Abstract: Article presents a retrospective analysis of using the modified way experience in removing the occlusive substrate from cerebral vessels in the ischemic stroke acute phase after failed standard thrombectomy. Aim: to study the efficacy and advantages of thrombectomy technique from intracranial arteries in patients with acute ischemic stroke combining a stent-retriever with reperfusion catheter in comparison with the standard stent retriever thromboextraction. Methods: we analyzed 54 hospital charts of patients who had underwent endovascular recanalization of intracranial large vessel occlusion in acute ischemic stroke. Patients were divided into two equal groups, depending on thrombus removal method. Standard stent-retriever thrombectomy with a balloon guide-catheter was performed as the first stage in both groups. In 27 cases (1st group), after standard stent-retriever technique failed, we carried out combination of retriever extraction with distal aspiration and a guiding balloon-catheter. If we couldn’t safely insert stent-retriever into catheter of distal approach (during thrombectomy), we switched to vacuum aspiration from guiding balloon-catheter (vacuum-blocked) and removed stent-retriever, microcatheter and distal approach catheter simultaneously without reducing tension. In 27 patients (2nd group) after standard thrombectomy failed we repeated this technique several times. Results: embolic complications relative risk was 2,249, 95% CI (1,126 - 4,492) and reperfusion mTICI 3 100% versus 74,07% rate was higher in the first group, in comparison with the second group. Other complications and hospital outcomes of disease did not differ between groups. Conclusion: a stent retriever combined with distal aspiration and a simultaneous transition to vacuum-blocked extraction using after an unsuccessful standard thrombectomy increases the efficiency of complete reperfusion by 25%. Its use is 1,8 times safer than standard thrombectomy in terms of embolic complications.
Abstract: Introduction: a case report of successful treatment of an extremely rare pathology (0,27-0,34%) - acute occlusion of both internal carotid arteries (ICA) is presented. Aim: was to show possibilities of endovascular surgery in the diagnosis and treatment of acute ischemic stroke (AIS) in patients with bilateral acute ICA occlusion. Materials and methods: a 38-year-old patient was hospitalized by ambulance with the diagnosis of AIS. Multispiral computed tomography (MSCT) revealed left ICA occlusion in the C2-C5 segment. Selective angiography of ICA was performed: right ICA - non-occlusive thrombosis C2-C3 segments; left ICA - thrombotic occlusion in C1 segment. Results: thrombaspiration was performed from the left ICA and right ICA; full recovery of antegrade cerebral blood flow was achieved in both ICA, according to the modified treatment in cerebral infarction score (mTICI) - 3. Patient was discharged after 28 days. At the time of discharge, the modified Rankin Scale (mRS) score was 3. 6 months after discharge mRS was 1. Conclusions: Selective angiography of both ICA in a patient with AIS enabled to detect right ICA thrombosis not detected by MCT, which in its turn changed the treatment tactics of the patient. Aspiration thromebctomy from both internal carotid arteries allowed to achiev full recovery of antergrade cerebral blood flow of both internal carotid arteries. References 1. The top ten cuases of death, WHO fact sheets 2020. https://www.who.int/ru/news-room/fact-sheets/detail/the-top-10-causes-of-death 2. Shapoval IN, Nikitina SYu, Ageeva LI, et al. Zdravoochranenie v Rossii. 2019 [In Russ]. https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2019.pdf 3. Aigner A, Grittner U, Rolfs A, et al. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017; 48: 1744-1751. https://doi.org/10.1161/STROKEAHA.117.016599 4. Gafarova AV, Gromova EA, Panov DО, et al. Social support and stroke risk: an epidemiological study of a population aged 25-64 years in Russia/Siberia (the WHO MONICA-psychosocial program). Neurology, Neuropsychiatry, Psychosomatics. 2019; 11(1): 12-20 [In Russ]. https://doi.org/10.14412/2074-2711-2019-1-12-20 5. Putaala J. Ischemic Stroke in Young Adults. Continuum. 2020; 26(2): 386-414. https://doi.org/10.1212/CON.0000000000000833 6. Si Y, Xiang S, Zhang Y. et al. Clinical profile of etiological and risk factors of young adults with ischemic stroke in West China. Clinical Neurology and Neurosurgery. 2020; 193. https://doi.org/10.1016/j.clineuro.2020.105753 7. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology. 2018; 17(9): 790-801. https://doi.org/10.1016/s1474-4422(18)30233-3 8. Chi X, Zhao R, Pei H, et al. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med. 2020; 3(1): 53-59. https://doi.org/10.1002/agm2.12105 9. Dietrich U, Graf T, Sch?bitzb WR. Sudden coma from acute bilateral M1 occlusion: successful treatment with mechanical thrombectomy. Case Rep Neurol. 2014; 6: 144-148. https://doi.org/10.1159/000362160 10. Pop R, Manisor M, Wolff V. Endovascular treatment in two cases of bilateral ischemic stroke. Cardiovasc Intervent Radiol. 2014; 37: 829-834. https://doi.org/10.1007/s00270-013-0746-4 11. Larrew T, Hubbard Z, Almallouhi E.et al. Simultaneous bilateral carotid thrombectomies: a technical note. Oper Neurosurg. 2019; 5(18): 143-148. https://doi.org/10.1093/ons/opz230 12. Storey C, Lebovitz J, Sweid A, et al. Bilateral mechanical thrombectomies for simultaneous MCA occlusions. World Neurosurg. 2019; 132: 165-168. https://doi.org/10.1016/j.wneu.2019.08.236 13. Braksick SA, Robinson CP, Wijdicks EFM. Bilateral middle cerebral artery occlusion in rapid succession during thrombolysis. Neurohospitalist. 2018; 8: 102-103. https://doi.org/10.1177/1941874417712159 14. Jeromel M, Milosevic Z, Oblak J. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case. Radiology and Oncology. 2020; 54(2): 144-148. https://doi.org/10.2478/raon-2020-0017
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.
Abstract: 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. References 1. 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. https://doi.org/10.1016/S1474-4422(19)30034-1 2. Клинические рекомендации по ведению больных с ишемическим инсультом и транзиторными ишемическими атаками. Москва; 2017: 92. Clinical guidelines for the management of patients with ischemic stroke and transient ischemic attacks. Moscow; 2017: 92 [In Russ]. 3. Клинические рекомендации по проведению тромболитической терапии при ишемическом инсульте. Москва; 2015: 34. Clinical guidelines for thrombolytic therapy in ischemic stroke. Moscow; 2015: 34 [In Russ]. 4. Chiasakul T, Bauer KA. Thrombolytic therapy in acute venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2020; 1: 612-618. 5. Yuan K, Zhang JL, Yan JY, et al. Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up. Int J Gen Med. 2021; 14: 3575-3581. 6. Клинические рекомендации: миома матки. Москва; 2020: 48. Clinical guidelines: uterine fibroids. Moscow; 2020: 48 [In Russ].
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: 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.
References 1. Ciccone A, del Zoppo GJ. Evolving Role of Endovascular Treatment of Acute Ischemic Stroke. Curr Neurol Neurosci Rep. 2014 Jan; 14(1): 416. 2. Sardar P, Chatterjee S, Giri J, et al. Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials. Eur Heart J. 2015; 36 (35): 2373-2380. 3. Novakovic RL, Toth G, Narayanan S, Zaidat OO. Retrievable stents, «stentrievers», for endovascular acute ischemic stroke therapy. Neurology. 2012; 79 (13 Suppl 1): 148–157. 4. Arnaout OM, Rahme RJ, El Ahmadieh TY, et al. Past, present, and future perspectives on the endovascular treatment of acute ischemic stroke. Tech Vasc Interv Radiol. 2012; 15: 87-92. 5. Koh JS, Lee SJ, Ryu CW, Kim HS. Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: A systematic review. J Neurointervention. 2012; 7: 1-9. 6. Singh P, Kaur R, Kaur A. Endovascular treatment of acute ischemic stroke. J Neurosci Rural Pract. 2013 Jul-Sep; 4(3): 298-303. 7. Goyal M, Yu AY, Menon BK, et al. Endovascular Therapy in Acute Ischemic Stroke. J Stroke. 2016; 47: 548-553. 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.
Abstract: Introduction: the role of intracerebral stenosis of brain arteries in the development of postoperative strokes in patients with extensive atherosclerosis remains unresolved, and in clinical practice, magnetic resonance angiography (MRA) of cerebral arteries is not carried out routinely to predict the risk of postoperative cerebrovascular disorders. Aim: was to identify factors of MRA of intracerebral arteries essential for prognosis of ischemic strokes in postoperative period of angiosurgical interventions and in acute period of myocardial infarction (AMI), from the quantitative processing of brain MRA recruited from the MRI — MRA register. Materials and methods: results of brain MRA of 195 patients with extensive atherosclerosis carried out before cardio- or angiosurgical interventions were analyzed. Of these, three had an ischemic stroke after carotid endarterectomy, three — after CABG operations, and five — after surgical treatment of thoracic aortic aneurysms, on 2-5 day after surgery. We also studied results of brain MRA in five patients who developed an episode of ischemic brain stroke in the acute period of acute myocardial infarction. In all cases of circulatory disorders were localized in the region of middle cerebral artery (MCA). Everyone was given a time-of-flight MRA with reconstruction of three-dimensional anatomical picture of cerebral arteries. The index of gradient of narrowing of arterial lumen (GNL) of artery was calculated as the ratio of the difference in the area of artery at stenosis and at nearest proximal non-stenosed level, to the distance between them, along the course of the vessel: GNL={(Snorm–Sstenosis)/Dnorm–stenosis}, mm2/mm. Results: analyzing the visual picture of brain MRA in patients, the sign of critical narrowing of MCA for >50% was observed in all five patients with acute ischemic stroke concomitant with acute myocardial infarction. In all 11 patients who developed postoperative stroke, the visual picture of MCA stenosis was bilateral, more pronounced on the side of the ischemic disorder after the operation. When using the GNL index, it was obvious that ischemic stroke developed only when the stenosis was more sharp than GSP >1,05 mm2/mm. Of five patients who showed signs of MCA stenosis but did not have postoperative stroke, four took doses of 250 mg/day or more of ethylmethylhydroxypyridine succinate (mexidol) for more than a month at the outpatient stage. The sensitivity of MRA preoperative sign of MCA stenosis in relation to postoperative ischemic stroke was 100% in all groups, the specificity and diagnostic accuracy was 97,5%, the predictability of a positive conclusion was 62,5-75%, and the predictability of a negative conclusion was 97-99%. Conclusion: technology for evaluating the gradient of narrowing of arterial lumen in the area of atherosclerotic stenosis of intracerebral arteries in patients with extensive atherosclerosis allows predicting the risk of postoperative stroke. Gradient of narrowing of arterial lumen index for atherosclerotic middle cerebral artery over 1,05 mm2/mm in patients with extensive atherosclerosis predicts increased risk of strokes in postoperative period, or as a complication of acute myocardial infarction. Long-term preoperative injection of mexidol probably reduces the risk of postoperative stroke in extensive atherosclerosis.
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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. Embolic complications of reperfusion treatment adversely affect ischemic stroke outcomes and should be considered as a factor requiring minimization. References 1. Domashenko MA, Maksimova MY, Gafarova ME et al. The personification of reperfusion therapy approaches for ischemic stroke. Annals of Clinical and Experimental Neurology. 2017;11(1):7-13 [In Russ]. 2. 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(3):e46-e99. https://doi.org/10.1161/STR.0000000000000158 3. Sandercock P, Wardlaw JM, Lindley RI et al.; IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. 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Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. The Lancet Neurology. 2016;15(11):1138-1147. https://doi.org/10.1016/S1474-4422(16)30177-6 12. Jovin T, Chamorro A, Cobo E et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. New England Journal of Medicine. 2015;372(24):2296-2306. https://doi.org/10.1056/NEJMoa1503780 13. Muir K, Ford G, Messow C et al. Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. Journal of Neurology, Neurosurgery & Psychiatry. 2016;88(1):38-44. https://doi.org/10.1136/jnnp-2016-314117 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. https://doi.org/10.1056/NEJMoa1415061 15. McCarthy D, Diaz A, Sheinberg D et al. 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Abstract: 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. References 1. Hankey G.J. Stroke. The Lancet. 2017; 389 (10069): 641-654. https://doi.org/10.1016/S0140-6736(16)30962-X 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. 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Abstract Aim: was to evaluate the effectiveness of carotid arterial revascularization by stenting of internal carotid arteries ( Materials and methods: in FSBI «Treatment and rehabilitation center» of the Ministry of Health of 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 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 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 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. References 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]. 2. 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Abstract: 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. References 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.
Abstract: The review is devoted to possibilities of ultrasound and functional diagnostic methods in the diagnosis of ischemic stroke of unknown etiology. Main causes of cryptogenic ischemic stroke are highlighted in the article. Advances in high resolution ultrasound of extracranial and intracranial vessels and of the heart, prolonged heart rhythm monitoring are instrumental techniques to identify arterial and cardiac hidden causes of stroke. We reviewed literature, on the basis of available data, designed a diagnostic algorithm for patients with patent foramen ovale (PFO) and risk of embolism from atherosclerotic plaque. References I. Petrikov S.S., Chamidova L.T. O conferencii «Neotlozhnaya pomosh bolnim s ostrimi narusheniaymi mozgovogo krovoobrasheniaya». [About conferention «Urgent treatment of patients with acute stroke»] Zhurnal im. N.V. Sklifisivskogo Neotbzhnayapomosh. 2015; 1:10-18 [In Russ]. 2. Grau A.J., Weimar C., Buggle F. et al. 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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. Newsletter of the WHO №317, 2015 January. 2. Jansen O., von Kummer R., Forsting M. et al. Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation. AJNR Am J Neuroradiol. 1995; Nov-Dec; 16(10): 1977-86. 3. Furlan A., Higashida R., Wechsler L. et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999 Dec; 282(21): 2003-11. 4. Domashenko M.A., Maksimova M.Yu., 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. 6. Emberson J. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. - 2014; 384(9958): 1929-1935. 7. Fransen P.S., Berkhemer O.A., Lingsma H.F. et al. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2016 Feb; 73(2): 190-196. 8. Seet R.C., Rabinstein A.A. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions. Cerebrovasc Dis. 2012; 34: 106-114. 9. Yaghi S., Eisenberger A., Willey J.Z. Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment. JAMA Neurol. 2014; 71(9): 1181-1185. 10. Yaghi S., Boehme A.K., Dibu J. et al. Treatment and Outcome of Thrombolysis-Related Hemorrhage: A Multicenter Retrospective Study. JAMA Neurol. 2015; 72(12): 1451-1457. 11. Hacke W., Kaste M., Bluhmki E. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359: 1317-1329. 12. 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. 13. Kornienko V.N., Pronin I.N. Diagnosticheskaya nejroradiologiya. [Diagnostic Neuroradiology]. Moscow. 2006: 1317 [In Russ]. 14. Urbach H. et al. Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type? Neuroradiology 2002; 44: 695-699. 15. Riedel C.H., Zimmermann P., Jensen-Kondering U. et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011;Jun; 42(6):1775-1777. 16. Del Zoppo C.J. et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann. Neurol. - 1992, 32: 78-86. 17. Mori E. et al. Intravenous recombinant tissue plasminogen activator in acute carotid territory stroke. Neurology, 1992; 42: 976-982. 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. 26. Kang D.H., Hwang YH., Kim YS. et al. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol. 2011 Feb; 32(2): 283 - 287. 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. 28. Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointervent Surg. 2014 Apr; 6(3): 231-237. 29. Lee D.H., Sung J.H., Kim S.U. et al. Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization. Acta Neurochirurgica 2017 Sept; 159(9): 1671-1677. 30. Kang D.H., Kim YW., Hwang YH. et al. Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation. Stroke. 2013; Dec; 44(12): 3577-3579. 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. 32. Humphries W., Hoit D., Doss V.T. et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 2015; 7(2): 90-94. 33. Lee J.S., Hong J.M., Lee S.J. et al. The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochir (Wien) 2013; 155(4): 635 - 641. 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. 36. Maus V., Behme D., Kabbasch C. et al. Maximizing First-Pass Complete Reperfusion with SAVE. Clin Neuroradiol. 2017 Feb 13. doi: 10.1007/s00062-017-0566-z. 37. Wiesmann M., Brockmann M.A., Heringer S. et al. Active push deployment technique improves stent/vesselwall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointerv Surg. 2017 Mar; 9(3): 253 - 256. 38. Nikoubashman O., Alt J.P, Nikoubashman A. et al. Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow. J Neurointerv Surg. 2017 May; 9(5): 459-462. 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. 40. Volodyukhin M.U. Rentgenendovaskulyarnyj metod vosstanovleniya cerebral'nogo krovotoka pri ostroy tandemnoj okklyuzii vnutrennej sonnoj arterii s razvitiem embolii v srednyuyu mozgovuyu arteriyu. [Endovascular method of cerebral blood flow restoration in acute tandem occlusion of the internal carotid artery with embolism development in the middle cerebral artery.] Kazanskij meditsinskijzhurnal. 2016; 97(3): 457-460. 41. Noser EA, Shaltoni HM, Hall CE, et al. Aggressive mechanical clot disruption: a safe adjunct to thrombolytic therapy in acute stroke? Stroke 2005; 36: 292-296. 42. 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 thrombolysis. Stroke 2002; 33: 2872-2876. 43. Qureshi AI, Siddiqui AM, Suri MF. et al. Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agent for ischemic stroke: a prospective study. Neurosurgery 2002; 51: 1319-1329. 44. von Gadow N., Nikoubashman O., Freiherr J. et al. Endovascular stroke treatment now and then-procedural and clinical effectiveness and safety of different mechanical thrombectomy techniques over time. Quant Imaging Med Surg. 2017 Feb; 7(1): 1-7.
Abstract: 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. References 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.
Abstract: Aim: was to identify features of disorders of brain perfusion and diffusion in venous stroke anc arterial stroke by CT and MRI. Material and methods: in groups with acute venous stroke due dural sinustrombosis without primary hemorrhage (n=39) and atherothrombotic stroke (n=33) were performed perfusion CT (with relative MTT, CBV CBF) and MRI (with relative DWI and ADC), besides routine CT and CTA. Results: rMTT in central areas were not different, but in venous stroke perifocal zone rMTT=1.27±0.2 vs. 1.68± Conclusion: MR or CT perfusion and MR diffusion imaging in acute stroke make it possible to distinguish between primary arterial ischemic brain damage from congestive plethora due venous stroke. Perfusion-diffusion mismatch venous stroke has a different origin than in arterial stroke. If infarction is not formed benign hyperemia (not oligemia) - early vasogenic edema identified like basis of venous stroke. Venous ischemia is secondary and is associated with an externally constriction of microcirculation. References 1. Palena L.M., F.Toni, V.Piscitelli et al. CT Diagnosis of Cerebral Venous Thrombosis: Importance of the First Examination for Fast Treatment. The Neuroradiology J. 2009;22 :137-49. 2. Hacke W., Hennerici M.G., Gelmers H.J., Kramer G. Cerebral ischemia. Springer Verlag 3. Tarulli A. Neurology. A Clinician’s Approach. 4. Saposnik G., Barinagarrementeria F., Brown R.D. et al. Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011; 42: 1158-92. 5. 6. Nentwich L.M., Veloz W. Neuroimaging in acute stroke. Emerg Med Clin North Am. 2012; 30: 659-80. 7. Luby M., Ku K.D., Latour L. Et al. Visual perfusion-diffusion mismatch is equivalent to quantitative mismatch. Stroke. 2011;42:1010-14. 8. Semenov S.E., Kovalenko A.V., Khromov A.A. et al. Kriterii diagnostiki negemorragicheskogo venoznogo insul'ta metodami rentgenovskoj mul'tispiral'noj komp'yuternoj (MSKT) i magnitno-rezonansnoj tomografii (MRT). [Non-haemorrhagic venous stroke diagnosis criteria by multisliced computed tomography (MSCT) and magnetic resonsnce imaging (MRI).] Complex Issues of Cardiovascular Diseases. 2012;1:43-53 [In Russ.]. 9. Portnov YU.M., Semenov S.E., Kokov A.N. Perfuzionnaya komp'yuternaya tomografiya v ocenke sostoyaniya cerebral'noj gemodinamiki u pacientov s ishemicheskoj bolezn'yu serdca, perenesshih koronarnoe shuntirovanie v usloviyah iskusstvennogo krovoobrashcheniya. [ 10. Shatohina M.G. Magnitno-rezonansnaya i komp'yuternaya tomografiya v diagnostike negemorragicheskogo insul'ta, vyzvannogo cerebral'nym venoznym trombozom. [MRI and CT in diagnosis of non-hemorrhagic stroke, caused by venous thrombosis]Diss. kand. med. nauk. Tomsk. 2012; 193 [In Russ]. 11. Koenig M., Kraus M., Theek C. et al. Quantitative assessment of ischemic brain by means of perfusion related parameters derived from perfusion CT. Stroke. 2001; 322: 431-7. 12. Nguyen T.B., Lum C., Eastwood J.D. et al. Hyperperfusion on perfusion computed tomography following revascularization for acute stroke. Acta Radiol. 2005; 46(6):610-15. doi: 10.1080/02841850510021607. 13. Semenov S., 14. Oray D., Limon O., Ertan C. et al. Inter-observer agreement on diffusion-weighted magnetic resonance imaging interpretation for diagnosis of acute ischemic stroke among emergency physicians. Turk J Emerg Med. 2015; 15(2): 64-68. doi: 10.5505/1304.7361.2015.32659. 15. Semenov S.E., Moldavskaya I.V., Semenov A.S., Barbarash L.S. Kriterii MR- i KT-differencial'noj diagnostiki venoznogo I arterial'nogo insul'ta. [The MR- and CT-Differential Diagnostic Criteria of Venous and Arterial Insult.] Meditsinskaya vizualizatsiya. 2010; 6: 41-9 [In Russ.]. 16. Mullins M.E., Grant P.E., Wang B. et al. Parenchymal abnormalities associated with cerebral venous sinus thrombosis: assessment with diffusion-weighted MR imaging. Am J Neuroradiol. 2004; 25: 1666-75. 17. Semenov S.E., Moldavskaya I.V., Kovalenko A.V. et al. Ocenka rutinnyh topomorfometricheskih kriteriev mul'tispiral'noj komp'yuternoj tomografii i magnitno-rezoansnoj tomografii v diagnostike negemorragicheskogo insul'ta, vyzvannogo cerebral'nym venoznym trombozom. [Evaluation of routine topomorphometric criteria of multispiral computed tomography and magnetic resonance imaging in the diagnosis of non-hemorrhagic stroke, caused by cerebral venous thrombosis.] Clinical Physiology of Circulation. 2013; 3: 37-45 [In Russ.]. 18. Leach J.L., Fortuna R.B., Jones B.V., Gaskill-Shipley M.F. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006; 26(suppl 1): 19-41. 19. Bousser M.G., Ferro J.M. Cerebral venous thrombosis: an update. Lancet Neurol. 2007; 6: 162-70. 20. Semenov S., Portnov Yu., Semenov A. et al. Neuroimaging patterns of cerebral hyperperfusion. IOP Conf. Series: Journal of Physics: Conf. Series. 2017; 886: 012014 doi :10.1088/1742-6596/886/1/012014 21. Gonzalez R.G., Hirsch J.A., Koroshetz W.J. et al. Acute Ischemic Stroke Imaging and Intervention. Springer. Verlag. Berlin. Heidelberg. 2006; 268. 22. Semenov S.E., Moldavskaya I.V., Shatokhina M. G. et al. CT and MRI patterns of focal hyperemia in venous insult. Neuroradiology. 2012; 54 (Suppl. 1): 176. 23. Powers W.J., Derdeyn C.P, Biller J. et al. 2015 American heart association/American stroke association focused update of the 2013. Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. A guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2015; 46: 3024-39. DOI: 10.1161/STR.0000000000000074. 24. Luchevaya diagnostika i terapiya zabolevanij golovy i shei: nacional'noe rukovodstvo [Radiation diagnostics and therapy of head and neck diseases: the national leadership ] / gl. red. toma T. N. Trofimova. M.: GEOTAR-Media, 2013; 888 s. (Seriya «Nacional'nye rukovodstva po luchevoj diagnostike i terapii» / gl. red. serii S.K. Ternovoj) [In Russ]. 25. Bogdanov EH.I., Hasanov I.A. Differencial'naya diagnostika infarktov v bassejne zadnih mozgovyh arterij i sindroma zadnej obratimoj lejkoehncefalopatii. [Differential diagnosis of infarctions in the basin of the posterior cerebral arteries and the syndrome of posterior reversible leukoencephalopathy] Mat. Rossijsk. nauchn.-prakt. konf. «Narusheniya mozgovogo krovoobrashcheniya: diagnostika, profilaktika, lechenie». Irkutsk. 2011; 54-5 [In Russ.].
Abstract: 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. Reference 1. Гусев Е.И., Скворцова В.И., Киликовский В.В., Стаховская Л.В., Айриян Н.Ю.«Проблема инсульта в Российской Федерации». Качество жизни. 2006; (13): 10- 14. 2. European Stroke Initiative Recommendations for stroke Management - Update 2003. Cerebrovasc Dis. 2003; 16:311-337. 3. del Zoppo G. J., Higashida R.T., Furlan A.J., Pessin M.S., Rowley H.A., Gent M. PROACT: A Phase II Randomized Trial of Recombinant Pro-Urokinase by Direct Arterial Delivery in Acute Middle Cerebral Artery Stroke. Stroke. 1998; 29: 4 - 11. 4. Arnold M., Schroth G., Nedeltchev K., Loher T.J., Stepper E, Remonda L., Sturzenegger M., Mattle H. Intra-arterial thrombolysis in 100 patients with acute stroke due to middle cerebral artery occlusion. Stroke. 2002; 33: 1828-1833. 5. Arnold M., Nedeltchev K., Mattle H.P., Loher T.J., Stepper E, Schroth G., Brekenfeld C., Sturzenegger M., Remonda L. Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T-occlusions. J. Neurol Neurosurg Psychiat. 2003; 74: 739-742. 6. Lee D.H., Jo K.D., Kim H.G., Choi S.J., Jung S.M., Ryu D.S., Park M.S. Local intra-arterial urokinase thrombolysis of acute ischemic stroke with or without intravenous abciximab: a pilot study. J. Vasc Interv Radiol. 2002; 13: 769 - 774. 7. ThОron J., Coskun O., Huet H., Oliveira G., Toulas P., Payelle G. Local intra-arterial thrombolysis in the carotid territory. Interventional Neuroradiology. 1996; 2: 111 - 126. 8. Zeumer H., Freitag H.J., Zanella E, Thie A., Arning C. Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (rt-PA). Neuroradiology. 1993; 35: 159- 162 9. Lisboa C., Borko D. Jovanovic, Mark J.Alberts. Analysis of the Safety and Efficacy of Intra-Arterial Thrombolytic Therapy in Ischemic Stroke. Stroke. 2002; 33: 2866. 10. Волынский Ю.Д., Гаврилов А.В. Оценка гемодинамики и перфузии на основе компьютерного анализа ангиографических изображений. Материалы конференции «Современные технологии в клинической медицине» Санкт-Петербург. 2003; 151 - 152. 11. Волынский Ю.Д., Гаврилов А.В. Рентгеновидеоденситометрия - метод оценки кровотока по плечеголовным и внутримозговым сосудам. Материалы конференции «Повреждения и заболевания шейного отдела позвоночника». 2004; 9-11.
Abstract: 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. References 1. Feigin V.L., Lawes C.M.M., Bennet D.A., Anderson C.A. (Stroke epidemiology: a review of population-based studies of incidence, prevalence, and casefatality in the late 20th century. Lancet Neurol. 2003;2:43-53. 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, et.al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc. Interv. 2000; 50: 160-167
Abstract: In clinical practice, ischemic stroke still remains a difficult problem, being in most leading causes of death. Development of new treatments, founding of new therapeutic algorythmes and untiringly technical progress in sphere of instrumental support of operation-room allow to proceed endovascular intervention in group of patients with cardioembolic stroke. Case report presents successful endovascular treatment of patient from cardio-surgical department of Belgorod Region Clinical Hospital named after St. loasaf, with cardioembolic stroke, onset in preoperative period (before aorto-coronary bypass). Materials and methods: patient A., 59 years, diagnosis: «Ischemic heart disease. Exertional angina FC II. Post-infarction cardiosclerosis. (AMI in September 2014). Stenosis of coronary arteries according to coronary angiography (CAG), hemodynamically significant. Hypertensive heart disease III st., 2 degree, with the defeat of the heart and blood vessels of the brain, with the achievement of target blood pressure (BP). Diabetes mellitus type 2, the second insulin-depended, stage subcompensation. Risk factor 4. congestive heart failure 2a class, functional class III. Chronic gallstone disease. Chronic calculous cholecystitis without exacerbation». 05.02.15 - onset of ischemic stroke in left hemisphere of brain. Patient urgently underwent: multislice computed tomography (MSCT), MSCT-angiography of main brain arteries, direct angiography of main brain arteries. Survey showed: occlusion of proximal third of left common carotid artery (CCA) with TICI-0 blood flow; left middle cerebral artery (MCA) and anterior cerebral artery (ACA) were filled threw anterior communicating artery (ACoA) from right internal carotid artery (ICA). Patient underwent: recanalization of occlusion, thrombectomy from left CCA, stenting of CCA-ICA segment, selective thrombolythic therapy into left MCA. Results: «Time-To-Treatment» was 4 hours 15 minutes. Made endovascular treatment leaded to regression of neurological deficit. Conclusions: the use of endovascular methods in patients with cardioembolic stroke car decrease neurological deficit and increase quality of life of patients in this group. References
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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 1. Gillum R.F, Kwagyan J, Obisesan Th.O. Ethnic and Geographic Variation in Stroke Mortality Trends. Stroke:. 2011; 42:3294-3296. 2. Frolich A.MJ, Psychogios M.N, Klotz E, Knauth M, Knauth P. Angiographic Reconstructions From Whole-Brain Perfusion CT for the Detection of Large Vessel Occlusion in Acute Stroke. Stroke. 2012; 43:97-102. 3. Жулев Н.М, Пустозерцев В.Г, Жулев С.Н. Цереброваскулярные заболевания. 2002, М. Москва, BINOM. Zhulev N.M., Pustozertsev, V.G., Zhulev, S.N..(2002) Cerebrovascular Diseases. BINOM, Moscow [In Russ]. 4. Roman G.C. Facts, myths, and controversies in vascular dementia. J. Neurol. Sci. 2004; 226: 49-52. 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]. 9. Maksimovich I.V. Transluminal Laser Revascularization of Cerebral Blood Vessels in the Treatment of Ischemic Stroke. J. Am. Coll. Cardiol. 2010;56; B48-9. 10. Mahoney F.I, Barthel D.W. Functional Evaluation: The Barthel Index. Md. State Med. J. 1965; 14: 61-65. 11. El Ali A, Doeppner T.R, Hermann D.M. Increased Blood-Brain Barrier Permeability and Brain Edema After Focal Cerebral Ischemia Induced by Hyperlipidemia: Role of Lipid Peroxidation and Calpain-1/2, Matrix Metalloproteinase-2/9, and RhoA Overactivation. Stroke. 2011;42:3238-3244. 12. Roman G.C, Kalaria R.N. Vascular determinants of cholinergic deficits in Alzheimer disease and vascular dementia. Neurobiol Aging. 2006; 27(12): 1769-85. 13. Roman G.C. Facts, myths, and controversies in vascular dementia. J. Neurol. Sci. 2004; 226: 49-52. 14. Skoog I. Psychiatric disorders in the elderly. Can. J. Psychiatry. 2011; 56 (7):387-97. 15. Silver F.L, Mackey A, Clark W.M, Brooks W, Timaran C.H, Chiu D, Goldstein L.B, Meschia J.F, Ferguson R.D, Moore W.S, Howard G, Brott T.G. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011; 42 (3): 675-80. 16. Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald I.Q, Viera J, Politi M, K^ner H, Kostopoulos P, Haass A, Fassbender K, Reith W. Carotid artery stenting in acute stroke. J. Am. Coll. Cardiol. 2011; 58 (23):2363-9. 17. Biamino G., The excimer laser: science fiction fantasy or practical tool? J Endovasc Ther. 2004; 11; Suppl. 2 :II207-22. 18. Benedek I., Hintea T. Current developments in interventional treatment of total terminal aortic occlusions-laser, stenting and balloon angioplasty: experience of cardiology clinic of Targu-Mures. Rom J. Intern. Med. 2005; 43 (3-4): 223-32. 19. Ecanow J.S., Schwartz B.T., Park R. Tibial recanalization with excimer laser angioplasty. Semin InterventRadiol. 2007; 24(1):58-62. 20. Amb
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Abstract: Modern radiodiagnostics of carotid arteries (CA) defeat has very important value in such patients' treatment tactics. CA reconstruction operations are based on 3 general factors - clinic and arterial blood flow lack in dynamics, special methods of extra- and intracrania brachial arteries diagnostics, risk of arterial blood flow lack. We have pointed indications for surgical prophylactics and necessary patients diagnostic methods. References 1. Alsheikh-Ali A.A. et al. The vulnerable atherosclerotic plaque. Scope of the literature. Ann. Intern. Med. 2010; 153 (6): 7. 387-395. 2. Cohen J.E., Itshayek E. Asymptomatic carotid stenosis. Natural history versus therapy. Isr. Med. Assoc. J. 2010; 12 (4): 237-242. 3. Delgado Almandoz J.E. et al. Computed tomography angiography of the carotid and cerebral circulation. Radiol. Clin. North. Am. 2010; 48 (2): 265-281. 4. Hebb M.O. et al. Perioperative ischemic complications of the brain after carotid endarterectomy. Neurosurgery. 2010; 67 (2): 286-293. 5. Kar S. et al. Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis. Eurolntervention. 2010; 6 (4): 492-497. 6. Naylor A.R. Managing patients with symptomatic coronary and carotid artery disease. Perspect. Vasc. Surg. Endovasc.Ther. 2010; 22 (2): 70-76. 7. Pokrovsky A.V., Bogatov Yu.P. Vascular surgery in Russia. Pages of history. Eur. J. Vasc. Endovasc. Surg. 1997; 13 (2): 93-95. 8. Rockman C., Riles T. Carotid artery disease: selecting the appropriate asymptomatic patient for intervention. Perspect. Vasc. Surg. Endovasc. Ther. 2010; 22 (1): 30-37. 9. Spence J.D. Secondary stroke prevention. Nat. Rev. Neurol. 2010; 6 (9): 477-486. 10. Tallarita T., Lanzino G., Rabinstein A.A. Carotid intervention in acute stroke. Perspect. Vasc. Surg. Endovasc. Ther. 2010;22 (1): 49-57. 11. Tholen A.T. et al. Suspected carotid artery stenosis. Cost-effectiveness of CT angiography in work-up of patients with recent TIA or minor ischemic stroke. Radiology. 2010; 256 (2): 585-597. 12. Walkup M.H., Faries P.L. Update on surgical management for asymptomatic carotid stenosis. Curr. Cardiol. Rep. 2010; 5.
Abstract: The article presents the experience of stenting the internal carotid arteries (ICA) in 45 patients. The patients' age ranged from 49 to 78 years, on average 64.8 years. The degree of ICA stenosis ranged from 60% to 95%, on average 72.7 ± 7.2%. 28 (62.2%) patients had a history of acute cerebrovascular accident, 17 (37.7%) patients had cerebral symptoms of circulatory disorders. After 48 endovascular procedures, neurological complications developed in 3 (6.2%) cases: transient ischemic attack - in 2 (4.1%) patients, minor stroke - in one (2%) patient. Hospital mortality was 2.2%. In the remote period, 13 (28.8%) patients were examined. There were no myocardial infarctions and strokes.
Abstract: Aim: was to study influence of surgical reconstruction of left ventricular (LV) in patients with postinfarction LV aneurysm, on dynamics of stroke volume (SV) and determine basic predictors of its decreasement. Materials and Methods: retrospective study included patients with various types of surgical reconstruction of post-infarction LV aneurysm who underwent cardiac MRI before surgery, and subsequent control study by the same method in the postoperative period (mean 17,6 ± 4,7 days ) from March 2010 to February 2014. For statistical analysis, patients were divided into 2 groups according to the postoperative increase or decrease of SV Performed statistical analysis of baseline and post-operative structure - geometric and functional parameters of LV A mathematical model, based on which the multivariate analysis was performed using an automated method of linear modeling tc identify the most important predictor of subsequent risk assessment and its impact on postoperative decrease SV Results: the left ventricular reconstruction surgery in the early postoperative period leads to reduce of left ventricular end diastolic (LVED) and end-systolic volume (LVES), respectively 22,41% and 21,85% (p <0,001), and an increase in ejection fraction (EF) at 21,76% (p <0,001), that seemingly indicates improvement in the pumping function of the heart. But, however, pointed out that the stroke volume, which more accurately reflects the feature after reconstruction LV increases less than half of patients (42.6%), an average of 11,2±1,6%, (p <0,001) and the majority (57,4%) decreases in average 21,0 ± 1,6%. (p <0,001). Groups with a postoperative increase or decrease in the value of SV differed except its dynamics (p <0,001), for the volume reduction of LVES (p = 0.25) increase in EF (p <0,001), a decrease INLS (p = 0.006). Found that the most important predictor of postoperative dynamics affecting the SV is the surgical reduction of LV volume (LVED). With a decrease in LV volume more than 25% of the original LVED risk reduction SV becomes high (OR 0,53; 95% CI 0,35, 0,79). When surgical volume reduction ratio greater than 35% chance of postoperative improvement SV maximally reduced (RR 4,74; 95% CI 1,27; 17,73; p = 0,042). Conclusion: after surgical reconstruction of postinfarction LV aneurysms in the early postoperative period increase SV occurs in less than half of patients (42.6%), despite an increase in ejection fraction and decreased LVED. Leading predictor of postoperative determining the dynamics of the SV, is surgical reduction of left ventricular volume. Reduction of the volume of the left ventricle during the operation of surgical correction of left ventricular aneurysm more than 25% of the original LVED increases the risk of postoperative decrease in stroke volume, and more than 35% reduces chances of his promotion. References 1. Borisov N.A., Popov L.V., Bletkin A.N. Hirurgicheskoe lechenie postinfakrtnoj anevrizmy levogo zheludochka [Surgical treatment of postinfarction aneurysm of left ventricular]. Annaly hirurgii. 2002; 3:14-19 [ in Russ]. 2. Cooley D.A. Surgical restoration of left ventricular aneurysm. Oper. Tech. Cardiac. Thorac. Surg. 1997; 2:151-161. 3. Otsuji Y, Handschumacher M.D., Liel-Choen N., et al Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: Three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J. Am. Coll. Cardiol. 2001; 37:641-648. 4. Kalon K., Ho. L., Pinsky J.L., Karmd W.B., Levy D. The epidemiology of heart failure: the Framingham Study. J. of 5. Grigioni F., regurgitationEnriquez-Sarano M., Zehr K.J. et al. Ischaemic mitral. Circulation. 2001; 103: 1759-1764. 6. Athanasuleas C.L., Buckberg G.D., Stanley A.W., et al. RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J. Am.Coll. Cardiol. 2004; 44:1439-1445. 7. Di Donato M., Fantini F., Toso A., Castelvecchio S., Menicanti L., Annest L., Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2010; 140:1325-1331 8. Menicanti L., Castelvecchio S., Ranucci M., et al. Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration. J. Thorac. Сardiovasc. Surg. 2007; 134: 433-441. 9. Annest L., Burkhoff D., 10. Cirillo M., Amaducci A., Brunelli F., et al. Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2004; 127:1648-1656. 11. Di Donato M., Toso A., Dor V., et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004; 109:2536-2543. 12. Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J. Thorac. Cardiovasc. Surg. 2002; 124:886-890. 13. O’Neill J.O., Starling R.C., McCarthy P.M., et al. The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy. Eur. J. Cardiothorac. Surg. 2006; 30:753-759. 14. Patel N.D., Williams J.A., Nwakanma L.U., et al. Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration. Ann.Thorac. Surg. 2007; 83:2017-2027. 15. Tulner S.A., Bax J.J., Bleeker G.B., et al. Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy. Ann. Thorac. Surg. 2006; 82:1721-1727. 16. Athanasuleas C.L., Stanley A.W. Jr., Buckberg G.D., et al. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group. Reconstructive Endoventricular Surgery, returning Torsion Original Radius Elliptical Shape to the LV. J. Am. Coll. Cardiol. 2001; 37:1199-1209. 17. Dor V., Sabatier M., Montiglio F., Coste P., Di D.M. Endoventricular patch reconstruction in large ischemic wall-motion abnormalities. J. Card .Surg. 1999;14:46-52. 18. Patel N.D., Williams J.A., Barreiro C.J., et al. Surgical ventricular remodeling for multiterritory myocardial infarction: defining a new patient population. J. Thorac. Cardiovasc. Surg. 2005; 130:1698-1706. 19. Ribeiro G.A., da Costa C.E., Lopes M.M., et al. Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium. Eur. J. Cardiothorac. Surg. 2006; 29: 196-201. 20. Suma H., Isomura T., Horii T., et al. Nontransplant cardiac surgery for end-stage cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2000; 119:1233-1244. 21. Yamaguchi A., Adachi H., Kawahito K., et al Left ventricular reconstruction benefits patients with dilated ischemic cardiomyopathy. Ann. Thorac. Surg. 2005; 79:456-461. 22. Yu H.Y, Chen YS., Tseng W.Y, et al. Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis withmagnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration. J. Thorac. Cardiovasc. Surg. 2009; 137:887-894. 23. Rossejkin E.V., Kobzev E. E., Bazylev V. V. Neposredstvennye rezul'taty hirurgicheskoj rekonstrukcii levogo zheludochka [Immediate results of surgical reconstruction of left ventricular]. XIX Vserossijskij s#ezd serdechno-sosudistyh hirurgov. 2013. http://new.rassh.ru/report/neposredstvennye _rezultaty_khirurgi_cheskoy_rekonstruktsii_ levogo_ zheludochka/[In Russ]. 24. Shabalkin B.V., Rabkin I.H., Belov Ju.V. i dr. Prognozirovanie posleoperacionnoj serdechnoj nedostatochnosti pri hirurgicheskom lechenii anevrizm serdca. Krovosnabzhenie, metabolizm i funkcija organov pri reko struktivnyh operacijah. [Prognosis of post-operative heart insufficiency on surgical treatment of heart aneurysms. Blood circulation, metabolism and functioning of organs during reconstruction operations.] 25. Komeda M., David T.E., Malik A., Ivanov J., Sun Z. Operative risks and long-term results of operation for left ventricular aneurysm. Ann. Thorac. Surg. 1992; 53:22-29. 26. Van der Wall E.E., Bax J.J. Different imaging approaches in the assessment of left ventricular dysfunction: all things equal? Eur. Heart J. 2000; 21:1295-1297. 27. Lorenz C.H., Walker E.S., Morgan V. L., Klein, S.S., Graham T.P. Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1:7-21. 28. Belov Ju.V. Postinfarktnoe remodelirovanie levogo zheludochka serdca: ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left ventricular: from concept to surgical treatment.]. M., izd. De-Novo. 2002; S:194 [In Russ]. 29. Dor V., Sbatier M., DiDonato M., et al. Efficacy of endoventricular patchplasty in large post-infarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J. Thorac. Cardiovasc. Surg. 1998;116:50-59. 30. Dor V., Civaia F., Alexandrescu C., Sabatier M., Montiglio F. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J. Thorac. Cardiovasc. Surg. 2011; 141:905-9164. 31. Bokerija L.A., Fedorov G.G. Hirurgicheskoe lechenie bol'nyh s postinfarktnymi anevrizmami serdca i soputstvujushhimi tahiaritmijam [Surgical treatment of patients with postinfarction aneurysms accompanying tachyarrhythmia.]. Grudnaja i serd.-sosud.hirurgija. 1994; 4:4-8 [In Russ]. 32. Cooley D.A. Repair of post-infarction aneurysm of the left ventricle. Cardiac surgery: state of the art reviews, Vol. 4, No. 2. Philadelphia: Hanley and Belfus, 1990; P. 309 33. Dor V. Clinical, Sabatier M., Montiglio F., et al. Hemodynamic, and electrophysiologic results of 207 left ventricular patch reconstructions for infarction left ventricular aneurysm. l. Presented at the 72nd Annual Meeting of the American Association for Thoracic Surgery, 34. Artrip J.H., Oz M., Burkhoff D. Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J. Thorac. Cardiovasc. Surg. 2001;122: 75-82. 35. Burkhoff D., Wechsler A.S. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J. Thorac. Cardiovasc. Surg. 2006;132:459-63. 36. Ratcliffe M.B., Guy T.S. The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling. J. Thorac. Cardiovasc. Surg. 2007; 134:280-283 37. Jones R.H., Velazquez E.J. Michler R.E., et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N. Engl. J .Med. 2009;360:1705-17. 38. Chernjavskij A.M., Marchenko A.V., Karas'kov A.M. Raschet ploshhadi vykljuchenija postinfarktnoj anevrizmy levogo zheludochka [Calculation of area of postinfarction aneurism dismiss]. (Grudnaja i serdechnososudistaja hirurgija. 2002; 6. 54-58 [In Russ].
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Abstract: 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. References 1. Shamalov N.A. Reperfuzionnaja terapija pri ishemicheskom insul'te. Jeffektivnaja farmakoterapija [Reperfusion therapy in ischemic stroke]. 2014; 31: 54-60[ In Russ]. 2. Berkhemer O., Fransen P., Beumer D., et al., A randomized trial of intraarterial treatment for acute ischemic stroke. The 3. Li-Ping Liu, An-Ding Xu, Wong K.S., et all., Chinese consensus statement on the evaluation and intervention of collateral circulation for ischemic stroke. CNS Neuroscience & Therapeutics. 2014 (20): 202-208. 4. Hill M., Shobha N., 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 (10): 2254-2258. 5. Mortimer A.M., Bradley M.D., Renowden S.A. Endovascular therapy in hyperacute ischaemic stroke: history and current status department of neuroradiology. Interventional Neuroradiology. 2013 (19): 506-518. 6. Gacs G., Fox A., Barnett H., et all. Occurrence and mechanisms of occlusion of anterior cerebral artery. Stroke. 1983 (14). 952-959. 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. 9. Archer C.R., Horenstein S. Basilar artery occlusion: clinical and radiological correlation. Stroke. 1977 (8): 383-390. 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. 11. Liebeskind D.S., Cotsonis G.A., Saver J.L., et al. Collateral circulation in symptomatic intracranial atherosclerosis. J. Cereb. Blood. Flow. Metab. 2011 (31): 1293-1301. 12. Christoforidis G.A., Mohammad Y, Kehagias D., et all. Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. Am. J. Neuroradiol. 2005 (26): 1789-1797. 13. Al-Ali F., Jefferson A., Barrow T., et al. The capillary index score: rethinking the acute ischemic stroke treatment algorithm. J. Neurointerv. Surg. 2013 (5): 139-143. 14. McVerry F., Liebeskind D.S., Muir K.W. Systematic review of methods for assessing leptomeningeal collateral flow. Am. J. Neuroradiol. 2012 (33): 576-582. 15. Chuang YM., Chan L., Lai YJ., et al. Configuration of the circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with‘ intravenous thrombolysis. J. Crit. Care. 2013 (28): 166-172. 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. 21. Davalos A., Pereira V.M., Chapot R. et al. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke. 2012 (43): 2699-2705. 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.
Abstract: 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. References 1. Bokerija L.A., Gudkova R. G. Serdechno-sosudistaja hirurgija. 2010; Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija. [Cardio-vascular surgery. 2010. Diseases and congenital abnormalities of blood circulation]. M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 192 [In Russ]. 2. Pokrovskij A.V. Klinicheskaja angiologija. A.V. Pokrovskij. [Clinical Angiology]. Moscow; 2004;1; 808. [In Russ]. 3. Chernjavskij A.M. Programma bor'by s insul'tom, prehodjashhimi narushenijami mozgovogo krovoobrashhenija i discirkuljatornymi jencefalopatijami: metod. rekomendacii A.M.Chernjavskij, T.E.Vinogradova. [The program for prevention of stroke, TIA and encephalopathy: recommendations]. 4. Go A.S., Mozaffarian D., Roger V.L. et al; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2014 update: a report from the American Heart Association. Circulation. 2014;129:e28-e292. 5. Kleindorfer D., Panagos P, Pancioli A., et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke. 2005; 36:720-723. 6. Suslina Z.A. Ocherki angionevrologii. [Angionevrology contexts] . Moscow: 2005; 126. [In Russ]. 7. Leljuk V.G., Leljuk S.Je. Cerebral'nyj rezerv pri ateroskleroticheskom porazhenii brahiocefal'nyh arterij. Jetjudy sovremennoj ul'trazvukovoj diagnostiki. [Mechanisms of development of cerebral vascular compensation due to atherosclerotic lesions of cerebral arteries]. Kiev; 2001; 4p. [In Russ]. 8. Nacional'nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal'nyh arterij. Rossijskij soglasitel'nyj dokument. [National recommendations for treatment of patients with cerebrovascular disorders]. Angiologija i sosudistaja hirurgija. 2013; 19 (2): 70. [In Russ]. 9. Committee for the National Institute of Neurological Disorders and Stroke. Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke. 1990;21:637-76. 10. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273(18): 1421-8. 11. Halliday A., Harrison M.. Hayter E. et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010;376(9746): 1074-84. 12. Chambers B.R. Donnan G.A. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev. 2005(4):CD001923. 13. Barnett H.J., Meldrum H.E., Eliasziw M. North American Symptomatic Carotid Endarterectomy Trial collaborators. The appropriate use of carotid endarterectomy. CMAJ. 2002; 166(9):1169-79. 14. Inzitari D., Eliasziw M., Gates P et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl. J. Med. 2000;342(23): 1693-700. 15. Chaturvedi S., Bruno A., Feasby T. et al. Carotid endarterectomy an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the AmericanAcademy of Neurology. Neurology. 2005;65(6):794-801. 16. 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. 17. Abbott A.L. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke. 2009;40(10):e573-83. 18. Spence J.D. Tamayo A. Lownie SP et al. Absence of microemboli on transcranial Doppler identifies low-risk patients with asymptomatic carotid stenosis. Stroke. 2005;36(ll):2373-8. 19. Spence J.D. Coates V., Li H. et al. Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Arch Neurol. 2010;67(2): 180-6. 20. Markus H., King A., Shipley S.et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. LancetNevrol. 2010; 9:663-71. 21. Kakkos S.K., Sabetai M., Tegos T. et al. Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis. J. Vasc. Surg. 2009;49;903-909. 22. Hougaku H., Matsumoto M., Handa N. et al. Asymptomatic carotid lesions and silent cerebral infarction. Stroke. 1994;25:566-70. 23. Tegos T.J., Sabetai M.M., Nicolaides A.N. et al. Patterns of brain computed tomography infarction and carotid plaque echogenicity. J. Vasc. Surg. 2001;33:334-9. 24. Hashimoto H., Tagaya M., Niki H. Htani H. Computer-assisted analysis of heterogeneity on В-mode imaging predicts instability of asymptomatic carotid plaque. Cerebrovasc. Dis. 2009;28:357-64. 25. Liapis С., Kakisis J., Kostakis A. Carotid Stenosis. Factors Affecting Symptomatology. Stroke. 2001; 32:2782-2786. 26. Nicolaides А., Kakkos S., Kyriacou E. et al. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J.Vasc. Surg. 2010;52:1486-96. 27. Yi-Ning Qian, Yong-Ting Luo, Hong-Xia Duan et al. Adhesion Molecule CD146 and its Soluble Form Correlate Well with Carotid Atherosclerosis and Plaque Instability. CNS Neuroscience & Therapeutics 2014; 20:438-445. 28. Jones C.B., SaneD.C., Herrington D.M. Matrix metalloproteinases: a review of their structure and role acute coronary syndrome. Cardiovasc. Res. 2003,59: 812-823. 29. Carlos T.M., Harlan J.M. Leukocyte-endothelial adhesion molecules. Blood. 1994;84:2068-2101. 30. Inoue M., Ishida T., Yasuda T., et al. Endothelial cell-selective adhesion molecule modulates atherosclerosis through plaque angiogenesis and monocyte-endothelial interaction. Microvasc. Res. 2010;80:179-187. 31. McEver R.P Selectins: lectins that initiate cell adhesion under flow. Curr Opin Cell Biol. 2002;14:581-586. 32. Hwang S.J., Ballantyne C.M., Sharrett A.R., et al. Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: the Atherosclerosis Risk In Communities (ARIC) study. Circulation. 1997,96:4219-4225. 33. Pelisek J., Rudelius M., Zepper P., et al. Multiple biological predictors for vulnerable carotid lesions. Cerebrovasc. Dis. 2009;28:601-610. 34. Abbott A.L., Paraskevas K.I., Kakkos S.K. et al. Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis. Stroke. 2015 Nov;46(11):3288-301. 35. Goldstein L.B. Bushnell C.D. Adams RJ. et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 ;42(2): 517-84. 36. Brott T.G., Hobson 2nd R.W. Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N. Engl. J.Med. 2010;363(1): 11-23. 37. Voeks J.H., Howard G., Ronbin G.S, Malas M.B et al. Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke. 2011;42( 12):3484-90. 38. Nallamothu B.K., Lu M., Rogers M.A. et al. Physician specialty and carotid stenting among elderly medicare beneficiaries in the United States. Arch. Intern. Med. 2011; 171 (20): 1804-10. 39. Gowri R., Denish M., Nira H. et al. Management Strategies for Asymptomatic Carotid Stenosis. Ann. Intern. Med. 2013;158:676-685. 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.
Abstract: 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. References 1. Casserly I.P, Sachar R., Yadav J.S. Practical peripheral vascular interventions. Second edition. Wolters Kluwer Health/Lippincott Williams & Wilkins. Philadelphia. 2011; 466 p. 2. Cutlip D. 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Abstract: 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. References 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. 2. Powers W., Derdeyn C., Biller J., et al. Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association //American Stroke Association Stroke. published online June 29, 2015. 3. Abou-Chebl A., Bajzer C.T., Krieger D.W., et al. Multimodal therapy for the treatment of severe ischemic stroke combining GP IIb/IIIa antagonists and angioplasty after failure of thromboysis. Stroke. 2005. (36): 2286-2288. 4. Levy E.I., Ecker R.D., Horowitz M.B., et al. Stent-assisted intracranial recanalization for acute stroke: early results. Neurosurgery. 2006 (58): 458-463. 5. Gupta R., Vora N.A., Horowitz M.B., et al. Multimodal reperfusion therapy for acute ischemic stroke: factors predicting vessel recanalization. Stroke. 2006 (37): 986-990. 6. Castano C., Dorado L., Guerrero C., et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010 (41): 1836-1840. 7. Kvan der Marel K., Chueh J.Y, Brooks O.W., et al. Quantitative assessment of device-clot interaction for stent retriever thrombectomy. JNeurointervSurg. 2016 (0): 1-6. 8. Haussen D., Lima A., Nogueira R. The Trevo XP 3x20 mm retriever (‘Baby Trevo’) for the treatment of distal intracranial occlusions. J NeuroIntervent Surg. 2016 (8): 2951299. 9. Kahles T., Garcia-Esperon C., Zeller S., et al. Mechanical thrombectomy using the new ERIC retrieval device is feasible, efficient, and safe in acute ischemic stroke: a swiss stroke center experience. Am. J. Neuroradiol. 2016 (37): 114 -119. 10. Raoult H., Redjem H., Bourcier R., et al. Mechanical thrombectomy with the ERIC retrieval device: initial experience. J. NeuroIntervent. Surg. 2016 (0): 1-4. 11. Machi P, Jourdan F., Ambard D., et. al. Experimental evaluation of stent retrievers mechanical properties and effectiveness J. NeuroIntervent. Surg. 2016 (0):1-7. 12. Schwaiger B., Gersing A., Zimmer C., et al. The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke. Am. J. Neuroradiol. 2015 (36): 971-976. 13. Tetsuya Hashimoto, Mikito Hayakawa, Naoko Funatsu, et al., Histopathologic analysis of retrieved thrombi associated with successful reperfusion after acute stroke thrombectomy. Stroke. 2016 (47): 3035-3037. 14. Mokin M., Morr S., Natarajan S., et al. Thrombus density predicts successful recanalization with Solitaire stent retriever thrombectomy in acute ischemic stroke. J. Neurointerv. Surg. 2015 (7): 104-107. 15. Bourcier R., Volpi S., Guyomarch B., et al., Susceptibility vessel sign on MRI predicts favorable clinical outcome in patients with anterior circulation acute stroke treated with mechanical thrombectomy. Am. J. Neuroradi- -2353. 16. Haussen D., Rebello L., Nogueira R. Optimizating clot retrieval in acute stroke: The push and fluff technique for closed-cell stentrievers. Stroke. 2015 (46): 2838-42.
