Abstract: 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. References 1. Reinemeyer NE, Tadi P, Lui F. Basilar Artery Thrombosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 31, 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532241/ 2. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018; 17(9): 790-801. https://doi.org/10.1016/S1474-4422(18)30233-3 3. Ikram A, Zafar A. Basilar Artery Infarct. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551854/ 4. Gory B, Mazighi M, Labreuche J, et al. Predictors for Mortality after Mechanical Thrombectomy of Acute Basilar Artery Occlusion. Cerebrovasc Dis. 2018; 45(1-2): 61-67. https://doi.org/10.1159/000486690 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. https://doi.org/10.1001/jamaneurol.2020.0156 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. https://doi.org/10.1016/S1474-4422(16)30177-6 7. Liu Z, Liebeskind DS. Basilar Artery Occlusion and Emerging Treatments. Semin Neurol. 2021; 41(1): 39-45. https://doi.org/10.1055/s-0040-1722638 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. https://doi.org/10.1161/STR.0000000000000211 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. https://doi.org/10.1148/radiol.2019181924 10. Weber R, Minnerup J, Nordmeyer H, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry. Eur J Neurol. 2019; 26(2): 299-305. https://doi.org/10.1111/ene.13809 11. Kang DH, Jung C, Yoon W, et al. Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study. J Am Heart Assoc. 2018; 7(14): 009419. https://doi.org/10.1161/JAHA.118.009419 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. https://doi.org/10.1016/S1474-4422(19)30395-3 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.
Abstract: 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. 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Abstract: 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. References 1. 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Abstract: Immediate and long-term results of pharmacologically "facilitated" percutaneous coronary inter-ventions (PCI) evaluated in 172 patients with myocardial infarction (MI). Pharmacological reperfusion tried prior to PCA with thrombolytic therapy (TLT, streptokinase or tenecteplase) in 81% of patients, and combination TLT + glycoprotein IIb/IIIa inhibitors (abciximab) in 19%. Average symptom onset to reperfusion time was 197±103 min. Immediately after PCI 88% patients in both groups presented TIMI - 3 flow (р<0.01 to the initial). Repeated PCI during the hospital stay performed in 4 patients (3 in TLT group, 1 in TLT + abciximab group) with recurrent ischemia or subacute vessel occlusion as a cause of intervention. CABG needed in 2 cases. In-hospital survival rate after 'facilitated' PCI was 98,6 - 100%. 6 months clinical follow-up done in 67% of survivors, 16% of them required admission to hospital (recurrent angina due to restenosis), in 9% patients repeated PCI was performed, 6% underwent coronary bypass grafting. All the repeated procedures were success. Overall 6 months mortality was 5%. This prospective study has shown both immediate and long-term safety and efficiency of "facilitated" coronary interventions in patients with myocardial infarction. Reference 1. Lincoff A.M., Topol E.J. Illusion of reperfusion: does anyone achieve optimal reperfusion during acute myocardial infarction? Circulation. 1993; 87: 1792-1805. 2. FibrinolyticTherapy Trialist's (FTT) Collaborative Group. Indication for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1,000 patients. Lancet. 1994; 343: 311-322. 3. Gibbons R.J., Holmes D.R., Reeder G.S. et al. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. N. Engl.J. Med. 1993; 328: 685-691. 4. Grines C.L., Browne K.F., Marco J. et al. For the Primary Angioplasty in Myocardial Infarction Study Group. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial Infarction. N. Engl. J. Med. 1993; 328: 673-679. 5. Simoons M.L., Serruys P.W., van den Brand M. et al. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. J. Am. Coll. Cardiol. 1986; 7: 717-728. 6. The GUSTO IIb Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N. Engl.J. Med. 1997; 336: 1621-1628. 7. GUSTO Angiographic Investigators.The comparative effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after myocardial infarction. N. Engl. J.Med. 1993; 329: 1615-1622. 8. Vermeer F., Oude Ophuis A.J.M. et al. Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study. Heart. 1999; 82: 426-431. 9. CORAMI Study Group. Outcome of attempted rescue coronary angioplasty after failed thrombolysis for acute myocardial infarction. Am. J. Cardiol. 1994; 74: 172-174. 10. Ellis S.G., Da Silva R.E., Heyndrickx G. et al. Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction. Circulation. 1994; 90: 2280-2284. 11. Ross A.M., Lundergan C.F., Rohrbeck S.C. et al. Rescue angioplasty after failed thrombolysis: technical and clinical outcomes in a large thrombolysis trial. J. Am. Coll. Cardiol. 1998; 31: 1511-1517. 12. Ellis S.G., Da Silva E.R., Spaulding C.M. et al. Review of immediate angioplasty after fibrinolytic therapy for acute myocardial infarction: insights from the RESCUE I, RESCUE II, and other contemporary clinical experiences. Am. Heart. J. 2000; 139: 1046-1053. 13. Lefkovits J., Ivanhoe R.J., Califf R.M. et al. Effects of platelet glycoprotein IIb/IIIa receptor blockade by a chimeric monoclonal antibody (abciximab) on acute and six-month outcomes after percutaneous transluminal coronary angioplasty for acute myocardial in farction. Am.J. Cardiol. 1996; 77: 1045-1051. 14. Neumann F.J., Blasini R., Schmitt C. et al. Effect of glycoprotein I Ib/II Ia receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998; 98: 2695-2701. 15. Antoniucci D., Santoro G.M., Bolognese L. et al. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: Results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.J. Am. Coll. Cardiol. 1998; 31: 1234-1239. 16. Antoniucci D., Valenti R., Santoro G.M. et al. Primary coronary infarct artery stenting in acute myocardial in farction. Am.J. Cardiol. 1999; 84: 505-510. 17. Pershukov I., Batyraliev T., Niyazova-Karben Z. et al. Efficacy and Safety of Direct Stenting in Patients with Acute Myocardial Infarction. Catheter. Cardiovasc. Intervent. 2003; 59: 125-126. 18. Rodriguez A., Bernardi V., Fernandez M. et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Am.J. Cardiol. 1998; 81:1286-1291. 19. Stone G.W., Brodie B.R., Griffin J.J. et al. Clinical and angiographic follow-up after primary stenting in acute myocardial infarction. Тhe Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial. Circulation. 1999; 99: 1548-1554. 20. Petronio A.S., Musumeci G., Limbruno U. et al. Abciximab Improves 6-Month Clinical Outcome After Rescue Coronary Angioplasty. Am. Heart.J. 2002; 143 (2): 334-341. 21. Miller J.M., Smalling R., Ohman M. et al. Effectivennes of early coronay angioplasty and abciximab for failed thrombolysis (reteplase or alteplase) during acute myocardial infarction (results from the GUSTO-III Trial). Am.J. Cardiol. 1999; 84: 779-784. 22. Jong P., Lazzam C., Cohen E. et al. Bleeding risks with abciximab post thrombolysis in rescue or urgent angioplasty for acute myocardial infarction [abstract 971]. Circulation. 1999; 100: 188. 23. Sundlof D.W., Rerkpattanapitat P., Wongprapanut N. et al. Incidence of bleeding complications associated with abciximab use in conjunction with thrombolytic therapy in patients requiring percutaneous transluminal coronary angioplasty. Am.J. Cardiol. 1999; 83: 1569-1571. 24. Neumann F.J., Blasini R., Schmitt С et al. Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998; 98: 2695-2701. 25. Keeley E.C., Boura J.A., Grines C.L. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet. 2006; 367: 579-588. 26. Stone G.W., Gersh B.J. Facilitated angioplasty: paradise lost. Lancet. 2006; 367: 543-546. 27. Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acutemyocardial infarction (ASSENT-4 PCI): randomized trial. Lancet. 2006; 367: 569-578. 28. Шпектор А.В., Васильева Е.Ю., Артамонов В.Г. и др. Комбинированная реперфузия у больных острым инфарктом миокарда. Кардиология. 2007; 6: 27-30.
Abstract: Aim: was to improve results of treatment of patients with myocardial infarction who underwent emergency coronary stenting, by prevention of bleeding complications from puncture place. Materials and methods: we present retrospective analysis of clinical case of interventional treatment of myocardial infarction, with late post-puncture bleeding complication (41 day after PCI). Its consequences caused the thrombosis of the external iliac vein with further pulmonary embolism, and acute reocclusion of previously stented coronary artery Results: developed complications were surgically treated (recurrent coronary stenting, elimination of defect of the femoral artery, implantation of cava filter with its subsequent removal), and thrombolytic therapy Patient was discharged to outpatient care without any indications of cardiopulmonary insufficiency and compensated arterial and venous circulation of operated lower limb. After 11 months, the patient’s condition was without negative dynamics with a satisfactory quality of life. Conclusion: this clinical example demonstrates how difficult is to detect bleeding from a puncture wound. In cases of femoral access, the routine use of vascular closure devices can reduce the risk of bleeding complications. References 1. Rekomendacii po lecheniju ostrogo koronarnogo sindroma bez stojkogo pod#joma segmenta ST Evropejskogo obshhestva kardiologov [European cardiological society recommendation: treatment of acute coronary syndrome without stable ST-segment elevation]. Racional'naja farmakoterapija v kardiologii. 2012; 2: 2-64[In Russ]. 2. Sulimov V.A. Antitromboticheskaja terapija pri chreskozhnyh koronarnyh vmeshatel'stvah [Antithrombotic therapy during percutaneous coronary interventions]. Racional'naja farmakoterapija v kardiologii. 2008; 3: 91-100 [In Russ]. 3. Goloshhapov-Aksjonov R.S., Sitanov A.S. Luchevoj arterial'nyj dostup - prioritetnyj dostup dlja vypolnenii chreskozhnoj koronarnoj angioplasti
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Abstract: Primary angioplasty in patients with ST elevation myocardial infarction reduces mortality and reinfarction rate. Immediate restoration of myocardial perfusion has a direct impact on one-year mortality Achieving TIMI 3 flow in epicardial arteries does not mean that the myocardial perfusion has normalized. In addition to that, it is vital to evaluate alternative markers such as rapid resolution of the ST-segment elevation and restoration of optimal distal flow, blush grade 2-3. The intracoronary infusion of adenosine, administered prior to the opening of the artery limiting the size of the infarction and decreases the incidence of no-reflow phenomenon. Direct stent implantation without pre dilation significantly minimizes the incidence of adverse effects. The Amicath catheter (IHT-Cordynamic, Spain) that we use in patients with ST elevation myocardial infarction allow us to obtain an effective myocardial reperfusion, in different clinical situations avoiding the displacement of the thrombus, or a distal embolism, and preventing the no-reflow phenomenon. References 1. Stone G.W., Grines C.L., Cox D., et al. A prospective, randomized trial comparing balloon angioplasty with or without abciximab to primary stenting with or without abciximab in acute myocardial infarction: primary endpoint analysis from the CADILLAC trial. Circulation 2000; 102: II-664 (abstract). 2. Stone G.W., Peterson M.A., Lansky A.J., et al.. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. J. Am. Coll. Cardiol. 2002 Feb. 20;39(4): 591-7. 3. Napodano M., Pasquetto G., Saccа S., et al. Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction. J. Am. Coll. Cardiol. 2003; 42: 1395-1402. 4. Svilaas T., Vlaar PJ., Iwan C., et al. Thrombus Aspiration during Primary Percutaneous Coronary Intervention. N. Engl. J. Med. 2008; 358:557-567 February 7, 2008 DOI: 10.1056/NEJ Moa 0706416. 5. Mahaffey K.W., Puma J.A., Barbagelata N.A., et al. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial. J. Am. Coll. Cardiol. 1999 Nov 15; 34(6): 1711-20. 6. Marzilli M., Orsini E., Maraccini P., Testa R. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000; 101: 2154-59. 7. Loubeyre C., Morice M., Lefe'vre T., et al. A Randomized Comparison of Direct Stenting With Conventional Stent Implantation in Selected Patients With Acute Myocardial Infarction. JACC. 2002:39(1): 15-21. 8. Gibson C.M., Maehara A., Lansky AJ., et al. Rationale and design of the INFUSE-AMI study: A 2Ч2 factorial, randomized, multicenter, single-blind evaluation of intracoronary abciximab infusion and aspiration thrombectomy in patients undergoing percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction. Am. Heart. J. 2011 Mar; 161 (3): 478-486.e 7. doi: 10.1016/j. ahj. 2010.10.006. Epub 2011 Jan 28.
Abstract: An important clinical challenge the management of patients with pulmonary embolism is to determine prognosis of the treatment generally, and thrombolytic reperfusion therapy as the main component of a specific pathogenetic treatment in particular. This knowledge is necessary to adjust the plan of remedial measures, the intensification of concomitant pharmacotherapy and provide a personalized approach to patients with thromboembolic lesions of the pulmonary circulation Aim: was to identify reliable predictors of the onset of reperfusion in patients with pulmonary thromboembolism based on methods of radiographic diagnosis. Materials and Methods: 138 patients (73 women and 65 men) underwent examination. Age of patients ranged from 20 to 80 years (mean age 55±25 years). The first group includes observation of 102 patients admitted to hospital in early stages of disease ( 1 month after onset of symptoms). The second group consisted of 36 patients admitted to the hospital at a later date (from 1.5 to 12 months). In groups we studied predictors of pulmonary reperfusion channel on the basis of direct angiography and multislice computed tomography As a control, a diagnostic method used direct angiography, which has a high sensitivity and specificity in identifying symptoms of pulmonary embolism. Using the method of multiple logistic regression odds ratios were prepared to achieve reperfusion in patients with certain diagnostic symptoms compared with patients who have no signs data in angiography Results: diagnostic criteria, in presence of which on angio-pulmonography significantly increased the likelihood of reperfusion are «amputation» of segmental branches of the pulmonary artery ( p<0.05, 16,55(6,50-42,09 ) ), intraluminal defects of contrast staining (p < 0.05, 30.56 (8,66-107,84)) and the absence of distal blood flow (p<0,05; 6,16(2,47-15,40)). Signs, significantly reducing chances of achieving reperfusion are tortuosity of segmental branches of the pulmonary artery (p<0,05; 0,03(0,01-0,08)), slowing of contrast branches of the pulmonary artery (p<0,05; 0,11( 0.05-0.25)), and the presence of defects in the near-wall staining (p<0,05; 73,182 (9,606-557,542)). Conclusions: basing on results of modern beam-diagnostics may reliably predict the likelihood of reperfusion in patients with pulmonary embolism. Список литературы: 1. Котельников М.В. Тромбоэмболия легочной артерии (современные подходы к диагностике и лечению). М.: Медицина. 2002; 136. 2. Рекомендации Европейского Кардиологического Общества (ЕКО) по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). European Heart Journal. 2008; 29: 2276-2315. 3. Darryl Y. Sue, MD (ed.): Pulmonary Disease. In Frederic S. 4. Kline JA, 5. Grifoni S., Olivotto I. et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101: 2817-2822. 6. Kreit J.W. The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism. Chest. 2004; 125: 1539-1545. 7. Савельев В.С., Яблоков Е.Г, Кириенко А.И., Массивная эмболия легочных артерий. М.: Медицина. 1990; 336
