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202. Cardiovascular events in elderly patients with isolated systolic hypertension. A subgroup analysis of treatment strategies in STOP-hypertension-2.

Author

Ekbom, Tord, Linjer, Erland, Hedner, Thomas, Lanke, Jan, De Faire, Ulf, Wester, Per-Olov, Dahlöf, Björn, Scherstén, Bengt, Ekbom, Tord, Linjer, Erland, Hedner, Thomas, Lanke, Jan, De Faire, Ulf, Wester, Per-Olov, Dahlöf, Björn, and Scherstén, Bengt

Abstract

OBJECTIVE: To perform a subgroup analysis on those patients in STOP-Hypertension-2 who had isolated systolic hypertension. DESIGN AND METHODS: The STOP-Hypertension-2 study evaluated cardiovascular mortality and morbidity in elderly hypertensives comparing treatment with conventional drugs (diuretics, beta-blockers) with that of newer ones [angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists]. In all, 6614 elderly patients with hypertension (mean age 76.0 years, range 70-84 years at baseline) were included in STOP-Hypertension-2. In the present subgroup analysis of STOP-Hypertension-2, isolated systolic hypertension was defined as systolic blood pressure at least 160 mmHg and diastolic blood pressure below 95 mmHg, in accordance with the Syst-Eur and Syst-China study criteria. In total, 2280 patients in STOP-Hypertension-2 met these criteria. In the study, patients were randomized to one of three treatment groups: "conventional" antihypertensive therapy with beta-blockers or diuretics (atenolol 50 mg, metoprolol 100 mg, pindolol 5 mg, or fixed-ratio hydrochlorothiazide 25 mg plus amiloride 2.5 mg daily); ACE inhibitors (enalapril 10 mg or lisinopril 10 mg daily); or calcium antagonists (felodipine 2.5 mg or isradipine 2.5 mg daily). Analysis was by intention to treat. RESULTS: The blood pressure lowering effect in patients with systolic hypertension was similar with all three therapeutic regimens: 35/13 mmHg in the conventional group (n=717), 34/12 mmHg in the ACE inhibitor group (n = 724), and 35/13 mmHg in the calcium antagonist group (n=708). Prevention of cardiovascular mortality, the primary endpoint of the study, did not differ between the three treatment groups. All stroke events, i.e. fatal and non-fatal stroke together, were significantly reduced by 25% in the newer-drugs group compared with the conventional group (95% CI 0.58-0.97; p=0.027). This difference was attributable to reduction of non-fatal stroke while fatal stroke events did not

Published
2004
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207. The Riks-Stroke Story: Building a Sustainable National Register for Quality Assessment of Stroke Care

Author

Asplund, Kjell, primary, Hulter Åsberg, Kerstin, additional, Appelros, Peter, additional, Bjarne, Daniela, additional, Eriksson, Marie, additional, Johansson, Åsa, additional, Jonsson, Fredrik, additional, Norrving, Bo, additional, Stegmayr, Birgitta, additional, Terént, Andreas, additional, Wallin, Sari, additional, and Wester, Per-Olov, additional

Published
2010
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223. Progressive and reproducible focal cortical ischemia with or without late spontaneous reperfusion generated by a ring-shaped, laser-driven photothrombotic lesion in rats

Author

Hu, Xiaolei, Wester, Per, Brännström, Thomas, Watson, Brant D., Gu, WeiGang, Hu, Xiaolei, Wester, Per, Brännström, Thomas, Watson, Brant D., and Gu, WeiGang

Abstract

Clinical stroke is mostly of thromboembolic origin, in which the magnitude of brain damage resulting from arterial occlusions depends on the degree and duration of the concomitant ischemia. To facilitate more controllable and reproducible study of stroke-related pathophysiological mechanisms, a photothrombotic ring stroke model was initially developed in adult rats. The ring interior zone comprises an anatomically well confined cortical region-at-risk which is gradually encroached by progressive hypoperfusion, thus mimicking the situation (albeit in inverse fashion) of an ischemic penumbra or stroke-in-evolution. Modification of this model using a thinner ring irradiation beam resulted in late spontaneous reperfusion in the cortical region-at-risk and a remarkable morphological tissue recovery in this ostensibly critically injured region. On the other hand, doubling the thin irradiating beam intensity facilitates a complementary situation in which lack of reperfusion in the region-at-risk after stroke induction leads to tissue pannecrosis. The dual photothrombotic ring stroke model, effectuated either with or without reperfusion and thereby tissue recovery or pannecrosis, may be well suited for the study of events related to postischemic survival or cell death in the penumbra region. To popularize the photothrombotic ring stroke model, we present a detailed protocol of how this model is induced in either version as well as protocols for transcardial carbon black perfusion and laser-Doppler flowmetry experiments.

Published
2001
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226. Carotid calcifications on panoramic radiographs: a 5-year follow-up study.

Author

Johansson, Elias, Ahlqvist, Jan, Garoff, Maria, Levring Jäghagen, Eva, Meimermondt, Amanda, and Wester, Per

Abstract

Objective The aim of this study was to determine whether people with calcifications in the area of the carotid arteries on panoramic radiographs (CALPANs) have an increased prevalence of vascular risk factors or an increased risk of future vascular events. Materials and Methods We included 113 consecutive patients with CALPANs and 116 gender- and age-matched controls without CALPANs. Vascular risk factors were generally known in the study population, since it was recorded in a population-based community-screening program. Results Patients with CALPANs had a higher prevalence of vascular risk factors than controls independent of previous vascular events. During the 5.4-year follow-up, patients with CALPANs had a higher risk of a combined endpoint of vascular events (5.6%/yr) compared with the controls (2.4%/yr) ( P = .004 by log rank test; unadjusted hazard ratio (HR) 2.4; 95% CI 1.3-4.3). This difference was not significant when previous vascular events and risk factors were taken into account (adjusted HR; 1.2; 95% CI 0.6-2.3; P = .62; Cox regression). Conclusions People with CALPANs are very likely to have vascular risk factors, but these factors might be unknown when CALPANs are detected. Accordingly, patients with CALPANs should be advised to have their vascular risk factors regularly checked in order to receive advice on preventive lifestyle modifications and medical treatment when indicated. However, it remains unknown whether CALPANs add information about the independent risk of future vascular events. Therefore, further studies are warranted to investigate whether the detection of CALPANs indicates a need for additional or more intense vascular treatment. [ABSTRACT FROM AUTHOR]

Published
2015
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227. Calcium quantity in carotid plaques: detection in panoramic radiographs and association with degree of stenosis.

Author

Garoff, Maria, Johansson, Elias, Ahlqvist, Jan, Arnerlöv, Conny, Levring Jäghagen, Eva, and Wester, Per

Abstract

Objective To determine calcium volume in extirpated carotid plaques, analyze correlations between calcium volume and degree of stenosis, and analyze whether calcium volume influences the possibility of detecting stenosis in panoramic radiographs. Study Design Ninety-seven consecutive patients with ultrasonography-verified carotid stenosis were examined with panoramic radiography before surgery. Extirpated carotid plaques (n = 103) were analyzed for calcium volume by cone beam computed tomography (CBCT). Panoramic radiographs were analyzed for carotid calcifications. Results The median calcium volume was 45 mm 3 (first quartile subtracted from the third quartile [IQR], 14-98 mm 3 ). We observed no correlation between calcium volume and degree of stenosis. Seventy-eight stenoses were situated within the region included in the panoramic radiographs, and their volumes ranged from 0 to 509 mm 3 . Of these, 99% revealed carotid calcifications on panoramic radiographs. Conclusions We found no association between calcium volume and degree of carotid stenosis. Calcium volume did not influence the possibility of detecting carotid calcifications in panoramic radiographs. [ABSTRACT FROM AUTHOR]

Published
2015
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239. Maintained acute stroke admission during the first wave COVID-19 pandemic in Sweden, a register-based study.

Author

Rydell, Melissa, Wester, Per, Laska, Ann-Charlotte, and Rudberg, Ann-Sofie

Abstract

Objectives: Clinicians and researchers have addressed concerns about the negative impact of COVID-19 outbreaks on the ability of health care systems to provide timely assessment and acute therapies to patients with stroke. The aim of this study is to describe stroke care during the first wave of the COVID-19 pandemic compared to the same period the year before at an acute care hospital in Sweden.Materials and Methods: In this cohort study data were collected from March 1st to August 31st in 2019 and 2020 on all patients diagnosed with stroke and TIA and registered at Danderyd Hospital in the national quality registry (Riksstroke). Data were completed with information from the hospital record. Sweden had no lockdown during 2020.Results: During the study period in year 2019 there were 426 registered stroke patients at Danderyd hospital, compared to 403 registered stroke patients the same period during 2020 (p = 0.483). The number of minor stroke and TIA during the period in 2019 compared to 2020 were 468 versus 453 respectively (minor stroke p = 0.475 versus TIA p = 0.50).Conclusions: There were no difference in the number of patients diagnosed with stroke and TIA during the first wave of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Published
2022
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240. Beyond Conventional Stroke Guidelines Setting Priorities

Author

Norrving, Bo, Wester, Per, Sunnerhagen, Katharina Stibrant, Terént, Andreas, Sohlberg, Anna, Berggren, Fredrik, Wester, Per-Olov, and Asplund, Kjell

Abstract

Priorities in the care of stroke patients are often intuitive. An open and translucent priority-setting procedure would benefit patients, professionals, and decision-makers. Prioritization is an innovative part of the new Swedish national stroke guidelines.

Published
2007
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246. Detection of calcifications in panoramic radiographs in patients with carotid stenoses ≥50%.

Author

Garoff, Maria, Johansson, Elias, Ahlqvist, Jan, Jäghagen, Eva Levring, Arnerlöv, Conny, and Wester, Per

Abstract

Objective: Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs). Study Design: Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101). Results: It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%. Conclusions: Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent of gender. FRs do not contribute significantly to this identification. [ABSTRACT FROM AUTHOR]

Published
2014
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250. Alteplase for Acute Ischemic Stroke

Author

Lindley, Richard I., Wardlaw, Joanna M., Whiteley, William N., Cohen, Geoff, Blackwell, Lisa, Murray, Gordon D., Sandercock, Peter A.G., Baigent, Colin, Chadwick, David, Tyrrell, Pippa, Lowe, Gordon, Dennis, Martin, Innes, Karen, Goodare, Heather, Farrall, Andrew, von Kummer, Rüdiger, Cala, Lesley, von Heijne, Anders, Morris, Zoe, Adami, Alessandro, Peeters, Andre, Potter, Gillian, Brady, Nick, Collins, Rory, Bath, Philip, van Gijn, Jan, Gray, Richard, Hart, Robert, Yusuf, Salim, Muir, Keith, Hankey, Graeme J., Matz, Karl, Brainin, Michael, Peters, Andre, Gubitz, Gord, Phillips, Stephen, Ricci, Stefano, Arauz, Antonio, Berge, Eivind, Bruins Slot, Karsten, Czlonkowska, Anna, Kobayashi, Adam, Correia, Manuel, Lyrer, Phillippe, Engelter, Stefan, Murray, Veronica, Norrving, Bo, Terént, Andreas, Wester, Per, Venables, Graham, Innes, Karen, Clark, Alison, Perry, David, Soosay, Vera, Buchanan, David, Grant, Sheila, Sakka, Eleni, Drever, Jonathan, Walker, Pauli, Herath, Indee, Brown, Ann Leigh, Chmielnik, Paul, Armit, Christopher, Walton, Andrea, Hautvast, Mischa, Lewis, Steff, Heron, Graeme, Odusanya, Sylvia, Linksted, Pam, Kane, Ingrid, Sellar, Robin, White, Philip, Keston, Peter, Farrell, Andrew, Morris, Zoe, Miranda, Hector, Celani, Maria Grazia, Righetti, Enrico, Cenciarelli, Silvia, Mazzoli, Tatiana, Cantisani, Teresa Anna, Bembenek, Jan, and Isaakson, Eva

Abstract

Our aim was to identify whether particular subgroups of patients had an unacceptably high risk of symptomatic intracranial hemorrhage or low chance of benefit when treated with alteplase (recombinant tissue-type plasminogen activator).

Published
2015
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