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Clinical Effects of Pollution
Published in William J. Rea, Kalpana D. Patel, Reversibility of Chronic Disease and Hypersensitivity, Volume 5, 2017
William J. Rea, Kalpana D. Patel
Intracranial atherosclerosis, one of the leading causes of ischemic stroke, is associated with an increased risk for recurrent stroke and dementia.795,796 Individuals of Asian, Hispanic, and African-American ancestry are especially affected. Recent European studies revealed a much higher prevalence of intracranial lesions than commonly presumed, suggesting that intracranial atherosclerotic disease is potentially the most common cause of ischemic stroke worldwide.795,797 Ischemic strokes are clinically categorized into five subtypes based on their underlying cause: (1) large-artery atherosclerotic stenosis, (2) small-artery disease (lacunes), (3) cryptogenic, (4) major-risk-source cardiogenic embolism, and (5) unusual (e.g., dissections, arteritis). Most nonlacunar ischemic strokes are thought to be thromboembolic, which presumably also accounts for most cryptogenic strokes. Embolic sources include minor-risk or covert cardiac sources, veins via paradoxical embolism, and nonocclusive atherosclerotic plaques in the aortic arch or cervical or cerebral arteries.798 Besides embolic strokes, two other mechanisms have been associated with intracranial atherosclerosis-related strokes, namely, hypoperfusion through a stenotic artery causing watershed or border-zone stroke and plaque overgrowth of perforator artery ostia, which is associated with penetrating artery disease and lacunar infarcts and has been related to cryptogenic strokes.799–801 Even mild stenosis of intracranial atherosclerotic arteries (<50%) may therefore be clinically relevant, and high-resolution MRI studies are needed to identify and determine the degree and location of stenosis in this patient group.799,802 The possibly causal role of nonstenotic plaques in ischemic stroke highlights the need for more insight into the mechanisms and occurrence of intracranial atherosclerosis.
Interatrial shunts: technical approaches to percutaneous closure
Published in Expert Review of Medical Devices, 2018
Gianluca Rigatelli, Marco Zuin, Nguyen Tuong Nghia
PFO is the main cause of RL cardiac shunts followed by pulmonary arteriovenous fistulas, and it is potentially a risk factor for paradoxical embolism. Classical clinical presentations of PFO include cryptogenetic stroke, decompression syndrome, platypnea-orthodeoxia and peripheral embolism [4]. Other associations like migraine with aura, are still being investigated [5].