SUMMARY We retrospectively reviewed the dinkal course and angiograms of 15 patients with carotid siphon stenosis of 50% or greater. Fourteen had less than 50% stenosis at the origin of the ipsilateral internal carotid artery, and one had a greater degree of stenosis but underwent endarterectomy after an initial angiogram. Angiograms were examined for evidence of hemodynamk abnormalities in addition to residual lumen diameter. Seven patients initially had TIAs, 5 had strokes, and 3 were asymptomatic. In an average followup of 51 months (range 4-123 months) subsequent cerebral ischemic events occurred in 6 (40%), but only 1 had a stroke with a persisting neurological deficit that could be directly attributed to the siphon stenosis. Stenoses were hemodynamically significant by angiography in 5 of 7 TIA patients, and only 1 of 5 stroke patients. The incidence of subsequent ischemic events in this study was similar to 2 previous studies of siphon stenosis, however hi this study most of the events ipsilateral to the siphon stenosis were TIAs or minor strokes. The association of hemodynamk angiographic abnormalities and initial TIAs but not strokes suggests that the mechanism producing ischemic symptoms may differ in patients with TIA and stroke who have carotid siphon stenosis. Stroke Vol 17, No 4, 1986 CALCIFICATION of the carotid siphon or intracranial internal carotid artery occurs frequently, but significant stenosis of this segment is less common.' Stenosis of the carotid siphon has been estimated to be about one-sixth as common as disease of the carotid bifurcation.2 Until recently, little was known about the natural history of stenosis of the carotid siphon. Two previous studies of siphon stenosis found that 30-^40% of such patients had subsequent ischemic events, and more than half of these events were ipsilateral to the siphon stenosis.3 ' 4 Clinical details of events occurring during followup were limited in both studies, and the angiographic data included only the site and severity of stenosis. Angiograms were not examined for collateral flow or hemodynamic significance of the siphon stenosis.We therefore retrospectively reviewed clinical and angiographic information on 15 patients with carotid siphon stenosis of 50% or greater. Fourteen had less than 50% stenosis of the ipsilateral extracranial carotid and 1 had severe ipsilateral extracranial stenosis but underwent endarterectomy shortly after angiography. All angiograms were reviewed for hemodynamic as well as anatomic information and the results were correlated with the nature of initial and subsequent ischemic events. MethodsPatients were identified by reviewing the angiography records of the neuroradiology department for the past 5 years for the diagnosis of stenosis of the carotid siphon. Those with greater than 50% stenosis of the ipsilateral extracranial internal carotid artery, ipsilateral carotid occlusion, or middle cerebral artery stenosis were excluded unless carotid endarterectomy was performed after angiography. The medical records were t...
Allergic asthma is a chronic inflammatory disease in which interleukin-18 (IL-18) plays an important role. However, there are controversial reports on IL-18 promoter polymorphism as an independent marker of asthma susceptibility. The aim of the present study was to examine the IL-18 promoter polymorphism in patients with allergic asthma. Two hundred and thirty-one patients with allergic asthma from a Polish population diagnosed according to the National Heart, Lung, and Blood Institute (NHLBI)/WHO guidelines were examined. An allele-specific polymerase chain reaction was used to analyse polymorphisms at positions -137 and -607 in the promoter region of the IL-18 gene. Neither in the -607 C>A nor in the -137 G>C promoter polymorphism were there any differences observed between the total group of asthmatic patients and the controls in the frequencies of genotypes, alleles, diplotypes or haplotypes. In patients with severe asthma, the -607 CC and -137 GG genotypes were observed significantly more frequently (P = 0.03 for both), whereas in patients with mild and moderate asthma, the -137 CC genotype was more prevalent than in the former group. The strongest difference between mild to moderate and severe asthma was observed in -137 allele frequencies (P = 0.006). The results of the present study suggest that the -137 G allele and the C-G/C-G diplotype seem to be involved in the pathogenesis of the severe form of asthma.
ObjectiveThe rs12526453 (C/G) is a single nucleotide polymorphism in an intron of the PHACTR1 gene (phosphatase and actin regulator 1). The C allele is associated with increased risk of coronary artery disease in an unknown mechanism. We investigated its association with long-term overall mortality in patients with ST-elevation myocardial infarction (STEMI) treated invasively.MethodsTwo independent groups of patients with STEMI were analyzed: a derivation group (n= 638) and a validation one (n=348). Genotyping was performed with the TaqMan method. The analyzed end-point was total long term mortality. Additionally, transcriptomic analysis was performed in mononuclear blood leukocytes from rs12526453 CC monozygotes or G allele carriers.ResultsIn the study group (mean age 62.3 ± 11.9 years; 24.9% of females, n=159), percentages of CC, CG, and GG genotypes were 45.3% (n=289), 44.7% (n=285), and 10% (n=64), respectively. In the 5-year follow-up 105 patients died (16.46%). CC homozygotes had significantly lower mortality compared to other genotypes: 13.1% (n=38) vs. 18.3% in G-allele carriers (n=67), (p=0.017, Cox`s F test). In the validation group 47 patients died within 3 years (13.5%). We confirmed lower mortality of CC homozygotes: 10.1 % (n=18) vs. 16.95% in G-allele carriers (n=29), (p=0.031, Cox`s F test). Transcriptomic analysis revealed a markedly higher expression of NLRP-2 in CC homozygotes.ConclusionsThe rs12526453 CC homozygotes (previously associated with increased risk of myocardial infarction) showed, in 2 independent samples, better long-term survival. The finding of such high effect size, after appropriate validation, could potentially be translated into clinical practice.
The CHA DS VASc score routinely used in thromboembolic risk assessment may be a simple, easy and reliable scoring system that can be used to predict unsuccessful electrical cardioversion.
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