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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.

authors: 

 

Abstract:

The author presents the endovascular technique for treatment of the Alzheimer disease. 40 patients aged 34–78 years were included into the study 4 of them were at risk, 13 had early and moderate stage, 16 – full-scaled stage, and 7 had preterminal stage of the disease.

The survey design included computed tomography with temporal lobes volume calculation, brain scintigraphy, rheoencephalography, and digital cerebral angiography.

Temporal lobes atrophy and capillary flow reduction in fronto-parietal and temporal regions are shown to be the characteristic radiomorphological features of the Alzheimer disease. Indications and contrindications for the treatment are presented.

Interventions were pefformed in terms of 1 to 12 years after the disease manifestation. The aim of treatment was percutaneous revascularization and capillary bed restoration by means of transluminal low-energy laser.

Clinical improvement was seen in all the cases; however, it differed in each group of patients. Thus, it is possible not only suspend the advancement of the Alzheimer disease, but to achieve its regression, with regeneration of the brain tissues and to return the people into the active life.  

 

References 

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10.      Жариков Г.А., Рощина И.Ф. Диагностика деменции альцгеймеровского типа на ранних этапах ее развития. Психиатрия и психофармакотерапия. 2001; 2 (2): 3–27.

11.      Гаврилова С.И. Фармакотерапия болезни Альцгеймера. М.: Пульс. 2003; 337.  

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authors: 

Abstract:

Aim. Was to investigate the efficiency of transluminal laser revascularization of brain in treatment of vascular dementia.

Materials and methods. We have examined and treated 665 patients aged 29 to 81 (average age 75) suffering from various kinds of atherosclerotic lesions of cerebral vessels accompanied by developed vascular dementia. The research included: CT, MRI, scintigraphy, rheoencephalography, poliprojectional angiography To perform endovascular treatment we selected 639 patients: Group 1 (CDR-1) - 352, Group 2 (CDR-2) - 184, Group 3 (CDR-3) - 103 patients. To conduct revascularization of main intracranial arteries high-energy laser systems were used; for revascularization of distal intracranial branches low-energy laser systems were used.

Results. The clinical outcome depended on the severity of dementia and timing of the intervention. A good clinical outcome in Group 1 was obtained in 281 (79.82%) cases, in Group 2 in 81 (44.02%) cases, in Group 3 in 9 (8.73%) cases. A satisfactory clinical outcome in Group 1 was obtained in 53 (15.34%) cases, in Group 2 in 62 (33.70%) cases, in Group 3 in 31 (30.09%) cases. A relatively satisfactory clinical outcome in Group 1 was obtained in 17 (4.83%) cases, in Group 2 in 41 (22.28%) cases, in Group 3 in 63 (61.16%) cases. No negative effects were observed after the interventions.

Conclusions. Evaluating the data obtained it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of atherosclerotic lesions of the brain accompanied by dementia.  

 

Reference 

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5.    Folstein M.F, Folstein S.E, McHugh P.R. «Mini-mental state.» A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975;12(3):189-98.

6.    Skoog I. Psychiatric disorders in the elderly. Can. J. Psychiatry. 2011; 56 (7):387-97.

7.    Maksimovich I.V. Long-term Results of Brain Transluminal Laser Revascularization In The Treatment of Ischemic Stroke. J. Am Coll. Cardiol. 2010; 56; B49-0.

8.    Максимович И.В. Транслюминальная лазерная ангиопластика в лечении ишемических поражений головного мозга. дис. д-ра мед. наук М, 2004. Maksimovich, I.V. Transljuminal laser angioplasty in treatment of ischemic lesions of a brain. M. D. 2004, dissertation, Moscow [In Russ].

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20.  Amb

authors: 

 

 

Abstract:

The research investigates the possibility of restoring the blood supply in patients with atherosclerosis of the brain, as well as the treatment of chronic cerebrovascular insufficiency, both not burdened and the burdened development of small strokes, with use for this method of transcatheter laser revascularization.

The research involves 946 patients aged 29-81 (average age 74) suffering from various types of cerebral atherosclerosis. 568(60,04%) patients underwent transcatheter treatment - Test Group. 378 (39,96%) patients underwent conservative treatment - Control Group. The examination plan included laboratory diagnostics, assessment CDR, MMSE, IB, cerebral SG, REG, CT, MRI, MRA, MUGA. To restore the blood supply, the method of transcatheter laser revascularization was applied; high-energy pulsed lasers were used for major intracranial arteries treatment, and low-energy CW lasers - for distal intracranial branches treatment.

Test Group: 459(80,81%) patients had good clinical outcome, 91(16,02%) - satisfactory clinical outcome, 18(3,17%) - relatively satisfactory clinical outcome; relatively positive clinical outcome was not obtained in any case. Control Group: good clinical outcome was not obtained in any case; 65(17,20%) patients had satisfactory clinical outcome, 121(23,26%) - relatively satisfactory clinical outcome; 192(50,79%) - relatively positive clinical outcome.

The method of transcatheter laser revascularization of cerebral vessels is a physiological, effective and low-invasive treatment for patients suffering from atherosclerosis of the brain. Obtained results last up to 10 years and more; it causes regression of mental and motor disorders, promotes regression of dementia and largely improves patients' quality of life; it has virtually no alternative - which makes the proposed method significantly different from conservative treatment methods. 

 

References

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2.     Maksimovich I.V. Transcatheter Treatment of Atherosclerotic Lesions of the Brain Complicated by Vascular Dementia Development. World Journal of Neuroscience. 2012; 2(4): 200-209.

3.     Frolich A.M., Psychogios N.M., Klotz E., et al. Angiographic Reconstructions From Whole-Brain Perfusion CT for the Detection of Large Vessel Occlusion in Acute Stroke. Stroke. 2012; 43: 97-102.

4.     Abou-Chebl A. Management of acute ischemic stroke. Curr Cardiol Rep. 2013; 15(4): 348-354.

5.     Gjulev N.M., PustozertsevV.G., Gjulev S.N. Cerebrovaskuljarnye zabolevanija [Cerebrovascular Diseases]. M.: BINOM, 2002 [ In Russ].

6.     Qureshi A.I., Caplan L.R. Intracranial atherosclerosis. Lancet. 2014; 15, 383 (9921): 984-998.

7.     Caplan L.R., Thomas A.J., Inoa V. Interventional treatment of brain ischemia related to intracranial cerebrovascular occlusive lesions. Curr Opin Neurol. 2014; 27(1):1-7.

8.     Pendlebury S.T., Wadling S., Silver L.E., et al. Transient Cognitive Impairment in TIA and Minor Stroke. Stroke. 2011; 42: 3116-3121.

9.     Maksimovich I.V. Possibilities of transcatheter treatment of patients after extensive ischemic stroke. World Journal of Neuroscience. 2013; 3: 171-185.

10.   Hashmi J.T., Huang YY, Osmani B.Z., et al. Role of Low-Level Laser Therapy in Neurorehabilitation, PM& R. 2010; 2, 12 Suppl 2: S292-S305.

11.   Naeser M.A., Hamblin M.R. Potential for transcraniallaser or LED therapy to treatstroke, traumatic brain injury, and neurodegenerative disease. Photomed Laser Surg. 2011; 29(7): 443-446.

12.   Song S., Zhou F., Chen W.R. Low-level laser therapy regulates microglial function through Src-mediated signaling pathways: implications for neurodegenerative diseases. J Neuroinflammation. 2012; 18(9): 219.

13.   Stephan W., Banas L.J., Bennett M., et al. Efficacy of super-pulsed 905 nm Low Level Laser Therapy (LLLT) in the management of Traumatic Brain Injury (TBI): A case study, World Journal of Neuroscience. 2012; 2(4): 231-233.

14.   Konstantinovi L.M., Jeli M.B., Jeremi A., et al. Transcranial application of near-infrared low-level laser can modulate cortical excitability. Lasers Surg Med. 2013; 45(10):648-653.

15.   Klopfenstein J.D., Ponce F.A., Kim L.J., et al. Middle cerebral arterystenosis: endovascular and surgical options. Skull Base. 2005; 15(3):, 175-189.

16.   Takaiwa A., Kuwayama N., Akioka N., et al. Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis. Acta Neurochirurgica. 2013; 155: 627-633.

17.   Altinbas A., Algra A., Martin M., et al. Effects of carotid endarterectomy or stenting on hemodynamic complications in the International Carotid Stenting Study: a randomized comparison. International Journal of Stroke, 2014; 9(3): 284-290.

18.   Muroi C., Khan N., Bellut D., et al. Extracranial-intracranial bypass in atherosclerotic cerebrovascular disease: Report of a single centre experience. British Journal of Neurosurgery. 2011; 25: 357-362.

19.   Papanagiotou P., Roth C., Walter S., et al. Carotid artery stenting in acute stroke. Journal of the AmericanCollege of Cardiology. 2011; 58: 2363-2369. 

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22.   Dorn F. Prothmann S., Wunderlich S., et al. Stent angioplasty of intracranial stenosis: single center experience of 54 cases. Clin Neuroradiol. 2012; 22(2):149-156.

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24.   Maksimovich I.V. Intracerebral Transcatheter Technologies in the Treatment of Ischemic Stroke. J Am Coll Cardiol. 2015; 66:15S.

25.   Morris J.C. The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology. 1993; 43: 2412- 2414.

26.   Folstein M.F., Folstein S.E. and McHugh P.R. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 1975; 12: 189-198.

27.   Mahoney F.I. and Barthel D.M. Functional evaluation: The barthel index. Maryland State Medical Journal. 1965; 14: 61-65.

28.   Maksimovich I.V. Sposob transljuminal'noj lazernoj revaskuljarizacii golvnogo mozga pri ateroskleroticheskih porazhenijah. [Method for carrying out transluminal laser-induced brain revascularization in atherosclerotic injury cases]. 2006; RF Patent No. 2297861 [In Russ].

29.   Maksimovich I.V. Method of transluminal laser revascularization of cerebral blood vessels having atherosclerotic lesions. 2006; US Patent No. 7490612.

30.   Maksimovich I.V. Transcatheter Treatment of Patients after Extensive Ischemic Stroke. Journal of the Americal College of Cardiology. 2013; 62(18): S1: B155-B156. 

31.   Deviatkov  N.D., Rabkin I.Kh. Maksimovich, I.V. et al. Primenenie izluchenich lazera na parah medi dlja isparenija ateroskleroticheskih porazhenij magistral'nyh arterij in vitro. [Use of copper-vapor laser radiation for the evaporation of atherosclerotic lesions of the major arteries in vitro]. Surgery. 1986; 4: 116-121[In Russ].

32.   Petrovskiy B.V., Deviatkov N.D., Rabkin I.Kh., Maksimovich I.V. et al. Razrushenie ateroskleroticheskih porazhenij kadavernyh arterij cheloveka izlucheniem lazera na parah medi. [Destruction of arteriosclerotic lesions of human cadaveric arteries by laser irradiation with copper vapors]. Surgery, 1986; 5, 112-116 [In Russ].

33.   Kuleshov E.V., Maksimovich I.V. Jendovaskuljarnaja hirkrgija u pacientov starshe 65 let s rasprostranennym aterosklerozom sosdov taza i nizhnih konechnostej. [Endovascular surgery in patients over 65 with disseminated atherosclerosis of the vessels of the pelvis and lower extremities]. Vestnik Surgery Imeni 1.1. Grekova, 1994; 152: 27-30 [In Russ].

34.   Maksimovich I.V. Transljuminal'naja lazernaja angioplastika v lechenii ishemicheskih porazhenij golovnogo mozga. [Transljuminal laser angioplasty in treatment of ischemic lesions of a brain]. M.D. Dissertation, Russian University of Friendship of the People, 2004; Moscow [In Russ].

35.   Chizhov, G.K., Kovalskaia, N.I. and Kozlov V.I. Jeffekt jenergii izluchenija gelij-neonovogo lazera na metabolicheskie indeksy miokarda. [The effect of helium-neon laser radiation on the energy metabolic indices of the myocardium]. Bulletin of Experimental Biology and Medicine, 1991; 111: 302-305 [In Russ].

36.   Kozlov V.I., Azizov G.A. Patofiziologicheskie osobennosti mikrocirkuljatornyh narushenij v hronicheskoj arterial'noj ishemii nizhnih konechnostej. [Pathophysiological characteristics of microcirculatory disorders in chronic arterial ischaemia of lower limbs]. Angiology and Vascular Surgery. 2007; 13: 17-23 [In Russ].

37.   Moskvin S.V. Sistemnyj analiz jeffektivnosti upravlenija biologicheskimi sistemami nizkojenergeticheskim lazernym izlucheniem. [System analysis of efficiency in controlling biological systems with low-energy laser radiation]. Thesis for Degree of Doctor of Biological Sciences. 2008; City of Tula [In Russ].

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41.   Starck T., Nissil J., Aunio A., et al. Stimulating brain tissue with bright light alters functional connectivity in brain at the resting state. World Journal of Neuroscience. 2012; 2: 81-90.

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