Akuutin aivovaltimotukoksen uudet hoitolinjat

Akuu­tin ai­vo­val­ti­mo­tu­kok­sen las­ki­mon­si­säis­tä liuo­tus­hoi­toa voi­daan an­taa nel­jän ja puo­len tun­nin ku­lues­sa oi­rei­den alus­ta. Hoi­to on aloi­tet­ta­va he­ti, kun vas­ta-ai­heet on pois­sul­jet­tu. Jos po­ti­laan ai­vo­ve­ren­kier­to­häi­riön oi­reet ovat vai­keat, ei suu­ren ai­vo­val­ti­mon tu­kok­sen las­ki­mon­si­säi­nen liuo­tus­hoi­to yleen­sä rii­tä. Sen li­säk­si har­ki­taan en­do­vas­ku­laa­ri­hoi­to­na lä­hin­nä me­kaa­nis­ta trom­bek­to­miaa kuu­den tun­nin ku­lues­sa. En­do­vas­ku­laa­ri­hoi­toa har­ki­taan myös sil­loin, kun las­ki­mon­si­säi­sel­le liuo­tus­hoi­dol­le on vas­ta-ai­he: INR-ar­vo yli 1,7 tai po­ti­las käyt­tää sään­nöl­li­ses­ti uut­ta ve­re­no­hen­nus­lää­ket­tä da­bi­gat­raa­nia, ri­va­rok­sa­baa­nia tai ­apik­sa­baa­nia. Pää­tös en­do­vas­ku­laa­ri­hoi­don aloit­ta­mi­ses­ta teh­dään ylio­pis­to­sai­raa­las­sa mo­niam­ma­til­li­ses­ti, ja toi­men­pi­teen ai­hees­ta päät­tää neu­ro­lo­gi yh­des­sä sen suo­rit­ta­van ra­dio­lo­gin kans­sa. Hoi­dos­ta on an­net­tu uu­si oh­jeis­tus, jo­ka kos­kee neu­ro­lo­gian päi­vys­tä­jien li­säk­si myös päi­vys­tyk­sen eri­koi­sa­laa, ku­ten kes­kus­sai­raa­la­ta­soi­sia päi­vys­tä­jiä. Päi­vys­tyk­sel­li­seen AVH-hoi­toon lä­het­tä­mi­sen kri­tee­rit säi­ly­vät en­nal­laan ja hoi­don va­lin­taan ote­taan kan­taa ylio­pis­to­sai­raa­loi­den päi­vys­tys­pis­teis­sä.Peer reviewe

Screening of unruptured intracranial aneurysms in 50 to 60-year-old female smokers : a pilot study

The prevalence of unruptured intracranial aneurysms (UIAs) is around 2-3% in the general population. We hypothesized that the prevalence of small UIAs is higher among 50 to 60-year-old female smokers, since the incidence of aneurysmal subarachnoid hemorrhage (aSAH) is exceptionally high in 60 to 70-year-old female smokers. Ethics approval for this pilot study of 50 women was obtained from the hospital ethics committee. In order to minimize recruitment bias, preliminary invitation letters were sent to 50 to 60-year-old women who were known to be active smokers. Those interested in participating were further informed about the study rationale and protocol. Following written consent, participants filled a detailed questionnaire and underwent computed tomography angiography (CTA) analysis. All abnormalities were recorded. Of the 158 preliminary invitation letters, 70 potential participants initially replied. Of these, 50 returned questionnaires and written consents, 43 of which underwent CTA analysis. Most (39; 91%) were postmenopausal, and 9 (21%) were hypertensive. Two reported a family history (>= 1 first-degree members) of intracranial aneurysms. UIAs (maximum sizes of 2, 2, 3, 3 and 7 mm) were found in five (12%) female smokers. One woman was operated on, and the remaining four were treated with non-invasive preventive actions (smoking cessation and follow-ups). Small UIAs, which may be best suited for non-invasive preventive actions, may be relatively common in 50 to 60-year-old female smokers. Whether this kind of targeted screening leads to improved health in female smokers requires further investigation.Peer reviewe

Sclerotherapy complications of peripheral venous malformations

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Akuutin aivohalvauspotilaan kuvantaminen valtimotukoksen hoidon suunnittelussa

English summaryPeer reviewe

Akuutin aivohalvauspotilaan kuvantaminen valtimotukoksen hoidon suunnittelussa

English summaryPeer reviewe

Moyamoya vasculopathy - Patient demographics and characteristics in the Finnish population

Background and purpose Moyamoya vasculopathy, a rare steno-occlusive progressive cerebrovascular disorder, has not been thoroughly studied in Caucasian populations. We established a registry of Finnish patients treated at the Helsinki University Hospital, to collect and report demographic and clinical data. Methods We collected data both retrospectively and prospectively from all the patients with a moyamoya vasculopathy referred to our hospital between January 1987 and December 2014. All patients underwent a neurological outpatient clinic visit. Results We diagnosed 61 patients (50 females, 10 children) with moyamoya vasculopathy. The mean age at the disease-onset was 31.517.9 years. The two most common presenting symptoms were ischemic stroke (n=31) and hemorrhage (n=8). Forty-four percent underwent revascularization surgery, and 70% were prescribed antithrombotic treatment. Conclusions The results support in part the Western phenotype of the disease considering the later presentation and larger female predominance compared to the Asian moyamoya vasculopathy reports. However, the proportion of ischemic strokes and hemorrhagic strokes is closer to Japanese population than German population. The absence of familial cases points to a different genetic profile in the Finnish patients.Peer reviewe

Complications of sclerotherapy for 75 head and neck venous malformations

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Moyamoya angiopathy: radiological follow-up findings in Finnish patients

Moyamoya angiopathy (MMA) is a chronic progressive disorder, but imaging changes observed over time are not yet characterized in European populations. We analyzed the progression of MMA with magnetic resonance imaging and angiography (MRI and MRA) in our Finnish MMA registry. Stage classification based on MRA findings was used to evaluate the progress of the disease.Peer reviewe

IV Thrombolysis-Bridging and Endovascular Treatment for Occlusive Internal Carotid Artery Dissection with Tandem Occlusion

Compared to other etiologies of ischemic stroke, occlusive internal carotid artery dissection responds worse to intravenous (IV) thrombolysis. Intracranial tandem occlusion is a predictor of poor outcome. A direct endovascular approach has been proposed as a safe and probably superior alternative to IV thrombolysis. However, it may lead to considerable treatment delays. We used rapidly initiated IV thrombolysis-bridging and subsequent endovascular treatment in two patients with severe hemispheric ischemia due to occlusive internal carotid artery dissection with tandem occlusion and achieved good outcomes. Minimizing recanalization times likely improves patient outcome and IV thrombolysis-bridging may be a reasonable strategy to achieve this. The positive initial results obtained with endovascular approaches and IV thrombolysis-bridging in this patient group deserve further scientific exploration

Treatment of Ruptured Intracranial Aneurysms Using the Woven EndoBridge Device : A Two-Center Experience

BACKGROUND: The Woven EndoBridge (WEB) device is a new treatment modality developed for broad-necked unruptured intracranial aneurysms (IAs) but shows potential for the treatment of ruptured IAs as well. Our aim was to describe 6-month aneurysm obliteration rates, clinical outcomes, and procedure-related complications after WEB treatment for ruptured IAs from 2 academic centers. METHODS: We conducted a retrospective observational study, including all consecutive patients treated with the WEB device (WEB single layer and single-layer sphere) for a ruptured IA causing acute subarachnoid hemorrhage between 2014 (start of use) and 2017. Primary outcome was angiographic aneurysm obliteration (Beaujon Occlusion Scale Score) rate. Secondary outcomes were early re-bleedings, complications, and patient outcome (death and modified Rankin Scale). RESULTS: A total of 33 patients with ruptured IAs were treated 0-4 days from IA rupture. Of 27 survivors, 6-month angiographic follow-up was available for 26 patients, of whom 81% showed complete occlusion. Of the 27 survivors, 24 patients (89%) had a favorable neurologic outcome at 6 months after subarachnoid hemorrhage. Two aneurysms were retreated (8% of all). There was 1 fatal procedure-related complication. No early aneurysm re-bleedings were noted. CONCLUSIONS: For anatomically suitable ruptured IAs, WEB device treatment seems to be safe and results in acceptable occlusion rates. Still, larger studies with long-term results are needed before recommendations can be made.Peer reviewe