0.001, per 1-score increase) on admission were independently related to HE. 〈 i 〉 Conclusions: 〈 /i 〉 Acute ICH in patients on long-term warfarin treatment appears to be associated with HE.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000289348
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
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  • 5
    Online Resource
    Online Resource
    Effect of Prothrombin Complex Concentrate on Hematoma Enlargement and Clinical Outcome in Patients with Anticoagulant-Associated Intracerebral Hemorrhage
    S. Karger AG ; 2011
    In:  Cerebrovascular Diseases Vol. 31, No. 2 ( 2011), p. 170-176
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 31, No. 2 ( 2011), p. 170-176
    Abstract: 〈 i 〉 Background: 〈 /i 〉 The present study was carried out to determine the effect of prothrombin complex concentrate (PCC) on hematoma enlargement (HE) and the early clinical outcome of intracerebral hemorrhage (ICH) patients on long-term warfarin treatment. 〈 i 〉 Methods: 〈 /i 〉 Themedical records and computed tomography (CT) images of 50 consecutive ICH patients on long-term warfarin treatment (35 men, 15 women; 69 ± 12 years old) were reviewed. International normalized ratio (INR) values, frequency of HE and clinical outcome were compared between patients treated with and without PCC. 〈 i 〉 Results: 〈 /i 〉 INR values on admission were above 2.0 in 37 patients, of whom 19 were given PCC (PCC group) and 18 were not given PCC (control group). In these 37 patients, the frequency of HE (p = 0.017), the number of patients with a poor clinical outcome (modified Rankin Scale score ≧3 at 30 days or at discharge; p = 0.045) and in-hospital mortality (p = 0.042) were significantly higher in the control than in the PCC group. On multivariate logistic regression analysis with adjustment, PCC administration was independently associated (odds ratio 0.03, 95% confidence interval 0.00–0.63; p = 0.023) with a reduction in poor clinical outcome in ICH patients whose INR values were 〉 2.0 on admission. 〈 i 〉 Conclusions: 〈 /i 〉 Immediate INR reversal with PCC may prevent HE and subsequent poor outcome.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000321766
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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