White matter hyperintensity patterns

in cerebral amyloid angiopathy and hypertensive arteriopathy.  Neurology; 2016; 86: 505-511.  Authors Charidmou A, Boulouis G, Haley K, et al.

 

Authors studied 319 patients with cerebral amyloid angioapthy and 137 with hypertensive arteriopathy for different patterns of white matter hyperintensity in the two diseases. 

 

Results showed that the presence of multiple subcortical spots was higher in the CAA group, and the peribasal ganglia WMH pattern was more prevalent in the HA group.  Multiple spots was associated with presence of cortical cerebral microbleeds.

The risk of symptomatic carotid stenosis:the

future is not what it used to be.  Chaturvedi S, Rothwell PM.  Neurology 2016; 86-494-495 (editorial) and refers to

 

Johannson E, Cuadrado -Gida E, Hayden D., et al.  Recurrent stroke in symptomatic carotid stenosis awaiting revascularizatio: a pooled analysis. Neurology 2016; 86: 498-504  and to

 

Shahidi S. , Owen Falkenberg A, Hjerpsted U et al.  Urgent best medical therapy may obviate the need for urgent surgery in patients with symptomatic carotid stenosis.

 

Idea: Best medical therapy of today, "second generation medical therapy" including statins, dual antiplatelets, and optimal BP control was not used in NASCET trials in the 1990s.  Therefore, the studies are obsolete and need to be repeated.

 

The two studies mentioned above give opposite suggestions.  Johannson et al. studied patients from three European centers with 50-99% stenosis and recent stroke or tia, and found in 227 suitable patients, a pooled risk risk of ipsilateral stroke of 11.5 % at 14 days and 18.8 % at 90 days, with less risk as usual for retinal ischemia.  A single center in Denmark studied patients with severe carotid stenosis, symptomatic, awaiting CEA with 21st century modern best medical therapy  and found that the rate of events in patients fell from 29 to 2.5 % , with events being TIA's. 

 

They also suggest that the risk in patients with asympromatic stenosis has fallen with "optimal medical therapy" (see Marquardt L, Geraghty OC, Mehta Z et al.  Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective population based study. Stroke 2010; 41: e 11-e17  and Spence JD, Coates V, Li H et al.  Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis.  ArchNeurol 2010; 67: 180-1`86.