Period Of Ischemic Stroke Research Articles

Нейронспецифическая енолаза как маркер поражения мозговой ткани у пациентов с ишемическим инсультом

Актуальность. Перспективным направлением в современной ангионеврологии является исследование маркеров повреждения мозговой ткани в сыворотке крови пациентов в остром периоде ишемического инсульта и их сопоставление с инициальным уровнем неврологического дефицита и исходом инсульта. В качестве маркера повреждения мозговой ткани активно изучаются функции нейронспецифической енолазы (НСЕ). Цель — исследовать уровень НСЕ в остром периоде ишемического инсульта. Материалы и методы. В клиническое исследование включен 151 пациент (средний возраст 61,5 ± 8,2 года), которые распределены на 2 группы: в 1-ю группу вошли 85 пациентов с острым ишемическим инсультом; во 2-ю группу — 66 пациентов с хронической ишемией мозга. Всем пациентам определяли уровень НСЕ в плазме крови. Анализировали корреляции НСЕ с выраженностью неврологического дефицита по NIHSS, функциональной активностью по шкале Бартел, уровнем инвалидизации по шкале Ренкина, выраженностью когнитивных расстройств по MMSE. Определяли взаимосвязи между уровнем НСЕ и выживанием пациентов с ишемическим инсультом. Результаты. У пациентов 1-й группы уровень НСЕ превышал показатель пациентов 2-й группы в 3,8 раза (p < 0,001). Установили достоверные различия уровня НСЕ в зависимости от локализации очага ишемии — в бассейне левой средней мозговой артерии и вертебробазилярном бассейне (p = 0,04). У пациентов с тяжелым неврологическим дефицитом уровень НСЕ превышал показатель пациентов со средним и легким неврологическим дефицитом в 1,3 (p = 0,251) и в 2,3 (p = 0,007) раза соответственно. Установили корреляционную связь между уровнем НСЕ и степенью выраженности неврологического дефицита (r = 0,67, p = 0,027), что свидетельствует о прямой зависимости степени ишемического повреждения и неврологических расстройств. У пациентов с тяжелыми когнитивными расстройствами уровень НСЕ превышал показатель пациентов с умеренными и легкими когнитивными расстройствами в 1,2 (p = 0,444) и в 1,9 (p = 0,037) раза соответственно. При оценке взаимосвязи уровня НСЕ с исходом инсульта выявлена тенденция к более высоким показателям НСЕ у умерших (p = 0,083). Определили пороговое значение уровня НСЕ в крови пациентов с ишемическим инсультом — 40 нг/мл. Выводы. Определение НСЕ в плазме крови подтверждает степень повреждения нейронов и является информативным показателем наличия неврологического дефицита у больных с острым ишемическим инсультом. Полученные результаты свидетельствуют о потенциальной роли определения содержания НСЕ в улучшении стратификации риска летального исхода у пациентов с ишемическим инсультом.

Possibilities of diff usion-weighted magnetic resonance imaging in determining the rehabilitation potential of the acute period of ischemic stroke

Studies over the past decade demonstrate the high potential of diff usion-weighted MRI (dMRI) as a modern technique for non-invasive quantitative assessment of the microstructural integrity of the white matter of the brain, which allows predicting some aspects of the rehabilitation potential. Purpose of the study: to calculate the threshold values of fractional anisotropy (FA) of some cerebral tracts, which are informative in determining various aspects of the rehabilitation potential in the acute period of ischemic stroke. Patients and methods. We examined 100 patients with ischemic stroke and 10 persons without stroke and cognitive impairment. All patients underwent dMRI and clinical assessment of indicators of rehabilitation potential at discharge. Results. The NIHSS at discharge is associated with the size of infarction, the FA of the anterior, posterior leg and knee of the internal capsule, the superior longitudinal, cingular and inferior fronto-occipital bundles. Similar associations were noted for the Rivermead mobility index and the Rankin scale. The function of the hand according to the Frenchay scale is associated with the size of the lesion, FA of the anterior leg of the internal capsule, superior longitudinal, inferior fronto-occipital and cingular bundles. The MoCA is interrelated only with the size of the infarction and the FA of the anterior leg of the internal capsule, the Berg scale — with the size of the lesion and the FA of the upper longitudinal bundle, the FIM scale — with the FA of the upper longitudinal, inferior fronto-occipital and cingular bundles. The threshold values of FA of the cerebral tracts which are most informative in determining various aspects of the rehabilitation potential in the acute period of ischemic stroke were determined. Conclusion. The quantitative assessment of the FA of the main projection and associative tracts is informative in relation to the determination of the rehabilitation potential in the acute period of ischemic stroke.

The treatment effi cacy of disturbed swallowing function in patients with ischemic stroke and neurogenic dysphagia

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p < 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.

Possibility of increasing the «therapeutic window» for revascularization of the carotid arteries in the acute period of ischemic stroke

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

To the issue of degree of removal of gliomas of supratentorial localization

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

Assessment of Neuron-Specific Enolase and Brain-Derived Neurotrophic Factor Levels at Rehabilitation Stages in the Early and Late Recovery Periods of Ischemic Stroke

Assessment of Neuron-Specific Enolase and Brain-Derived Neurotrophic Factor Levels at Rehabilitation Stages in the Early and Late Recovery Periods of Ischemic Stroke

Assessment of the effectiveness of antihypertensive therapy in the early post-stroke period of ischemic stroke based on indicators of arterial stiffness

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Globally, stroke is the second leading cause of death, leading to a reduction in life expectancy and disability of patients. It seems important to study and introduce into practical health care both new approaches to stroke prevention and measures aimed at full recovery in the post-stroke period. Purpose To assess the antihypertensive therapy (AHT) in patients with arterial hypertension (AH) in the early post-stroke period of ischemic stroke (IS), based on indicators of arterial stiffness. Methods The study included 180 patients with hypertension (mean age 64 years) in the acute period of ischemic stroke (IS). Inclusion criteria in this trial: AH, age over 40 years, time from the onset of stroke no more than 48 hours. Arterial stiffness was assessed by an oscillometric method with an assessment of the 24-hour reflected wave transit time (RWTT), aortic augmentation index (AIxao)), arterial stiffness index (ASI), and pulse wave velocity (PWV). The indicators were assessed at the time of admission, at the time of discharge from the hospital (14-21 days) and 2 months after discharge. We determined endothelin-1 (ET-1) levels by ELISA at admission and 2 months after discharge. Retrospectively, patients were divided into 5 groups depending on the prescribed AHT: group 1 (48 patients) - ACEIs/ARBs, thiazide-like diuretics (TLDs), group 2 (46 people) - ACEIs/ARBs, nondihydropyridine calcium antagonists (ACs) and beta-blockers (BBs), group 3 (39 people) - ACEIs/ARBs and ACs, group 4 (26 patients) - ACEIs/ARBs and BBs, group 5 (21 people) - ACEIs/ARBs, TLDs and BBs. Results AHT showed a positive trend in terms of arterial stiffness in all 5 groups. Compared with the baseline values, the significant decrease in PWV (12.4 ± 1.7m/s vs 10.9 ± 1.8m/s, p < 0.01), AIxao (39.8 ± 6.3% vs 36.8 ± 5,2%, p < 0.001), ASI (167.9(127.0;174.5) vs 158.8(115.0;168.7)), p < 0.05), increased RWTT (98.0 ± 9.8ms vs 105.3 ± 7.5ms) in group 2 of patients were found. After 2 months, when comparing indicators between groups the significant decrease in PWV to 9.1(8.7; 11.6)m/s, p < 0.01), AIxao to 31.7(29.8;41.9)%, p < 0.01, an increase in RWTT to 107.7(102.4; 110.2)ms, p < 0.01 in the group of patients taking ACEIs/ARBs, ACs and BBs were detected. After 2 months after discharge, a significant decrease of ET-1 was also observed in group 2 (5.8 ± 2.2ng/ml vs 4.2 ± 1.8ng/ml). The combination of ACEs/ARBs and BBs showed the least effectiveness in reducing arterial stiffness. Conclusions The combination of ACEIs/ARBs, ACs and BBs showed the greatest efficiency in reducing the stiffness in patients with hypertension in the early post-stroke period of IS. It seems important for the functional recovery of patients in the post-stroke period to use the drug therapy aimed not only at lowering blood pressure, but also favorably affecting the arterial stiffness.

Prognostic Value of Investigating Neuron-Specific Enolase in Patients with Ischemic Stroke.

The aim of the study was to assess the prognostic value of the plasma neuron-specific enolase (NSE) level as a predictor of functional outcome and motor function recovery in the acute period of ischemic stroke (IS).Materials and MethodsFifty patients with IS have been examined. On admission to the hospital and at 12–14 days after stroke onset, a clinical and neurological examination have been carried out with the supplementary quantitative assessment of neurological deficit severity according to the National Institutes of Health Stroke Scale (NIHSS), functional outcome according to the Modified Rankin Scale, and Rivermead Mobility Index. Enzyme immunoassay was used to determine NSE concentration in blood plasma in the acute period of the disease.ResultsThe NSE level in patients’ blood plasma in the first 48 h after stroke onset positively correlates with the ischemic focus volume (r=0.49; p=0.003) and the severity of neurological symptoms (according to NIHSS) (r=0.33; p=0.02). NSE less than 2 ng/ml in the acute disease period is a predictor of good functional outcome 12–14 days after stroke onset (OR=12.4; р=0.006). The NSE level >2.6 ng/ml is associated with a high likelihood of lethal outcome.Neurological deficit below 15 according to NIHSS as well as the NSE level <2 ng/ml in the acute IS period are estimated as prognostic factors of significant recovery of motor function at 2 weeks after disease onset (OR=5.8; р=0.02).ConclusionDetermination of NSE in blood plasma makes it possible to predict functional outcome of the disease development and the recovery of motor function in patients with IS.

Rehabilitation treatment in patients with cerebral stroke

Introduction. Treatment and rehabilitation of ischemic stroke patients is an important medical and social problem.&#x0D; The purpose of the study is to compare effectiveness of different complex rehabilitation methods for improving patient functional abilities and social adaptation.&#x0D; Materials and methods. 114 patients, aged 61.1 10.7 years, in early and late rehabilitation period of ischemic stroke were examined. Group I (n = 73, age 63.2 10.9) was represented by the patients that received conventional rehabilitation treatment ambulatory or in neurological department with additional biological feedback; patients of group II (n = 41, aged 60.4 10.3) received ambulatory conventional rehabilitation treatment.&#x0D; Results. There was no significant difference in the patients age of groups I and II. The most frequent stroke location in the middle cerebral artery in the II group patients was in the right hemisphere (p 0.05). The improvement of damaged function was revealed in both groups. Clinical scale data on discharge indicated more severe manifestations in the I group patients. In the main group, the restriction of daily activity in women was more pronounced than in men (p 0.05).&#x0D; Conclusions. Rehabilitation treatment in post-stroke patients led to functional improvement. Clinical manifestations in the patients that require rehabilitation in hospital, were more severe in comparison with ambulatory rehabilitated group. Data on more pronounced disturbances in activities of daily living in women compared to men require further study.

Prognostic value of assessment of glial cell line-derived neurotrophic factor in ischemic stroke patients

Objective. The aim of the study was to estimate the prognostic value of GDNF in acute IS patients. Glial neurotrophic factor (GDNF) is a neuropeptide, which promotes the proliferation and differentiation of the cells of the central and peripheral nervous system, possesses antihypoxic and neuroprotective properties in ischemic stroke (IS).&#x0D; Materials and methods. 50 patients with first-ever acute IS were examined at the National Institutes of Health Stroke Scale (NIHSS); modified Rankin scale was used on admission to the hospital, 7 and 14 days after stroke. The plasma GDNF level was measured at the first 48 hours and after 7 days of IS onset. GDNF was analyzed by commercially available ELISA kit. The comparison group included 20 healthy persons.&#x0D; Results. The average GDNF level in the group of patients with IS (3.4 [2.8; 5.0] pg/ml) was significantly higher than in the group of healthy individuals (2.8 [2.6; 2.9] pg/ml), p = 0.02.&#x0D; The risk of unfavourable functional outcome on the day 14 after IS onset was higher by 2.8-fold in those patients whose level of GDNF was increased on the 7th day of the disease by more than 30% compared to its level in the first 48 hours (RR = 2,8; 95% CI [1,45,7]).&#x0D; The GDNF level less than 2.9 pg/ml was associated with a high risk of death during 14 days after the IS onset (RR = 6,7; 95% CI [1,530,5]).&#x0D; Conclusions. Plasma concentrations of GDNF have a high predictive value for unfavorable functional outcome and risk of death in acute period of IS.

Abstract P530: Safety of Intravenous Cangrelor in Acute Ischemic Stroke

Introduction: Mechanical Thrombectomy often requires immediate antiplatelet therapy when emergent stenting is needed. Intravenous cangrelor (CGR) is a potent reversible intravenous antiplatelet with a fast onset, a short half-life, and predictable pharmacokinetics. We sought to evaluate the safety and efficacy of this drug in MT patients. Methods: We performed a retrospective case control study at a CSC between 3/2016 and 4/2020. Patients who received intravenous CGR within 6 hours of admission (between 10/2019 - 4/2020) were compared with patients with anterior circulation tandem MCA occlusions who required stenting and oral antiplatelet therapy (between 3/16 - 10/19), prior to the availability of CGR at our facility. Results: We identified 35 patients, 12 of whom received IV CGR and 23 received acute oral antiplatelets for tandem occlusions. Average age of the cohort was 68.5 ± 13.4. Baseline characteristics including co-morbidities, rate of IV tPA, and time metrics were similar between the two groups. In the CGR group, nine patients had tandem anterior circulation occlusions, two had basilar occlusions, and one patient had an MCA occlusion secondary to severe stenosis. Eleven of the twelve patients in the CGR group required acute stenting. Intravenous CGR was used for an average of 20.2 hours after which patients were transitioned to aspirin and ticagrelor (33%) or clopidogrel (67%). Successful recanalization was achieved in all patients who received IV-CGR and in 95.7% of the tandem group. Final infarct volumes were comparable between the CGR and tandem cohorts (7.1 vs 15.5 ml; p=0.75). There were two cases of asymptomatic hemorrhage in both the CGR group and the tandem cohort, and one case of symptomatic ICH in the tandem cohort. Final functional outcomes (83.3% vs 60.9%; p=0.259) and mortality at three months (13% vs. 17%; p=1) were similar between the two groups. Conclusions: IV CGR is a promising medication for patients with acute ischemic stroke who require an immediate antiplatelet effect and is comparable in safety and efficacy to oral antiplatelets in the acute period of ischemic stroke. Larger prospective studies on the efficacy and safety of CGR in neurointervention are warranted.

High-frequency electrical activity of the brain in patients with hemispheric ischemic stroke in combination with cognitive functions

Abstract. The mathematical analysis of electroencephalography (EEG) provides information about the functional state of the brain, expands the understanding of the mechanisms of interaction between different areas of the brain, increases the possibilities of diagnostics and allows to put forward new tasks in the field of studying brain activity. Aim. To assess changes in the gamma-rhythm in patients with hemispheric ischemic stroke in the most acute and acute periods in comparison with cognitive and anxiety-depressive disorders. Material and methods. The study included 32 patients with hemispheric ischemic stroke. All patients underwent complex clinical, neurological, instrumental and laboratory studies. The study and recording of the EEG was carried out on the 1st and 21st days of the disease, lasting 20 minutes. The method of mathematical analysis was used to estimate the power spectra and the peak frequency of the gamma — rhythm of the background EEG. Results. As a result of the study, it was found that cognitive and anxiety-depressive disorders are detected already in the most acute and acute periods of ischemic stroke. In the mathematical analysis of the EEG statistically significant correlations between the gamma — rhythm index and cognitive, anxiety-depressive disorders in the frontal, central temporal areas are noted. Conclusion. The complex of examination of patients should include, in addition to clinical and neuropsychological research, mathematical analysis of EEG data.

Independence of ischemic stroke patients after alteplase systemic thrombolytic therapy

Was to determine the proportion of patients with ischemic stroke (IS) who achieved functional independence by the end of the hospitalization, among those who underwent systemic thrombolytic therapy (STT) with two different alteplase preparations (Actilyse and Revelisa). An open, prospective observational non-interventional cohort study of the results of STT in patients with IS was carried out. The study included 195 patients, 123 men and 72 women aged 32 to 86 years, who received STT in the acute period of IS. Of these, 120 patients received Actilyse, 75 - Revelisa. Patients who achieved independence in movement (0-2 points on the modified Rankin scale (MRS)) among those who received STT with Actilyse and Revelisa, the value of the χ2 criterion was 0.014 (p=0.905), which showed that there was no statistical significance of the difference in the frequency of recovery of functional disorders on the MRS scale, in patients receiving STT with two different alteplase preparations. After STT with alteplase preparations, patients with IS experienced a significant improvement, which was expressed in a statistically significant decrease in the severity of neurological deficit and a decrease in the degree of disability. When comparing the results of STT with two different alteplase preparations, no statistically significant differences were found in terms of mortality, survival, and independence during the acute period of IS.

Primary vasculitis of internal carotid and vertebral arteries: a role of cytokines, transforming growth factor beta 1 and basic fibroblast growth factor

To study clinical/laboratory signs of primary vasculitis (PV) of the internal carotid artery (ICA) and vertebral artery (VA). We examined 31 patients (23 men, 74%, mean age - 36.2±5.7 years) with ICA/VA PV verified by vessel wall contrast enhancement on black blood MRI (T1-weighted fat and blood suppressed sequences with- and without contrast injection) at the Research Center of Neurology (Moscow) from January 2012 to September 2019. Systemic vasculitis was excluded in all cases. Interleukins (IL-1β, IL-2, IL-6, IL-17), TNF-a, transforming growth factor beta 1 (TGF-β1) and basic fibroblast growth factor (bFGF) were analyzed by ELISA in 25 patients. Control group consisted of 21 healthy volunteers (12 men, 57%; mean age - 35.3±10.2 years). Clinical manifestations of ICA/VA PV included: ischemic stroke (IS) (94%), which combined with transient ischemic attacks (TIA) in 35%; isolated TIA (3%); Tolosa-Hunt syndrome (3%). Recurrent strokes were observed in 41% of patients on average in 5.3±2.1 months. Carotid artery was involved in 77%, VA - in 16%, both arteries - in 7%. Concomitant involvement of ICA/VA branches was in 19% patients. The level of arterial damage was follows: Intracranial part of arteries involved in 55%, intra-extracranial - in 35%, extracranial - in 10%. Bilateral involvement was found in 26%. Headache/neck pain in the acute IS period was observed in 21%. IS severity (NIHSS) was as follows: moderate (59%), mild (34%), moderately severe (7%). Disability after 3 months according to mRankin scale was as follows: mild (72%) moderate (21%), none (7%). The laboratory study revealed an increased levels of IL-6 (8.19±3.89 pg/ml vs 4.7±1.48 in control, p=0.000), IL-2 (5.64±1.82 pg/ml vs 4.30±1.65, p=0.013), TNF-a (36.9±33.66 pg/ml vs 12.68±5.93, p=0.000), TGF β1 (2.77±1.60 pg/ml vs 1.63±0.64, p=0.006) and bFGF (417.67±132.68 pg/ml vs 335.71±105.08, p=0.018). The levels of IL-1β and IL-17 did not differ significantly from the control. ICA/VA PV has a number of clinical peculiarities. Proinflammatory cytokines produced by Th17 and Th1 CD4+ lymphocytes as well as bFGF and TGR-β1 play a role in its pathogenesis. Normal levels of IL-1β and IL-17 suggest that they are not significant in the development of isolated inflammation in ICA/PA, in contrast to systemic inflammation in giant cell arteritis, in which, according to literature data, their level increases. Isolated ICA/PA inflammation seems to be caused by transaxonal (trigeminal nerve, upper-cervical roots, autonomic nerves) spread of pathogens that initiate immune inflammation in the ICA/PA wall.

Two-stage contralateral combined microvascular and wide-lumen anastomosis inTwo-stage contralateral combined microvascular and wide-lumen anastomosis in a patient with acute ischemic stroke patient with acute ischemic stroke

Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.

Cellex in the therapy of patients with complex and central apnea in the early recovery period of ischemic stroke

A variety of structural and functional post-stroke disturbances demands an integrated clinical/diagnostic approach. Persistent hypoxemia due to disturbance of a saturation of blood oxygen in sleep can decrease the effectiveness of neurorehabilitation. In some cases of sleep apnea, the efficiency of continuous positive airway pressure therapy is insufficient and it should be combined with course neuroprotective therapy. Modern approaches to neuroprotective and neuroreparative therapy are considered as the independent direction for treatment of the central sleep apnea syndromes in patients with stroke consequences that is obviously important aspect of secondary prevention of a stroke.

Analysis of the experience of anesthetic management during endovascular mechanical thrombectomy in ischemic cerebral stroke

Objective ‒ to analyze our own experience of anesthetic management during mechanical thrombectomy (MTE) in patients with acute ischemic stroke (AIS) caused by large cerebral vessels occlusion. Materials and methods. Treatment of patients with AIS caused by large cerebral vessels occlusion was carried out in accordance with the recommendations of the European Stroke Organization (ESO). MTE was performed in 63 patients (23 women and 40 men aged 36 to 82 years, mean age ‒ 62.00 ± 16.31 years). The severity of neurological symptoms in the acute period of ischemic stroke was assessed over time using the National Institutes of Health Stroke Scale (NIHSS). The degree of disability due to stroke was assessed using a modified Rankine scale (mSR) before discharge and after 90 days. The results by mRS after 90 days were the most indicative. Early ischemic changes in the brain on computed tomograms were assessed using the Alberta Stroke Program Early CT score (ASPECTS). To reduce the time «onset-to groin time» (puncture of the femoral artery), all patients were immediately sent to the operating room upon hospitalization after neuroimaging. For MTE in 50 (79 %) cases conscious sedation with local anesthesia (sibazon, fentanyl) was used, in 13 (21%) cases ‒ general anesthesia (propofol, fentanyl, atracurium besylate). Regardless of the anesthesia method, vital signs were monitored and postoperative complications were assessed. The assessment of other important indicators related to the expiration of anesthesia was carried out: the time «onset-the the groin time» the time «from groin – to recanalization», the level of saturation, the stability of mean arterial pressure, the use of vasopressors or labetolol, the number of postoperative complications (pneumonia, dislocation with decompression craniotomy, nausea, myocardial infarction). Results. The algorithm for anesthetic management of the perioperative period included the anesthesia during MTE, postoperative anesthetic monitoring and correction of deviations over the next 72 hours. Mandatory components of anesthetic support of MTE were to maintain blood pressure of at least 140/90 mm Hg. before reperfusion and FiO2 0.45‒0.5%. Anesthetic management also included infusion therapy, prevention of vomiting and regurgitation, and symptomatic therapy. Special attention was paid to the control of hemodynamics in the postoperative period. The results of treatment according to mRS after 90 days showed that more than half of the patients ‒ 32 (50.8%) after MTE were independent of outside help (0‒2 points), 24 (38.1 %) ‒ 3‒5 points, 6 points (mortality) ‒ 7 (11.1 %). After general anesthesia during MTE, 2 (15.4 %) deaths were registered, after MTE with conscious sedation using ‒ 5 (10.0%). There more patients with the vasopressors or labetalol using and the number of postoperative pneumonia were identified in the group with general anesthesia. For other indicators, there was no statistically significant difference in the results depending on the type of anesthesia. There was no statistically significant difference in the results in depending on anesthesia method. Conclusions. The choice of the anesthesia method during MTE for large cerebral vessels should be individual. There was no statistically significant difference in the results in treatment of patients with AIS using MTE (in particular, in mortality), depending on the type of anesthetic management. It is also wasn’t found in the time «onset – to groin time» and the time «groin – to recanalization» with various methods of anesthesia. Indications of vital functions, saturation, mean arterial pressure in patients did not have a significant difference. Differences were revealed in terms of the vasopressors or labetolol using and the number of postoperative pneumonia, depending on the anesthesia type. The anesthesia team should be involved in patient management from the moment of hospitalization, regardless of the method of anesthesia. The results of AIS treatment depend on the initial NIHSS and ASPECTS scores, comorbidity, collateral development, perioperative complications, and the degree of reperfusion after surgery. Special attention should be paid to hemodynamics before and after reperfusion recovery after vessel recanalization, taking into account the degree of reperfusion. The influence of the type of anesthesia on the results of the treatment of AIS with the MTE using remains under the further discussion.

Formalised assessment of systemic thrombogenicity in patients with Polycythemia vera suffered an ischemic stroke

Introduction. Thrombosis diagnosis and prevention in patients with Polycythemia vera (PV) suffered an ischemic stroke (IS) are still open. The aim was to find the reasons for systemic thrombogenicity and to compare the applicability of the main scales assessing thrombosis risk in patients with PV suffered IS.Materials and methods. We followed up 127 people (42-75 y.o.), of which 68 were patients with PV suffered IS (group I) and 59 non-PV-patients with ischemic stroke (group II). Clinical study included common blood analysis, rheological properties of erythrocytes, coagulation and endothelial parameters, cytokines, inflammation markers, angiogenesis markers, and testing for the V617F mutation in the JAK2 gene. The follow up included common and neurological examinations as well, and the assesment of thrombosis risk factors with both Caprini scale and CHA2DS2-VASc scale. All patients were examined twice as in the acute period of IS as well as in 16-18 months.Results. Between the groups no significant differences were found for the NIHSS average score and for Bartel index as well.The Caprini score belonged to the “very high risk” (score &gt; 6) in both groups in the acute period of IS. At the same time, the score “8-10 points” prevailed in group II (68%) whereas the score “11-12 points” prevailed in group I.In the acute time of IS the CHA2DS2-VASc score revealed 12% of patients from both groups who had a score of “3-4 points” (moderate risk of thrombosis).In group I thrombotic complications rate correlated significantly with the JAK2V617F gene allelicloading (r = 0.236; p &lt; 0.05), and the development of recurrence cerebrovascular disorders correlated significantly with Caprini score (r = 0.241; p &lt; 0.05), but not with CHA2DS2-VASc score.Aiming to predict thrombotic complications in PV-patients the threshold (cut off) points were established for those markers as factor VIII, factor VII, red blood cell deformability, thrombin activated fibrinolysis inhibitor (TAFI), red blood cell count, white blood cell count, t-PA, VEGF-A, p-thrombomodulin, and ADAMTS-13.This pattern of parameters showed the odds ratio of thrombotic complications 10.3 (95% CI 7.6-13.8) in PV-patients in thelong-term period.At the end of the follow up the Caprini score showed a trend towards a decreasing in total while the CHA2DS2-VASc score remained virtually unchanged.Conclusion. We assume the accurate assessment of thrombotic risk in patients with Polycythemia vera suffered an ischemic stroke requires a proposed pattern of parameters including the test for JAK2V617F allelicloading and the calculation of Caprini score but not CHA2DS2-VASc score. Final results may provoke to change standard antithrombotic therapy in those patients towards its intensification due to pathogenetic featues of cancer-associated thrombosis.

Efficacy of Metabolic Correction in the Early Recovery Period in Patients with Ischemic Stroke

Objective. To assess the efficacy of including the formulation Cytoflavin in rehabilitation programs for patients in the early recovery period of ischemic stroke. Materials and methods. The results of rehabilitation measures were assessed in 100 patients (50 women and 50 men aged 18–85 years) in the early recovery period of ischemic stroke. Neurological and psychological investigations included the NIHSS, MMSE, and Rankin scales, the Rivermead mobility index, and a physical exercise tolerance test. Depending on the rehabilitation scheme, patients were divided into two groups. The study group included 50 patients receiving courses of verticalization and i.v. dropwise Cytoflavin infusions (20.0 ml in 250ml 5% glucose) for 14 days. The reference group consisted of 50 patients who received standard rehabilitation courses. Results and conclusions. Inclusion of Cytoflavin in the rehabilitation programs of patients with ischemic stroke increased treatment efficacy, which was apparent as decreases in the severity of neurological impairments (on the NIHSS) by 17.6% in the study group vs. 10.8% in the reference group (p < 0.05) and recovery of cognitive functions (on the MMSE) by 5.8% vs. 1.6% in the reference group (p < 0.05). In addition, there was an improvement in the recovery of arterial blood pressure, by 37.1% in the study group vs. 30.6% in the reference group (p < 0.05).

Качество жизни пациентов в резидуальном периоде ишемического инсульта и определяющие его факторы

Stroke remains one of the leading causes of disability; therefore, it is important to investigate factors that might affect the quality of life of stroke patients and refine rehabilitation technologies for better functional gains. The aim of this paper was to study possible factors that determine the quality of life in the residual ischemic stroke period. The MOS SF-36 health survey was completed by 210 patients undergoing early rehabilitation at a stroke care unit. The study revealed a significant decline in some quality of life indicators correlated with advancing age and severity of the condition (correlation coefficient –0.5; p &lt; 0.01). Both physical and mental component summary scores were lower in women than in men (p &lt; 0.01 and p &lt; 0.001, respectively). High scores on the majority of the applied subscales were observed in the patients with a vertebrobasilar stroke, as compared with those who had suffered a carotid stroke (p &lt; 0.05). The early rehabilitation regimen complemented with acupuncture in the acute stroke period and the subsequent rehabilitation program at the Rehabilitation Hospital significantly contributed (р &lt; 0.05) to improving the quality of life of stroke patients in the residual stroke period.