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Title: Asymptomatic embolisation and strategies for treatment in carotid artery disease
Author: Molloy, Jane Elizabeth
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1999
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Background & Purpose: Stroke is the third leading cause of death in industrialized countries. Incidence in the UK is estimated at 2 per 1000, rising dramatically with age. Ischaemic stroke accounts for the majority of these events, and may arise due to embolism, thrombosis or haemodynamic mechanisms. At present, there is no proven accepted treatment for the acute ictus, and management - both medical and surgical - places the emphasis on secondary prevention. The presence of carotid artery stenosis is one factor known to be associated with increased stroke risk, whether symptomatic or asymptomatic This may arise indirectly, due to its association with other vascular risk factors, such as hypertension and diabetes, or directly to cause both embolic and haemodynamic stroke. Contents: i) Assessment of Multi-Gated Doppler - use of transcranial Doppler ultrasound is hindered by lack of an automated system for analysis of patient recordings. Issues surrounding this will be discussed, and a new method to aid in differentiation of embolic signals from artifact is assessed both in a model and in patients. ii) Clinical Significance and Variability of Embolic Signals - presence of embolic signals as an independent risk factor for stroke is not proven, and studies have assessed their correlation with individual risk markers in small numbers. In a larger patient group clinical assessment of a number of factors is made in combination with transcranial Doppler studies. In a smaller sub-group, the temporal variability of embolic signals is assessed. iii) Reduction of Embolisation Using S-Nitrosoglutathione - though evidence from validation studies in vitro and in animal models supports the particular nature of emboli detected by transcranial Doppler, no definite conclusions can be drawn regarding the nature of the emboli material. By studying anti-platelet and anti-thrombotic agents in patients with frequent embolic signals it may be possible to reduce these signals - combining intervention studies with a knowledge of the molecular action of such agents may allow a better understanding of the mode of emobilisation in such a setting. A study of the use of an anti-platelet agent, S-Nitrosoglutathione, GSNO, to reduce embolisation rates in the setting of carotid endarterectomy is described.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available