Recanalisation of cerebral artery aneurysms treated endovascularly — a midterm follow-up

Endovascular methods of aneurysm treatment, as an alternative to neurosurgical clipping, have proved a welcome opportunity to treat patients with unruptured aneurysms or those disqualified from neurosurgical intervention. This paper presents our own experience of endovascular treatment of cerebral aneurysms in 107 patients. It includes clinical and technical data from the perioperative period and a 12-month radiological follow-up of 78 patients. Method. Our retrospective evaluation covered patients with intracranial aneurysms treated endovascularly. The following were analysed: age, sex, neurological symptoms, and familial burden of intracranial aneurysm. Multivariate analysis was performed to determine independent factors of recanalisation of the cerebral aneurysm 12 months after embolisation. Results. The data of 107 patients at a mean age of 61 years [57.09 ± 14.27] treated with embolisation was analysed. The indication for intervention in 16 patients was subarachnoid haemorrhage; in the remaining 91 cases, aneurysms were revealed during diagnostic procedures for different symptoms or during imaging examinations. The intracranial segment of the internal carotid artery and the anterior communicating artery were the most common locations for aneurysms. After embolisation, subarachnoid haemorrhage occurred in one patient, ischaemic stroke in two patients, and one patient died because of acute circulatory insufficiency. The functional status of 94 patients on the day of discharge from the department (on days 4-21) was very good. 78 patients completed a 12-month follow-up period. In 11 of those, a follow-up MR angiography revealed recanalisation 12 months after the intervention. Except for one patient reporting vertigo, aneurysm recanalisation procedures were asymptomatic. The only independent risk factor for recanalisation was the size of aneurysm > 10 mm; OR 3.0; CI [1.15–7.83] p = 0.0255. Conclusions. Embolisation of cerebral aneurysms is a safe method with few perioperative complications, and most of these are mild and transient.The size of the aneurysm during qualification for embolisation is a risk factor for recanalisation in the subsequent 12 months. Recanalisation of embolised cerebral aneurysms concerns less than 20% of patients in a one-year follow-up and is most often asymptomatic

Wewnątrznaczyniowa terapia niedokrwiennego udaru mózgu — doniesienie wstępne nt. doświadczeń jednego ośrodka

A thrombolytic therapy is still more and more commonly used treatment in the cases of the brain ischemia of the vascular origin. Despite the growing experience in this kind of therapy, its clinical efficacy seems to be still not sufficient. Looking for the new ways of the acute brain ischemia treatment, the potential role of the brain vessel thrombectomy is taken into account. In the paper, the own experiences concerning the treatment of 28 patients with ischemic stroke who underwent intracranial endovascular interventions due to the acute vessel occlusion, are presented.Leczenie trombolityczne udaru mózgu jest coraz częściej stosowanym postępowaniem terapeutycznym w przypadku niedokrwienia mózgu pochodzenia naczyniowego. Ciągle jednak jego skuteczność, jak i możliwości zastosowania wydają się niewystarczające. Stąd też zrozumiałe wydaje się coraz większe zainteresowanie w ostatnich latach metodami mechanicznej trombektomii naczyń wewnątrzczaszkowych w leczeniu przyczynowym niedokrwiennego udaru mózgu. W pracy przedstawiono własne doświadczenia w leczeniu wewnątrznaczyniowym w grupie 29 chorych z udarem niedokrwiennym mózgu, u których wykonano interwencje wewnątrznaczyniowe w obrębie naczyń wewnątrzczaszkowym z powodu ich ostrej niedrożności

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 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