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Complications of Cerebrovascular Accidents (CVA)
Cerebrovascular accidents (CVA), commonly known as strokes, are significant medical events that can lead to severe complications and increased mortality. This article synthesizes research findings on the complications associated with CVA across various patient populations and medical conditions.
CVA in Sickle Cell Disease Patients
Incidence and Risk Factors
CVA is a major complication in patients with sickle cell disease (SCD). The highest prevalence and incidence rates of CVA are observed in patients with sickle cell anemia (SS), particularly among children and older adults. Hemorrhagic strokes are most common in SS patients aged 20 to 29 years, with a 26% mortality rate within two weeks post-stroke. Key risk factors for infarctive strokes include prior transient ischemic attacks, low steady-state hemoglobin, recent acute chest syndrome, and elevated systolic blood pressure. Hemorrhagic strokes are associated with low steady-state hemoglobin and high leukocyte counts.
Molecular Characteristics
In pediatric patients with sickle cell anemia, certain genetic factors increase the risk of CVA. Children with specific βS haplotypes, such as Ben/CAR, and those without α-gene deletions are at higher risk. Females and patients with four or more α-genes are particularly susceptible to CVA.
CVA in Patients with Central Venous Access Devices (CVADs)
Complications and Risk Factors
Central venous access (CVA) is essential for many medical treatments but carries risks of thrombotic, stenotic, and infectious complications. The site of CVA insertion significantly impacts these risks. Subclavian routes are preferable for short-term catheterization due to lower risks of catheter colonization and thrombotic complications compared to femoral routes. In long-term catheterization, subclavian and internal jugular routes have similar risks. In pediatric patients, CVAD failure and complications, including bloodstream infections, are significant concerns, with hemodialysis catheters showing the highest failure rates.
CVA in Chronic Renal Failure and Dialysis Patients
Atherosclerotic Complications
Patients with chronic renal failure (CRF) have a higher incidence of atherosclerotic CVA compared to the general population. Key risk factors include cigarette smoking, high systolic blood pressure, low HDL cholesterol, and high levels of LDL cholesterol, triglycerides, apoB, Lp(a), fibrinogen, and homocysteine. These factors suggest that the uremic state in CRF patients contributes to atherogenesis, necessitating early prophylactic measures.
CVA in Pediatric Ventricular Assist Device (VAD) Patients
Incidence and Outcomes
CVA is a common complication in pediatric patients with ventricular assist devices (VADs). The highest incidence is observed in patients with paracorporeal continuous VADs. Risk factors include ascites, higher patient profile groups, and implants in small volume centers. CVA significantly increases mortality in these patients, highlighting the need for focused preventive strategies.
CVA After Cardiac Procedures
Coronary Artery Bypass Grafting (CABG)
CVA is a serious complication following coronary artery bypass grafting (CABG). Risk factors include advanced age, low left ventricular ejection fraction, diabetes mellitus, chronic renal failure, redo surgery, peripheral vascular disease, and previous CVA. Perioperative factors such as longer myocardial ischemia and cardiopulmonary bypass times also contribute to the risk. Preventive measures should focus on preoperative risk assessment and tailored surgical strategies.
Transcatheter Aortic Valve Implantation (TAVI)
CVA is a significant adverse event following transcatheter aortic valve implantation (TAVI), with most events occurring within the first day post-procedure. Independent predictors include repeated device implantation attempts, chronic pulmonary disease, and low body mass index. CVA after TAVI is associated with increased all-cause and cardiovascular mortality.
Conclusion
Cerebrovascular accidents (CVA) present a substantial risk across various medical conditions and procedures. Understanding the specific risk factors and complications associated with CVA in different patient populations is crucial for developing effective preventive and management strategies. Early identification and intervention can significantly improve patient outcomes and reduce the burden of CVA-related complications.
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