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

Zator tętnicy podstawnej - kompleksowe leczenie z zastosowaniem trombektomii mechanicznej

Occlusion of the intracranial arteries is the cause of up to 80% of ischaemic strokes. Of these, 1% are caused by occlusion of the basilar artery. There are currently two methods for treating the acute phase of ischemic stroke: intravenous thrombolysis and mechanical recanalization of the blood vessel. We present the case of a 59-year-old man with basilar artery occlusion treated endovascularly. Treatment was begun in the second hour after onset of symptoms. First intravenous thrombolysis was performed, followed by mechanical thrombectomy. Complete reperfusion of the blood vessel was achieved and the patient’s neurological condition improved significantly. The patient was discharged after 10 days of treatment with a diagnosis of paroxysmal atrial fibrillation. Oral anticoagulants were used in secondary prevention.    Udar mózgu (UM) stanowi trzecią w kolejności, po chorobach serca i nowotworach, przyczynę zgonów w krajach wysokorozwiniętych. W przeważającej większości występuje udar niedokrwienny mózgu (UNM), a jego przyczyną jest zwężenie lub zamknięcie naczynia krwionośnego materiałem pochodzenia zakrzepowo-zatorowego. Wprowadzona w latach 90 ubiegłego wieku tromboliza dożylna przez ponad 20 lat była jedynym, przyczynowym sposobem leczenia. W 2007r. pojawiła się koncepcja stent retrieverów, samorozprężalnych stentów służących do mechanicznego usuwania skrzepu z naczynia mózgowego, jednak dopiero rok 2015 wydaje się być początkiem nowej ery w przyczynowym leczeniu UNM. Skuteczność aktualnie stosowanych stent retrieverów kształtuje się w okolicach 60%. Pomimo braku dowodów naukowych na możliwość zastosowania tej nowej metody w leczeniu patologii w krążeniu tylnym mózgu, pojawiające się doniesienia w literaturze medycznej, w tym także opis naszego przypadku, dowodzą jej skuteczności i bezpieczeństwa w leczeniu inwazyjnym UNM.

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