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

An attempt toward objective assessment of brain tumor vascularization using susceptibility weighted imaging and dedicated computer program : a preliminary study

Background: Susceptibility weighted imaging (SWI) is a novel MRI sequence which demonstrates the susceptibility differences between adjacent tissues and it is promising to be a sequence useful in the assessment of brain tumors vascularity. The aim of our study was to demonstrate usefulness of SWI in evaluation of intratumoral vessels in comparison to CET1 sequence in a standardized, objective manner. Material/Methods: 10 patients with supratentorial brain tumors were included in the study. All of them underwent conventional MRI examination with a 1,5 T scanner. SWI sequence was additionally performed using the following parameters: TR 49 ms,TE 40 ms. We used authors' personal computer software - Vessels View, to assess the vessels number. Results: Comparison of SWI and CET1 sequences was performed using our program. Analysis of all 26 ROIs demonstrated predominance of SWI in the amount of white pixels (vessel cross-sectional) and a similar number of elongated structures (blood vessels). Conclusions: To conclude, the results of this study are encouraging; they confirm the added value of SWI as an appropriate and useful sequence in the process of evaluation of intratumoral vascularity. Using our program significantly improved visualization of blood vessels in cerebral tumors. The Vessel View application assists radiologists in demonstrating the vessels and facilitates distinguishing them from adjacent tissues in the image

Rare infraglottic lesions in magnetic resonance imaging

Background: Primary pathological laryngeal lesions occur rarely in infraglottic space. Modern possibilities of diagnostic imaging of infraglottic space include computed tomography (CT) and magnetic resonance (MR). Diagnostic imaging was performed in potential lesions in this area: inflammatory process - cicatrical pemphigoid, benign neoplastic process - chondroma, malignant neoplastic - squamous cell carcinoma. The aim of the paper is to present clinical and radiographical characteristics of selected lesions located in infraglottic space in MRI examination. Material and Methods: Three patients examined at the Department of Radiology and Diagnostic Imaging of University Hospital No. 1 in Lodz (SPZOZ USK nr 1) from 2010-2011 with a pathological mass in infraglottic space. Standard imaging protocol for MRI of the neck was used in all patients: field of 1.5 T, slice thickness 3 mm, the distance between the scans 10-20%, FOV - 3 mm, sequences: T1 (TR/TE 455/9, 7 ms, T2 (TR/TE 5300/67 ms), T1 + Gd-DTPA (contrast agent Gd-DTPA at 0.2 mmol/kg). Conclusions: 1. It is possible to determine characteristic signal pattern for rare lesions of the infraglottic space in MRI. 2. MRI is a valuable complementary modality for the diagnostics and differentiation of lesions in infraglottic space, the evaluation of their advancement and treatment planning

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