Single-center experience of stent retriever thrombectomy in acute ischemic stroke

Background and purpose Recently, positive data from several randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke (AIS) has emerged. The aim of this retrospective study is to present our clinical experience in cerebral vessel occlusion treatment using retrievable intracranial stents. Methods Forty-three consecutive patients with ischemic stroke (median age 75, range 22–87) treated by stent retriever thrombectomy (Solitaire™ FR) between January 2013 and December 2015 were identified. We retrospectively assessed Thrombolysis in Cerebral Infarction (TICI) scale (2b–3 considered as successful recanalization), clinical outcome using modified Rankin scale (mRs) at 3 months (regarding score 0–2 as good clinical outcome), device-related complications and symptomatic intracranial hemorrhage (sICH; parenchymal hematoma Type 1 or 2 and National Institutes of Health Stroke Scale [NIHSS] score increment ≥4 points) rate. Results The mean NIHSS score on admission was 16.4 (median 16). The mean time from onset to groin puncture (time to treatment) was 290min (median 254min). Successful recanalization was achieved in 30 (69.8%) cases. The mean time from onset to successful reperfusion or procedure termination (time to reperfusion) was 394min (median 375min). Good outcome was observed in 17 (39.5%) patients and mortality was 27.9% (n=12). We found 2 (4,7%) sICHs, one (2,3%) thromboembolic event in different vascular territory and one (2,3%) groin hematoma. Conclusion Stent retriever thrombectomy for the treatment of ischemic stroke is safe, provides high rate of recanalization and good clinical outcomes in the setting of large vessel occlusion

Valence band of Ce2Co0.8Si3.2Ce_{2}Co_{0.8}Si_{3.2} and Ce2RhSi3Ce_{2}RhSi_{3} studied by resonant photoemission spectroscopy and FPLO calculations

This work presents studies of the valence band of two Kondo lattice systems: Ce2Co0.8Si3.2, which is paramagnetic with the Kondo temperature T-K approximate to 50 K and Ce2RhSi3, which is antiferromagnetic below T-N = 4.5 K and exhibits TK approximate to 9 K. The photoemission spectra, which are obtained with photon energy tuned to Ce - 4d 4f resonance, reveal a Kondo peak at the Fermi energy (E-F), its spin orbit splitting partner at 0.24 eV and a broad maximum related to Ce f(0) final state. The spectra indicate that Kondo peak has a higher intensity for Ce2Co0.8Si3.2. The off-resonance photoemission data reveal that a maximum in the 3d electron density of states is shifted towards EF for Ce2Co0.8Si3.2 as compared to Ce2RhSi3. Full-potential local-orbital calculations were realized with local spin density approach +U approach for 213 stoichiometry. They show that a higher density of states near EF is observed for Ce2CoSi3. The calculations also reveal the existing tendencies for antiferromagnetic and ferromagnetic ground states in a case of Ce2RhSi3 and Ce2CoSi3, respectively

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic

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: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Background and purpose Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. Methods We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015–2016). Among subjects confirmed with LVO: time-to-presentation, premorbid functional and on-admission neurological state, site of occlusion and initial imaging data were further assessed. Two sets of criteria based on recent trials and recommendations were used to determine MT eligibility. The onset-to-evaluation time limit was set to 5h allowing ≤60min procedure initiation delay. Results 895 patients with the final diagnosis of AIS were admitted to our stroke center as the initial treatment facility. 246 (27.5%) presented within 5h of symptom onset and had non-invasive imaging performed. Among those 102 (41.5%) had causative LVO. The number of ≤5h presenting patients eligible for MT was 51 (20.7%) when applying restrictive or 80 (32.5%) with more permissive criteria. Conclusion Among AIS patients, in whom onset-to-arrival time allowed to initiate the endovascular procedure within 6h of symptom duration, 21% were eligible for MT treatment according to more and 33% to less restrictive criteria. It accounts for about 6% and 9% of all AIS cases, respectively

The development and new perspectives of stroke treatment in Poland

Udar mózgu jest jednym z niewielu schorzeń neurologicznych znanych od starożytności. Jest to zespół kliniczny charakteryzujący się nagłym ogniskowym, a niekiedy uogólnionym zaburzeniem czynności mózgu, którego objawy utrzymują się dłużej niż 24 godziny lub wcześniej prowadzą do śmierci i nie mają przyczyny innej niż naczyniowa. Rocznie na udar mózgu na świecie zapada ok. 15 mln osób. W krajach wysoko rozwiniętych stanowi trzecią co do częstości przyczynę niesprawności osób dorosłych i drugą przyczynę zespołów otępiennych. W artykule przedstawiono historię leczenia udarów mózgu w Polsce, od pierwszych wzmianek w podręcznikach neurologii z lat 50. do czasów współczesnych. Przełomowe w leczeniu udarów mózgu okazały się minione 2 dekady, kiedy to dokonała się istotna zmiana w podejściu do osoby z udarem. Początkowo leczenie udaru polegało jedynie na pielęgnacji chorego i zapobieganiu powikłaniom ogólnoustrojowym oraz odleżynom. Dopiero w 2. połowie lat 90. XX w. rozpoczęto tworzenie wyspecjalizowanych oddziałów udarowych zapewniających kompleksową opiekę dla pacjentów. Przełomowe okazało się wprowadzenie do leczenia tkankowego aktywatora plazminogenu w celu rekanalizacji zamkniętego przez zmiany zakrzepowe lub zatorowe naczynia w ostrym okresie zachorowania. Leczenie to znacznie poprawiło stan funkcjonalny chorych. W ciągu ostatnich kilkunastu lat rozwija się koncepcja mechanicznej rekanalizacji naczyń wewnątrzczaszkowych, której pierwsze próby wykonywanesą w kilku ośrodkach w Polsce.Stroke is one of the few neurological disorders known since antiquity. It is a clinical syndrome characterized by a sudden focal, and sometimes generalized brain dysfunction whose symptoms persist for more than 24 hours or sooner leads to death and has no other reason than vascular. This disease is common, approximately 15 million people fall ill with a stroke a year. In developed countries it is the third most common cause of adult disability and the second cause of dementia syndromes. The article presents the history of treatment of a stroke in Poland from the first mention in the textbooks on neurology from the 50’s to the present time. The past two decades proved to be the breakthrough in the treatment of strokes, when a significant change in the approach to this disease was adopted. Stroke from a hopeless state has become an acute illness, on the treatment of which neurologists have an increasing impact. Initially, the treatment of a stroke involved only patient care and prevention of systemic complications and bedsores. It was not until the 2nd half of the 90’s of the twentieth century that specialized stroke units were established, providing comprehensive care for patients. A breakthrough was an introduction of the rt-PA -recombinant tissue plasminogen activator to the treatment whose task is recanalization of a vessel closed by a blood clot or embolism in the acute period of the disease. This treatment significantly improved the functional status of patients. For the last several years, the concept of mechanical recanalization of the intracranial vascular system has developed, whose first tests have been conducted in several centers in Poland

Development of landslide research at the Polish Geological Institute

The paper presents the history and latest achievements in landslide research at the Polish Geological Institute (PGI). Since the establishment of PGI in 1919, landslides have been investigated during geological mapping in the Carpathians and considered by engineering geologists. After the 2nd World War, the importance of landslide research becomes more and more important following each landslide catastrophic event. Since 2008, the research on landslide and mass movements has been carried out systematically at the PGI within the SOPO (Landslide Counteracting System) project framework. Since that time, the SOPO project has been developing from landslide mapping and recording into a large spatial database, a sophisticated monitoring system (including on-line data acquisition) and susceptibility analysis, and early warnings with prediction capabilities. SOPO plays an important role to local and national administration. Together with the legal component, it allows defining a strategy for landslide risk reduction in Poland. Recently, landslide research plays so important role at the PGI that a special department, called Geohazard Center, has been established within the PGI organizational structure

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

Colorectal Adenocarcinomas Harboring ALK Fusion Genes : a Clinicopathologic and Molecular Genetic Study of 12 Cases and Review of the Literature

This study determined the frequency, clinicopathologic, and genetic features of colorectal carcinomas driven by oncogenic fusions of the anaplastic lymphoma kinase gene (ALK). Out of 8150 screened tumors, 12 (0.15%) were immunohistochemically ALK-positive with D5F3 antibody. These cancers harbored CAD-ALK (n=1), DIAPH2-ALK (n=2), EML4-ALK (n=2), LOC101929227-ALK (n=1), SLMAP-ALK (n=1), SPTBN1-ALK (n=4) and STRN-ALK (n=1) fusions as detected by an RNA-based NGS assay. ALK fusion carcinomas were diagnosed mostly in older patients with a 9:3 female predominance (median age, 72 years). All tumors, except a rectal one, occurred in the right colon. Most tumors were stage T3 (n=7) or T4 (n=3). Local lymph node and distant metastases were seen at presentation in 9 and 2 patients. These tumors showed moderate (n=6) or poor (n=3) glandular differentiation, solid medullary growth pattern (n=2), and pure mucinous morphology (n=1). DNA mismatch repair deficient phenotype was identified in 10 cases. Tumor-infiltrating lymphocytes were prominent in 9 carcinomas. In 4 carcinomas, tumor cells showed strong, focal (n=3) or diffuse PD-L1 immunoreactivity. CDX2 expression and loss of CK20 and MUC2 expression were frequent. CK7 was expressed in 5 tumors. Four patients died of disease within 3 years and 7 were alive with follow-up ranging from 1–8 years. No mutations in BRAF, RAS and genes encoding components of PI3K-AKT/MTOR pathway were identified. However, one tumor had a loss-of-function PTEN mutation. Aberration of p53 signaling, TP53 mutations and/or nuclear accumulation of p53 protein was seen in 9 cases. ALK fusion colorectal carcinomas are a distinct and rare subtype of colorectal cancers displaying some features of mismatch repair-deficient tumors