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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.



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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.

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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.

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Introduction: more than 10 million ischemic strokes are recorded in the world every year - a disease, the mechanism of development of which is associated with impaired blood flow to the brain tissues, mainly due to embolism in intracranial arteries. One of treatment methods of ischemic stroke within the «therapeutic window», in the absence of contraindications, is systemic thrombolytic therapy. Thrombolytic therapy has a number of limitations and contraindications, including ongoing or occurring bleeding of various localization within a period of up to 6 months.

Aim: was to evaluate the possibility of performing and the effectiveness of «off-label» simultaneous selective thrombolytic therapy and uterine arteries embolization in a patient with acute ischemic stroke with multiple distal lesions of middle cerebral artery branches against the background of ongoing uterine bleeding.

Case report: patient S., 42 years old, was hospitalized to the pulmonary department for bronchial asthma treatment with the aim of preoperative preparation before extirpation of the uterus, against the background of menometrorrhagia. At one of days of hospitalization, patient suffered from acute dysarthria, right-sided hemiparesis. When performing multislice computed tomography and angiography, multiple occlusions were revealed in the distal segments (M3-M4) of the left middle cerebral artery. The patient underwent simultaneous selective thrombolytic therapy of the left middle cerebral artery and uterine artery embolization.

Results: in the next few hours of the postoperative period, the patient experienced regression of neurological deficit: symptoms of dysarthria were arrested, almost complete restoration of motor activity in the right extremities, residual slight asymmetry of the face; bleeding from uterine stopped.

The patient was discharged on the 16th day with a slight neurological deficit. The follow-up period is 18 months. Neurological status with minor deficits: slight asymmetry of facial muscles; the strength of muscles of right limbs is reduced to 4-4,5 points. Ultrasound: a significant decrease in the size of the uterus and myomatous nodes. Menstrual cycle is restored.

Conclusions: a wide range of angiographic instruments and skills of endovascular surgeons made it possible to perform «off-label» simultaneous intervention in a patient with ischemic stroke and multiple distal lesions of branches of the middle cerebral artery against the background of ongoing uterine bleeding and giant myoma. The use of methods of endovascular hemostasis makes it possible to stop bleeding by overcoming contraindications to thrombolytic therapy. The use of thrombolytic therapy within the «therapeutic window» allows regression of neurological deficits in patients with multiple distal cerebral artery lesions.



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Clinical guidelines for the management of patients with ischemic stroke and transient ischemic attacks. Moscow; 2017: 92 [In Russ].

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Introduction: basilar artery thrombosis (BAT) is the cause of about 1% of ischemic strokes (IS). About 27% of strokes in posterior circulation are associated with BAT. Mortality in BAT without recanalization reaches 85-95%. In 80.7% of patients with BAT at the onset of disease a decrease in level of consciousness is observed, in 34% of them – coma.

Aim: was to show the possibility of performing thrombectomy (TE) in patients with BAT and reduced level of consciousness as the only effective way to prevent death in this pathology.

Materials and methods: two case reports of successful TE from basilar artery in patients with IS and decrease in level of wakefulness to coma, are presented.

Results: article describes two successful cases of TE in patients with angiographically confirmed BAT and decrease in the level of consciousness to moderate coma at the onset of disease. In two presented patients, TE made a complete restoration of BA blood flow. Good clinical outcomes were noted in both patients by 90th day of disease (modified Rankin scale 0-2 points). The Rivermead mobility index at discharge from hospital was 14 points, and the Bartel index by 90th day – complete independence from others in everyday life (from 90 to 100 points), and that once again indicates that TE in BAT is not only a life-saving procedure, but significantly improves functional and clinical outcomes of disease.

Conclusions: basilar artery thrombosis is a life-threatening condition that requires urgent reperfusion therapy as the only effective method of treatment. Endovascular treatment for basilar artery thrombosis should be considered in all patients, regardless the decrease in the level of consciousness at the onset of disease, because thrombectomy is a life-saving procedure.




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3.     Ikram A, Zafar A. Basilar Artery Infarct. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020. Available at:

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5.     Writing Group for the BASILAR Group, Zi W, Qiu Z, et al. Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry. JAMA Neurol. 2020; 77(5): 561-573.

6.     Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; 15(11): 1138-1147.

7.     Liu Z, Liebeskind DS. Basilar Artery Occlusion and Emerging Treatments. Semin Neurol. 2021; 41(1): 39-45.

8.     Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): 344-418.

9.     Baik SH, Park HJ, Kim JH, et al. Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome. Radiology. 2019; 291(3): 730-737.

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12.   Liu X, Dai Q, Ye R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol. 2020; 19(2): 115-122.

13.   Potter JK, Clemente JD, Asimos AW. Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion. Am J Emerg Med. 2021; 42: 221-224.



Introduction: every year in the world, more than 13 millions strokes are recorded, most often (up to 80%) - acute cerebrovascular accidents of ischemic type, in which the cause of cerebral infarction is acute embolic occlusion of intracranial artery. Restoration of cerebral perfusion as early as possible from the onset of the disease can lead to a decrease of infarction zone and an improvement in clinical outcomes of the disease.

Case report: a 78-year-old patient was admitted with a clinical picture of acute stroke 90 minutes after onset; after computed tomography was performed, according to generally accepted method, systemic thrombolytic therapy was started. Angiography (occlusion of left middle cerebral artery (MCA) in the M1 segment followed by aspiration and then mechanical thrombectomy showed an «early» bifurcation of middle cerebral artery with a large lateral branch. Occluding thrombus was localized precisely in the area of MCA bifurcation, in branches of equal diameter. After unsuccessful attempts at thrombus extraction using the standard thrombus extraction and aspiration technique, patient underwent thrombus extraction using the original method (we called R-Culotte): simultaneous use of two retrievers positioned in the Culotte style (Culotte - «pants», French, R -retriever, English) in lumen of the bifurcation of middle cerebral artery. Blood flow in MCA was restored to mTICI-3 without complications. After the intervention, there was a rapid positive trend. Patient was discharged on 12th day with minimal neurological deficit.

Conclusions: this technique allowed to remove the thrombus and restore antegrade blood flow without complications after a series of unsuccessful attempts using the standard approach. Endovascular treatment of ischemic stroke has opened a new era in the treatment of this formidable disease. The search for new techniques for using existing devices contributes to the development of this promising technique.



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8.     GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5): 439-458.



Introduction: up to the present day, there were no published multicenter randomized researches, that could compare combined concept of thrombectomy, including different methods of stent-retrievers traction with elements of aspiration and thrombolysis. There is no data on the effect of embolic complications after extraction of thrombus from cerebral arteries on outcomes of treatment.

Aim: was to increase the effectiveness of treatment of patients with ischemic stroke basing on a comparison of results of various methods of endovascular thrombectomy from cerebral vessels and intravenous thrombolysis, and on the base of assessment of effect of distal embolism on treatment outcomes in acute period of ischemic stroke.

Materials and methods: we carried out statistical analysis of results of different methods of thrombectomy in 75 patients and intravenous thrombolysis in 75 patients in acute phase of ischemic stroke. Effect of embolic complications after thrombectomy on outcomes of treatment of ischemic stroke was determined.

Results: groups of patients were comparable in age, neurological deficit, sex, localization and stroke subtype. The first group is burdened by the proportion of documented cerebral artery occlusion, diabetes mellitus and ischemic stroke in anamnesis. Differences in deaths and disability rates were not reliable. Thrombectomy demonstrated neurological deficit regression at all evaluation intervals, as well as the superiority of 2 times at achievement of functionally independent outcome in comparison with intravenous thrombolysis group.

Conclusions: a concept to thrombectomy, that supposes different methods of use of stent-retrievers and aspiration demonstrates better functional outcomes in treatment of ischemic stroke in the acute phase compared with intravenous thrombolysis. Embolic complications of reperfusion treatment adversely affect ischemic stroke outcomes and should be considered as a factor requiring minimization.



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9.     Goyal M, Demchuk A, Menon B et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. New England Journal of Medicine. 2015;372(11): 1019-1030.

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14.   Saver J, Goyal M, Bonafe A et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. New England Journal of Medicine. 2015;372(24):2285-2295.

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Introduction: among patients with ischemic stroke (IS), more than 17% has atrial fibrillation (AF). The active application of aspiration thrombectomy (AT), in addition to thrombolytic therapy (TLT), can significantly improve functional outcome, prognosis and survival of patients with IS. The main method of preventing of IS in patients with nonvalvular AF today is still an anticoagulant therapy, but percutaneous transcatheter occlusion of the left atrium appendage (LAA) can be an alternative method, especially if anticoagulant therapy is contraindicated or ineffective.

Aim: was to demonstrate results of a complex staged treatment of an age-related patient with nonvalvular atrial fibrillation, complicated by the development of cardioembolic ischemic stroke while taking anticoagulants.

Material and methods: a clinical observation of a 81-year-old patient delivered to the hospital with a clinical manifestation of ischemic stroke in the “therapeutic window”, with a history of persistent AF and taking anticoagulants, is presented. After conservative therapy - a regression of neurological symptoms was achieved. Three days after - negative dynamics in the clinical picture with development of aphasia and right-sided hemiplegia. Multispiral computed tomography with contrast (MSCT-A): occlusion of M2 segment of the left middle cerebral artery (MCA). Patient underwent aspiration thrombectomy with complete restoration of blood flow and regression of neurological symptoms. After 2 months from the episode of IS, patient underwent implantation of occlude in the left atrial appendage as a prophylaxis of re-embolism, followed by the abolition of warfarin.

Results: a senile patient returned to normal life and self-care (assessed using the modified Rankin scale 1). During next 13 months patient had no major adverse cardiac events (MACE) or significant bleeding and all that shows that occlusion of LAA is effective.

Conclusions: in the early period of ischemic stroke, isolated aspiration thrombectomy is the operation of choice in patients with atrial fibrillation and contraindication for thrombolytic therapy, and endovascular occlusion of the left atrial appendage can be the method of choice for secondary prevention of ischemic stroke. Further studies are required to assess applicability and reproducibility of the approach we have described in routine clinical practice.



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2.     Feigin V.L., Krishnamurthi R.V., Parmar P., et al; GBD Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015; 45 (3):161-76.

3.     Savello AV, Voznjuk IA, Svistov DV, Babichev KN, Kandyba DV, Shenderov SV, Vlasenko SV, Shlojdo EA, Kachesov JeJu, Esipovich ID, Haritonova TV. Results of treatment of ischemic stroke using intravascular thromboembolectomy in conditions of regional vascular centers in a metropolis (St. Petersburg). Zhurnal nevrologii i psihiatrii im. C.C. Korsakova. 2018; 118 (12-2): 54-63.

4.     Savello AV, Svistov DV, Sorokoumov VA. Endovascular treatments for ischemic stroke: Present status and prospects. Nevrologia, nejropsihiatria, psihosomatika. 2015; 7 (4): 42-49.

5.     Saposnik G., Gladstone D., Raptis R., et al. Investigators of the Registry of the Canadian Stroke Network (RCSN) and the Stroke Outcomes Research Canada (SORCan) Working Group. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke. 2013; 44 (1): 99-104.

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7.     Pistoia F., Sacco S., Tiseo C., et al. The Epidemiology of Atrial Fibrillation and Stroke. Cardiol Clin. 2016; 34 (2): 255-268.

8.     Aguilar M.I., Hart R., Pearce L.A. Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks. Cochrane Database Syst Rev. 2007; 18 (3): CD006186.

9.     Kamel H., Healey J.S. Cardioembolic Stroke. Circ Res. 2017; 120 (3): 514-526.

10.   Go A.S., Hylek E.M, Phillips K.A., et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285 (18): 2370-2375.

11.   Demaerschalk B.M., Kleindorfer D.O., Adeoye O.M., et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2016; 47 (2): 581-641.

12.   Powers W.J., Rabinstein A.A., Ackerson T., et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50 (12): 344-418

13.   Bajwa R.J., Kovell L., Resar J.R., et al. Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. Clin Cardiol. 2017; 40 (10): 825-831.

14.   Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS. 2017; 70 (1): 50. 



Aim: was to evaluate the effectiveness of carotid arterial revascularization by stenting of internal carotid arteries (ICA) in patients with a previous ischemic stroke.

Materials and methods: in FSBI «Treatment and rehabilitation center» of the Ministry of Health of Russia,104 patients on treatment and rehabilitation after previous ischemic stroke, underwent stenting of symptomatic atherosclerotic stenosis of the ICA. The average time since stroke was 67 days (from 28 to 273 days). ICA stenting was performed according to generally accepted standards with the mandatory use of intravascular protective devices against cerebral embolism. In most patients we used a filter protection system (77 observations), and for stenosis of more than 95% and in the presence of an unstable atherosclerotic plaque, a proximal defense system was used (27 patients). In some cases, if the situation required it, a combination of protective devices was used (5 observations). A few days before upcoming operation, all patients were evaluated for microcirculation and perfusion in brain tissue using single photon emission computed tomography (SPECT), followed by analysis of results and comparison with SPECT data in the postoperative period.

Results: when analyzing 30 days after stenting, there were no fatal outcomes. In one case (0.96%) after stenting of the subtotal stenosis of the ICA, a hemorrhagic stroke on the ipsilateral side developed on the fifth day. In another case, intraoperative embolism of the ophthalmic artery occurred on the side of the operation with partial loss of vision field.

In the long-term period (4 years and 7 months), the number of undesirable events was 2%. In one case (0.96%), the patient died of ischemic stroke on the ipsilateral side after 3 years and 2 months after stenting. In another case, patient after 1 year and 2 months had an ischemic stroke on the side of the operation. Thus, the total number of complications associated with ICA stenting (30-day period + long-term period) was 3.8%.

When evaluating results of stenting by the SPECT method, the state of cerebral perfusion was assessed using perfusion maps in two modes and by axial perfusion sections.

In all observations after stenting, improvement of cerebral perfusion was noticed, regardless of the side and severity of ICA stenosis and the presence of focal postischemic changes. Visually, perfusion sections show a general increase in cerebral blood perfusion (CBP), a decrease in one-sided focal deficiency of CBP . Same results were obtained for relative cortex perfusion (relCP) in four regions and in vascular basins.

Comparing results, obtained by the number of undesirable events (strokes, restenosis and death) with the four-year data of the analysis of the international CREST study, the complication rate in our group is significantly lower (3.8% versus 8.6% in the CREST stenting group and 8.4% in carotid endarterectomy group CREST).

Conclusion: carotid stenting is an effective method of treatment of atherosclerotic lesions of main cerebral arteries in patients with previous stroke. The effectiveness of this type of treatment is confirmed by a positive clinical result and with the help of modern diagnostic methods, in particular SPECT.



1.     Damulin IV, Parfenov VA, Skoromets AA, Yah NN. Circulatory disorders in the brain and spinal cord. In the book: «Diseases of the nervous system. A guide for doctors». Yakhno N.N., Shtulman D.R. (ed.). 2003; 231302 [In Russ].

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10.   Sacco RL, Adams R, Albers G et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke. 2006; 37: 577 - 617.

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Aim: was to perform a retrospective comparative analysis of clinical and angiographic results of primary endovascular treatment of ischemic stroke in patients who had contraindications for adjuvant thrombolytic therapy, and results of applying standard pharmaco-invasive (thrombolysis and thrombus extraction) treatment.

Material and methods: angiography was performed in 61 patients. The main criterion for the selection of patients for cerebral angiography according to MSCT-angiography, was a confirmed occlusion of a large intracranial vessel (the internal carotid artery or the middle cerebral artery at M1-2 segment). After MSCT-angiography, in the absence of contraindications, (STT) systemic throbolytic therapy (Alteplaza in the standard dose) was started and patients were sent to an endovascular operation, where selective angiography of the syndrome-responsive artery was performed, followed by an endovascular procedure, according to standard procedure. For endovascular treatment, Penumbra Reperfusion catheters - ACE 68 , were used in combination with 3MAX catheters, or stent-retrievers (Trevo, PRESET, ERIC). In a number of cases, the use of retrievers was supplemented with an assisting thrombus aspiration («Solumbra» method). The criterion for the effectiveness of endovascular treatment was the achievement of blood flow in the syndrome-responsible artery TICI 2b - 3. 6 patients with lesion of distal segments of middle cerebral artery (M3-4) or with no occlusion of large intracranial occlusion were excluded from the study.

Results: all 55 patients who received endovascular treatment, retrospectively were divided into two groups depending on the performance of adjuvant STT Group of combined treatment (STT and endovascular procedure (EVP)) included 24 patients; 31 patients were included in the primary EVP group.

Conclusions: basing on results of the study it can be supposed that primary endovascular treatment of ischemic stroke without thrombolysis can provide comparable efficacy and safety of treatment.



1.      Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010; 41:2254-2258.

2.      Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Dбvalos A. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemicstroke: a pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017;74:268-274.

3.      Broeg-Morvay A, Mordasini P, Bernasconi C, Bьhlmann M, Pult F, Arnold M. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis. Stroke. 2016; 47:1037-1044.

4.      Bellwald S, Weber R, Dobrocky T, Nordmeyer H, et al Direct Mechanical Intervention Versus Bridging Therapy in Stroke Patients Eligible for Intravenous Thrombolysis: A Pooled Analysis of 2 Registries. Stroke. 2017 Nov 7.

5.      Merlino, G., Sponza, M., Petralia, B. et al. Short and long-term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy: a prospective single-center study. J Thromb Thrombolysis. 2017; 44: 203.

6.      Guedin P, Larcher A, Decroix JP, Labreuche J, Dreyfus JF, Evrard S. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015; 24:952-957.

7.      Behme D, Kabbasch C, Kowoll A, Dorn F, Liebig T, Weber W, Mpotsaris A. Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions. J Stroke Cerebrovasc Dis. 2016; 25:954-959.

8.      Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke. 2015; 46:3241-3248.

9.      Kass-Hout T, Kass-Hout O, Mokin M, Thesier DM, Yashar P, Orion D. Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke? WorldNeurosurg. 2014; 82:e453-458.



The article presents an analysis of the choice of strategy for the treatment of ischemic stroke in the acute period, based on literature review.

Aim: was to develop the concept of effective thromboextraction (TE), based on the evaluation of factors influencing results of reperfusion treatment of ischemic stroke (IS), methods of endovascular restoration of cerebral blood flow

Materials and methods: meta-analysis of 44 sources of domestic and foreign literature is performed. The analysis of factors limiting the effectiveness of various reperfusion approaches and the analysis of modern methods of thrombectomy are performed.

Results: it is established, that SMAT (Solumbra) and PROTECT techniques have an advantage in comparison with aspiration approaches to thrombectomy in reducing the period to full reperfusion; methods with temporary occlusion of the source vessel (BGC) SAVE and PROTECT significantly reduce the risk of stroke spread to new vascular areas of the brain and increase the frequency of successful recanalization.

Conclusion: at present time, the PROTECT is the most effective technique in the frequency of successful recanalization, the degree and speed of achieved reperfusion, as well as in the prevention of distal embolization. Extrapolation of experience and principles from other sections of interventional radiology, development of new methods and strategies of brain reperfusion, depending on the morphology of thromboembolism, its size, localization and extent may contribute to improving results of endovascular treatment of ischemic stroke.



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5.      Domashenko M.A., Panova K.V., Murtazalieva D.M. i dr. Personifikatsiya tromboliticheskoj terapii patsientov s ishemicheskim insulom [Personification of thrombolytic therapy in patients with ischemic stroke.] Medica mente. 2017; 3(1): 45-48.

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18.    Shamalov N.A. Optimizatsiya reperfusionnoj terapii u patsientov s ishemicheskim insultom. Diss. dokt. med. nauk [Optimization of reperfusion therapy in patients with ischemic stroke. Dr. med. sci. diss.]. Moscow. 2012: 47 [In Russ].

19.    Lansberg M.G. et al. Risk factors of symptomatic intracerebral hemorrhage after tPA therapy for acute stroke. Stroke. - 2007; 38: 2275-2278.

20.    Bracard S., Ducrocq X., Mas J.L., et. al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; Oct; 15(11): 1138-1147.

21.    Powers W.J., Rabinstein A.A., Ackerson T. et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2018 Mar; 49(3): 46 - 99.

22.    Eva A. Mistry, Akshitkumar M. Mistry, Mohammad Obadah Nakawah, Mechanical Thrombectomy Outcomes with and without Intravenous Thrombolysis in Stroke Patients. Stroke. 2017 Sept; 48(9): 2450-2456.

23.    Kaesmacher J., Boeckh-Behrens T., Simon S. et al. Risk of Thrombus Fragmentation during Endovascular Stroke Treatment. AJNR Am J Neuroradiol. 2017 May; 38(5): 991-998.

24.    Nikoubashman O., Reich A., Pjontek R. et al. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers. Neuroradiology. 2014 Dec; 56(12): 1087-1096.

25.    Kang D.H., Park J. Endovascular Stroke Therapy Focused on Stent Retriever Thrombectomy and Direct Clot Aspiration: Historical Review and Modern Application J Korean Neurosurgical Society 2017 May; 60(3): 335-347.

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27.    Hwang YH., Kang D.H., Kim YW. et al. Outcome of forced-suction thrombectomy in acute intracranial internal carotid occlusion. J Neurointervent Surg. 2013; 5 (Suppl 1): 81-84.

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31.    Deshaies EM. Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci. 2013; 20(9): 1303-1305.

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34.    Jadhav A.P, Aghaebrahim A., Horev A. et. al. Jovina, Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke. Interv Neurol. 2017 Mar; 6(1-2): 16 - 24.

35.    Maegerlein C., Mцnch S., Boeckh-Behrens T. et al. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy - evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg. 2017; 0: 1 - 5.

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39.   Volodyukhin M.U., Novozhilova A.A. Sposob vosstanovleniya krovotoka pri sochetannom tromboze vnutrennej sonnoj I srednej mozgovoj arterij [A method for restoring of blood flow in a combined thrombosis of the internal carotid and middle cerebral artery]. Patent RF №2629046, 2016.

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Aim: was to assess efficiency of mechanical thrombectomy using stent-retriever pREset in patients with acute ischemic stroke (AIS).

Materials and methods: study included 27 patients with AIS. The average age of patients was 66 years, female - 12(44,4%). The average NIHSS was 20. Occlusion of middle cerebral artery (MCA) was observed in 21(77,8%) patients, internal carotid artery (ICA) - 4 patients, basilar artery - 2 patients.

Results: effective recovery of cerebral blood flow (TICI2b-3) was achieved in 22 patients (81,5%). The frequency of distal embolisms was 11,1%. The frequency of symptom hemorrhagic transformation was 7,4%. A favorable neurological outcome (mRs 0-2) was observed in 29,6% of patients, mortality was 25,9%.

Conclusions: the use of stent-retriever pREset allows to efficiently restore blood flow during occlusion of large cerebral arteries.



1.      Powers W., Rabinstein A., Ackerson T., et al. 2018 Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018; (49): DOI 10.1161/ STR.0000000000000158.

2.      Savello A.V., Voznyuk I.A., Svistov D.V. Vnutrisosudistoe lechenie ishemicheskogo insul'ta v ostrejshem periode (klinicheskie rekomendacii) [Intravascular treatment of ischemic stroke in the acute period (clinical recommendations)]. Sankt-Peterburg. 2015; [In Russ].

3.      Volodyuhin M.YU., Hasanova D.R., Dyomin T.V., i dr. Vnutriarterial'naya reperfuzionnaya terapiya u pacientov s ostrym ishemicheskim insul'tom [Intraarterial reperfusion therapy in patients with acute ischemic stroke.]. Medicinskij sovet. 2015; (10): 6-11 [In Russ].

4.      Krylov V.V., Savello A.V., Volodyuhin M.YU. Rentgenehdovaskulyarnoe lechenie ostrogo ishemicheskogo insul'ta [Endovascular treatment of acute ischemic stroke.]. Rukovodstvo. Moskva. 2017; 120 s [In Russ].

5.      Schwaiger B., Kober F., Gersing A., et al. The pREset stent retriever for endovascular treatment of stroke caused by MCA occlusion: safety and clinical outcome. Clin Neuroradiol. 2016; (26): 47-55.

6.      Machi P., Jourdan F., Ambard D., et. al. Experimental evaluation of stent retrievers mechanical properties and effectiveness. J. Neurolntervent. Surg. 2016; (0): 1-7.

7.      Prothmann S., Schwaiger B., Gersing A., et al. Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J. Neuro. Intervent. Surg. 2017; (9): 817-822.

8.      Shams T., Zaidat O., Yavagal D., et al. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) criteria: A 7M management approach to developing a stroke interventional laboratory in the era of stroke thrombectomy for large vessel occlusions. Intervent. Neurol. 2016; (5): 1-28.

9.      Seker F., Pfaff J., Wolf M., et al. Correlation of thrombectomy maneuver count with recanalization success and clinical outcome in patients with ischemic stroke. Am. J. Neuroradiol. 2017; (38): 1368-1371.

10.    Mokin M., Nagesh S., Ionita C., et al. Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model. Am. J. Neuroradiol. 2016; (36): 547-551.

11.    Raymond J., Ghostine J., Khoury N., et al. Endovascular interventions for acute stroke: past practice and current research. J. Neurolntervent.Surg. 2017; (9): 1-4.



Thrombolytic therapy (TLT) is the most efficient method of reperfusion therapy in ischemic stroke (IS), considerably increasing the number of patients with good functional restoration obtained. Carrying out selective intraarterial TLT (IA TLT) is feasible within the framework of a wider therapeutic window (up to 6-8 hours from the onset of the disease) under angiographic control and a possibility of individual dosing of a fibrinolytic employed. The present study demonstrated high efficiency of selective IATLT based on two clinical examples of patients presenting with IS. In the first case, a 55-year-old male patient with occlusion of M1 segment of the right median cerebral artery (MCA) and a baseline NIH score equalling 13 underwent IA TLT preformed 7 hours after the onset of IS, which led to complete recanalization of the vessel after 40 minutes, and resulted in a considerable clinical improvement (8 points by the NIH scale after TLT). The second case describes a 64-year-old female patient presenting with segment C7 stenosis of the left internal carotid artery and occlusion of segment M1 2 of the left MCA (20 points by the NIH scale). Carrying out IA TLT also promoted restoration of the blood flow after 60 minutes and restoration of the disordered functions (NIHSS score 14). Hence, the described examples demonstrate high efficacy of intra-arterial thrombolysis in management of patients with ischemic stroke.



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Aim: was to show possibilities of endovascular methods of treatment in patients with acute ischemic stroke in endovascular operation-room of cardiovascular surgical department.

Materials and methods: we present two case reports of treatment of patients with acute ischemic stroke, who were admitted to neurological department during first hours from onset.

Patients underwent CT perfusion, CT angiography of cerebral arteries. For blood-flow restoration, patients underwent thrombectomy

Results: thrombectomy from occluded artery was successful in both cases, that leaded to better recovery of neurological status.

Conclusions: wide application of endovascular techniques for restoration of cerebral blood flow in patients with ischemic stroke in the early hours of the onset of the disease, can lead to a more prosperous clinical outcomes, more rapid and complete recovery of the patient. Important is the presence of specialized personnel with appropriate skills and a wide spectrum of endovascular instruments.  



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2.    Stulin I.D., Musin R.S., Belousov Ju.B. Insul't s tochki zrenija dokazatel'noj mediciny. [Stroke from viewpoint of evidence-based medicine]. Kachestvennaja klinicheskaja praktika. 2003; 4: 10-18 [In Russ].

3.    Varakin Ju.A. Jepidemiologicheskie aspekty profilaktiki narushenij mozgovogo krovoobrashhenija. [Epidemiological aspects of the stroke prevention]. Nervnye bolezni. 2005; 2: 4-9 [In Russ].

4.    Hripun A.V., Malevannyj M.V. i soavt. Pervyj opyt oblastnogo sosudistogo centra ROKB po jendovaskuljarnomu lecheniju ostorogo narushenija mozgovogo krovoobrashhenija po ishemicheskomu tipu [First Experience of Regional Vascular Center ROKB in Endovascular Treatment of ischemic stroke]. Mezhdunarodnyj zhurnal intentencionnoj kardiologii. 2010; 23: 32-42 [In Russ].

5.    Gusev E.I., Skvorcova V.I., Martynov M.Ju. Vedenie bol'nyh v ostrom periode mozgovogo insul'ta [The treatment of the acute phase of the stroke]. Vrach. 2003; 3: 8-24 [In Russ].

6.    Nakano S., Iseda T., Yoneyama T., et. Al. Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombollysis. Stroke. 2002; 33: 2872-2876.

7.    White J., Cates Ch., Cowley M. et. al. Interventional stroke therapy: current state of the art and needs assessment. Catheterization and Cardiovascular Intervention. 2007; DOI 10.1002/ccd: 1-7.

8.    Suzuki S., et al. Access to intra-arterial therapies for acute ischemic stroke: an analysis of the US population. AJNR Am. J. Neuroradiol. 2004; 25: 1802-1806.

9.    Wholey M.H, Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167





Aim: was to show literature review and personal data on endovascular anatomy of intracranial lesions in patients with acute ischemic stroke.

Material and methods: we present clinical data on endovascular revascularization in patients with ischemic stroke, who were operated in Interregional clinical-diagnostic center for the period 2007-2014.

Results and conclusion: during cerebral angiography, we should estimate arterial, parenchymal and venous phase. Degree of flow recovery after endovascular reperfusion, is estimated on mTICI score. 



1.     Shamalov N.A. Reperfuzionnaja terapija pri ishemicheskom insul'te. Jeffektivnaja farmakoterapija [Reperfusion therapy in ischemic stroke]. 2014; 31: 54-60[ In Russ].

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7.     Mortimer A.M., Bradley M., Renowden S.A. Endovascular therapy for acute basilar artery occlusion: a review of the literature. J. NeuroIntervent. Surg. 2011 (10): 11-36.

8.     Haussen D.C., Dharmadhikari S.S., Snelling B. Posterior communicating and vertebral artery configuration and outcome in endovascular treatment of acute basilar artery occlusion. J. NeuroIntervent. Surg. 2014 (0):1-4.

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10.   Mordasini P., Brekenfeld C., Byrne J.V., et all. Technical feasibility and application of mechanical thrombectomy with the Solitaire FR revascularization device in acute basilar artery occlusion Am. J. Neuroradiol 2013 (34): 159 -163.

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16.   Nogueira R.G., Gupta R., Jovin T.G. ET et al. Predictors and clinical relevance of hemorrhagic transformation after endovascular therapy for anterior circulation large vessel occlusion strokes: a multicenter retrospective analysis of 1122 patients J. NeuroIntervent. Surg. 2015 (7): 16-21.

17.   R.G., Liebeskind D.S., Sung G., et all. Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the mechanical embolus removal in cerebral ischemia (Merci) and multi Merci trials. Stroke. 2009 (40): 3777-3783.

18.   Jayaraman M.V., Hussain M.S., Abruzzo T., et al., Embolectomy for stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery J. NeuroIntervent. Surg. 2015 (0):1-6.

19.   Broderick J.P., Palesch YY, Demchuk A.M., et al. The interventional management of stroke (IMS) III investigators. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N. Engl. J. Med. 2013 (368): 893-903.

20.   Yoo A.J., Simonsen C.Z., Prabhakaran S., et al. Refining angiographic biomarkers of reperfusion: modified TICI is superior to TIMI for predicting clinical outcomes after intra-arterial therapy. Stroke. 2013 (44): 62-66.

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22.   Humphries W., Hoit D., Doss V.T., et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J. NeuroIntervent. Surg. 2015 (7): 90-94.




Acute cerebrovascular accident (CVA) is one of leading causes of death and disability in the population, both in Russia and around the world.

Aim: was to improve the effectiveness of the prevention of ischemic stroke (IS) in patients with asymptomatic stenosis of internal carotid arteries (ICA).

Materials and methods: this article is an analysis of the world literature on the subject of stroke in patients without focal or ocular symptoms (asymptomatic stenosis), medical and surgical (carotid stenting / carotid endarterectomy) correction of such stenotic lesions, postoperative complications, and the risk of stroke in the immediate and late postoperative period. We presented data on development of stroke, depending on the type of plaques, brain CT data, comorbidities in these patients, the method of surgical correction of stenosis. On the basis of international multicenter studies and experience of individual domestic and foreign clinics we performed evaluation of IS conservative anc surgical prophylaxis in this group of patients.

Results: performed analysis allowed to formulate recommendations on the tactics of treatment and examination of patients with asymptomatic internal carotid artery stenosis.



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40.   Pahigiannis К., Kaufmann P., Koroshetz W. Carotid intervention: is it warranted in asymptomatic individuals if risk factors are aggressively managed? Stroke. 2014;45(3):e40-l. 



Aim: was to estimate efficacy and safety of carotid stenting and carotid endarterectomy Г patients, admitted to center of cardiovascular surgery.

Material and methods: we investigated possibilities of treatment with randomization one-by-one, according to admittance to hospital and use of carotid endarterectomy or stenting. Final decision in each case was made by consilium. For the period 2011-2013, 269 patients were treated including 132 patients who underwent carotid endarterectomy and 137 patients who underwent carotid stenting. The majority of patients had an anamnesis of coronary heart disease or needed coronary revascularization. Symptomatic stenosis was an indication for 19,0 % revascularization in both groups (p = 0.994).

Results: there were no in-hospital deaths registered. Incidence of stroke after carotid endarterectomy was 6(4,5%) and 2(1,5%) after stenting. Transient ischemic attack occurred in 3(2,2 %) patients in the stenting and 1 patient (0,76 %) in endarterectomy groups. Major bleeding was observed in both groups with equal frequency (p = 0,584). Defeat of cranial nerves (7,6 %; p = 0,001) was only observed in the endarterectomy group. Finally both methods of carotid revascularization showed the same level of complications (p = 0,569) besides cranial nerve defeat.

Conclusion: carotid stenting and endarterectomy show similar results in the treatment of patients with atherosclerotic lesions of carotid arteries. Both methods can equally be used in clinics with adequate experience in surgical interventions on the heart and peripheral vessels. The complex assessment of the patient and the lesion by the vascular team is necessary.



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Ischemic stroke (AS) is one of the leading causes of death and disability of the working populatior around the world. According to modern recommendations, mechanical thrombectomy with use of stent-retrievers is the most effective method of treatment for stroke. with localization of thrombus in large cerebral arteries of the carotid basin.

The article presents a literature review devoted to various stent-retrievers, their technical characteristics, and their potential for application in the treatment of acute cerebrovascular accident, ischemic type. The analysis and comparative characteristics of existing modern stent-retrievers are presented, depending on the diameter and artery bend, thromb characteristics, stent characteristics. 



1.     Savello A.V., Voznjuk I.A., Svistov D.V. Vnutrisosudistoe lechenie ishemicheskogo insul'ta v ostrejshem periode (klinicheskie rekomendacii) [Intravascular treatment of ischemic stroke in acute period (clinical recommendations)]. Sankt-Peterburg. 2015.

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