Profilaktyka pierwotna i wtórna udaru niedokrwiennego mózgu w świetle obecnych zaleceń i rekomendacji

Ischaemic stroke is still one of the leading causes of death an d disability in adults. The risk of recurrent stroke is significantly increased when compared to stroke risk in general population. Thus, both primary and secondary ischaemic stroke prevention remains crucial regarding to both, medical and social reasons. In presented paper, the authors present the selected aspects of the primary and secondary prevention of a stroke and transient ischemic attack (TIA), respectively to modification of current guidelines and recommen­dations, including not only novel aspects of pharmacotherapy, but also increasing role of nonpharmacological interventions.Udar niedokrwienny mózgu jest nadal jedną z przodujących przyczyn zgonów i niepełnosprawności u dorosłych. Ponadto ryzyko zachorowania na udar mózgu o pacjentów po przebytym uprzednio incydencie mózgowo – naczyniowym jest znacznie większe niż w populacji ogólnej. Dlatego, pomimo znacznego rozwoju metod terapii ostrej fazy udaru niedokrwiennego mózgu, nadal kluczową kwestią z medycznego i społecznego punktu widzenia pozostaje skuteczna profilaktyka pierwotna i wtórna. W poniższym artykule autorzy przedstawiają wybrane elementy prewencji pierwotnej i wtórnej udaru niedokrwiennego mózgu oraz przemijającego niedokrwienia mózgu (ang. Transient Ischaemic Attack, TIA) w odniesieniu do najnowszych modyfikacji obowiązujących zaleceń i rekomendacji, uwzględniających nie tylko zmodyfikowane zasady farmakoterapii, ale również coraz istotniejszą rolę działań niefarmakologicznych

Mikrokrwotoki mózgowe — nowe oblicze mikroangiopatii mózgowej: obraz kliniczny i aspekty praktyczne

A family physician who systematically takes care of elderly patients with progressive dementia, stroke and demanding chronic use of oral antiplatelet drugs, anticoagulants and statins, is increasingly facing a concept of cerebral microbleeds (CMBs) in medical records. This article allows family doctors to get the latest data regarding the clinical significance of CMBs and learn the latest guidelines and recommendations of scientific societies in relation to therapy of acute cardiovascular events and secondary stroke prevention in patients with CMBs previously detected.Lekarz rodzinny sprawujący systematyczną opiekę nad chorymi w starszym wieku, z postępującym procesem otępiennym, po udarze mózgu oraz wymagających przewlekłego stosowania doustnych leków przeciwpłytkowych, antykoagulantów i statyn, coraz częściej spotyka się w dokumentacji lekarskiej z pojęciem mikrokrwotoki mózgowe (cerebral microbleeds; CMBs). Artykuł pozwala przybliżyć lekarzom rodzinnym najnowszą wiedzę o znaczeniu klinicznym CMBs oraz poznać najnowsze zalecenia i rekomendacje towarzystw naukowych, w odniesieniu do prowadzenia terapii w ostrych incydentach sercowo-naczyniowych oraz profilaktyki wtórnej udaru mózgu u chorych z wcześniej wykrytymi CMBs

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Mechanical thrombectomy in acute stroke : five years of experience in Poland

Objectives: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250 99 min. 90.3% of the studied patients had MT within 6 h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0–2 - in 31.4% and mRS of 6 in 22% of cases. Conclusion: Our results can help harmonize standards for MT in Poland according to international guideline