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

Leczenie ruksolitynibem u chorego na pierwotne włóknienie szpiku oraz małopłytkowość

46-years old male diagnosed with primary myelofibrosis (PMF) was included into therapeutic program of treatment with ruxolitinib. Due to initial thrombocytopenia with basal platelets [PLT] range below 100 G/l, initial dosage of the treatment was reduced according to characteristics of drug. No treatment-related toxicity was noted, the dosage was gradually increased reaching the dose 20 mg twice a day at twelfth week of therapy. Although alleviation of systemic symptoms was reached, lack of diminishment of spleen size demanded by therapeutic program led to cessation of treatment. In group of patients with PMF and secondary thrombocytopenia treatment with ruxolitinib may lead to improvement of patient condition.Przedstawiono przypadek 46-letniego pacjenta z pierwotnym włóknieniem szpiku (PMF) z wyjściową liczbą płytek krwi (PLT) poniżej 100 G/l, którego ze względu na splenomegalię oraz objawy ogólne zakwalifikowano do leczenia ruksolitynibem. Z powodu małopłytkowości początkową dawkę leku zmniejszono zgodnie z charakterystyką produktu leczniczego. Nie obserwowano toksyczności hematologicznej, co pozwoliło na osiągnięcie dawki 2 razy 20 mg w 12. tygodniu terapii. Mimo pozytywnego wpływu na zmniejszenie objawów ogólnych, u chorego nie doszło do wymaganego w programie terapeutycznym zmniejszenia wielkości śledziony w 6. miesiącu leczenia, co skutkowało przerwaniem terapii. Ruksolitynib, mimo potencjalnej toksyczności hematologicznej, może przynosić korzyści terapeutyczne u chorych na PMF i z niską początkową liczbą płytek krwi

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