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  • 1
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    Online Resource
    Prospective Study on the Complication Rate of Carotid Surgery
    S. Karger AG ; 1999
    In:  Cerebrovascular Diseases Vol. 9, No. 3 ( 1999), p. 152-156
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 9, No. 3 ( 1999), p. 152-156
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Randomized trials of carotid endarterectomy for high-grade stenosis have shown a benefit for surgery under the condition of low perioperative complication rates. Concerns have been expressed that the complication rates of carotid surgery are higher in everyday practice and may vary considerably between centers. We prospectively established the complication rate for carotid surgery in a single institution. 〈 i 〉 Design: 〈 /i 〉 Prospective 2-year study. All patients received pre- and postoperative neurological evaluation. Laboratory tests included pre- and postoperative brain imaging, intracranial and neck vessel sonography, conventional angiography, magnetic resonance angiography, and intraoperative monitoring. Participants: 108 consecutive patients: 54 symptomatic patients fulfilling the inclusion criteria of the European Carotid Surgery Trial (ECST) and 54 asymptomatic patients fulfilling the inclusion criteria of the North American Trial on Asymptomatic Stenoses (ACAS). Setting: Single academic center with a high volume of carotid endarterectomies ( 〉 50 per year). Participating center in ECST. Main Outcome Measures: Stroke or death as defined in the randomized trials. 〈 i 〉 Results: 〈 /i 〉 The overall complication rate was 8.3% (95% CI 4.1–15.6%). Complications were more frequent in patients with symptomatic stenosis (11.1%, CI 4.6–23.3%) than in asymptomatic cases (5.6%, CI 1.5–16.4%). Three patients died (2 strokes, 1 myocardial infarction). Disabling strokes were found in 2 patients (Rankin scale scores 3 and 4). Nondisabling strokes (Rankin scale score 1 and 2) occurred in 4 patients. The complication rates for symptomatic and asymptomatic patients were higher than the ones reported in the randomized trials, but 95% confidence intervals showed that the differences were not statistically significant. The point estimates of complication rates still supported a benefit of surgery for patients with symptomatic stenosis, but denied a positive effect of endarterectomy for patients with asymptomatic stenosis. 〈 i 〉 Conclusion: 〈 /i 〉 In this center, a beneficial effect of carotid surgery for asymptomatic stenoses cannot be safely assumed.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000015945
    Language: English
    Publisher: S. Karger AG
    Publication Date: 1999
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  • 2
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    Determinants and Prognostic Significance of Hematoma Sedimentation Levels in Acute Intracerebral Hemorrhage
    S. Karger AG ; 2016
    In:  Cerebrovascular Diseases Vol. 41, No. 1-2 ( 2016), p. 80-86
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 41, No. 1-2 ( 2016), p. 80-86
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 This study aimed at identifying the determinants and prognostic significance of a sedimentation level (fluid-blood level) in the hematoma among patients with acute intracerebral hemorrhage (ICH) who participated in the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Post-hoc analysis of the INTERACT2 dataset, a randomized controlled trial of patients with acute ICH with elevated systolic blood pressure (SBP), randomly assigned to intensive (target SBP 〈 140 mm Hg) or guideline-based ( 〈 180 mm Hg) BP management. Patients with a sedimentation level at baseline assessment on CT, and modified Rankin Scale score at 90-day, were included in these analyses. Factors associated with a sedimentation level and its significance in relation to 90-day clinical outcomes were assessed in univariable and multivariable logistic regression models. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 2,065 participants, 19 (1%) had sedimentation level on baseline CT, which was independently associated with warfarin use (p = 0.006) and lobar ICH (p = 0.025). Sedimentation level was also associated with death or major disability at 90-day in both crude (84 vs. 53%; p = 0.014) and multivariable analyses adjusted for age, gender, Chinese region, warfarin use, baseline National Institutes of Health Stroke Scale score, onset to CT time, volume and location of ICH, intraventricular extension, and randomized intensive BP lowering (OR 3.94, 95% CI 1.01-15.37; p = 0.049). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The presence of hematoma sedimentation level on baseline CT is associated with warfarin use and lobar location of ICH, and predicts a worse outcome. Although uncommon, sedimentation level is an easily detectable prognostic factor in acute ICH.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000442532
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 3
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    Rapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies
    S. Karger AG ; 2015
    In:  Cerebrovascular Diseases Vol. 39, No. 3-4 ( 2015), p. 242-248
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 39, No. 3-4 ( 2015), p. 242-248
    Abstract: 〈 b 〉 〈 i 〉 Background and Purpose: 〈 /i 〉 〈 /b 〉 Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH ( 〈 6 h) and elevated systolic BP (SBP 150-220 mm Hg) who were randomized to intensive (target SBP 〈 140 mm Hg) or guideline-recommended (target SBP 〈 180 mm Hg) BP lowering treatment. Treatment effects were examined according to repeated measures analysis of an ordinal (‘shift') across all 7 levels of the modified Rankin Scale (mRS) assessed during follow-up at 7, 28, and 90 days, post-randomization. Clinical trial registration information: http://www.clinicaltrials.gov, NCT00226096 and NCT00716079. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Intensive BP lowering resulted in a significant favorable distribution of mRS scores for better functioning (odds ratio 1.13, 95% confidence interval 1.00-1.26; p = 0.042) over 7, 28 and 90 days, and the effect was consistency for early (7-28 days) and later (28-90 days) time periods (p homogeneity 0.353). Treatment effects were also consistent across several pre-specified patient characteristic subgroups, with trends favoring those randomized early, and with higher SBP and milder neurological severity at baseline. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Intensive BP lowering provides beneficial effects on physical functioning that manifests consistently through the early and later phases of recovery from ICH.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000381107
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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  • 4
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    Presentation and Prognosis of Bilateral Infarcts in the Territory of the Superior Cerebellar Artery
    S. Karger AG ; 1999
    In:  Cerebrovascular Diseases Vol. 9, No. 6 ( 1999), p. 328-333
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 9, No. 6 ( 1999), p. 328-333
    Abstract: Unilateral cerebellar infarcts in the territory of the superior cerebellar artery (SCA) have been studied in recent years to delineate the clinical presentation and stroke mechanism, but most studies excluded bilateral infarctions. We have studied patients with bilateral SCA infarctions to provide data on clinical findings, stroke distribution and outcome. We collected data of 8 patients with bilateral SCA infarctions recognized by computed tomography and/or magnetic resonance imaging. The most common clinical presentation of patients with bilateral SCA infarctions were nausea, vomiting or vertigo (6 patients), often associated with ataxia and dysarthria (5 patients). Further symptoms were variable and depended on additional infarcts in other vascular territories. Infarcts were often partial or scattered with equal distribution between the medial and lateral branches of the SCA. Complete infarction within the SCA area occurred in less than half of the cases. Clinical outcome was either benign (full recovery in 3 patients) or fatal (5 patients). Predictors for a good clinical recovery were young age, few vascular risk factors, only partial involvement of the SCA territory without involvement of other vascular territories, and absent limb weakness on clinical presentation.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000016007
    Language: English
    Publisher: S. Karger AG
    Publication Date: 1999
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  • 5
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    Stroke Unit Management and Revascularisation in Acute Ischemic Stroke
    S. Karger AG ; 2015
    In:  European Neurology Vol. 73, No. 1-2 ( 2015), p. 98-105
    Details
    In: European Neurology, S. Karger AG, Vol. 73, No. 1-2 ( 2015), p. 98-105
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Stroke affects one in six people throughout their lifetimes and is the most frequent cause of disability in adults. Several recanalization therapies have emerged and the management of patients in stroke units has improved over the last decades. 〈 b 〉 〈 i 〉 Summary: 〈 /i 〉 〈 /b 〉 This article examines the current treatment options for stroke patients, summarizing the key clinical evidence, as well as listing the complications and practical issues related to each of these main treatment options. 〈 b 〉 〈 i 〉 Key Messages: 〈 /i 〉 〈 /b 〉 Recent advances in the treatment of acute stroke include developments in intravenous thrombolysis (IVT), intra-arterial treatment and bridging therapies. 〈 b 〉 〈 i 〉 Clinical Implications: 〈 /i 〉 〈 /b 〉 Treatment within a stroke unit reduces mortality and disability regardless of age, sex and stroke severity. IVT is widely available and reduces disability when initiated within 4.5 h after the onset of symptoms. The major limitations of IVT are the low recanalization rates and the narrow time frame. Intra-arterial treatment, especially when using newly developed stent-retrievers, achieves very high recanalization rates. It is restricted by its limited availability and by the longer time span required to initiate therapy. Bridging both therapies is a promising approach that combines the advantages of both therapies, but the superiority of this approach remains to be proven. Future strategies to reduce the burden of acute stroke in Europe should focus on immediate access to acute stroke care and dedicated stroke units for all patients. 〈 b 〉 〈 /b 〉 i 2014 S. Karger AG, Basel
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    URL: Article
    DOI: 10.1159/000365210
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
    detail.hit.zdb_id: 1482237-4
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  • 6
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    European Research Priorities for Intracerebral Haemorrhage
    S. Karger AG ; 2011
    In:  Cerebrovascular Diseases Vol. 32, No. 5 ( 2011), p. 409-419
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 32, No. 5 ( 2011), p. 409-419
    Abstract: Over 2 million people are affected by intracerebral haemorrhage (ICH) worldwide every year, one third of them dying within 1 month, and many survivors being left with permanent disability. Unlike most other stroke types, the incidence, morbidity and mortality of ICH have not declined over time. No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death and disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000330653
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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  • 7
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    Incidence of Adult Brain Arteriovenous Malformation Hemorrhage in a Prospective Population-Based Stroke Survey
    S. Karger AG ; 2002
    In:  Cerebrovascular Diseases Vol. 13, No. 1 ( 2002), p. 43-46
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 13, No. 1 ( 2002), p. 43-46
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Brain arteriovenous malformations (AVMs) represent a potential source of intracranial hemorrhage, especially in young adults, but prospective population-based incidence data on AVM hemorrhage are lacking. We investigated the incidence of first-ever AVM hemorrhage in adults based on population data from the Northern Manhattan Stroke Study (NOMASS). 〈 i 〉 Methods: 〈 /i 〉 NOMASS is a prospective, population-based, stroke incidence survey collecting all hospitalized and nonhospitalized cases with first-ever (incident) stroke over the age of 20 in a ZIP code-defined area. All patients undergo CT and/or MR brain imaging and clinical data are systematically collected from the medical records. For this study, data on all cases with incident intracranial hemorrhage, i.e. any intracerebral, intraventricular and/or subarachnoid hemorrhage, occurring between July 1, 1993 and June 30, 1997 were used. Patients with intracranial hemorrhage due to trauma, tumor or intracranial vascular malformations other than a previously unknown AVM were excluded from the study. 〈 i 〉 Results: 〈 /i 〉 Of the 207 patients diagnosed with a first-ever intracranial hemorrhage, 3 cases (1.4%) with an underlying brain AVM were identified. The crude incidence rate for first-ever AVM hemorrhage in our adult population was 0.55 per 100,000 person-years (95% confidence interval 0.11–1.61). 〈 i 〉 Conclusions: 〈 /i 〉 Our results support prior findings from retrospective surveys. Population-based studies providing a prospective design for AVM detection and diagnosis are needed to confirm the data.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000047745
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2002
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  • 8
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    Early Blood Pressure Lowering Does Not Reduce Growth of Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage: Results of the INTERACT Studies
    S. Karger AG ; 2016
    In:  Cerebrovascular Diseases Extra Vol. 6, No. 3 ( 2016-9-8), p. 71-75
    Details
    In: Cerebrovascular Diseases Extra, S. Karger AG, Vol. 6, No. 3 ( 2016-9-8), p. 71-75
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Intraventricular hemorrhage (IVH) extension is common following acute intracerebral hemorrhage (ICH) and is associated with poor prognosis. 〈 b 〉 〈 i 〉 Aim: 〈 /i 〉 〈 /b 〉 To determine whether intensive blood pressure (BP)-lowering therapy reduces IVH growth. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Pooled analyses of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and INTERACT2) computed tomography (CT) substudies; multicenter, open, controlled, randomized trials of patients with acute spontaneous ICH and elevated systolic BP, randomly assigned to intensive ( 〈 140 mm Hg) or guideline-based ( 〈 180 mm Hg) BP management. Participants had blinded central analyses of baseline and 24-hour CT. Association of BP lowering to IVH growth was assessed in analysis of covariance. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 There was no significant difference in adjusted mean IVH growth following intensive (n = 228) compared to guideline-recommended (n = 228) BP treatment (1.6 versus 2.2 ml, respectively; p = 0.56). Adjusted mean IVH growth was nonsignificantly greater in patients with a mean achieved systolic BP ≥160 mm Hg over 24 h (3.94 ml; p trend = 0.26). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Early intensive BP-lowering treatment had no clear effect on IVH in acute ICH.
    Type of Medium: Online Resource
    ISSN: 1664-5456
    URL: Article
    DOI: 10.1159/000448897
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 2651613-5
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  • 9
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    Acute Bilateral Arm Paresis
    S. Karger AG ; 2000
    In:  Cerebrovascular Diseases Vol. 10, No. 3 ( 2000), p. 239-243
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 10, No. 3 ( 2000), p. 239-243
    Abstract: 〈 i 〉 Objective: 〈 /i 〉 To study pure motor bilateral arm paresis of acute onset. This syndrome is as yet a barely described clinical feature attributed to ischemia in the territory of the anterior spinal artery (ASA). 〈 i 〉 Cases: 〈 /i 〉 We present 2 patients with acute onset of pure motor deficit in both upper extremities. 〈 i 〉 Results: 〈 /i 〉 Magnetic resonance imaging of the cervical spinal cord revealed infarcts in the territory of the ASA. In 1 case, electrophysiology further suggested discrete gray matter involvement. 〈 i 〉 Conclusion: 〈 /i 〉 In patients with acute weakness of both arms without further neurological deficits, an incomplete ASA syndrome should be considered with the anterior horns predominantly being affected. Magnetic resonance imaging and electrophysiology are valuable tools to further confirm both location and extension of the spinal lesion.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000016063
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2000
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  • 10
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    Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial
    S. Karger AG ; 2015
    In:  Cerebrovascular Diseases Vol. 40, No. 3-4 ( 2015), p. 114-120
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 40, No. 3-4 ( 2015), p. 114-120
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP 〈 140 mm Hg) or guideline-based ( 〈 180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000434690
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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