Trends of stroke hospitalisation and fatality rates in young vs. elderly people in Poland during 2010–2019 decade

Introduction. Since the turn of the century, epidemiological studies have shown an increase in stroke hospitalisation rates among young adults in contrast to a decline in rates seen among the older population. The aim of the present study was to investigate the trends of stroke hospitalisation rates and case fatality ratios (CFR) over the decade starting in 2010 in different age groups of the Polish population. Material and methods. The patients were identified on the basis of the Polish National Health Fund that gathers all the data of the Hospital Discharge Registry as well as the National Cause of Death Registry of patients with stroke who were hospitalised between 2010 and 2019 and who were diagnosed according to the International Classification of Diseases — Tenth Revision (ICD-10) with haemorrhagic stroke (HS; codes I61* and I62*) and ischaemic stroke (IS; codes I63*). Results. From a total nationwide cohort of 799,132 stroke patients (86.2% with IS and 13.8% with HS) treated between 2010 and 2019, a group of 22,329 patients (2.79%) aged 18–44 years was selected, among whom 69.6% had IS and 30.4% had HS. We documented a statistically significant increase in the IS hospitalisation rate in young adults alongside a decrease of this rate in those aged > 64. Among young adults with IS, the highest increase (p = 0.001) was observed for those aged 35–44 in 2019 (up to 39.2), and was significant each year starting from 2017 (2017–2019: p < 0.01). In the case of HS, the annual number of patients did not change significantly. In 2019 (compared to 2010), a decrease in 30-day, 90-day and 1-year CFR was noted in all age groups of patients with IS and HS. Stroke aetiology of IS was diagnosed in 60% of patients. More than 40% of patients with IS were discharged with the diagnosis of stroke of unspecified cause. Conclusions. In the case of IS, opposite trends of hospitalisation rates in younger and older age groups were documented, with the highest increase of IS in patients aged 35–44. A decline in CFR was observed for both IS and HS in all age groups

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