Possibilities of transcatheter treatment of patients after extensive ischemic stroke

Ivan V Maksimovich

doi:10.4236/wjns.2013.33022

Abstract

The research investigates the efficacy of brain transcatheter laser revascularization in patients who have had extensive ischemic stroke. 1125 patients aged 29 - 81 (average age 75) with cerebral atherosclerosis were examined. The examination plan included: CT brain scan, magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA), laboratory tests, assessment of severity of dementia (CDR), cognitive impairment (MMSE) and activities of daily living (IB). 93 patients suffered extensive ischemic stroke of whom 7 (7.53%) had 10 - 15 IB points, 25 (26.88%)—20 - 30 IB points, 61 (65.59%)—35 - 45 IB points. 69 patients underwent transcatheter treatment (Test Group). 24 patients underwent conservative treatment (Control Group). High-energy laser systems were used for revascularization of major intracranial arteries; lowenergy laser systems were used for revascularization of distal intracranial branches. Test Group: 67 (97.10%) patients had good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization. 12 - 24 months later the following positive trend was observed: 14 (20.59%) patients demonstrated good clinical outcome (IB 90 - 100); 26 (38.24%) patients had satisfactory clinical outcome (IB 75 - 85); 28 (41.18%) patients showed relatively satisfactory clinical outcome (IB 60 - 70); relatively positive clinical outcome (IB satisfactory clinical outcome (IB 60 - 70), relatively positive clinical outcome (IB causes regression of mental, intellectual and motor disorders, promotes regression of post-stroke dementia and significantly improves the quality of life, which makes it noticeably different from the conservative methods of treatment.

Highlights

Stroke is currently one of the most common pathological conditions both in neurological practice and in all clinical medicine
According to CT and magnetic resonance imaging (MRI) Data According to CT and MRI data, there was no significant reduction in the size of the postischemic cyst in any case in the first 12 - 24 months after treatment
In patients who have had small or medium-sized focal ischemic strokes, the severity of mental and motor disorders does not always have a direct relationship to the size of the ischemic focus; it is often associated with the localization of the ischemic injury, the duration of ischemia, as well as with the prevalence of atherosclerosis leading to hemodynamic instability both in the stroke area and in other intracranial arterial basins [13]

Summary

Introduction

Stroke is currently one of the most common pathological conditions both in neurological practice and in all clinical medicine. In many countries, it is one of the most common causes of death and severe disability of patients [1]. The hardest to endure are macrofocal strokes associated with severe neurological deficit resulting in functional, motor, speech disorders, cognitive impairment and dementia [3,4,5]. An important role in the development of ischemic brain lesions is played by hypertension, hyperlipidemia, systemic hemodynamics disorders, microembolism caused by arrhythmia [6,7,8,9]. The main cause of the stroke is the atherosclerotic lesion of the vascular system of the brain [10]

Methods

Results

Conclusion