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Stroke
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Stroke occurs when blood flow to the brain is restricted, causing life-threatening damage and tissue death. Transient ischemic attacks (TIA) are like strokes, but don’t cause permanent damage. Stroke in children can occur, but is rare, and is usually caused by a blood clot. Stroke kills about 150,000 Americans every year, and is the third leading cause of death in the U.S. It occurs most frequently in people 65 years of age or older and affects more men than women (though women experience greater mortality from stroke than do men). Depending on the diagnosis (most often made with a CAT scan), stroke can be treated or prevented with carotid endarterectomy, a surgical procedure that removes plaque from the carotid arteries, or cerebral angioplasty to treat occlusions in the cerebral vessels with the use of balloons, stents and coils. The two types of stroke are: (1) Ischemic Stroke: Nearly 80% of strokes are ischemic in nature, caused by cerebral arterial occlusion (lacunar stroke), carotid artery occlusion, or embolism from the heart or an artery; and (2) Hemorrhagic Stroke: The remaining 20% or so of strokes are caused by hemorrhaging within or around the brain. The most common type of hemorrhagic strokes are cerebral strokes, usually the result of high blood pressure, while about 3% of strokes are subarrachnoic hemorrhages from a ruptured aneurysm, injury or other causes.
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Stroke Complicating Cardiac Catheterization ? A Preventable and Treatable Complication
ABSTRACT: Stroke is a rare but serious complication of cardiac catheterization. Due to the low incidence of stroke complicating catheterization of the left heart, there is no clearly defined optimal treatment. With increasing numbers of diagnostic and interventional cardiac procedures being performed, definitive management pathways for periprocedural neurological complications need to be defined. Many studies have shown excellent results with both thrombolytic and catheter-based neurovascular rescue, but equal attention should be paid to identify measures to prevent this iatrogenic complication. It is also imperative that management decisions be taken jointly by the cardiologist and stroke physician. We review the literature regarding the features of ischemic stroke complicating cardiac catheterization, the various management modalities and suggest a management protocol.
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Differences in Baseline Characteristics and In-hospital Outcomes in Patients with or without Prior Stroke Undergoing Percutaneous Coronary Intervention
Background. Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who have a higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke. Methods. Review of a PCI database of 9,088 consecutive PCIs from 7/97 to 12/02 identified 812 PCIs in patients with a history of prior stroke and 8,044 PCIs without prior stroke. Results. Patients with prior stroke had high-risk baseline characteristics [diabetes, hypertension, hyperlipidemia, smoking, peripheral arterial disease, congestive heart failure, chronic renal failure, history of prior myocardial infarction and prior coronary artery bypass graft (CABG)] and high-risk coronary anatomy (p < 0.001 for each one). The triple composite (death, myocardial infarction and emergent CABG) and the triple composite plus post-PCI stroke were higher in patients with prior stroke (11.2% vs. 4.8%; p < 0.001; z = 7.617 and 12.1% vs. 5.0%; p < 0.001; z = 8.271, respectively. Conclusion. Patients with prior stroke constitute a high-risk PCI cohort with higher rates of in-hospital adverse events. A prior stroke history should be considered in evaluating potential candidates for PCI.
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Should Interventional Cardiologists Treat Ischemic Strokes? A Global Perspective
Stroke is the third leading cause of death and the leading cause of severe neurological disability in our nation. The stroke death rate has the potential to reach epidemic proportions as the elderly segment of the population continues to rise. There is an insufficient number of trained physicians to supply the care for this patient population. The logical source for qualified physicians to care for these patients is the interventional cardiologist. We review the recent intraarterial therapy trials and detail the training necessary to allow interventional cardiologists to treat ischemic strokes.
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2002 IAGS Proceedings: Intracranial Interventions (Part I of II)
Paul La Violette: From industry? Nick Hopkins: I don? Doug Cavaye: I am a vascular surgeon.
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Contemporary Prevention, Management and Treatment of Stroke ? Who Will Treat Acute Stroke in 2010 and How Will It Be Treated? Setting the Stage
The data on this first slide (Figure 1) show the magnitude of the problem of stroke. What do we know about the changing incidence of stroke? What are the mechanisms of stroke?
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The SPIDER? Embolic Protection Device Performance Evaluation in the Cartoid Artery during PTA and/or Stenting
Recently completed studies have compared carotid endarterectomy with carotid artery stenting, a nonsurgical method of improving blood flow in the carotid arteries. Embolic protection devices can prevent particles dislodged during carotid artery stenting from causing stroke or death. An ev3 Inc.-sponsored trial (PROTECT) evaluated the performance requirements of the SPIDER? Embolic Protection Device in the carotid artery for CE Marking. Patients who were candidates for percutaneous transluminal angioplasty (PTA) and/or stenting were enrolled. Performance was assessed by determining the incidence of major adverse neurological events (MANE) through 30 days postprocedure in 74 patients, along with the successful placement and recovery rates of the filter. MANE was defined as stroke or death. There were a total of 5 MANE events reported in 5 patients, 1 major stroke and 4 minor strokes. There were no deaths. The total MANE event rate was 6.8% (5/73). The overall SAE rate was 8.2% (6/73). An SAE was defined as an event that resulted in the hospitalization or prolongation of hospitalization due to potential disability, or due to danger of life that resulted in an intervention or that was terminal. Technical success of the SPIDER device was defined as placement of the filter at the distal edge of the lesion in the carotid artery, placement of the recovery catheter and successful retrieval of the filter with the recovery catheter. An inability to place or retrieve the filter was concluded to be a system failure. The SPIDER device was successfully placed in the carotid artery and retrieved with an overall successful placement rate of 88.1% (74/84), and a retrieval rate of 98.6% (73/74). In conclusion, the PROTECT Trial demonstrated that the performance of the SPIDER device in the carotid artery complied with the relevant Product Directives for CE Marking. The incidence of MANE was low and comparable to what has been reported in recently published literature. J INVASIVE CARDIOL 2005;17:463?467
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To Close or Not To Close? PFO, Sex and Cerebrovascular Events
ABSTRACT: We report on 2 patients with cerebrovascular events associated with sexual activity and PFO who subsequently underwent endovascular patent foramen ovale (PFO) closure. The concurrence of sexual activity (a Valsalva equivalent) at symptom onset, together with supporting data ? prior paradoxical embolus in 1 case, elevated D-dimer in another ? supported paradoxical embolization as the most likely mechanism of the cerebrovascular events. These cases emphasize that clinicians evaluating patients for PFO closure should explicitly inquire about sexual activity at stroke onset.
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Combination Antithrombotic Therapy with Antiplatelet Agents and Anticoagulants for Patients with Atherosclerotic Heart Disease (Part II)
if warfarin therapy is commenced in patients with acute MI and CAD, aspirin therapy should be discontinued until the planned course of therapy with warfarin is complete.? Since such patients are at high risk for recurrent ischemic events, combination therapy with aspirin and warfarin (INR, 2.0? The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial, evaluating the efficacy of antithrombotic therapy with warfarin versus aspirin versus clopidogrel in patients with heart ...
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The Current State of Stroke and Stroke Treatment
I don? What strategies are available for treating stroke today? What are the market needs?
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2002 IAGS Proceedings: Intracranial Intervention (Part II of II)
Nick Hopkins: I think you are absolutely correct. Nick Hopkins: The team concept is certainly the best approach. Reginald Low: Why don?
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
Click Here for More Info.
Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
Birmingham, AL - Date: Friday, May 9, 2008 6:00pm EST -8:00 pm EST
This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
Non-Accredited
This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
Complimentary Accredited CME Program
This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
A Complimentary Accredited ON-DEMAND Webcast
This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
Accredited CD
This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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Webcast and Web Archives |
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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© 2008 HMP Communications | All Rights Reserved
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Release Date: December 8, 2006