Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Steno-Occlusive Arterial Disease and Early Neurological Deterioration in Acute Ischemic Stroke

Ois A. · Martinez-Rodriguez J.E. · Munteis E. · Gomis M. · Rodríguez-Campello A. · Jimenez-Conde J. · Cuadrado-Godia E. · Roquer J.

Author affiliations

Unitat d’Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina, Universitat Central de Barcelona, IMIM-Hospital del Mar, Barcelona, Spain

Related Articles for ""

Cerebrovasc Dis 2008;25:151–156

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: May 14, 2007
Accepted: July 09, 2007
Published online: January 23, 2008
Issue release date: February 2008

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Aim: To evaluate the influence that steno-occlusive arterial disease may have on the development of early neurological deterioration (END) in a large series of patients with acute ischemic stroke. Methods: We studied a prospective cohort of 1,093 patients admitted to a single tertiary hospital with presence of neurological symptoms in the first 24 h after stroke onset. END was defined as any increase in the National Institutes of Health Stroke Scale score ≧4 points in the first 72 h. The arterial study assessed the presence of arterial occlusion or significative stenosis in the symptomatic territory. Additionally, age, initial stroke severity, blood pressure, glucose levels, vascular risk factors, lacunar stroke and prior use of antithrombotic treatment were also analyzed in a multivariable analysis. Results: END was detected in 179 patients (16.3%). Steno-occlusive disease (adjusted OR 3.60), initial blood pressure and abdominal obesity were independently associated with END. Both arterial stenosis (adjusted OR 2.33) or occlusions (adjusted OR 3.65) were associated with END. The higher adjusted OR (5.49) was obtained for steno-occlusive arterial disease in the vertebrobasilar system. Conclusions: An early arterial study may provide key data for the selection of patients with higher risk of END after acute ischemic stroke.

© 2008 S. Karger AG, Basel


References

  1. Karepov VG, Gur AY, Bova I, Aronovich BD, Bornstein NM: Stroke-in-evolution: infarct-inherent mechanisms versus systemic causes. Cerebrovasc Dis 2006;21:42–46.
  2. Weimar C, Mieck T, Buchthal J, Ehrenfeld CE, Scgmid E, Diener HC: German Stroke Study Collaboration. Neurologic worsening during the Acute Phase of ischemic stroke. Arch Neurol 2005;62:393–397.
  3. Roden-Jullig A, Britton M: Effectiveness of heparin treatment for progressing ischemic stroke: before and after study. J Int Med 2000;248:287–291.
  4. Roden-Jullig A, Britton M, Malmkvist K, Leijd B: Aspirin in the prevention of progressing stroke: a randomised controlled study. J Int Med 2003;254:584–590.
  5. Serena J, Rodríguez-Yáñez M, Castellanos M: Deterioration in acute ischemic stroke as the target for neuroprotection. Cerebrovasc Dis 2006;21:80–88.
  6. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Effect of blood pressure and diabetes on stroke in progression. Lancet 1994;344:156–159.
  7. DeGraba TJ, Hallenbeck JM, Pettigrew KD, Dutka AJ, Kelly BJ: Progression in acute stroke: value of the initial NIH Stroke Scale score on patient stratification in future trials. Stroke 1999;30:1208–1212.
  8. Toni D, Fiorelli M, Gentile M, Bastianello S, Sacchetti ML, Argentino C, Pozzilli C, Fieschi C: Progressing neurological deficit secondary to acute ischemic stroke: a study on predictability, pathogenesis and prognosis. Arch Neurol 1995;52:670–675.
  9. Alvarez FJ, Segura T, Castellanos M, Leira R, Blanco M, Castillo J, Davalos A, Serena J: Cerebral hemodynamic reserve and early neurologic deterioration in acute ischemic stroke. J Cereb Blood Flow Metab 2004;24:1267–1271.
  10. Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV: Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke 2001;32:89–93.
  11. Barber PA, Davis SM, Darby DG, Desmond PM, Gerraty RP, Yang Q, Jolley D, Donnan GA, Tress BM: Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra. Neurology 1999;52:1125–1132.
  12. Irino T, Watanabe M, Nishide M, Gotoh M, Tsuchiya I: Angiographical analysis of acute cerebral infarction followed by ‘cascade’-like deterioration of minor neurological deficits: what is progressing stroke? Stroke 1983;14:363–368.
  13. Toni D, Fiorelli M, Zanette EM, Sachetti ML, Salerno A, Argentino C, Solaro M, Fieschi C: Early spontaneous improvement and deterioration of ischemic stroke patients. A serial study with transcranial Doppler ultrasonography. Stroke 1998;29:1144–1148.
  14. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T: Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Org 1980;58:113–130.
  15. Koo CK, Teasdale E, Muir KW: What constitutes a true hyperdense middle cerebral artery sign? Cerebrovasc Dis 2000;10:419–423.
  16. Adams HP, Bendixen BH, Kappelle LJ; the TOAST Investigators: Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke 1993;24:35–41.
  17. Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, Haley EC, Grotta J, Marler J; the NINDS t-PA Stroke Study Group: Improved reliability of the NIH Stroke Scale using video training. Stroke 1994;25:2220–2226.
  18. Grotta JC, Welch KMA, Fagan SC, Lu M, Frankel MR, Brott T, Levine SR, Lyden PD: Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial. Stroke 2000;32:661–668.
    External Resources
  19. Executive summary of third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.
  20. Zanette EM, Fieschi C, Bozzao L, Roberti C, Bastianello S, Toni D, Argentino C, Lenzi GL: Comparison of cerebral angiography and transcranial Doppler sonography in acute stroke. Stroke 1989;20:899–903.
  21. Anzola GP, Gasparotti R, Magoni M, Prandini F: Transcranial Doppler sonography and magnetic resonance angiography in the assessment of collateral hemispheric flow in patients with carotid artery disease. Stroke 1995;26:214–217.
  22. Akopov S, Whitman GT: Hemodynamic studies in early ischemic stroke serial transcranial Doppler and magnetic resonance angiography evaluation. Stroke 2002;33:1274–1279.
  23. Alexandrov AV, Neumyer MM: Diagnostic criteria for cerebrovascular ultrasound; in Alexandrov AV (ed): Cerebrovascular Ultrasound in Stroke Prevention and Treatment. London, Blackwell Publishing, 2004, pp 81–129.
  24. Rorick MB, Nichols FT, Adams RJ: Transcranial Doppler correlation with angiography in detection of intracranial stenosis. Stroke 1994;25:1931–1934.
  25. Baumgartner RW, Mattle HP, Schroth G: Assessment of 50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 1999;30:87–92.
  26. Allendoerfer J, Goertler M, Reutern G von: Prognostic relevance of ultraearly Doppler sonography in acute ischaemic stroke: a prospective multicentre study. Lancet Neurol 2006;5:835–840.
  27. Engström G, Hedblad B, Stavenow L, Jonsson S, Lind P, Janzon L, Lindgärde F: Incidence of obesity-associated cardiovascular disease is related to inflammation-sensitive plasma proteins: a population-based cohort study. Arterioscler Thromb Vasc Biol 2004;24:1498–1502.
  28. Suk S-H, Sacco RL, Boden-Albala B, Cheun JF, Pittman JG, Elkind MS, Paik MC: Abdominal obesity and risk of ischemic stroke: The Northern Manhattan Stroke Study. Stroke 2003;34:1586–1592.
  29. Tanne D, Medalie JH, Goldbourt U: Body fat distribution and long-term risk of stroke mortality. Stroke 2005;36:1021–1025.
  30. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al: Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 2006;113:555–563.
  31. Matsumoto N, Kimura K, Yokota C, Yonemura K, Wada K, Uchino M, Minematsu K: Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke. J Neurol Sci 2004;15:151–155.
    External Resources
  32. Yamamoto H, Bogousslavsky J, van Melle G: Different predictors of neurological worsening in different causes of stroke. Arch Neurol 1998;55:481–486.
  33. Barber PA, Davis SM, Darby DG, Desmond PM, Gerraty RP, Yang Q, Jolley D, Donnan GA, Tress BM: Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra. Neurology 1999;52:1125–1132.
  34. Adams HP, Adams RJ, Brott T, et al: Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke 2003;34:1056–1083.
  35. Aleksic M, Rueger MA, Lehnhardt FG, Sobesky J, Matoussevitch V, Neveling M, Heiss WD, Brunkwall J, Jacobs AH: Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke. Cerebrovasc Dis 2006;22:276–281.
  36. Bond R, Rerkasem K, Rothwell PM: Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery. Stroke 2003;34:2290–2303.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: May 14, 2007
Accepted: July 09, 2007
Published online: January 23, 2008
Issue release date: February 2008

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.