Abstract:

Introduction: research is dedicated to use of intracerebral laser photobiomodulation therapy (PBMT) in treatment of ischemic stroke after-effects in comparison with conservative therapy methods.

Aim: was to evaluate effectiveness of intracerebral transcatheter laser PBMT in patients with previous ischemic stroke.

Materials and methods: 836 patients were included in study, within the period from 6 months to 6 years after ischemic strokes of various severity, aged 29-81 (mean age 74,9): 593 men (70,93%), 243 women (29,07%). Test Group - 511 (61,12%) patients with distal lesions of intracerebral arteries who underwent transcatheter intracerebral laser PBMT; control Group - 325 (38,88%) patients with similar distal lesions of intracerebral arteries who received conservative treatment.

Results: Test Group: good clinical results were obtained in 259 (87,21%) cases after small focal strokes; in 94 (60,26%) after midfocal strokes; in 12 (20,69%) after macrofocal strokes. Satisfactory clinical results were obtained in 33 (11.11%) cases after small focal strokes; 39 (25,00%) after midfocal strokes; 22 (37,93%) after macrofocal strokes.

Control Group: 51 (21,07%) patients after small focal strokes showed good clinical results; patients after midfocal strokes and macrofocal strokes did not have good results; 60 (24,79%) patients after small focal strokes and 8 (19,05%) patients after midfocal strokes showed satisfactory clinical results; patients after macrofocal strokes did not have satisfactory results.

Conclusions: transcatheter intracerebral laser photobiomodulation therapy is an effective, pathogenetically substantiated method of treatment in patients with ischemic stroke after-effects, leading to restoration of activities of daily living, of cognitive and mental functions and returning patients to fully active life.

References

1.     Ahmad FB, Anderson RA. The Leading Causes of Death in the US for 2020. JAMA. 2021.

2.     Maksimovich IV. Transcatheter Treatment of Atherosclerotic Lesions of the Brain Complicated by Vascular Dementia. Diagnostic and Interventional Radiology. 2013; 7(2): 65-75 [In Russ].

3.     Maksimovich IV. Transcatheter intracerebral photobiomodulation in ischemic brain disorders: clinical studies (Part 2). Photobiomodulation in the Brain. 2019; 529-544.

4.     Caplan LR. The Effect of Small Artery Disease on the Occurrence and Management of Large Artery Disease. JAMA Neurol. 2016; 73(1): 19-20.

5.     Zhulev NM, Pustozertsev VG, Zhulev SN. Cerebrovascular Diseases. 2002; Moscow, BINOM [In Russ].

6.     Maksimovich IV. Application of transcatheter laser technologies in treatment of atherosclerotic lesions of the brain. Diagnostic and Interventional Radiology. 2016; 10(3): 57-67 [In Russ].

7.     Hamblin MR. Photobiomodulation for Traumatic Brain Injury and Stroke. J Neurosci Res. 2018; 96(4): 731-743.

8.     Maksimovich IV. Results of brain transcatheter laser revascularization in the treatment of the consequences of ischemic stroke. J Vas Dis Treat. 2017; 1(1): 2-5.

9.     Pasi M, Cordonnier Ch. Clinical Relevance of Cerebral Small Vessel Diseases. Stroke. 2020; 51(1): 47-53.

10.   Regenhardt RW, Das AS, Lo EH, et al. Advances in Understanding the Pathophysiology of Lacunar Stroke: A Review. JAMA Neurol. 2018; 75(10): 1273-1281.

11.   Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019; 18(3): 248-258.

12.   Akioka N, Takaiwa A, Kashiwazaki D, et al. Clinical significance of hemodynamic cerebral ischemia on cognitive function in carotid artery stenosis: a prospective study before and after revascularization. J Nucl Med Mol Imaging. 2017; 61(3): 323-330.

13.   Haupert G, Ammi M, Hersant J, et al. Treatment of carotid restenoses after endarterectomy: A retrospective monocentric study. Ann Vasc Surg. 2020; 64: 43-53.

14.   Featherstone RL, Dobson J, Ederle J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis. Health Technol Assess. 2016; 20(20): 81-94.

15.   Lamanna A, Maingard J, Barras CD, et al. Carotid artery stenting: Current state of evidence and future directions. Acta Neurol Scand. 2019; 139(4): 318-333.

16.   Kim NY, Choi JW, Whang K, et al. Neurologic complications in patients with carotid artery stenting. J Cerebrovasc Endovasc Neurosurg. 2019; 21(2): 86-93.

17.   Yoo J, Choi JW, Lee SJ, et al. Ischemic Diffusion Lesion Reversal After Endovascular Treatment. Stroke. 2019; 50(6): 1504-1509.

18.   Gramegna LL, Cardozo A, Folleco E, Tomasello A. Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke. BMJ Case Rep. 2020; 13(1).

19.   Snyder T, Agarwal S, Huang J, et al. Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS. J Neuroimaging. 2020; 30(5): 625-630.

20.   Chu YT, Lee KP, Chen CH, et al. Contrast-Induced Encephalopathy After Endovascular Thrombectomy for Acute Ischemic Stroke. Stroke. 2020; 51(12): 3756-3759.

21.   Maksimovich IV. Laser Technologies as a New Direction in Transcatheter Interventions. Photobiomodul Photomed and Laser Surg. 2019; 37(8): 455-456.

22.   Maksimovich IV. Transluminal laser angioplasty in treatment of ischemic lesions of a brain. Ph.D. Dissertation, Russian University of Friendship of the People 2004; Moscow [In Russ].

23.   Hamblin MR. Photobiomodulation, Photomedicine, and Laser Surgery: A New Leap Forward Into the Light for the 21st Century. Photobiomodul Photomed Laser Surg. 2018; 36(8): 395-396.

24.   Salehpour F, Gholipour-Khalili S, Farajdokht F, et al. Therapeutic potential of intranasal photobiomodulation therapy for neurological and neuropsychiatric disorders: a narrative review. Reviews in the Neurosciences. 2020; 31(3): 269-286.

25.   Saltmarche AE, Margaret A, Naeser MA, et al. Significant Improvement in Cognition in Mild to Moderately Severe Dementia Cases Treated with Transcranial Plus Intranasal Photobiomodulation: Case Series Report. Photomedicine and Laser Surgery. 2017; 35(8): 432-441.

26.   Hamblin MR. Mechanisms and Mitochondrial Redox Signaling in Photobiomodulation. Photochem Photobiol. 2018; 94(2):199-212.

27.   Huang YY, Hamblin MR. Photobiomodulation on cultured cortical neurons. Photobiomodulation in the Brain. 2019: 35-46.

28.   Hamblin MR. Mechanisms of photobiomodulation in the brain Photobiomodulation in the Brain. 2019: 97-110.

29.   Lapchak PA. The challenge of effectively translating transcranial near-infrared laser therapy to treat acute ischemic stroke. Photobiomodulation in the Brain. 2019: 289-298.

30.   Taboada LD, Hamblin MR. Transcranial photobiomodulation for stroke in animal models. Photobiomodulation in the Brain. 2019: 111-124.

31.   Maksimovich IV. Intracerebral Transcatheter Laser PBMT in the Treatment of Binswanger's Disease and Vascular Parkinsonism: Research and Clinical Experience. Photobiomodul Photomed and Laser Surg. 2019; 37(10): 606-614.

32.   Mahoney FI, Barthel DM. Functional evaluation: The barthel index. Maryland State Medical Journal. 1965; 14: 61-65.

33.   Morris JC. The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology. 1993; 11(43): 2412-2414.

34.   Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3): 189-198.