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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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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.



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This article spotlights problems of diagnostic and treatment of rare vascular complication: false aneurysm of transplanted kidney artery We describe a case of successful treatment using stent-assisted aneurysm embolization. Our case is illustrated with ultrasound, computed tomography and angiographic images and 30-day follow-up data.



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Article describes a case report of successful treatment of coronary artery perforation using handmade stent-graft, ex tempore made of coronary balloon and two bare-metal stents. Article also reports results of follow-up, including control angiography and optical coherence tomography 3 months later. 



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