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  • 1
    Online Resource
    Online Resource
    Is the Long-Term Prognosis of Transient Ischemic Attack or Minor Ischemic Stroke Affected by the Occurrence of Nonfocal Symptoms?
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 5 ( 2014-05), p. 1318-1323
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 5 ( 2014-05), p. 1318-1323
    Abstract: In patients with a transient ischemic attack or ischemic stroke, nonfocal neurological symptoms, such as confusion and nonrotatory dizziness, may be associated with a higher risk of vascular events. We assessed the relationship between nonfocal symptoms and the long-term risk of vascular events or death in patients with a transient ischemic attack or minor ischemic stroke. Methods— We related initial symptoms with outcome events in 2409 patients with a transient ischemic attack (n=723) or minor ischemic stroke (n=1686), included in the Life Long After Cerebral ischemia cohort. All patients underwent a standardized interview on the occurrence of focal and nonfocal neurological symptoms during the qualifying event. The primary outcome was the composite of any stroke, myocardial infarction, or vascular death. Secondary outcomes were all-cause death, vascular death, cardiac death, myocardial infarction, and stroke. Hazard ratios were calculated with Cox regression. Results— Focal symptoms were accompanied by nonfocal symptoms in 739 (31%) patients. During a mean follow-up of 10.1 years, the primary outcome occurred in 1313 (55%) patients. There was no difference in the risk of the primary outcome between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (adjusted hazard ratio, 0.97; 95% confidence interval, 0.86–1.09; P =0.60). The risk of each of the secondary outcomes was also similar in both groups. Conclusions— About one third of the patients with a transient ischemic attack or minor ischemic stroke has both focal and nonfocal neurological symptoms. Nonfocal symptoms are not associated with an increased long-term risk of vascular events or death. Clinical Trial Registration— This trial was not registered because enrollment began before July 1, 2005.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.004360
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome
    Springer Science and Business Media LLC ; 2015
    In:  Journal of Neurology Vol. 262, No. 2 ( 2015-2), p. 410-417
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 262, No. 2 ( 2015-2), p. 410-417
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-014-7583-5
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 1421299-7
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  • 3
    Online Resource
    Online Resource
    Nonfocal Symptoms are More Frequent in Patients with Vertebral Artery than Carotid Artery Stenosis
    S. Karger AG ; 2013
    In:  Cerebrovascular Diseases Vol. 35, No. 4 ( 2013), p. 378-384
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 35, No. 4 ( 2013), p. 378-384
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 In patients with a transient ischemic attack (TIA) or ischemic stroke, the combination of focal and nonfocal symptoms has been associated with a higher risk of cardiovascular events. We hypothesized that nonfocal symptoms are more frequent in patients with symptomatic stenosis of a vertebral artery (VA) than of a carotid artery (CA). Therefore, we assessed the prevalence of nonfocal symptoms in patients with a recent TIA or nondisabling ischemic stroke and studied their relation with symptomatic CA or VA stenosis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We administered a standardized questionnaire on the occurrence of focal and nonfocal symptoms during the qualifying TIA or nondisabling ischemic stroke and in the preceding 6 months. We included 50 consecutive patients with a recently symptomatic CA stenosis ≥50%, 50 consecutive patients with a recently symptomatic VA stenosis ≥50%, 25 consecutive patients with an anterior circulation event without an ipsilateral CA stenosis ≥50%, and 25 consecutive patients with a posterior circulation event without a relevant VA stenosis ≥50%. Relative risks for the presence of nonfocal symptoms in relation to the presence of a symptomatic stenosis were calculated with univariate and multivariate Poisson regression. Adjustments were made for age, sex, stroke as the qualifying event, and cardiovascular risk factors. A subgroup analysis was performed for patients in whom the vascular territory of the event was confirmed on imaging. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 During the qualifying ischemic event, focal symptoms were accompanied by nonfocal symptoms in 80 (53%) patients. Nonfocal symptoms occurred more frequently in patients with a VA stenosis (72%) than in patients with a CA stenosis [26%; adjusted relative risk (aRR), 2.9; 95% confidence interval (CI), 1.8-4.6]. A higher prevalence of nonfocal symptoms was found in patients with posterior circulation TIAs and strokes (73%) than in patients with anterior circulation TIAs and strokes (33%; aRR, 2.2; 95% CI, 1.6-3.1). During the preceding 6 months, 45% of patients with and 20% of patients without a symptomatic stenosis had had nonfocal symptoms (aRR, 2.4; 95% CI, 1.3-4.3). Subgroup analysis for the 89 (59%) patients with ischemia visible on imaging gave essentially the same results. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 More than half of the TIAs or nondisabling ischemic strokes were associated with nonfocal neurological symptoms. Nonfocal symptoms occurred more frequently in patients with a symptomatic VA stenosis than CA stenosis.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000348849
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
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  • 4
    Online Resource
    Online Resource
    Prevalence and Prognosis of Asymptomatic Vertebral Artery Origin Stenosis in Patients With Clinically Manifest Arterial Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 10 ( 2011-10), p. 2795-2800
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 10 ( 2011-10), p. 2795-2800
    Abstract: The risk of ischemic stroke in patients with asymptomatic vertebral artery stenosis is unknown. We examined the incidence of posterior circulation ischemic stroke in patients with asymptomatic stenosis of the vertebral artery origin (VAo). Methods— We studied a hospital-based cohort of 3717 patients (median age, 60 years; interquartile range, 52 to 68 years) with atherosclerotic arterial disease enrolled in the Second Manifestations of ARTerial disease (SMART) study. We included patients in whom duplex ultrasound of the carotid artery and vertebral artery had been performed. Patients with symptomatic VAo stenosis or planned revascularization of the carotid artery or vertebral artery were excluded. Data were analyzed with Cox regression; hazard ratios were adjusted for age and vascular risk factors. Results— In 282 patients (7.6%), asymptomatic VAo stenosis 〉 50% was diagnosed with duplex ultrasound. During a mean follow-up of 4.6 years (SD, 3.0), posterior circulation ischemic stroke occurred in 5 of the 282 patients with asymptomatic VAo stenosis at baseline (annual stroke rate, 0.4%) and in 12 of the 3435 patients without VAo stenosis (annual stroke rate, 〈 0.1%). The risk of posterior circulation ischemic stroke was higher in patients with VAo stenosis than in patients without VAo stenosis (hazard ratio, 4.2; 95% CI, 1.4 to 13.1) and was further increased in patients with both VAo and carotid artery stenosis (hazard ratio, 10.5; 95% CI, 3.0 to 37.3). In multivariable analysis, this risk remained essentially the same. Conclusions— Patients with atherosclerotic arterial disease and asymptomatic VAo stenosis have a higher risk of posterior circulation ischemic stroke than patients without such a stenosis, but the absolute risk remains low.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.612903
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Acute Basilar Artery Occlusion in the Basilar Artery International Cooperation Study : Does Gender Matter?
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 11 ( 2010-11), p. 2693-2696
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 11 ( 2010-11), p. 2693-2696
    Abstract: Background and Purpose— Randomized trials suggested a different benefit of intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) between men and women with anterior circulation stroke because of a worse outcome of women in the control group. Methods— We compared outcome and recanalization in men and women with basilar artery occlusion treated with antithrombotic treatment alone, IVT or combined IVT–IAT, or IAT in the Basilar Artery International Cooperation Study. Results— Overall, 389 male and 226 female patients were analyzed. In the antithrombotic treatment group, 68 of 111 (61%) men and 47 of 70 (67%) women had a poor outcome defined as a modified Rankin Scale score of 4 to 6 (adjusted risk ratio [aRR], 0.96; 95% CI, 0.75 to 1.24), in the IVT/combined IVT–IAT group, 47 of 77 (61%) men and 24 of 43 (56%) women (aRR, 1.19; 95% CI, 0.89 to 1.60), and in the IAT group, 142 of 185 (77%) men and 71 of 102 (70%) women (aRR, 1.01; 95% CI, 0.88 to 1.17). Mortality was not different between men and women in the antithrombotic treatment group (aRR, 0.80; 95% CI, 0.55 to 1.16), the IVT/combined IVT–IAT group (aRR, 1.11; 95% CI, 0.72 to 1.73), or in the IAT group (aRR, 1.01; 95% CI, 0.75 to 1.36). Insufficient recanalization after combined IVT–IAT or IAT was similar in men and women (23% versus 22%; aRR, 0.92; 95% CI, 0.58 to 1.46). Conclusions— In patients with acute basilar artery occlusion, no significant gender differences for outcome and recanalization were observed, regardless of treatment modality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.594036
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 1467823-8
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