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No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50352/1/410320425_ftp.pd

Right atrial spontaneous contrast: echocardiographic and clinical features

We describe the clinical and echocardiographic findings in eight patients with right atrial spontaneous echo contrast who were identified from 648 consecutive patients undergoing transesophageal echocardiography. Common findings in these patients were right atrial enlargement (8 patients), tricuspid regurgitation (7 patients), atrial fibrillation or flutter (6 patients), elevated right ventricular pressure (5 patients), moderate or severe mitral valve disease (5 patients), and right to left interatrial shunts (3 patients). Right heart catheterization in three patients showed markedly elevated right atrial, right ventricular, and pulmonary artery pressures. Two patients had thromboembolic events — one patient had recurrent pulmonary emboli, and another patient with an atrial septal aneurysm had recurrent transient ischemic attacks. Right atrial echo contrast is an uncommon finding at echocardiography that is associated with severe right heart dysfunction. It may also be associated with paradoxical or pulmonary embolism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42538/1/10554_2005_Article_BF01137904.pd

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1-60%) and more likely to have lower efficiency scores (range: 5-16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms

Intracranial Stenosis: Impact of Randomized Trials on Treatment Preferences of US Neurologists and Neurointerventionists

Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multi-center randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS)

Rationale for ischemic conditioning to prevent stroke in patients with intracranial arterial stenosis

Intracranial atherosclerotic arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with particularly a high risk of recurrent stroke. Although aggressive medical management, consisting of dual antiplatelet therapy and intensive control of vascular risk factors, has improved the prognosis of patients with ICAS, subgroups of patients remain at very high risk of stroke. More effective therapies for these high-risk patients are urgently needed. One promising treatment is remote limb ischemic conditioning, which involves producing repetitive, transient ischemia of a limb by inflating a blood pressure cuff with the intention of protecting the brain from subsequent ischemia. In this study, we review the limitations of currently available treatments, discuss the potential mechanisms of action of ischemic conditioning, describe the preclinical and clinical data suggesting a possible role of ischemic conditioning in treating patients with ICAS, and outline the questions that still need to be answered in future studies of ischemic conditioning in subjects with ICAS

Pathology-based brain arterial disease phenotypes and their radiographic correlates

Introduction: Brain arterial diseases, including atherosclerosis, vasculitis, and dissections, are major contributors to cerebrovascular morbidity and mortality worldwide. These diseases not only increase the risk of stroke but also play a significant role in neurodegeneration and dementia. Clear and unambiguous terminology and classification of brain arterial disease phenotypes is crucial for research and clinical practice. Material and methods: This review aims to summarize and harmonize the terminology used for brain large and small arterial phenotypes based on pathology studies and relate them to imaging phenotypes used in medical research and clinical practice. Conclusions and results: Arteriosclerosis refers to hardening of the arteries but does not specify the underlying etiology. Specific terms such as atherosclerosis, calcification, or non-atherosclerotic fibroplasia are preferred. Atherosclerosis is defined pathologically by an atheroma. Other brain arterial pathologies occur and should be distinguished from atherosclerosis given therapeutic implications. On brain imaging, intracranial arterial luminal stenosis is usually attributed to atherosclerosis in the presence of atherosclerotic risk factors but advanced high-resolution arterial wall imaging has the potential to more accurately identify the underlying pathology. Regarding small vessel disease, arteriosclerosis is ambiguous and arteriolosclerosis is often used to denote the involvement of arterioles rather than arteries. Lipohyalinosis is sometimes used synonymously with arteriolosclerosis, but less accurately describes this common small vessel thickening which uncommonly shows lipid. Specific measures of small vessel wall thickness, the relationship to the lumen as well as changes in the layer composition might convey objective, measurable data regarding the status of brain small vessels.</p

Echocardiography in patients with symptomatic intracranial stenosis

BACKGROUND: Echocardiography is often performed in patients with stroke, even when alternative stroke causes are identified. We evaluated the use of echocardiography in patients with transient ischemic attack (TIA) or stroke caused by stenosis of a major intracranial artery. METHODS: The Warfarin Versus Aspirin for Symptomatic Intracranial Disease (WASID) trial was a National Institutes of Health-funded, randomized, double-blind, multicenter clinical trial in which 569 patients with TIA or ischemic stroke attributed to angiographically proven 50% to 99% stenosis of a major intracranial artery were randomly assigned to warfarin or aspirin. Patients with unequivocal cardiac sources of embolism were excluded. The risk of ischemic stroke, myocardial infarction, and vascular death was compared among patients who had or did not have echocardiography performed before enrollment, and Cox proportional hazards models were used to determine whether echocardiographic abnormalities present in greater than 5% of patients were associated with these outcomes. RESULTS: In all, 264 of 569 patients in WASID had echocardiograms; 37% were transesophageal. Of these 264 patients, 69 had subsequent ischemic stroke, myocardial infarction, or vascular death. Patients who underwent echocardiography had similar event rates to those who did not (P = .18). Common abnormalities identified on echocardiography were not associated with subsequent risk in this population. CONCLUSIONS: Among patients with TIA or stroke caused by intracranial arterial stenosis, echocardiography appears to offer limited diagnostic and prognostic value