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vrijdag 8 juni 2018

The Lancet: [Articles] Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosi...

[Articles] Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial
At least moderate (≥50%) restenosis occurred more frequently after stenting than after endarterectomy and increased the risk for ipsilateral stroke in the overall population. Whether the restenosis-mediated risk of stroke differs between stenting and endarterectomy requires further research.
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[Comment] Is surveillance for restenosis justified after carotid revascularisation?
A common dilemma in clinical practice is whether to request an imaging test if the prognostic implications of the results of the test are uncertain. An example of such a dilemma is whether surveillance for recurrent stenosis should be routine in patients who have undergone carotid endarterectomy or stenting either after an ischaemic stroke or as a preventive procedure. Surveillance for restenosis after a carotid revascularisation procedure is common practice in many centres. Carotid ultrasound is usually done within the first 6 months after the procedure, and then at yearly intervals, to check for restenosis.
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[Articles] In-vivo staging of pathology in REM sleep behaviour disorder: a multimodality imaging case-control study
Patients with idiopathic REM sleep behaviour disorder had fully developed pathology in the peripheral autonomic nervous system and the locus coeruleus, equal to that in diagnosed Parkinson's disease. These patients also showed noradrenergic thalamic denervation, but most had normal putaminal dopaminergic storage capacity. This caudorostral gradient of dysfunction supports the hypothesis that α-synuclein pathology in Parkinson's disease initially targets peripheral autonomic nerves and then spreads rostrally to the brainstem.
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[Comment] Dissecting premotor Parkinson's disease with multimodality neuroimaging
Parkinson's disease is diagnosed when parkinsonism (ie, bradykinesia, rigidity, and resting tremor) is clinically apparent. Parkinsonism manifests when a dopaminergic deficit of about 80% is present in the striatum due to neuronal loss of about 60% in the substantia nigra pars compacta. Parkinson's disease has a premotor period of several years during which progressive neuronal loss occurs outside the substantia nigra in non-dopaminergic regions, leading to non-motor symptoms such as hyposmia, constipation, depression, and rapid eye movement (REM) sleep behaviour disorder.
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[Articles] Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis
Bubble-TCD was feasible in most older patients with transient ischaemic attack or non-disabling stroke, the association of RLS with cryptogenic events remained at older ages, and the population burden of PFO-associated events is substantial. Randomised trials of PFO closure at older ages are required and should be feasible.
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