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Titolo:
TEMPORAL VARIABILITY OF ASYMPTOMATIC EMBOLIZATION IN CAROTID-ARTERY STENOSIS AND OPTIMAL RECORDING PROTOCOLS
Autore:
MOLLOY J; KHAN NH; MARKUS HS;
Indirizzi:
INST PSYCHIAT,DEPT CLIN NEUROSCI,DE CRESPIGNY PK LONDON SE5 8AF ENGLAND INST PSYCHIAT,DEPT CLIN NEUROSCI LONDON SE5 8AF ENGLAND UNIV LONDON KINGS COLL,SCH MED & DENT,DEPT CLIN NEUROSCI LONDON ENGLAND
Titolo Testata:
Stroke
fascicolo: 6, volume: 29, anno: 1998,
pagine: 1129 - 1132
SICI:
0039-2499(1998)29:6<1129:TVOAEI>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL EMBOLIC SIGNALS; TRANSCRANIAL DOPPLER; PLAQUE ULCERATION; ENDARTERECTOMY; MICROEMBOLISM; DISEASE;
Keywords:
CAROTID ARTERY DISEASES; CEREBRAL EMBOLISM; ULTRASONOGRAPHY, DOPPLER;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
15
Recensione:
Indirizzi per estratti:
Citazione:
J. Molloy et al., "TEMPORAL VARIABILITY OF ASYMPTOMATIC EMBOLIZATION IN CAROTID-ARTERY STENOSIS AND OPTIMAL RECORDING PROTOCOLS", Stroke, 29(6), 1998, pp. 1129-1132

Abstract

Background and Purpose-Although asymptomatic embolization can be detected in patients with carotid artery stenosis, its temporal variability is unclear. An understanding of this is important in designing optimal recording protocols for future prospective studies of the predictive value of embolic signals (ES), We determined the effect of repeatingand extending recording times in patients with symptomatic and asymptomatic carotid stenosis. Methods-In 20 asymptomatic and 20 symptomaticsubjects with >60% carotid stenosis, we used transcranial Doppler ultrasound to record for ES in the ipsilateral middle cerebral artery. Three 1-hour recordings were performed on three separate days, and on one occasion (not necessarily the first) the recording was extended to 2hours. The recordings were saved onto digital tape for subsequent blinded analysis, Results-Marked temporal variability was seen in symptomatic patients in whom the cumulative proportion of subjects with ES increased from 10 (50%) after a single hour of recording to 12 (60%) and15 (75%) after two and three recordings, respectively. Extending the recording to 2 hours increased the yield of ES-positive patients from 6 (30%) to 8 (40%), In symptomatic patients there was excellent agreement between whether patients were positive for ES during each of two consecutive 1-hour recordings (kappa=0.78, P=0.0003) but poor agreementbetween the results of two single-hour recordings performed on different days (kappa=0.22, P=0.27). In asymptomatic patients, 4 (20%) were ES positive during the first hour; this increased to 5 (25%) after therecording was repeated once, with no further increase after the thirdrecording. Extending the recording to 2 hours increased the yield from 3 (15%) to 7 (35%), In contrast to symptomatic stenoses, in patientswith asymptomatic stenoses there was fair agreement between whether patients were ES positive on two consecutive 1-hour recordings (kappa=0.49, P=0.01) or two single-hour recordings performed on different days(kappa=0.48, P=0.02). Symptomatic subjects were more likely to have ES (when all 1-hour recordings were considered, 24/60 versus 10/60; P=0.0046), ES in symptomatic subjects had a higher relative intensity increase than in asymptomatic subjects (P=0.01), Conclusions-The temporalvariability of ES needs to be taken into account in the design of optimal recording protocols and comparisons of results from different studies. Extending the duration of recording beyond an hour in symptomatic stenoses is of less value, but repeating the recording on a different day will often identify additional subjects with ES. in interventionstudies in symptomatic patients, the time since last symptoms must beconsidered. In asymptomatic stenosis, extending the duration of recording beyond an hour will increase the proportion of patients positive for ES.

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Documento generato il 05/04/20 alle ore 02:55:56