cardiovascular-agents and Cerebral-Infarction

Delayed cerebral ischemia seriously affects the prognosis of patients surviving the initial aneurysmal subarachnoid hemorrhage. Application of cilostazol was reported to ameliorate vasospasm and improve outcomes in series and clinical trials. But the effectiveness and feasibility of cilostazol on aneurysmal subarachnoid hemorrhage remained controversial. We performed a systematic review to clarify this issue.. PubMed, Ovid and Cochrane library database were systematically searched up to May 2018 for eligible publications in English. Quality assessment was conducted for included studies. Meta-analysis was conducted to evaluate the overall effect on events of interest. Subgroup analyses and sensitivity analyses were used to check whether the results were robust. Publication bias was evaluated with the funnel plot.. Pooled analyses found cilostazol significantly reduced incidences of severe angiographic vasospasm (p = 0.0001), symptomatic vasospasm (p < 0.00001), new cerebral infarction (p < 0.00001) and the poor outcome (p < 0.0001). Subgroup and sensitivity analyses achieved consistent results. There was no statistical difference between cilostazol and the control group in reducing mortality (p = 0.07). But sensitivity analysis changed the result after excluding one study. Under the prescribed dosage, complication was few and non-lethal.. Cilostazol was effective and safe to reduce incidences of severe angiographic vasospasm, symptomatic vasospasm, new cerebral infarction and poor outcome in patients after aneurysmal subarachnoid hemorrhage. However, its effect on mortality and the interactive effect with nimodipine warranted further research.

Topics: Brain Ischemia; Cardiovascular Agents; Cerebral Infarction; Cilostazol; Humans; Intracranial Aneurysm; Outcome Assessment, Health Care; Subarachnoid Hemorrhage; Vasospasm, Intracranial

'Translation' in medicine immediately suggests 'translational research', but there are many other varieties of 'translation'. I have selected 4 translations in the field of vascular neurology in which I have been involved in different respects: (1) the translation of results from men to women, taking the example of aspirin which, in primary prevention, decreases the risk of myocardial infarction in men and the risk of cerebral infarction in women, the reason for this sex difference being so far unknown; (2) the 'inverse translational research', from bedside to bench, taking the example of the disease we have identified--CADASIL--and showing how the study of one patient and his family led to the identification of a gene, Notch3, so far unknown in humans and to the discovery of its key role in the physiology of vascular smooth muscle cells; (3) the translation from individual case reports to multidisciplinary trials taking the example of hemicraniectomy in malignant cerebral infarction and emphasizing the interest in such rare and severe conditions of pooling and reporting the results of randomized clinical trials before the results of individual trials, and (4) the translation from research to practice, emphasizing not the well-known 'evidence to practice gap' but the slippery slope of 'lack of evidence to overpractice', taking the example of patent foramen ovale closure in migraine.

Topics: Aspirin; Awards and Prizes; Biomedical Research; CADASIL; Cardiovascular Agents; Cardiovascular Diseases; Cerebral Infarction; Craniotomy; Evidence-Based Medicine; Female; Foramen Ovale, Patent; Humans; Male; Medical Records; Migraine Disorders; Myocardial Infarction; Neurology; Randomized Controlled Trials as Topic; Receptor, Notch3; Receptors, Notch; Sex Factors; Treatment Outcome

Topics: Arterial Occlusive Diseases; Arteriosclerosis; Cardiovascular Agents; Cerebral Infarction; Fibrinolytic Agents; Humans; Myocardial Infarction; Recurrence

Topics: Anesthesia, General; Anesthetics; Cardiovascular Agents; Cerebral Infarction; Humans; Intraoperative Complications

Topics: Anesthesia, General; Anesthetics; Cardiovascular Agents; Cerebral Infarction; Humans; Intraoperative Complications

Acute cerebral infarction (ACI) is one of the most commonly seen cerebral vascular disease and the current therapy options are not satisfied. Ginkgo leaf extract and dipyridamole injection (GDI) is widely used as adjuvant therapy for ACI. However, there is no systemic review and meta-analysis published regarding the efficacy and safety of GDI. Herein, we describe the protocol of a proposed study aims to systemically evaluate the efficacy and safety of GDI in ACI patients.. Five electronic databases (Medline, EMBase, Cochrane database, China National Knowledge Infrastructure, and Wanfang database) will be searched up to February 28, 2018. Randomized controlled trials (RCTs) meet the eligibility criteria will be identified and included. Data synthesis will be run using RevMan software after the data extraction and risk of bias assessment of included studies. The primary outcomes of this study are effective rate and adverse event rate.. This study will provide a high-quality synthesis of RCTs on the efficacy and safety of GDI as an adjuvant therapy in the treatment of ACI.. This systemic review and meta-analysis will provide high quality evidence to evaluate GDI as adjuvant therapy in patients with ACI.Registration: PEROSPERO CRD42018107112.

Topics: Acute Disease; Adjuvants, Pharmaceutic; Cardiovascular Agents; Cerebral Infarction; Clinical Protocols; Dipyridamole; Ginkgo biloba; Humans; Meta-Analysis as Topic; Plant Extracts; Randomized Controlled Trials as Topic; Systematic Review as Topic; Treatment Outcome

Postoperative atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG). We investigated the risk factors for postoperative AF and analyzed the relationship between blood sugar concentration (BS) and AF after CABG.. A total of 199 consecutive patients who underwent isolated CABG were retrospectively examined and classified according to the presence (n=95) or absence (n=104) of postoperative AF. On univariate analysis mean postoperative BS (P<0.001), postoperative drainage volume (P<0.001), age (P=0.034), presence of diabetes mellitus (DM; P=0.004), and postoperative estimated glomerular filtration rate (P=0.032) were significant risk factors for postoperative AF. On multivariate analysis mean postoperative BS (OR, 1.041; 95% CI: 1.008-1.079; P<0.001), postoperative drainage volume (OR, 1.003; 95% CI: 1.001-1.006; P=0.001), and age (OR, 1.040; 95% CI: 1.002-1.083; P=0.041) were significant risk factors for postoperative AF. Postoperative AF often occurred in patients with high postoperative BS, irrespective of DM. The BS cut-off that predicted postoperative AF occurrence was 180 mg/dl. A strong positive correlation existed between the time of the maximum postoperative BS and AF onset time (ρ=0.746).. Mean postoperative BS and postoperative drainage volume are risk factors for AF after CABG. AF was strongly associated with maximum postoperative BS. Intensive glycemic control could reduce AF occurrence after CABG.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Blood Glucose; Cardiovascular Agents; Case-Control Studies; Cerebral Infarction; Comorbidity; Coronary Artery Bypass; Diabetes Mellitus; Female; Humans; Hyperglycemia; Male; Odds Ratio; Postoperative Complications; Retrospective Studies; Risk Factors

The aim of this study is to evaluate the rate of progression of stenosis and development of symptoms in patients with asymptomatic carotid artery stenosis (aCAS) treated with contemporary medical therapy over a prolonged time interval.. This study is a retrospective review of consecutive patients diagnosed with moderate or severe aCAS at our institution between 2000 and 2001. Data were gathered from both carotid arteries for each patient excluding vessels operated within 1 year of diagnosis and occlusions. Multivariate analysis was performed to analyze factors associated with ipsilateral transient ischemic attack (TIA)/stroke.. We identified 214 patients (58.8% men; median age 70 years) and collected data on 349 vessels. Degree of stenosis was severe (>70%) upon diagnosis in 92 (26.4%) vessels. Median length of follow-up was 13 years (interquartile range 10-14), and mean number of time points for follow-up imaging were 8.1 ± 3.9. Progression of stenosis was observed in 237 (67.9%) vessels, and 72 (20.6%) patients developed symptoms ipsilateral to the stenosis (TIA in 14.4%, non-disabling stroke in 4%, disabling stroke in 2.2%). Median time to appearance of first symptom was 6 years (range 1-13). On multivariate analysis, degree of baseline stenosis, intracranial stenosis >50%, plaque ulceration, silent infarction and previous history of TIA/stroke were associated with ipsilateral TIA/stroke, but progression of stenosis was not.. There was a substantial rate of progression of stenosis in patients with aCAS over time despite adequate medical therapy, but progression of stenosis did not increase the risk of ipsilateral TIA/stroke. Over long-term follow-up, 1 in 5 patients with aCAS developed ipsilateral TIA/stroke, though most events were either transient or non-disabling.

Topics: Aged; Asymptomatic Diseases; Cardiovascular Agents; Carotid Stenosis; Cerebral Infarction; Comorbidity; Disease Progression; Endarterectomy, Carotid; Female; Follow-Up Studies; Humans; Ischemic Attack, Transient; Male; Middle Aged; Retrospective Studies; Risk; Risk Factors; Stents

Low-dose aspirin is used as a preventive treatment for ischemic heart disease and ischemic cerebrovascular disease, on the other hand gastrointestinal injuries are an adverse effect of aspirin. We reported that endoscopic surveillance reveals a high risk of gastroduodenal ulcer and erosion in aspirin users of ischemic heart disease. But risk of gastroduodenal injuries may be different among pre-existing disease. In the present study, endoscopic examination was performed to investigate the frequency of gastroduodenal injuries associated with low-dose aspirin in patients with cerebrovascular disease.. Routine examination using upper gastrointestinal tract endoscopy was prospectively performed for all patients admitted to Sasson Hospital for rehabilitation after cerebral infarction from April 2005 to September 2007. Endoscopic findings such as ulcers and flat erosions were assessed as mucosal injuries.. Endoscopic examination was performed for 142 successive patients, divided into three groups: 70 patients as low-dose aspirin users (aspirin group); 61 as non-aspirin users (non-aspirin group); and 11 as multi-drug users of aspirin plus other anti-platelet drugs (combination group). The aspirin group without anti-ulcer drugs (A(-) group) comprised 47 patients and the non-aspirin group without anti-ulcer drugs (NA(-) group) 31 patients. Mucosal injuries were detected in 29.8% of the A(-) group and in 6.4% of the NA(-) group (P < 0.05). The frequency of ulcer was similar between the A(-) group (6.4%) and NA(-) group (3.2%).. Endoscopy reveals low-dose aspirin-induced gastroduodenal injuries in patients with cerebral infarction.

Topics: Aged; Aged, 80 and over; Anti-Ulcer Agents; Aspirin; Cardiovascular Agents; Cerebral Infarction; Chi-Square Distribution; Duodenal Ulcer; Duodenoscopy; Duodenum; Female; Gastric Mucosa; Gastroscopy; Humans; Intestinal Mucosa; Japan; Male; Middle Aged; Prevalence; Prospective Studies; Stomach Ulcer

Changes in hemorheological parameters were studied in patients with ischemic cerebrovascular disease and elderly healthy men who ingested ethanol at 0.5 and 1 g/kg body weight. Following ingestion of 1 g/kg, but not 0.5 g/kg of ethanol, there were significant changes in hemorheologic factors. Whole blood viscosity (WBV, shear rate: 18.8, 37.5, 75, 150, 350 sec(-1)) and blood viscosity corrected for hematocrit (BVC) were increased. WBV and BVC at high shear rate were increased and red blood cell deformability impaired in patients with ischemic cerebrovascular disease, while those factors were not significantly changed in healthy men. It is considered that ethanol ingestion could has bad influences for the microcirculation in patients with ischemic cerebrovascular disease.

Topics: Acetaldehyde; Aged; Alcohol Drinking; Blood Proteins; Blood Viscosity; Brain Ischemia; Cardiovascular Agents; Cerebral Infarction; Diuresis; Dose-Response Relationship, Drug; Erythrocyte Deformability; Ethanol; Hematocrit; Hemodynamics; Hemorheology; Humans; Hyperlipidemias; Hypertension; Male; Microcirculation; Middle Aged

In search of a better treatment for acute ischemic stroke, we evaluated the use of lubeluzole and hemodilution with diaspirin cross-linked hemoglobin (DCLHb) therapy to test whether treatment with two complementary acting compounds provides more potent protection than either treatment alone.. We used unilateral reversible middle cerebral artery (MCA) and common carotid artery (CCA) occlusion of various durations in Long-Evans rats to produce ischemic cortical lesions. We calculated the average maximal lesion volume (Volmax) and the time required to produce half maximal lesion size (T50) in control animals (n = 31) and evaluated the effects on cerebral perfusion and infarct size of treatment with lubeluzole (n = 23), hemodilution (to 30% hematocrit) with albumin (n = 17) or DCLHb (n = 23), and combined lubeluzole + DCLHb therapy initiated 15 minutes after MCA/CCA occlusion.. The Volmax produced by MCA/CCA occlusion in control animals was 138.5 +/- 7.7 mm3, and T50 was 98.5 +/- 10.2 minutes. Lubeluzole alone reduced Volmax by 53% with no significant effect on T50. In contrast to lubeluzole, DCLHb hemodilution prolonged T50 by 68% with no significant effect on Volmax. Prolongation of T50 by DCLHb was not due to hemodilution itself, since a similar degree of hemodilution with albumin had no effect. Finally, combined lubeluzole+DCLHb rescued 72% of the tissue and augmented the effect of lubeluzole alone by 40% (Volmax, 66.3 +/- 13.0 versus 39.4 +/- 12.2 mm3) while prolonging T50 by 31%.. Combination therapy for acute stroke using compounds with complementary action can result in more complete attenuation of neuronal damage and demonstrates the possible clinical utility of combined neuroprotective and reperfusion therapies.

Topics: Animals; Aspirin; Cardiovascular Agents; Cerebral Infarction; Cerebrovascular Disorders; Drug Therapy, Combination; Hemodilution; Hemoglobins; Male; Neuroprotective Agents; Piperidines; Rats; Rats, Inbred Strains; Reperfusion; Thiazoles

A patient with a history of cerebrovascular disease, hypertension, and previous gastrectomy developed metabolic alkalosis and myoclonus. His medications included the anti-hypertensive agents nicardipine hydrochloride, delapril, prazosin; dihydroergotoxin and ticlopidine for cerebral infarction; estazolam for insomnia; azuren-L-glutamine compound and S-M powder. In addition, he had taken 12 grams per day of Ohta's Isan antacid, which contained 625 mg sodium bicarbonate per 1.3 g of antacid powder over a 6-month period. This antacid is commonly used in Japan. This is the first report of a case of metabolic alkalosis and myoclonus secondary to ingestion of a commercially available antacid in Japan.

Topics: Aged; Alkalosis; Antacids; Cardiovascular Agents; Cerebral Infarction; Dyspepsia; Gastrectomy; Humans; Hypertension; Hypnotics and Sedatives; Hypokalemia; Male; Myoclonus; Sleep Initiation and Maintenance Disorders; Sodium Bicarbonate

The authors examined peculiarities of the central and cerebral hemodynamics before and after treatment in 108 patients with cerebral infarction and acute or chronic ischemic heart disease (IHD). When myocardial and cerebral infarctions were combined, as well as in most cases of cerebral ischemia in the post-infarction period, the heart worked in conditions of hypodynamia. Disorders of the cerebral circulation were expressed in hypo- and hyperperfusion of the cerebral vessels. Patients with acute versus chronic IHD displayed differences in changes of hemocirculatory parameters in the process of treatment.

Topics: Adult; Aged; Cardiovascular Agents; Cerebral Infarction; Cerebrovascular Disorders; Coronary Disease; Female; Hemodynamics; Humans; Male; Middle Aged

The protective effect of 2-(5-chloro-2-phenoxyanilino)-2-imidazoline [FR35447] on cerebral infarction was examined in animal models. FR35447 in p.o. doses of 1 mg/kg or more caused a marked reduction of arachidonate-induced cerebral infarction in rats. Since FR35447 (10(-6) M) inhibited platelet aggregation induced by adrenaline plus the divalent cation ionophore A23187, as did yohimbine (10(-6) M), the protective effect of FR35447 is presumed to be due to its blocking activity on the alpha 2 adrenoceptors of platelets. However, additional mechanisms appear to participate in the protective effect of FR35447 on cerebral infarction. A ten-day treatment with FR35447 in p.o. doses of 1 to 10 mg/kg/day decreased serum lipid peroxide levels in vitamin E deficient rats, suggesting that FR35447 may have free radical scavenging activity. Moreover, FR35447 (greater than or equal to 10(-5) M) increased red cell deformability. These effects of FR35447 suggest that it may be useful in preventing or treating cerebral infarction.

Topics: Animals; Arachidonic Acid; Arachidonic Acids; Calcimycin; Cardiovascular Agents; Cerebral Infarction; Epinephrine; Epoprostenol; Erythrocyte Deformability; Imidazoles; Lipid Peroxides; Male; Platelet Aggregation; Prazosin; Rats; Rats, Inbred Strains; Vitamin E Deficiency; Yohimbine