Leczenie mózgowych malformacji tętniczo-żylnych metodą przezskórnej embolizacji

Background: In this paper we present our results of treating cerebral arteriovenous malformations implementing percutaneous embolization between 2001-2003. Material/Methods: From year 2001 to 2003, a group of 34 patients underwent endovascular embolization of cerebral arteriovenous malformations. This group consisted of 10 female and 24 male patients aged 15 to 78 (mean: 45.3). DSA examination was performed to assess the possibility of percutaneous embolization. Microcatheters 1.2 F, 1.5 F, or 1.8 F were used in accordance with the dimensions of the malformation. The tip of the catheter was placed close to the nidus of the malformation. Results: Cerebral arteriovenous malformations were localized mainly in the temple region (38%) or in the parietal region (27%). Primary embolization resulted in total occlusion in 41% of AVMs fed by up to three vessels, Repeated interventions led to occlusion of the additional hemangiomas in up to 70.5% of all lesions. In cases of AMVs fed by more than 4 vessels, the second embolization did not result in total occlusion of the hemangiomas. Curative results were obtained in only 12 patients (35%). Total or partial occlusion resulted in the partial reduction of the diameters of the malformations by 30 to 80% (mean: 74%). Conclusions: The best results of embolization were achieved in cases of small and medium malformations fed by 1-3 vessels (70.5% of cases). In our opinion, percutaneous embolization could be applied as an independent curative method in adult patients with small and medium arteriovenous malformations, grades I - III of the Spetzler-Martine scale

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

Obustronna głęboka stymulacja jądra niskowzgórzowego w leczeniu zaawansowanej choroby Parkinsona. Doświadczenia własne w obserwacji pięcioletniej

Background and purpose The objective of the study was to assess bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with advanced Parkinson disease (PD). Material and methods The study population included 5 patients with bilateral STN DBS who completed a 5-year postoperative follow-up period. In all patients electrodes (Model 3387 or 3389) were stereotactically bilaterally inserted into the STN using a Leksell stereotactic G frame. The clinical rating tests included Unified Parkinson's Disease Rating Scale (UPDRS) and two motor-timed tests derived from CAPIT (rapid movements between two points and stand-walk-sit test). All patients were assessed in off and on condition before implantation and 1, 3 and 5 years in medication on and off condition and stimulation on condition and stimulation off condition. To compare preoperative to postoperative UPDRS scores, only mean values and standard deviations are presented because of the small study population. Results The stimulation effect was noted in the off state, resulting in a 59% improvement in motor scores of UPDRS at 5-year follow-up, when compared to preoperative scores. In the on state the stimulation improved motor scores by 17%. At 5-year follow-up, reduction of daily levodopa dose was 50%. Conclusions Bilateral STN DBS is an effective and safe treatment for patients with advanced PD. Bilateral STN DBS contributes to improvement of parkinsonian symptoms in the off state and levodopa-induced dyskinesia. This can be correlated with a 50% reduction of daily levodopa dose 5 years postoperatively.Wstęp i cel pracy Celem pracy była ocena skuteczności obustronnej głębokiej stymulacji jądra niskowzgórzowego (subthalamic nucleus – STN) w leczeniu zaawansowanej postaci choroby Parkinsona (ChP). Materiał i metody Badany materiał kliniczny stanowiła grupa 5 chorych poddanych obustronnej stymulacji STN, u których czas pooperacyjnej obserwacji wynosił co najmniej 5 lat. U wszystkich chorych wszczepiono obustronnie elektrody do głębokiej stymulacji STN (Model 3387 lub 3389) z zastosowaniem ramy stereotaktycznej Leksell G. Kliniczną ocenę stanu chorych przeprowadzono za pomocą Ujednoliconej Skali Oceny Choroby Parkinsona (UPDRS) i dwóch testów ruchowych CAPIT (szybkie ruchy pomiędzy dwoma punktami oraz test chodu). Pacjentów oceniono w fazie off i on przed operacją oraz po upływie roku, 3 i 5 lat w fazie off i on w czasie stymulacji i przy włączeniu generatorów impulsów. Do oceny różnic pomiędzy pomiarami przedoperacyjnymi i pomiarami pooperacyjnymi według UPDRS podano wartości średnie i odchylenia standardowe ze względu na niewielką liczbę badanych chorych. Wyniki Wpływ stymulacji odnotowano w fazie off, co spowodowało zmniejszenie nasilenia objawów ruchowych o 59% w 5-letnim okresie pooperacyjnym w porównaniu z wartościami przedoperacyjnymi. W fazie on efekt stymulacji przyczynił się do zmniejszenia objawów ruchowych ChP o 17%. Pięć lat po operacji odnotowano zmniejszenie dobowej dawki lewodopy o 50%. Wnioski Obustronna stymulacja STN jest najbezpieczniejszą i najskuteczniejszą metodą leczenia chorych z zaawansowaną ChP. Obustronna stymulacja STN przyczynia się do ustąpienia objawów fazy off i dyskinez pląsawiczych, co związane jest z 50-procentowym zmniejszeniem dobowej dawki lewodopy w obserwacji 5-letniej

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