Severe acute kidney injury after pharmacomechanical thrombectomy for acute limb ischemia

Pharmacomechanical thrombectomy (PMT) with AngioJet (AJ) catheter is one of the most efficacious endovasculartechniques for rapidly removing clots and thrombi from occluded vessels. It has a high technical successrate but at the cost of hemolysis which may lead to renal damage. Such a complication after AJ has beenpublished but is still underreported in the literature. In this report, a case of a 68-year-old male patient withacute limb ischemia (ALI) and severe acute kidney injury (AKI) developed after the use of catheter-directedthrombolysis (CDT) and PMT AJ has been presented

Wstępne wyniki pierwszego w Polsce programu przesiewowego w tętniaku aorty brzusznej w województwie kujawsko-pomorskim

Background. Abdominal aortic aneurysm (AAA) is called a widening of the aorta below the renal arteries with a diameter more than 3 cm. The prevalence of AAA is estimated at 4–8% in men aged 65 years or more. The mortality rate for patients with ruptured AAA is 65%, while the mortality rate for aortic aneurysm repair surgery in elective patients undergoing pre-screened is 3%. The aim of this study was to determine the prevalence of AAA among men aged 60 years and older undergoing targeted ultrasonography of abdominal aorta. The additional aim was to determine the relationship between specific risk factors and the AAA, and to determine the prevalence of AAA in patients subgroups specified by the criteria for the screening programmes for AAA. Material and methods. Based on available data from the literature, study populations was defined as men aged 60 years and older. Applied research methods were as follow: 1) the questionnaire; 2) measurement of physical characteristics of aorta (diameter of abdominal aorta by ultrasound scan). The questionnaire consisted of two parts: 1) identification and demographic data; 2) the presence of risk factors. Analysis of data from the questionnaire determined the relationship between the risk factors and the AAA, whereas ultrasonography of the aorta, detected the disease (abdominal aortic aneurysm) and its prevelance. Statistical analysis of the data was performed using the software STATISTICA 9 (StatSoft, Inc., 2009). Results. Based on 1556 ultrasound scans, the abdominal aortic aneurysm was diagnosed in 94 men aged 60 years and older. The prevalence of AAA in the study group was 6.0%. Risk factors associated with the AAA were analyzed in two groups: I — AAA (n = 94) and II — normal aorta (n = 1464). The three risk factors were significantly associated with the AAA: age, smoking and family history, whereas the incidence of AAA in males at 65 years old was 4.0%, and a group of men between 65 and 75 years of age, smoking cigarettes ever, was 7.4%. Conclusions. In the obtained data the prevalence of AAA was similar to that of literature. Additionally, the positive relationship between age, smoking, and AAA was detected. Acta Angiol 2012; 18, 1: 9–17Wstęp. Tętniakiem aorty brzusznej (TAB) określa się poszerzenie aorty poniżej odejścia tętnic nerkowych o średnicy powyżej 3 cm. Częstość występowania TAB szacuje się na 4–8% u mężczyzn w wieku 65 lat i więcej. Współczynnik umieralności dla pacjentów z pękniętym TAB wynosi 65%, natomiast śmiertelność pooperacyjna dla operacji naprawczych tętniaka aorty w trybie planowym wśród pacjentów poddanych wcześniej badaniu przesiewowemu wynosi 3%. Podstawowym celem pracy było określenie częstości występowania (chorobowość, prevalence) TAB wśród mężczyzn w wieku 60 lat i starszych poddanych ukierunkowanemu badaniu ultrasonograficznemu aorty w odcinku brzusznym. Dodatkowo zbadano zależności między określonymi czynnikami ryzyka a TAB oraz częstość występowania TAB w subgrupach pacjentów określonych według kryteriów programów badań przesiewowych w kierunku TAB. Materiał i metody. Na podstawie dostępnego piśmiennictwa zdefiniowano populację narażoną, tj. mężczyzn w wieku 60 lat i starszych. Zastosowano następujące metody badawcze: 1) metodę kwestionariuszową; 2) pomiar cechy fizycznej (badanie ultrasonograficzne średnicy aorty w odcinku brzusznym). Kwestionariusz składał się z dwóch części: 1) dotyczącej danych identyfikacyjnych i demograficznych; 2) dotyczącej występowania czynników ryzyka. Analiza danych z kwestionariusza umożliwiła określenie zależności między badanymi czynnikami ryzyka a TAB, natomiast poddanie zdefiniowanej części populacji badaniu ultrasonograficznemu aorty umożliwiło wykrycie choroby (tętniak aorty brzusznej) i określenie częstość jej występowania. Analizę statystyczną uzyskanych danych przeprowadzono z wykorzystaniem oprogramowania STATISTICA 9 (StatSoft, Inc. 2009). Wyniki. Na podstawie wykonanych 1556 badań ultrasonograficznych aorty brzusznej tętniak zdiagnozowano u 94 mężczyzn w wieku 60 lat i starszych. Częstość występowania (prevalence) TAB w badanej grupie wyniosła 6,0%. Czynniki ryzyka związane z TAB analizowano, wyodrębniając dwie grupy: I — TAB (n = 94) i II — aorta prawidłowa (n = 1464). Istotny statystycznie związek z TAB miały 3 czynniki ryzyka: wiek, palenie tytoniu i występowanie rodzinne TAB. Częstość występowania TAB w grupie mężczyzn w 65. roku życia wyniosła 4,0%, natomiast w grupie mężczyzn między 65. a 75. rokiem życia, palących kiedykolwiek tytoń, wyniosła 7,4%. Wnioski. Na podstawie uzyskanych danych stwierdzono częstość występowania TAB podobną do tej z piśmiennictwa. Dodatkowo stwierdzono także zależności między wiekiem, paleniem tytoniu i występowaniem rodzinnym TAB a zachorowaniem na TAB. Acta Angiol 2012; 18, 1: 9–1

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

Prevalence of Lower Extremity Arterial Disease as Measured by Low Ankle-Brachial Index in Patients with Acute Cerebral Ischemic Events

Background: Low ankle–brachial index (ABI) of ≤0.9 is diagnostic of lower extremity arterial disease (LEAD). It is also a strong marker of generalized atherosclerosis. The objective of this study was to assess the prevalence of low ABI in patients with acute cerebral ischemic events (ACIE): ischemic stroke (IS) or transient ischemic attack (TIA). Methods: We compared 150 inpatients with ACIE to 50 inpatient controls and assessed risk factors, ABI measurements, and Duplex ultrasound of the cervical vessels. Results: Low ABI was seen in 69 patients (46%) in the ACIE group and in 8 (16%) in the control group; p < 0.01. The mean and median ABI values in the ACIE group were 0.88 (SD = 0.22) and 0.91 (0.24–1.33), which were significantly lower than in the control group: 1.04 (SD = 0.16) and 1.0 (0.66–1.36); p < 0.0001, respectively. Coronary artery disease, carotid stenosis of ≥50% and smoking were risk factors, which were associated with significantly lower ABI in the study group; the ABI with risk factors vs. without was 0.85 vs. 0.92 (coronary artery disease); p < 0.05, 0.7 vs. 0.92; (carotid stenosis) p < 0.001 and 0.83 vs. 0.98; (smoking) p < 0.001, respectively. Conclusion: Our study demonstrated that patients with ACIE have significantly higher involvement of another vascular bed as LEAD. Coronary artery disease, carotid stenosis ≥50% and smoking were main risk factors associated with coexistence of LEAD and ACIE

Występowanie tętniaków aorty brzusznej w populacji miejsko-wiejskiej w centralnej Polsce — Gniewkowo Aortic Study

Background and aim: Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4–8% in men aged 65 years or older and 1–2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. Methods: All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60–64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. Results: Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60–64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). Conclusions: The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60–64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.Wstęp i cel: Tętniakiem aorty brzusznej (AAA) nazywamy poszerzenie tętnicy głównej poniżej odejścia tętnic nerkowych równe lub większe niż 3 cm. Szacuje się, że AAA występują u 4–8% mężczyzn w wieku ≥ 65 lat i u 1–2% kobiet w tej samej grupie wiekowej. Metody: Do badania zaproszono wszystkich mężczyzn w wieku ≥ 60 lat i kobiety w wieku powyżej 65 lat zamieszkałych na terenie miejsko-wiejskiej gminy w centralnej Polsce. 922 osoby (61% wszystkich zaproszonych) wzięło udział w badaniu. Mężczyzn podzielono na dwie grupy: 60–64 lata oraz ≥ 65 lat. U wszystkich badanych wykonano przesiewowe badanie ultrasonograficzne jamy brzusznej oraz zebrano dane demograficzne i antropometryczne. Wyniki: Wśród przebadanych 922 osób znaleziono 2 (1,01%) AAA w grupie mężczyzn w wieku 60–64 lat, 3 (0,82%) AAA w populacji kobiet w wieku ≥ 65 lat oraz 33 (9,29%) AAA w grupie mężczyzn w wieku ≥ 65 lat. W grupie mężczyzn wykazano związek między występowaniem AAA a paleniem tytoniu (p = 0,0048), wiekiem (p = 0,0009) oraz przebytym zawałem serca/ostrym zespołem wieńcowym (MI/ACS) (p = 0,0079). Nie stwierdzono zależności między występowaniem AAA a cukrzycą (p = 0,46), nadciśnieniem tętniczym (p = 0,38) oraz rodzinnym występowaniem AAA (p = 0,44). Wnioski: Częstość występowania AAA w populacji mężczyzn w wieku ≥ 65 lat była nieco większa niż w badaniach epidemiologicznych przeprowadzonych w przeszłości, a w grupie mężczyzn 60–64 lat oraz kobiet powyżej 65. rż. zgodne z danymi z innych badań populacyjnych. Wykazano zależność między występowaniem AAA w grupie mężczyzn w wieku ≥ 65 lat a paleniem tytoniu, wiekiem i przebytym MI/ACS

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