Stroke; a journal of cerebral circulation 1999 Feb
Authors: Saver JL, Johnston KC, Homer D, Wityk R, Koroshetz W, Truskowski LL, Haley EC,
Reduction in infarct volume is the standard measure of therapeutic success in animal stroke models. Reduction in infarct volume has been advocated as a biological surrogate or auxiliary outcome measure for human stroke clinical trials to replace or supplement deficit, disability, and global clinical scales. However, few studies have investigated correlations between infarct volume and clinical end points in acute ischemic stroke patients.
CT scans at days 6 to 11 were acquired prospectively in 191 fully eligible patients enrolled in the Randomized Trial of Tirilazad Mesylate in Patients With Acute Stroke (RANTTAS). Patients were enrolled within 6 hours of onset of stroke in any vessel distribution. Infarct volume was measured by operator-assisted computerized planimetry.
One hundred thirty-two patients had visible new supratentorial infarcts, with median infarct volume of 28.0 cm3 (interquartile range, 9.0 to 93.0 cm3). Fifty-nine patients had no visible new infarct. Correlations with standard 3-month outcome scales and mortality were as follows: Barthel Index, r=0.43; Glasgow Outcome Scale, r=0.53; National Institutes of Health Stroke Scale, r=0.54; mortality, r=0.31. For visible infarcts alone, correlations were as follows: BI, r=0.46; GOS, r=0.59; NIHSS, r=0.56; mortality, r=0.32.
Subacute CT infarct volume correlates moderately with 3-month clinical outcome as assessed by widely used neurological and functional assessment scales. The modesty of this linkage constrains the use of infarct volume as a surrogate end point in ischemic stroke clinical trials.
PMID: 9933262 [PubMed - as supplied by publisher]
Mayo Clinic proceedings. Mayo Clinic 1991 Mar
Authors: Homer D, Ingall TJ, Baker HL,
The effect of serum lipids and lipoproteins on extracranial carotid artery atherosclerosis (CAS) was studied in patients who underwent carotid arteriography. Serum lipid and lipoprotein values along with data on other potential predictors of extracranial CAS were determined in 240 patients who had at least one extracranial carotid artery visualized. In a multiple logistic regression analysis, the independently significant predictors of the presence of extracranial CAS were, in decreasing order of significance, duration of smoking of cigarettes, hypertension, age, and low-density lipoprotein cholesterol. Serum cholesterol, triglycerides, high-density lipoprotein cholesterol, and apolipoprotein A-I did not show an independent effect. Although low-density lipoprotein cholesterol was an independent predictor of the presence of extracranial CAS, its effect as a predictor was far outweighed by the effects of the duration of smoking of cigarettes and a history of hypertension.
PMID: 2002684 [PubMed - as supplied by publisher]
Archives of neurology 1989 Apr
Authors: Ingall TJ, Homer D, Whisnant JP, Baker HL,
To assess the predictive value of carotid bruit for moderate-to-severe carotid atherosclerosis, the results of carotid arteriograms performed on 1004 subjects were correlated with the findings of auscultation of the carotid arteries. Predictive values of carotid bruit for ipsilateral extracranial carotid atherosclerosis were 77% for localized bruits and 74% for diffuse bruits. The predictive values of extracranial carotid bruit for ipsilateral intracranial carotid atherosclerosis were 16% for localized bruits and 18% for diffuse bruits. Assessing both carotid arteries together, the predictive value of carotid bruit for moderate-to-severe atherosclerosis at any extracranial carotid site was 85%, there being no difference whether the bruits were diffuse, localized, bilateral, or unilateral. Diffuse or localized bruits, whether unilateral or bilateral, are equally predictive of moderate-to-severe atherosclerosis in the extracranial carotid artery, but both are poor predictors of intracranial carotid artery disease.
PMID: 2705903 [PubMed - as supplied by publisher]
Stroke; a journal of cerebral circulation 1988 Mar
Authors: Trommer BL, Homer D, Mikhael MA,
We describe a patient who experienced focal cerebral and brainstem ischemia in the setting of postpartum eclampsia. Cerebral angiography showed spasm of large- and medium-caliber arteries. This case provides rare documentation that vasospasm may account for cerebral ischemia in eclamptic women with focal signs. This observation suggests that in such patients cerebral angiography may be informative and useful.
PMID: 3354016 [PubMed - as supplied by publisher]
Annals of neurology 1987 Aug
Authors: Homer D, Whisnant JP, Schoenberg BS,
The Mayo Clinic medical records system and records-linkage system have been used to study trends in the incidence of stroke in Rochester, Minnesota, for comparison with U.S. stroke mortality trends. This study extends the observations back through 1935. The average annual incidence rate for the period 1935 to 1944 was 188 and 179 per 100,000 population for men and women, respectively--not significantly different from 200 for men and 178 for women for the period 1945 to 1954. The blood pressure level in these patients did not affect probability of survival or recurrent stroke. The trend in the incidence rate of stroke for women showed no change for the 20 years from 1935 to 1954, after which there was a gradual decline. For men there was little change until 1969, after which there was a sharp decline. We suggest that the gradual decline in U.S. stroke mortality rates for this early period may include an artifact introduced by changing codes and changing fashions of diagnosis.
PMID: 3662455 [PubMed - as supplied by publisher]