Specific features of reperfusion therapy for vertebrobasilar ischemic stroke

Ischemic stroke in the vertebrobasilar system (VBS) is characterized by the high rates of death and disability; reperfusion therapy in patients with a lesion focus in the VBS is safe and effective beyond the 4.5-hour therapeutic window. Actively developed current methods for the endovascular treatment of acute ischemic stroke enable one to increase recanalization rates and hence to improve the degree of functional recovery in this group of patients. Considering that there are no significant differences in the outcomes of systemic and selective thrombolytic therapy in patients with occlusion of the basilar arteries, the urgent problem is to increase the time from the onset of the disease to reperfusion therapy, therefore combined reperfusion therapy may be an optimal option. This approach would make it possible to initiate the therapy in a shorter period of time and to use the advantages of both reperfusion techniques. Intravenous thrombolysis as the rapidest and technically simplest method may be performed in the first step of therapy in the clinics unequipped with an X-ray surgical service, with the patient being further transported to a specialized endovascular center if the intravenous injection of a thrombolytic agent has no effect. Taking into account the fact that reperfusion therapy may be performed in patients with vertebrobasilar stroke in the wider therapeutic window, a similar organizational chart with multistep therapy for this disease might become the treatment of choice

Онкологические заболевания как фактор риска криптогенного инсульта

Background. Acute cerebrovascular accidents in general, and ischemic stroke (IS) in particular, are multifactorial diseases with extremely heterogeneous and numerous risk factors. Currently, despite the development of diagnostic technologies, in approximately 25% of patients with IS, it is not possible to establish the causes and mechanism of its development (the so-called cryptogenic stroke (CS)). As a result, the optimal antithrombotic therapy as a secondary prevention in this group of patients remains unclear. It was found that in 10–20% of patients with CS, a detailed examination reveals oncological disease (OD). It is highly likely that the prevalence of OD-related IS will increase. The US National Cancer Registry has shown a decrease in mortality in patients with the most common forms of OD (lung, breast and prostate cancer). Active OD is a proven risk factor for both IS and other thrombotic events. Nevertheless, about 50% of IS in patients with OD are classified as cryptogenic, which significantly exceeds this indicator in patients without OD. This is associated with the difficulties of intravital diagnosis of the pathogenetic mechanism of IS in patients with OD.Aim of study. Raising the awareness of neurologists about the causes, pathogenetic mechanisms of development and methods of diagnosing IS in patients with OD.Materials and methods. To achieve this goal, the results of scientific research on OD as a risk factor for CS were analyzed. The literature search was carried out in electronic search engines Scopus, eLibrary, PubMed by keywords: ischemic stroke, cryptogenic stroke, cancer, pathogenesis of ischemic stroke. Scientific articles published between 1856 and 2021 were selected for analysis, 45% of the analyzed papers on the topic of CS were published not earlier than 5 years ago.Conclusion. The cause of the development of ischemic stroke can be both the oncological process itself and the means and methods of treating it. Despite the fact that in 10–20% of patients with cryptogenic stroke OD is diagnosed, the question remains whether patients with cryptogenic ischemic stroke should be screened for latent oncological pathology, and if so, how full should the screening be. Typical radiological patterns of ischemic stroke in patients with OD are multiple foci of acute cerebral ischemia in different vascular areas, which may indicate a cardioembolic nature and, in particular, non-bacterial thrombotic endocarditis. Lifetime diagnosis of the causes of cryptogenic stroke in patients with OD is extremely difficult. Since nonbacterial thrombotic endocarditis is one of the leading causes of cryptogenic stroke in the setting of cancer, it is advisable to perform transesophageal echocardiography due to the low sensitivity of transthoracic echocardiography. Актуальность. Острые нарушения мозгового кровообращения в целом, и ишемический инсульт (ИИ) в частности, являются мультифакториальными заболеваниями с чрезвычайно гетерогенными и многочисленными факторами риска. В настоящее время, несмотря на развитие диагностических технологий, приблизительно у 25% пациентов с ИИ не удается установить причины и механизм развития такового (так называемый криптогенный инсульт (КИ)), в результате чего остается неясной оптимальная антитромботическая терапия в качестве вторичной профилактики в этой группе пациентов. Установлено, что у 10—20% пациентов с КИ при детальном обследовании выявляют онкологическое заболевание (ОЗ). Весьма вероятно, что распространенность ИИ, связанного с ОЗ, будет увеличиваться. Национальный онкологический регистр США показал снижение летальности у пациентов с наиболее распространенными формами ОЗ (рак легких, груди и простаты). Активное ОЗ является доказанным фактором риска как ИИ, так и других тромботических событий. Тем не менее около 50% ИИ у пациентов с ОЗ классифицируют как криптогенные, что значительно превышает данный показатель у пациентов без онкологической патологии. Это связано со сложностями прижизненной диагностики патогенетического механизма ИИ у больных с ОЗ.Цель работы. Повышение информированности врачей-неврологов о причинах, патогенетических механизмах развития и методах диагностики ИИ у пациентов с ОЗ.Материал и методы. Для достижения поставленной цели были проанализированы результаты научных исследований, посвященных ОЗ как фактору риска КИ. Поиск литературы проводили в электронных поисковых системах Scopus, eLibrary, PubMed по ключевым словам: ишемический инсульт, криптогенный инсульт, онкологическое заболевание, патогенез ишемического инсульта. Для анализа были отобраны научные статьи, опубликованные в период с 1856 по 2021 год. 45% проанализированных работ, посвященных теме КИ, опубликованы не более 5 лет назад.Заключение. Причиной развития ишемического инсульта может быть как сам онкологический процесс, так и средства и методы лечения такового. Несмотря на то что у 10—20% пациентов с криптогенным инсультом выявляют онкологическое заболевание, в настоящее время остается открытым вопрос, должны ли пациенты с криптогенным ишемическим инсультом проходить скрининг на скрытую онкологическую патологию, и если да, то в каком объеме. Типичными радиологическими паттернами ишемического инсульта у больных с онкологическими заболеваниями являются множественные очаги острой церебральной ишемии в разных сосудистых бассейнах, которые могут указывать на кардиоэмболическую природу и в частности небактериальный тромботический эндокардит. Прижизненная диагностика причин криптогенного инсульта у пациентов с онкологической патологией крайне сложна. Так как одной из ведущих причин криптогенного инсульта на фоне онкологического заболевания является небактериальный тромботический эндокардит, целесообразно выполнение чреспищеводной эхокардиографии в связи с низкой чувствительностью трансторакальной эхокардиографии.

Effect of cerebrolysin on motor function restoration during medical rehabilitation

Ischemic stroke (IS) is characterized by high prevalence, mortality, and disability rates. Therapy aimed to correct one biochemical or molecular stage of ischemic cell injury fails to treat stroke, suggesting that it is necessary to study multimodality therapy affecting several related pathophysiological components.The paper gives the January 2016 results of the randomized placebo-controlled multicenter study CARS that demonstrates the positive effect of cerebrolysin versus placebo according to the primary efficiency criterion, the Action Research Arm Test (ARAT) scale, and total outcome 90 days after disease onset. The investigation enrolled mainly patients with moderate or severe IS (the mean National Institutes of Health Stroke Scale score was 9 at baseline).The specific features of the CARS study versus those of other clinical trials of neuroprotectors were the initial planning of narrower end criteria of efficiency (arm motor function recovery whereas the major goal of many investigations was to reduce mortality rates), as well as a standardized rehabilitation program in both treatment groups. Such investigations did not previously take into account the nature and volume of rehabilitation measures although the latter may have a substantial impact on the outcome of stroke.The CARS study is the first among the previously conducted clinical trials of neuroprotectors, which has attained the primary objective (to restore motor function), which opens up fresh opportunities for the medical support of rehabilitation measures in patients with IS

Problems of Selecting an Anticoagulant for Secondary Stroke Prevention in Patients with Atrial Fibrillation

The article describes the urgent problem of ischemic stroke prevention in patients with atrial fibrillation. It is proved that ischemic stroke in combination with AF is the most severe in terms of developing stable motor and speech disorders and disability. The frail older patients, as well as patients with swallowing disorders and reduced medical adherence present a special problem from this point of view. The most famous clinical studies on secondary prevention of cardioembolic stroke are RE-LY, ROCKET-AF, and ARISTOTLE. Based on subanalyses of randomized controlled trials, direct oral anticoagulants demonstrated a favorable efficacy profile in patients with atrial fibrillation and stroke/ transient ischemic attack, but the level of knowledge on each of them remained different. A number of advantages of rivaroxaban for primary and secondary prevention of stroke in patients with atrial fibrillation, including the elderly and patients with cognitive impairments and swallowing disorders, have been demonstrated. © 2021 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.Relationships and Activities. This publication was supported by AO Bayer (PPM_RIVRU00581)

The role of smoking in the development of strokes at a young age

Stroke in young patients is a disease based on a number of known specific non-modifiable factors (extracranial artery dissection, thrombophilia, open oval hole, etc.) and modifiable factors (alcohol abuse, drug use, smoking, etc.), in combination leading to the development of pathology. Smoking is a generally recognized modifiable risk factor for stroke, which is directly proportional to the number of tobacco-containing products smoked. Quitting smoking is the basis of prevention, an integral part of the treatment and rehabilitation of stroke patients. If it is impossible to completely give up smoking combustible cigarettes, it is advisable to switch to alternative smokeless products. This article presents the results of current studies on the comparative assessment of the risk of stroke in young people when using combustible cigarettes and smokeless analogues

Embolic strokes of undetermined source: prevalence and patient features in the ESUS Global Registry

Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. Results: Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation (n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years (p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2–8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions

Global survey of the frequency of atrial fibrillation-associated stroke: embolic stroke of undetermined source global registry

Background and Purpose—Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features. Methods—Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels. Results—Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (r=0.76; P=0.0002). Conclusions—This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women

Evaluation of Synthetic Conditions for H3PO4 Chemically Activated Rice Husk and Preparation of Honeycomb Monoliths

Activated carbons in this work were prepared from rice husk by phosphoric acid activation followed by alkaline desilication. Pseudo-random selection of 16 rice husk samples was subjected to carbonization at the following conditions: 0.5 to 2 h of activation time, 300-600 ºС and Н3РО4/precursor (wt/wt) impregnation ratio of 0.5 to 2. Concentration of NaOH desilication solution varied from 0.5 to 2M. It was found that out of the four factors impregnation ratio is clearly the strongest and at the impregnation ratio of 2 for 1 h at 500 °C N2 BET-surface area reaches 1690 m2/g (SBET (Ar)=2492 m2/g) while pore volume becomes 1.95 cm3/g. Elemental analysis showed highest carbon content for this sample (87.96%). All samples have insignificant amount of Si and traces of metals, but considerable amount of phosphorus. Blocks of honeycomb structure prepared from Ca-montmorillonite and desilicated carbonized rice husk (impregnation ratio is 1.5, 1 h at 600 ºC) have BET-surface area obtained by thermal desorption of argon up to 856 m2/g

In-vitro Optimization of Nanoparticle-Cell Labeling Protocols for In-vivo Cell Tracking Applications.

Recent advances in theranostic nanomedicine can promote stem cell and immune cell-based therapy. Gold nanoparticles (GNPs) have been shown to be promising agents for in-vivo cell-tracking in cell-based therapy applications. Yet a crucial challenge is to develop a reliable protocol for cell upload with, on the one hand, sufficient nanoparticles to achieve maximum visibility of cells, while on the other hand, assuring minimal effect of particles on cell function and viability. Previous studies have demonstrated that the physicochemical parameters of GNPs have a critical impact on their efficient uptake by cells. In the current study we have examined possible variations in GNP uptake, resulting from different incubation period and concentrations in different cell-lines. We have found that GNPs effectively labeled three different cell-lines - stem, immune and cancer cells, with minimal impairment to cell viability and functionality. We further found that uptake efficiency of GNPs into cells stabilized after a short period of time, while GNP concentration had a significant impact on cellular uptake, revealing cell-dependent differences. Our results suggest that while heeding the slight variations within cell lines, modifying the loading time and concentration of GNPs, can promote cell visibility in various nanoparticle-dependent in-vivo cell tracking and imaging applications.Israel Cancer Research Fund (ICRF), Israel Science Foundation (grant #749/14), Christians for Israel Chair in Medical Researc