Preoperative and perioperative issues in cerebrovascular disease:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2006
|
| Schriftenreihe: | Neurologic clinics
24,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI S., S. 607 - 827 zahlr. Ill., graph. Darst. |
| ISBN: | 1416038116 |
Internformat
MARC
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| 245 | 1 | 0 | |a Preoperative and perioperative issues in cerebrovascular disease |c guest ed. José Biller |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2006 | |
| 300 | |a XVI S., S. 607 - 827 |b zahlr. Ill., graph. Darst. | ||
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Datensatz im Suchindex
| _version_ | 1804135639971528704 |
|---|---|
| adam_text | PREOPERAT1VE AND PERIOPERATIVE ISSUES IN CEREBROVASCULAR
DISEASE
CONTENTS
Preface xv
Jose Biller
Discontinuation of Perioperative Antiplatelet
and Anticoagulant Therapy in Stroke Patients 607
Melissa J. Armstrong, Michael J. Schneck, and Jose Biller
Perioperative management of antithrombotic regimens in stroke
patients is faced increasingly by physicians. A literature review
of perioperative thromboembolic and bleeding risks of antiplatelet
agents (AP) or anticoagulants (AC) for stroke prevention suggests
that perioperative withdrawal of aspirin increases thromboembolic
risk without associated benefits. Many procedures are also safe
while continuing AC. Although exact risks associated with tempor¬
ary cessation of AP and AC are unknown and likely low, morbidity
and mortality associated with thromboembolism are high. Physi¬
cians must understand the risks and benefits of perioperative AP
and AC and when these agents can be safely continued.
Prevention of Ischemic Neurologic Injury
With Intraoperative Monitoring of Selected
Cardiovascular and Cerebrovascular Procedures: Roles
of Electroencephalography, Somatosensory Evoked
Potentials, Transcranial Doppler, and Near Infrared
Spectroscopy 631
Michael A. Sloan
All neuromonitoring techniques, although imperfect, provide use¬
ful information for monitoring cardiothoracic and carotid vascular
operations. They may be viewed as providing complementary
information, which may help surgical technique and, as a result,
possibly improve clinical outcomes. The efficacy of transcranial
Doppler and near infrared spectroscopy monitoring during
VOLUME 24 • NUMBER 4 • NOVEMBER 2006 vii
cardiothoracic and vascular surgery are not yet considered estab¬
lished. Well designed, prospective, adequately powered, double
blind, and randomized outcome studies are needed to determine
the optimal neurologic monitoring modality (or modalities), in spe¬
cific surgical settings.
Anesthetic Issues and Perioperative Blood Pressure
Management in Patients Who Have Cerebrovascular
Diseases Undergoing Surgical Procedures 647
W. Scott Jellish
Patients who have cerebrovascular disease and vascular insuffi¬
ciency routinely have neurosurgical and nonneurosurgical pro¬
cedures. Anesthetic priorities must provide a still bloodless
operative field while maintaining cardiovascular stability and renal
function. Patients who have symptoms or a history of cerebrovas¬
cular disease are at increased risk for stroke, cerebral hypoperfu
sion, and cerebral anoxia. Type of surgery and cardiovascular
status are key concerns when considering neuroprotective strate¬
gies. Optimization of current condition is important for a good
outcome; risks must be weighed against perceived benefits in pro¬
tecting neurons. Anesthetic use and physiologic manipulations can
reduce neurologic injury and assure safe and effective surgical care
when cerebral hypoperfusion is a real and significant risk.
Carotid Endarterectomy for Asymptomatic Plaque 661
Cathy M. Helgason
Statistical correlations are linear noninteractive relationships, but
the dynamics of causation are nonlinear and involve complex inter¬
actions where variables are present to degree, change through their
effect on one another and interact with the context of the patient
over time. The discovery and interpretation of plaque vulnerable
features in the individual patient are not determined statistically
for the asymptomatic patient being considered for carotid endarter¬
ectomy. New technologies for identification of plaque chemical and
morphologic composition are on the horizon and may be appli¬
cable to certain patients and change in their usefulness as the
plaque and patient change over time.
The Timing of Carotid Endarterectomy Post Stroke 669
Eli M. Baron, Darric E. Baty, and Christopher M. Loftus
The timing of carotid endarterectomy (CEA) post stroke remains a
controversial area. Most authorities have advocated waiting at
least 2 to 6 weeks after stroke before performing a CEA. More
recently, these recommendations have been challenged. This article
reviews the background leading to advocacy of delayed CEA after
viii CONTENTS
stroke, current literature recommendations regarding CEA after
subacute stroke, current literature regarding neuroradiologic imag¬
ing findings and their implications in decision making regarding
CEA after stroke, and the role of CEA for stroke in evolution.
Carotid Artery Stenting Versus Carotid Endarterectomy:
Current Status 681
Kevin M. Barrett and Thomas G. Brott
Carotid occlusive disease remains an important cause of ischemic
stroke. The results of large, randomized, clinical trials have estab¬
lished the benefit of surgical revascularization in patients with
symptomatic or asymptomatic carotid stenosis. The introduction
of balloon angioplasty and stenting of the extracranial carotid
artery as a potential alternative to surgery has been received with
enthusiasm by patients and physicians. Whether or not this enthu¬
siasm is justified fully has yet to be determined. This article reviews
established and emerging data from clinical trials evaluating the
safety and efficacy of carotid endarterectomy, carotid angioplasty,
and stenting.
Intracranial Angioplasty and Stenting for Cerebrovascular
Disease 697
Lotfi Hacein Bey and Panayiotis N. Varelas
Only 10 years ago, a review of the use of stents to treat cerebrovas¬
cular disease would have resulted in a limited report. Currently,
however, stents increasingly are used in clinical practice, and this
trend is expected to grow exponentially as a result of constant tech¬
nologic improvements and refinements and cross fertilization from
several fields of medicine, science, technology, business, and indus¬
try. Cerebrovascular conditions, which so far have been demon¬
strated to, and may benefit from the use of stents, include
atheromatous disease, broad based cerebral aneurysms, arterial
dissections, and venous occlusive disease causing increased intra¬
cranial pressure.
Hemicraniectomy and Durotomy for Malignant Middle
Cerebral Artery Infarction 715
Michael J. Schneck and Thomas C. Origitano
Decompressive hemicraniectomy with durotomy is a life saving
procedure for patients who have large middle cerebral artery or
carotid terminus strokes at high risk for malignant cerebral edema.
Although randomized clinical trial data are not yet available, there
are several case series that attempt to address issues of patient
selection and timing of the procedure in the context of survival
and functional outcomes. Patients who have an increased number
CONTENTS ix
of medical comorbidities, especially older age, are less likely to ben¬
efit from the procedure, but patients who have even large domi¬
nant hemispheric infarctions may do relatively well in certain
circumstances.
Is Extracranial Intracranial Bypass Surgery Effective
in Certain Patients? 729
Sepideh Amin Hanjani and Fady T. Charbel
Cerebral revascularization can be performed through a variety of
extracranial intracranial (EC IC) bypass operations, using several
different donor and recipient vessels, interposition grafts, and anas
tomotic techniques. The choice of bypass option is dependent on
many factors, including the goals of the operation and the availabil¬
ity and accessibility of particular donor and recipient vessels.
Potential indications for EC IC bypass fall into two major cate¬
gories: (1) flow replacement, in the treatment of complex aneur
ysms or tumors that require vessel sacrifice and (2) flow
augmentation, for treatment of cerebral ischemia. The effectiveness
of EC IC bypass for these indications is reviewed in this article.
Current Updates in Perioperative Management
of Intracerebral Hemorrhage 745
Patrick C. Hsieh, Issam A. Awad, Christopher C. Getch,
Bernard R. Bendok, Szymon S. Rosenblatt,
and H. Hunt Batjer
Spontaneous intracerebral hemorrhages (ICH) account for 10% to
30% of all strokes and are a result of acute bleeding into the brain
by rupturing of small penetrating arteries. Despite major advance¬
ments during the past several decades in the management of
ischemic strokes and other causes of hemorrhagic strokes, such
as ruptured aneurysm, arteriovenous malformations (AVMs), or
cavernous angioma, there has been limited progress made in the
treatment of ICH. The prognosis for patients who suffer intracere¬
bral hemorrhage remains poor. The societal impact of these hemor¬
rhagic strokes is magnified by the fact that affected patients
typically are a decade younger than those afflicted with ischemic
strokes.
Current Options in Clipping Versus Coiling
of Intracranial Aneurysms: to Clip, to Coil, to Wait
and Watch 765
Thomas C. Origitano
Treatment of intracranial aneurysms involves many factors: patient
preference and demographics; aneurysm size, site, geometry,
access, and intrinsics; practitioner experience and availability;
x CONTENTS
facility; technology; and ancillaries. Volume counts, teamwork
enhancement, and management should be individualized.
Risks of Stroke from General Surgical Procedures
in Stroke Patients 777
Richard A. Bernstein
Neurologists often assess the risk of stroke from general surgical
procedures in patients who have cerebrovascular disease. Common
questions for neurologists include: Should a symptomatic or an
asymptomatic carotid stenosis be revascularized before general
surgery? What is the risk of surgery in patients who have stenoses
in the cervicocephalic vasculature? What is the risk of recurrent
stroke in patients who have a history of stroke requiring surgery?
Can antithrombotic therapy be interrupted for surgery? and How
soon after a stroke may elective surgeries be performed? Although
definite answers to these questions are lacking, available clinical
evidence and knowledge of cerebrovascular pathophysiology can
help inform recommendations.
Safety and Efficacy of Thrombolytic Therapy
in Postoperative Cerebral Infarctions 783
Michael T. Mullen, Michael L. McGarvey,
and Scott E. Kasner
Ischemic stroke is a complication of many surgical procedures, but
data on postoperative thrombolysis are limited. Intravenous
thrombolysis is a treatment of acute ischemic stroke but is contra
indicated after major surgery; however, it should be considered
within 14 days of minor low risk surgical procedures. Intra arterial
thrombolysis seems safe in the postoperative period and should be
the mainstay of treatment for postoperative ischemic stroke, with
or without mechanical embolectomy. However, intra arterial
thrombolysis should not be used after craniotomy, major vascular
surgeries, organ transplantation, or other high risk interventions.
In these patients, mechanical thrombolysis alone should be
considered.
Risk Estimates of Stroke After Coronary Artery Bypass
Graft and Carotid Endarterectomy 795
Rima M. Dafer
Neurologic complications of cardiovascular surgeries are well
documented in the literature. Neurologic deficits may be mild
and reversible or may be associated with permanent neurologic
deficit. The incidence and severity of such complications vary
according to the type of surgical procedure and usually correlate
with patients preoperative general medical condition, duration
of surgeries, and intraoperative complications.
CONTENTS xi
Choice of Neuroimaging in Perioperative Acute Stroke
Management 807
Pablo R. Castillo, David A. Miller, and James F. Meschia
Fast examination time, wide availability, lack of contraindications,
and high accuracy make noncontrast CT imaging the diagnostic
study of choice for initial evaluation of preoperative stroke; it also
has a role in excluding patients who will not benefit from intrave¬
nous thrombolysis. Multimodal CT can depict early ischemic
changes, demonstrate hypoperfusion/ischemic penumbra, and
locate vascular lesions. When combined with clinical scenarios,
CT information often is sufficient to help decide appropriate treat¬
ment. MRI can provide more precise information but is more time
consuming and should be the method of choice for follow up,
rather than initial imaging in patients who have perioperative
stroke.
Index 821
xii CONTENTS
|
| adam_txt |
PREOPERAT1VE AND PERIOPERATIVE ISSUES IN CEREBROVASCULAR
DISEASE
CONTENTS
Preface xv
Jose Biller
Discontinuation of Perioperative Antiplatelet
and Anticoagulant Therapy in Stroke Patients 607
Melissa J. Armstrong, Michael J. Schneck, and Jose Biller
Perioperative management of antithrombotic regimens in stroke
patients is faced increasingly by physicians. A literature review
of perioperative thromboembolic and bleeding risks of antiplatelet
agents (AP) or anticoagulants (AC) for stroke prevention suggests
that perioperative withdrawal of aspirin increases thromboembolic
risk without associated benefits. Many procedures are also safe
while continuing AC. Although exact risks associated with tempor¬
ary cessation of AP and AC are unknown and likely low, morbidity
and mortality associated with thromboembolism are high. Physi¬
cians must understand the risks and benefits of perioperative AP
and AC and when these agents can be safely continued.
Prevention of Ischemic Neurologic Injury
With Intraoperative Monitoring of Selected
Cardiovascular and Cerebrovascular Procedures: Roles
of Electroencephalography, Somatosensory Evoked
Potentials, Transcranial Doppler, and Near Infrared
Spectroscopy 631
Michael A. Sloan
All neuromonitoring techniques, although imperfect, provide use¬
ful information for monitoring cardiothoracic and carotid vascular
operations. They may be viewed as providing complementary
information, which may help surgical technique and, as a result,
possibly improve clinical outcomes. The efficacy of transcranial
Doppler and near infrared spectroscopy monitoring during
VOLUME 24 • NUMBER 4 • NOVEMBER 2006 vii
cardiothoracic and vascular surgery are not yet considered estab¬
lished. Well designed, prospective, adequately powered, double
blind, and randomized outcome studies are needed to determine
the optimal neurologic monitoring modality (or modalities), in spe¬
cific surgical settings.
Anesthetic Issues and Perioperative Blood Pressure
Management in Patients Who Have Cerebrovascular
Diseases Undergoing Surgical Procedures 647
W. Scott Jellish
Patients who have cerebrovascular disease and vascular insuffi¬
ciency routinely have neurosurgical and nonneurosurgical pro¬
cedures. Anesthetic priorities must provide a still bloodless
operative field while maintaining cardiovascular stability and renal
function. Patients who have symptoms or a history of cerebrovas¬
cular disease are at increased risk for stroke, cerebral hypoperfu
sion, and cerebral anoxia. Type of surgery and cardiovascular
status are key concerns when considering neuroprotective strate¬
gies. Optimization of current condition is important for a good
outcome; risks must be weighed against perceived benefits in pro¬
tecting neurons. Anesthetic use and physiologic manipulations can
reduce neurologic injury and assure safe and effective surgical care
when cerebral hypoperfusion is a real and significant risk.
Carotid Endarterectomy for Asymptomatic Plaque 661
Cathy M. Helgason
Statistical correlations are linear noninteractive relationships, but
the dynamics of causation are nonlinear and involve complex inter¬
actions where variables are present to degree, change through their
effect on one another and interact with the context of the patient
over time. The discovery and interpretation of plaque vulnerable
features in the individual patient are not determined statistically
for the asymptomatic patient being considered for carotid endarter¬
ectomy. New technologies for identification of plaque chemical and
morphologic composition are on the horizon and may be appli¬
cable to certain patients and change in their usefulness as the
plaque and patient change over time.
The Timing of Carotid Endarterectomy Post Stroke 669
Eli M. Baron, Darric E. Baty, and Christopher M. Loftus
The timing of carotid endarterectomy (CEA) post stroke remains a
controversial area. Most authorities have advocated waiting at
least 2 to 6 weeks after stroke before performing a CEA. More
recently, these recommendations have been challenged. This article
reviews the background leading to advocacy of delayed CEA after
viii CONTENTS
stroke, current literature recommendations regarding CEA after
subacute stroke, current literature regarding neuroradiologic imag¬
ing findings and their implications in decision making regarding
CEA after stroke, and the role of CEA for stroke in evolution.
Carotid Artery Stenting Versus Carotid Endarterectomy:
Current Status 681
Kevin M. Barrett and Thomas G. Brott
Carotid occlusive disease remains an important cause of ischemic
stroke. The results of large, randomized, clinical trials have estab¬
lished the benefit of surgical revascularization in patients with
symptomatic or asymptomatic carotid stenosis. The introduction
of balloon angioplasty and stenting of the extracranial carotid
artery as a potential alternative to surgery has been received with
enthusiasm by patients and physicians. Whether or not this enthu¬
siasm is justified fully has yet to be determined. This article reviews
established and emerging data from clinical trials evaluating the
safety and efficacy of carotid endarterectomy, carotid angioplasty,
and stenting.
Intracranial Angioplasty and Stenting for Cerebrovascular
Disease 697
Lotfi Hacein Bey and Panayiotis N. Varelas
Only 10 years ago, a review of the use of stents to treat cerebrovas¬
cular disease would have resulted in a limited report. Currently,
however, stents increasingly are used in clinical practice, and this
trend is expected to grow exponentially as a result of constant tech¬
nologic improvements and refinements and cross fertilization from
several fields of medicine, science, technology, business, and indus¬
try. Cerebrovascular conditions, which so far have been demon¬
strated to, and may benefit from the use of stents, include
atheromatous disease, broad based cerebral aneurysms, arterial
dissections, and venous occlusive disease causing increased intra¬
cranial pressure.
Hemicraniectomy and Durotomy for Malignant Middle
Cerebral Artery Infarction 715
Michael J. Schneck and Thomas C. Origitano
Decompressive hemicraniectomy with durotomy is a life saving
procedure for patients who have large middle cerebral artery or
carotid terminus strokes at high risk for malignant cerebral edema.
Although randomized clinical trial data are not yet available, there
are several case series that attempt to address issues of patient
selection and timing of the procedure in the context of survival
and functional outcomes. Patients who have an increased number
CONTENTS ix
of medical comorbidities, especially older age, are less likely to ben¬
efit from the procedure, but patients who have even large domi¬
nant hemispheric infarctions may do relatively well in certain
circumstances.
Is Extracranial Intracranial Bypass Surgery Effective
in Certain Patients? 729
Sepideh Amin Hanjani and Fady T. Charbel
Cerebral revascularization can be performed through a variety of
extracranial intracranial (EC IC) bypass operations, using several
different donor and recipient vessels, interposition grafts, and anas
tomotic techniques. The choice of bypass option is dependent on
many factors, including the goals of the operation and the availabil¬
ity and accessibility of particular donor and recipient vessels.
Potential indications for EC IC bypass fall into two major cate¬
gories: (1) flow replacement, in the treatment of complex aneur
ysms or tumors that require vessel sacrifice and (2) flow
augmentation, for treatment of cerebral ischemia. The effectiveness
of EC IC bypass for these indications is reviewed in this article.
Current Updates in Perioperative Management
of Intracerebral Hemorrhage 745
Patrick C. Hsieh, Issam A. Awad, Christopher C. Getch,
Bernard R. Bendok, Szymon S. Rosenblatt,
and H. Hunt Batjer
Spontaneous intracerebral hemorrhages (ICH) account for 10% to
30% of all strokes and are a result of acute bleeding into the brain
by rupturing of small penetrating arteries. Despite major advance¬
ments during the past several decades in the management of
ischemic strokes and other causes of hemorrhagic strokes, such
as ruptured aneurysm, arteriovenous malformations (AVMs), or
cavernous angioma, there has been limited progress made in the
treatment of ICH. The prognosis for patients who suffer intracere¬
bral hemorrhage remains poor. The societal impact of these hemor¬
rhagic strokes is magnified by the fact that affected patients
typically are a decade younger than those afflicted with ischemic
strokes.
Current Options in Clipping Versus Coiling
of Intracranial Aneurysms: to Clip, to Coil, to Wait
and Watch 765
Thomas C. Origitano
Treatment of intracranial aneurysms involves many factors: patient
preference and demographics; aneurysm size, site, geometry,
access, and intrinsics; practitioner experience and availability;
x CONTENTS
facility; technology; and ancillaries. Volume counts, teamwork
enhancement, and management should be individualized.
Risks of Stroke from General Surgical Procedures
in Stroke Patients 777
Richard A. Bernstein
Neurologists often assess the risk of stroke from general surgical
procedures in patients who have cerebrovascular disease. Common
questions for neurologists include: Should a symptomatic or an
asymptomatic carotid stenosis be revascularized before general
surgery? What is the risk of surgery in patients who have stenoses
in the cervicocephalic vasculature? What is the risk of recurrent
stroke in patients who have a history of stroke requiring surgery?
Can antithrombotic therapy be interrupted for surgery? and How
soon after a stroke may elective surgeries be performed? Although
definite answers to these questions are lacking, available clinical
evidence and knowledge of cerebrovascular pathophysiology can
help inform recommendations.
Safety and Efficacy of Thrombolytic Therapy
in Postoperative Cerebral Infarctions 783
Michael T. Mullen, Michael L. McGarvey,
and Scott E. Kasner
Ischemic stroke is a complication of many surgical procedures, but
data on postoperative thrombolysis are limited. Intravenous
thrombolysis is a treatment of acute ischemic stroke but is contra
indicated after major surgery; however, it should be considered
within 14 days of minor low risk surgical procedures. Intra arterial
thrombolysis seems safe in the postoperative period and should be
the mainstay of treatment for postoperative ischemic stroke, with
or without mechanical embolectomy. However, intra arterial
thrombolysis should not be used after craniotomy, major vascular
surgeries, organ transplantation, or other high risk interventions.
In these patients, mechanical thrombolysis alone should be
considered.
Risk Estimates of Stroke After Coronary Artery Bypass
Graft and Carotid Endarterectomy 795
Rima M. Dafer
Neurologic complications of cardiovascular surgeries are well
documented in the literature. Neurologic deficits may be mild
and reversible or may be associated with permanent neurologic
deficit. The incidence and severity of such complications vary
according to the type of surgical procedure and usually correlate
with patients' preoperative general medical condition, duration
of surgeries, and intraoperative complications.
CONTENTS xi
Choice of Neuroimaging in Perioperative Acute Stroke
Management 807
Pablo R. Castillo, David A. Miller, and James F. Meschia
Fast examination time, wide availability, lack of contraindications,
and high accuracy make noncontrast CT imaging the diagnostic
study of choice for initial evaluation of preoperative stroke; it also
has a role in excluding patients who will not benefit from intrave¬
nous thrombolysis. Multimodal CT can depict early ischemic
changes, demonstrate hypoperfusion/ischemic penumbra, and
locate vascular lesions. When combined with clinical scenarios,
CT information often is sufficient to help decide appropriate treat¬
ment. MRI can provide more precise information but is more time
consuming and should be the method of choice for follow up,
rather than initial imaging in patients who have perioperative
stroke.
Index 821
xii CONTENTS |
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| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-014984755 |
| oclc_num | 470721333 |
| open_access_boolean | |
| owner | DE-19 DE-BY-UBM |
| owner_facet | DE-19 DE-BY-UBM |
| physical | XVI S., S. 607 - 827 zahlr. Ill., graph. Darst. |
| publishDate | 2006 |
| publishDateSearch | 2006 |
| publishDateSort | 2006 |
| publisher | Saunders |
| record_format | marc |
| series | Neurologic clinics |
| series2 | Neurologic clinics |
| spelling | Preoperative and perioperative issues in cerebrovascular disease guest ed. José Biller Philadelphia [u.a.] Saunders 2006 XVI S., S. 607 - 827 zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Neurologic clinics 24,4 Maladies cérébrovasculaires - Thérapeutique ram Biller, José 1948- Sonstige (DE-588)136445640 oth Neurologic clinics 24,4 (DE-604)BV000003008 24,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014984755&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Preoperative and perioperative issues in cerebrovascular disease Neurologic clinics Maladies cérébrovasculaires - Thérapeutique ram |
| title | Preoperative and perioperative issues in cerebrovascular disease |
| title_auth | Preoperative and perioperative issues in cerebrovascular disease |
| title_exact_search | Preoperative and perioperative issues in cerebrovascular disease |
| title_exact_search_txtP | Preoperative and perioperative issues in cerebrovascular disease |
| title_full | Preoperative and perioperative issues in cerebrovascular disease guest ed. José Biller |
| title_fullStr | Preoperative and perioperative issues in cerebrovascular disease guest ed. José Biller |
| title_full_unstemmed | Preoperative and perioperative issues in cerebrovascular disease guest ed. José Biller |
| title_short | Preoperative and perioperative issues in cerebrovascular disease |
| title_sort | preoperative and perioperative issues in cerebrovascular disease |
| topic | Maladies cérébrovasculaires - Thérapeutique ram |
| topic_facet | Maladies cérébrovasculaires - Thérapeutique |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014984755&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000003008 |
| work_keys_str_mv | AT billerjose preoperativeandperioperativeissuesincerebrovasculardisease |