Regional Vascular Center Research Articles

The efficiency of percutaneous coronary interventions in a Regional Vascular Center with regard to baseline risk, the significance of infarction-related artery and the number of affected arteries

The efficiency of percutaneous coronary interventions in a Regional Vascular Center with regard to baseline risk, the significance of infarction-related artery and the number of affected arteries

Indicator dynamics of the “Combating Cardiovascular Diseases” regional program aimed at reducing mortality from acute coronary syndrome

Aim. To analyze the dynamics of the application of medical and organizational technologies for achieving the target reduction of mortality from acute coronary syndrome (ACS) in the region. Materials and methods. In 2018, the research covered 1 regional vascular center (RVC), 8 primary vascular departments (PVD), and 41 medical organizations (MO). In 2022, the structure of medical organizations changed to include 3 RSCs, 9 PSOs, and 39 MOs. The indicators characterizing the provision of medical care to ACS patients in the Irkutsk region were calculated and analyzed. The presence, direction, and strength of correlation between the number of deaths from ACS and the number of medical and organizational activities was studied using linear correlation analysis by the Pearson method. Results. Over time, the share of hospitalization of patients with ACS in the early stages up to 12 hours increased from 42.1% to 46.5%. The mortality rate from ACS decreased by 20.4%, primarily due to a decrease in mortality in the first 24 hours (by 28.7%). The key medical and organizational technologies that have the greatest impact on mortality rates were identified. A strong relationship (r = -0.729) was established between the number of deaths from ACS and the number of patients transferred to the regional vascular center for emergency coronoplasty; two medium-level relationships (r = -0.343) were found between the number of deaths from ACS and the number of hospitalized patients with ACS in the first 12 hours; a correlation (r = -0.415) was determined between the number of deaths from ACS and the number of hospitalized patients who underwent thrombolytic therapy. The linear regression method showed that the availability of such procedures as emergency coronoplasty and thrombolytic therapy has prognostic significance for further reduction of the expected number of deaths from ACS in the region. Conclusion. The creation of the RVC and PVD infrastructure in the region allowed the major indicators of the “Combating Cardiovascular Diseases” regional program to be achieved.

Prediction of in-hospital mortality risk for patients with acute ST-elevation myocardial infarction after primary PCI based on predictors selected by GRACE score and two feature selection methods.

Accurate in-hospital mortality prediction following percutaneous coronary intervention (PCI) is crucial for clinical decision-making. Machine Learning (ML) and Data Mining methods have shown promise in improving medical prognosis accuracy. We analyzed a dataset of 4,677 patients from the Regional Vascular Center of Primorsky Regional Clinical Hospital No. 1 in Vladivostok, collected between 2015 and 2021. We utilized Extreme Gradient Boosting, Histogram Gradient Boosting, Light Gradient Boosting, and Stochastic Gradient Boosting for mortality risk prediction after primary PCI in patients with acute ST-elevation myocardial infarction. Model selection was performed using Monte Carlo Cross-validation. Feature selection was enhanced through Recursive Feature Elimination (RFE) and Shapley Additive Explanations (SHAP). We further developed hybrid models using Augmented Grey Wolf Optimizer (AGWO), Bald Eagle Search Optimization (BES), Golden Jackal Optimizer (GJO), and Puma Optimizer (PO), integrating features selected by these methods with the traditional GRACE score. The hybrid models demonstrated superior prediction accuracy. In scenario (1), utilizing GRACE scale features, the Light Gradient Boosting Machine (LGBM) and Extreme Gradient Boosting (XGB) models optimized with BES achieved Recall values of 0.944 and 0.954, respectively. In scenarios (2) and (3), employing SHAP and RFE-selected features, the LGB models attained Recall values of 0.963 and 0.977, while the XGB models achieved 0.978 and 0.99. The study indicates that ML models, particularly the XGB optimized with BES, can outperform the conventional GRACE score in predicting in-hospital mortality. The hybrid models' enhanced accuracy presents a significant step forward in risk assessment for patients post-PCI, offering a potential alternative to existing clinical tools. These findings underscore the potential of ML in optimizing patient care and outcomes in cardiovascular medicine.

Ischemic stroke in cancer patients: possibilities of reperfusion therapy in elderly patients

Globally, stroke and malignancies represent a major public health burden. Cancer and stroke are two clinical manifestations that are related: cancer patients have twice the risk of stroke than the general population [1]. Types of cancer most commonly associated with ischemic stroke are lung cancer, pancreatic cancer, breast cancer and prostate cancer [2]. An analysis of patients with ischemic stroke and concomitant cancer who underwent inpatient treatment at the regional vascular center in Botkin Hospital. A total of 199 patients with ischemic stroke and malignancy were analyzed. 68 patients received reperfusion therapy and 131 patients did not receive reperfusion therapy. As a result of the analysis, it was concluded that reperfusion therapy is possible and necessary for patients with malignant tumors. The risk of developing extracranial hemorrhages associated with the oncological process is extremely low, and the development of intracranial hemorrhagic complications does not significantly worsen the outcome of the disease. The severity of stroke in the presence of cancer was for the most part due to the stroke itself, its size and location, and depended less on the stage of cancer.

Clinical profile of patients with non-ST segment elevation acute coronary syndrome: experience of a regional vascular center

Aim. To identify the main clinical and paraclinical characteristics of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) of various risk groups for adverse ischemic events, as well as to describe the in-hospital outcomes of the disease.Material and methods. The retrospective analysis included 600 patients who were hospitalized at the regional vascular center from January 2019 to January 2021 with a diagnosis of NSTE-ACS.Results. Patients were stratified into very high — 208 (34,7%), high — 196 (32,7%), moderate — 108 (18%) and low — 88 (14,6%) risk groups. In the highand very high-risk groups, patients were older, characterized by a significant comorbidity index, increased bleeding risk, decreased left ventricular ejection fraction and glomerular filtration rate in comparison with patients of other groups (p<0,05). Very highrisk patients were characterized by associated clinical conditions, predominantly infectious diseases and decompensated heart failure. Unfavorable outcome of hospitalization was observed in 44 (7,3%) patients. The death probability in the very high-risk group (33; 15,9%) was higher than in the low-risk group (2; 2,3%) (Odds ratio 8,1 (95% confidence interval: 1,9-34,6); p=0,01). Regardless of the risk degree, there was a high (53,5%) likelihood of completing invasive coronary angiography as a diagnostic procedure. Most of the observed complications as a result of invasive coronary angiography were characteristic of the high(18,3%) and very high-risk groups (21,5%).Conclusion. NSTE-ACS patients at very high/high risk of adverse ischemic events represent a heterogeneous group with cardiac and noncardiac pathologies with high comorbidity and bleeding risks, decreased left ventricular ejection fraction and glomerular filtration rate, and associated clinical conditions.

Prevalence of main risk factors and cytokine profile in patients with acute coronary syndrome and different serum myostatin levels

Objective. To study the prevalence of the main risk factors and the value of proinflammatory cytokines in patients with acute coronary syndrome (ACS) depending on the determined level of serum myostatin. Materials and methods. 120 patients with ST elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS), hospitalized in the cardiology department of the regional vascular center were examined. In 86 patients, the level of serum myostatin and proinflammatory cytokines was determined on the 5th day of the development of acute coronary syndrome. Results. Patients were divided into two subgroups depending on the level of serum myostatin which was determined: group 1 – with a lower level of myostatin, group 2 – with a higher level of myostatin. Group 1 (serum myostatin level from 0.038 to 0.084 ng/ml) consisted of 23 patients (16 males). Group 2 (serum myostatin level from 0.137 to 0.630 ng/ml) contained 21 patients (14 males). The main risk factors for cardiovascular diseases such as family history of early development of cardiovascular diseases, smoking, dyslipidemia, obesity, arterial hypertension and type 2 diabetes mellitus were assessed. The levels of pro-inflammatory cytokines were determined. Tumor necrosis factor alpha (TNF-alpha) and interleukin 18 (IL-18) levels were significantly higher in patients with higher myostatin levels. Correlation analysis revealed a relationship between serum myostatin concentration and TNF-alpha level (r = 0.34; p = 0.0016). Conclusions. No differences in the prevalence of risk factors in patients with ACS and different myostatin levels, except for smoking were revealed in the study, the frequency of smoking was higher in the group with higher myostatin levels. Greater activity of pro-inflammatory cytokines TNF-alpha and IL-18 was revealed in patients with higher levels of myostatin, as well as a significant correlation between the level of myostatin and TNF-alpha.

Tendencies and features of cerebral stroke mortality according to the data of Tomsk Regional Vascular Center

Tendencies and features of cerebral stroke mortality according to the data of Tomsk Regional Vascular Center

Thrombus extraction in acute ischemic stroke: three years of experience at the regional vascular center

From a modern perspective, the key to successful treatment of ischemic stroke is early reperfusion with systemic thrombolytic therapy and thrombus extraction. Thrombectomy is the only reliable method of recanalization in patients with thrombosis of a large cerebral artery. Despite the fact that thrombus extraction has proven its effectiveness in the treatment of acute ischemic stroke in a number of large randomized trials, there are still issues that have not been fully studied, on which there are controversial opinions among specialists. For instance, there is different information about whether direct thrombectomy or thrombus extraction after systemic thrombolysis is more effective and safer. Moreover, in accordance with modern procedures for providing care to patients with acute cerebral circulatory disorders, patients admitted in the «therapeutic window» should receive intravenous thrombolytic therapy even if thrombectomy is planned. Based on the analysis of 164 thrombus extractions in patients with acute ischemic stroke admitted to the regional vascular center in 2020–2023, the results of direct thrombus extraction and staged reperfusion (systemic thrombolytic therapy + thrombectomy) were compared. It has been found that compared to direct thrombus extraction, staged reperfusion provides more frequent achievement of 2b-3 recanalization (71.83 % and 78.49 %, respectively), accompanied by lower mortality (45 % and 23.66 %, respectively) and more frequent achievement of Rankin 0–2 functional status at the time of discharge (48.72 % and 61.96 %, respectively). The worst results were observed among patients with vascular occlusion in the vertebrobasilar basin, at TICI 0-2a and the age of patients over 80 years.

In the Republic of Tatarstan in 2022: neurological deficit and the share of aggressive intracerebral hemorrhages

The article presents the results of a study on neurological disorders in patients with hypertensive intracerebral hematomas in the Republic of Tatarstan and the proportion of aggressive intracerebral hematomas requiring surgical treatment. A retrospective multicenter study was conducted, including data of 1,127 patients with hypertensive intracerebral hemorrhages from 4 regional vascular centers and 14 primary vascular centers in the Republic of Tatarstan in 2022. Motor disorders were observed in 86.3 % of patients, speech disorders — in 73 %, general cerebral symptoms — in 86.1 %, eye movement disorders — in 17.1 %, vestibular disorders — in 7.5 %, bulbar disorders — in 7.3 %, visual disturbances — in 7 %, generalized seizures at the onset of the disease — in 5.5 %, and mental disorders — in 2.9 % of the patients. At the time of admission to the vascular center, 13.1 % of the patients with an aggressive intracerebral hemorrhage were considered potential candidates for surgical treatment, and within the next day after hospitalization, this figure was 10.9 %. The hospital mortality of patients with hypertensive intracerebral hemorrhages with a Glasgow Coma Scale score of 8 or less upon admission was 4.7 times higher than that of patients with a Glasgow Coma Scale score of more than 8 points.

Influence of the implementation of automatic artificial intelligence-based CT image analysis systems in diagnosis of middle cerebral artery stroke in human

The purpose of the study was to investigate the possibility of applying first-reader and second-reader modes in the implementation of an automatic detection program for MCA ischemic stroke in the diagnostic process of radiologists with less than 3 years of experience and varying expertise in emergency neuroradiology.Material and methods. The study included a software product based on artificial intelligence technologies, as well as seven doctors with less than 3 years of experience and varying expertise in the diagnosis of ischemic stroke. Complementary evaluation was performed based on a cohort of 100 patients admitted to the regional vascular center in Saint Petersburg with clinical presentation of ischemic stroke in the territory of the middle cerebral artery, who underwent native CT brain studies. Ischemic stroke was confirmed in half of the patients based on clinical data, as well as CT angiography of the cerebral vessels and CT perfusion. The diagnosis was ruled out in the other half. Two variants of implementing the artificial intelligence algorithm as a decision support system in the diagnostic process of a radiologist were simulated: the first (parallel) and second reader modes.Results. The results of the study showed that the application of the complementary evaluation parallel- reader mode leads to an increase in diagnostic efficiency indicators and interobserver agreement in assessing ASPECTS scale among young specialists, regardless of their experience with urgent pathology.

Particularities of the course and treatment of non-ST elevation acute myocardial infarction: data from the REGION-IM registry

Aim. To characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p<0,05). In patients with a higher risk according to the GRACE, CRUSADE and ARC-HBR scales, CAG was performed less frequently.Conclusion. In patients with NSTEMI in Russian regions, there is a high frequency of CAG and PCI, including in the early stages. Inhospital mortality is low, especially in the invasive treatment group, and corresponds to data from international registries. In severely ill patients, revascularization is performed less frequently than in low-risk patients. There is room for increasing the prescription rate of modern effective anticoagulants and antiplatelet agents. In general, the quality of treatment for NSTEMI patients has improved in recent years.

Ischemic Stroke and COVID-19 Infection: an Analysis of Treatment Outcomes in Patients who Underwent Endovascular Thrombectomy

Aim. This study aimed to compare and evaluate treatment outcomes in groups of ischemic stroke patients with or without COVID-19 infection who underwent endovascular thrombectomy (EVT).
 Materials and methods. We conducted a retrospective analysis of 817 case records of IS patients aged 25 to 99 years with confirmed thrombotic occlusion of cerebral arteries and subsequent EVT who were treated in regional vascular centers in St. Petersburg from January 1, 2021
 to December 31, 2021.
 Results. Patients without COVID-19 had favorable outcome more often than patients with confirmed COVID-19 (35.0% vs. 7.3%, p 0.001); mortality rate was 30% vs. 52%, respectively (p 0.001).
 Conclusions. Intercurrent COVID-19 significantly worsened prognosis and increased risk of death in ischemic stroke patients who underwent EVT.

Assessment of the association of the rs12329760 polymorphism of the <i>TMPRSS2</i> gene with acute coronary syndrome in patients with new coronavirus infection

Introduction. Cardiovascular diseases (СVD) rank first in terms of morbidity and mortality not only in the Russian Federation but throughout the world. Since the end of 2019 a pandemic of Severe Acute Respiratory Syndrome (SARS) or new coronavirus infection (NCI) has spread throughout the world, which contributed to the development and course of CVD. Therefore, genetic markers began to be considered as factors potentially influencing CVD, its development and severity. Objective: To evaluate the association of the nucleotide sequence variant rs12329760 of the TMPRSS2 gene with acute coronary syndrome in patients who have had a new coronavirus infection.Material and methods. The study included 100 patients (women – 50, men – 50) with ACS and previous NCI, who were selected on the basis of a positive PCR test for the presence of SARS-CoV-2 in the anamnesis, hospitalized at the regional vascular center No. 7 of the City Clinical Hospital No. 2 of the city of Novosibirsk. Women age was 59.5 ± 7.2 years, men age was 53.5 ± 9.3 years. The diagnosis of ACS was established according to a set of criteria proposed and established by the Russian Society of Cardiology and in accordance with the updated clinical recommendations of the Ministry of Health of the Russian Federation of 2020. Patients underwent clinical and instrumental examination, coronary angiography with possible stenting, as provided for in the standards of medical care and clinical guidelines. The nucleotide sequence variant rs12329760 of the TMPSS2 gene was determined in patients using PCR with further analysis of restriction fragment length polymorphism. The comparison group consisted of 200 patients with ACS without previous NCI (no positive PCR test, no positive antibodies).Results. Carriage of CC, СТ, TT, genotype variants of the nucleotide sequence rs12329760 of the TMPSS2 gene are not associated with an increased risk of developing ACS in patients with previous NCI. When comparing the frequencies of the rs12329760 genotypes of the TMPSS2 gene in groups with ACS with NCI and ACS without NCI, no statistically significant differences were obtained. In the group with ACS with NCI, carriage of the homozygous genotype was more common (p = 0.011).Conclusions. Variants of the nucleotide sequence rs12329760 of the TMPSS2 gene are not associated with ACS with previous NCI.

Performance of the Models Predicting In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction with Predictors in Categorical and Continuous Forms.

A single-center retrospective study has been conducted, within the framework of which data from 4674 medical records of patients with STEMI after PCI, treated at the Regional Vascular Center of Vladivostok (Russia), have been analyzed. Two groups of patients were identified: group 1 consisted of 318 (6.8%) individuals who died in the hospital, group 2 included 4356 (93.2%) patients with a favorable outcome of treatment. IHM prognostic models were developed using multivariate logistic regression (MLR), random forest (RF), and stochastic gradient boosting (SGB). 6-metric qualities were used to evaluate the accuracy of the models. Threshold values of IHM predictors were determined using a grid search to find the optimal cut-off points, calculating centroids, and Shapley additive explanations. The latter helped evaluate the degree to which the model predictors influence the endpoint. Based on the results of the multi-stage analysis of indicators of clinical and functional status of the STEMI patients, new predictors of IHM have been identified and validated, complementing the factors of the GRACE scoring system, their categorization has been carried out and prognostic models with continuous and categorical variables based on MLR, RF, and SGB have been developed. These models had a high (AUC - 0.88 to 0.90) and comparable predictive accuracy, but their predictors differed in various degrees of influence on the endpoint. The comparative analysis has shown that the Shapley additive explanation method has advantages in categorizing predictors compared to other methods and allows for detailing the structure of their relationships with IHM. The use of modern data mining methods, including machine learning algorithms, categorization of predictors, and assessment of the degree of their effect on the endpoint, makes it possible to develop predictive models possessing high accuracy and the properties of explanation of the generated conclusions.

ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ И КОРОНАВИРУСНАЯ ИНФЕКЦИЯ: ПЕРЕСЕЧЕНИЕ ДВУХ ПАНДЕМИЙ

Вackground Acute coronary events (ACEs) in combination with SARS-COV 2 infection have their own distinctive features that determine the dynamics of the disease and differences in therapy. Since at present there are no generally recognized algorithms for the management of such patients, there is a need to search for approaches to determine the risk of adverse outcomes of this disease phenotype. Aim of the study. To study the peculiarities of clinical course and to build a prognostic model of lethal outcomes risk in patients with ACS combined with SARS-COV 2 infection at the hospital stage Characteristics of patients and methods of research. The study included 225 patients admitted to a regional vascular center with a diagnosis of ACS who had a verified diagnosis of SARS-Cov 2 infection. Initially, 120 general clinical, biochemical and instrumental parameters were evaluated. Results and Conclusion. A predictive model was constructed with the identification of eight variables most influencing outcomes: age, the presence of atrial fibrillation (except for the first time detected in ACS), severe and extremely severe course of SARS-COV 2 infection, AKI, CKD, ferritin, albumin and glycemia in blood serum on admission. Conclusion. The proposed author's approach for assessing the risk of death in acute coronary syndrome in combination with SARS-CoV 2 has good predictive accuracy and is easy to use.

Comparison of the effectiveness of non-immunogenic staphylokinase and alteplase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data

To compare the effectiveness and safety of the use of non-immunogenic staphylokinase (NS) and alteplase (AP) for intravenous thrombolysis (IT) for ischemic stroke (IS) in real clinical practice at a regional vascular center. Data from 100 patients with IS who received IT with NS and 100 patients who received IT with AP for the period 2022-2023 were analyzed. The groups were comparable on sociodemographic parameters, cardiovascular risk factors and diseases, and stroke characteristics. Door-to-needle time was 17 (13-22) min in the NS group and 38 (33-42) min in the AP group (p<0.001). During control neuroimaging, a cerebral infarction was detected in 46% of patients in the NS group and 61% of patients in the AP group (OR 0.479 [0.263; 0.875], p=0.035). When performing IT with NS, an NIHSS score of 0 points (no neurological deficit) was observed twice as often (OR 2.202 [1.079; 4.504], p=0.023). The incidence of hemorrhagic transformation, including symptomatic, as well as hospital mortality did not differ. IT with NS is associated with a lower probability of cerebral infarction and greater positive dynamics of the neurological status in comparison with the use of AP already within the first stage of treatment and rehabilitation.

СПЕЦИАЛИЗИРОВАННАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПАЦИЕНТАМ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ: ОТДЕЛЬНЫЕ АСПЕКТЫ

Significance. Diseases of the circulatory system are a class of diseases of high social importance and a reservoir for reducing mortality and increasing life expectancy, primarily through improving specialized medical care for working-age patients. The purpose of this study is to assess the results of improving specialized medical care for cardiovascular patients under the federal project “Fight against cardiovascular diseases”. Material and Methods. The analysis is based on data from statistical collections of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, and was focused on evaluating target and actual indicators of the federal project “Fight against cardiovascular diseases”. The content analysis of normative legal documents regulating provision of medical care to patients with cardiovascular diseases has been undertaken. Results. Results of the federal project implemented from October 1st, 2018 to December 31st, 2023, are as follows: 374 regional vascular centers and primary vascular departments were re-equipped (retrofitted); more than 310,000 therapeutic X-ray endovascular interventions were performed; 95.5% of patients who underwent through major cardiovascular surgery are provided with free medications; more than 70% of patients with a high risk of acute cardiovascular event are under medical follow-up and received medical care; hospital mortality from myocardial infarction is under 10%, and hospital mortality from acute cerebrovascular accidents is under16.2%. The standardized mortality rate from diseases of the circulatory system in Russia as a whole decreased by 6.0% in 2022 compared to 2018 and equaled to 408.8 per 100,000population. Conclusion. Implementation of the federal project “Fight against cardiovascular diseases” has made it possible to increase effectiveness of specialized medical care delivery in the Russian Federation primarily due to improved material and technical resources of health care facilities. Coverage of cardiovascular patients with quality clinical follow-up is a hard-to-implement component of the overall process of care delivery to such patients, requiring on-going improvements in the implementation approaches. Progress towards this target is the lowest. In order to achieve quality results in reducing morbidity and mortality from cardiovascular diseases, it is important to timely improve the regulatory framework rather than only develop the resource component.

CHARACTERISTICS OF COGNITIVE DYSFUNCTIONS IN PATIENTS WITH RIGHT-SIDE AND LEFT-SIDE ISCHEMIC STROKE

The goal of the study is to assess the characteristics of cognitive dysfunctions in patients with right-side and left-side ischemic stroke (IS).&#x0D; Materials and Methods. We examined 55 patients (aged 38–65) with right-side and left-side ischemic stroke during the early rehabilitation period. The patients were treated at the regional vascular center, District Clinical Hospital, Khanty-Mansiysk in 2019–2022. Mini-Mental State Examination (MMSE) was used to check patients for cognitive impairments: Frontal assessment battery, Verbal fluency test, Clock-drawing test, Backward digit span test, Visual assessment battery, Auditory assessment battery, and Verbal assessment battery.&#x0D; Results. Cognitive impairments are common post-stroke complications, which can significantly complicate rehabilitation therapy. In the early rehabilitation period, 41.8 % of patients with a hemispheric stroke demonstrate predementia. In patients with right-side stroke, predementia was observed in 22.2 %, whereas 60.7 % of patients with left-side stroke exhibited impaired abilities (p&lt;0.05). There was a significant decrease in short-term memory, time knowledge and orientation abilities in patients with left-side stroke. Assessment of visual, auditory and verbal memory also revealed poorer performance in patients with left-side stroke compared to those with right-side stroke – 20 (17–22) points versus 22 (22–24) points (p&lt;0.05). Moderate frontal dysfunction was detected in all patients (100 %).&#x0D; Conclusion. All patients with hemispheric stroke should undergo early cognitive rehabilitation, even if there are no active complaints. Particular attention should be paid to patients with left-side brain damage.

In-hospital mortality in patients with ischemic stroke and a large cerebral artery occlusion, who underwent mechanical thrombectomy

Occlusion of a large cerebral artery in ischemic stroke (IS) is associated with a high mortality rate. Despite the results of studies that have demonstrated the beneficial effect of endovascular therapy on functional outcome in IS, little research has been conducted on its impact on hospital mortality in IS, its timing and structure.Objective: to investigate hospital mortality in patients with IS and large cerebral artery occlusion, who underwent mechanical thrombectomy (MTE).Material and methods. The retrospective study included data from 233 patients with IS and confirmed occlusion of a large cerebral artery (internal carotid artery, M1 and M2 segments of the middle cerebral artery, basilar artery) treated at the regional vascular center V.V. Veresaev Hospital, Moscow, 2018 and 2022. A comparison of hospital mortality in the group of patients who underwent MTE and the group of patients who received basic therapy was performed.Results. MTE was performed in 107 patients (46%); 126 patients (54%) received only basic therapy. The mortality rate of all patients included in the study was 44.2%. Among all deaths, the proportion of patients with MTE was only 7.2%, while the proportion of patients on basic therapy was 36.9% (p&lt;0.001). Mortality in the MTE group was four times lower than in the basic therapy group – 15.8% compared to 68.2% (p&lt;0.001). We observed that certain manifestations were significantly more frequent in the basic therapy group: cerebral edema (42% vs. 18.6%), hemorrhagic transformation (19.9% vs. 12.9%), venous thromboembolism (6.3% vs. 3.7%) and infectious complications (42.8% vs. 14.3%). The mortality of patients in the basic therapy group was higher on the first day, on days 2–3 and also on days 4–7, while no differences in mortality were observed after the first week of the disease.Conclusion. Admission of a patient with IS within the “therapeutic window” creates the conditions for a significant reduction in hospital mortality and the incidence of stroke complications.

The state of the membrane potential of the mitochondria of blood leukocytes in acute coronary syndrome

Purpose: to assess the state of mitochondrial membrane potential of blood leukocytes in acute coronary syndrome (ACS) depending on the presence and absence of type 2 diabetes mellitus (T2DM).Material and Methods. The study involved 100 people hospitalized at the regional vascular center (RCC) of the Vladivostok Clinical Hospital No. 1 with a diagnosis of ACS, aged 35 to 65 years. The control group consisted of 30 apparently healthy volunteers of the same age and sex. At the time of admission, all patients underwent studies for the diagnosis of ACS, including an assessment of the content of troponin I (TrI), and the marker of the precursor of the cerebral natriuretic peptide (NTproBNP) and the membrane potential of mitochondria (MPM) of blood leukocytes were determined.Results. Indicators of the state MMP made it possible to assess the content of dead and living cells in the blood of the examined persons. An increase in non-viable leukocytes in the blood patients with all types of ACS, including myocardial infarction (MI) and unstable angina (UA), was established. A direct relationship was found between the increase in the number of these cells and the content of TrI in MI and a direct relationship between it and NTproBNP both in MI and NS. In patients with ACS, no significant difference was found between the MMP values of leukocytes depending on the presence of T2DM.Conclusion. An increase in the MPMP of blood leukocytes in patients accompanies of the redox balance disturbance in ACS. The established relationship between MPMP indices in MI and the content of TrI can be considered as a confirming fact of the participation of cells with mitochondrial dysfunction in the development of ischemic necrosis. The found relationship between the increase in blood leukocyte MPMP in patients with ACS and the level of NTproBNP indicates a certain contribution of mitochondrial dysfunction of leukocytes to the development of myocardial remodeling, regardless of the clinical form of ACS and the presence of DM2.