Ocena stężenia wybranych cytokin zapalnych w surowicy krwi u pacjentów ze zwężeniem tętnicy szyjnej

Background: The inflammatory process plays an important role in the formation, growth and destabilization of atherosclerotic plaque narrowing the internal carotid artery. The aim of the study was to determine the concentrations of TNF-alpha, interleukin-6 and interleukin-10 in the serum of patients with internal carotid artery stenosis. Another aim was to compare the concentrations of these inflammatory markers in patients with symptomatic and asymptomatic internal carotid artery stenosis. Material and methods: The study included 65 patients (F/M 20/45; aged 66.29 ± 7.77; 55–80) with symptomatic (39 individuals) or asymptomatic (26 individuals) atherosclerotic internal carotid artery stenosis above 50% on one or both sides. The control group consisted of 30 healthy volunteers (F/M 20/10; aged 61.03 ± 9.08; 50–78). Results: The mean serum concentration of interleukin-6 was significantly higher both in the group of patients with symptomatic and asymptomatic ICA stenosis, as compared with the control group (p = 0.0002; p = 0.0208, respectively) There were no significant differences in serum concentration of THF-alpha and interleukin-10 between patients and control group. Conclusions: Patients with atherosclerotic stenosis of the internal carotid artery have shown significantly elevated levels of interleukin-6 in the serum, which suggests that it is involved in the disease process. Cytokines and other inflammatory mediators in patients with carotid artery stenosis require further studies which would allow for a better understanding of the effect on the formation and activity of atherosclerotic lesions.Wstęp: W powstawaniu i aktywacji blaszek miażdżycowych zwężających tętnicę szyjną istotną rolę pełni proces zapalny. Celem badania było określenie stężenia TNF-alfa, interleukiny-6 i interleukiny-10 w surowicy krwi pacjentów ze zwężeniem tętnicy szyjnej wewnętrznej (ICA). Drugim celem badania było porównanie stężeń wymienionych markerów zapalnych u pacjentów z objawowym i nieobjawowym zwężeniem tętnicy szyjnej. Materiał i metody: W badaniu uczestniczyło 65 pacjentów (K/M 20/45; w śr. wieku 66,29 ± 7,77 roku) z objawowym (39 osób) lub bezobjawowym (26 osób) miażdżycowym zwężeniem ICA (≥ 50% po jednej lub obu stronach). Grupę kontrolną tworzyło 30 zdrowych osób (K/M 20/10; w śr. wieku 61,03 ± 9,08 roku). Wyniki: U chorych ze zwężeniem ICA (zarówno objawowym, jak i nieobjawowym) średnie stężenie interleukiny-6 w surowicy było znamiennie wyższe w porównaniu ze średnim stężeniem interleukiny-6 w surowicy osób z grupy kontrolnej (odpowiednio: p = 0,0002, p = 0,0208). Nie obserwowano znamiennych statystycznie różnic w średnim stężeniu TNF-alfa oraz interleukiny-10 między grupą pacjentów a grupą kontrolną oraz między pacjentami z objawowym zwężeniem tętnicy a pacjentami z nieobjawowym zwężeniem tętnicy. Wnioski: U chorych z miażdżycowym zwężeniem ICA stwierdza się znamienne podwyższenie stężenia interleukiny-6 w surowicy, co sugeruje jej udział w tym procesie chorobowym. Cytokiny i inne mediatory zapalne u pacjentów ze zwężeniem ICA wymagają dalszych badań w celu lepszego rozumienia mechanizmu ich wpływu na kształtowanie i aktywność zmian miażdżycowych

Analysis of echocardiographic parameters of cardiac function in patients with acute stroke

Introduction. Cardiologic diagnostics in stroke patients is designed to identify heart disease as a potential cause of stroke. The aim of this study was to evaluate the effect of low ejection fraction (EF) and left ventricular systolic/diastolic dysfunction (LVSD, LVDD) on the neurological state on the 1st day of stroke, as well as post-stroke functional status at 30 days after stroke. Patients and methods. For a prospective study, 162 stroke patients (mean age 74 years) were qualified. They were analysed according to neurological state on the 1st day of stroke, the results of transthoracic echocardiography, and functional status at 30 days after stroke. Results. The neurological state on the 1st day after stroke was significantly worse in patients with LVSD. In patients with reduced EF, functional status was significantly worse at 30 days after stroke. Patients with E/A 0.8–2 had a significantly worse functional status compared to patients with E/A < 0.8. Individuals with E/A 0.8–2 and segmental LVSD or EF < 50% had significantly worse functional status compared to patients without LVSD. An independent factor for moderate/severe status was identified: E/A > 0.8 (RR 3.28 [95% CI 1.15-9.37]); independent factors for poor functional status were lower EF (RR 4.68 [95% CI 1.22–18.00]) and age (RR 4.68 [95% CI 1.22–11.00]). Conclusions. One quarter of patients in the acute phase of stroke have LVSD and/or LVDD. LVSD adversely affects both neurological status in acute stroke as well as functional status in the short-term follow-up. Age at first-in-life stroke incidence and lower EF are predictors of poor functional status one month after a stroke

The importance of atrial fibrillation and selected echocardiographic parameters for the effectiveness and safety of thrombolytic therapy in patients with stroke

Background The efficacy and safety of thrombolytic therapy in stroke depend on multiple factors. The aim of this study was to evaluate the significance of atrial fibrillation the prognosis in terms of the functional status in patients with stroke treated with intravenous thrombolysis. An additional aim was also to assess the potential significance of reduced ejection fraction (EF) and enlarged left atrium (LA) of the heart for the prognosis in patients with stroke who underwent thrombolytic therapy. Methodology A prospective study involved enrollment of 222 patients, mean age of 72 years with first-in-life ischemic stroke. In all participants there were realized procedures as follows: neurological status before administering rt-PA (NIHSS), selected echocardiographic parameters, functional status on the 14th day from the onset (mRankin scale) and analysis the bleeding events. Results Atrial fibrillation was significantly more frequent in women than men; females had higher CHA2DS2VASc scores and heavier neurological conditions on day 1 of stroke. Two independent factors for poor prognosis (3–5 points by mRankin) were found: the NIHSS score and the CHA2DS2VASc score ≥3. We identified 2 independent factors for death within 14 days from the onset: the result by NIHSS and the EF. The NIHSS score turned out to be the only independent predictor of hemorrhage during hospitalization: RR 1.19; CI [1.06–1.33]; p=0.003; p for model=0.0025. Conclusions The presence of atrial fibrillation worsens the patient's prognosis in terms of the functional status and survival during the acute period of stroke in patients treated with intravenous thrombolysis. Higher NIHSS and CHA2DS2VASc scores and reduced EF in patients with stroke treated with thrombolysis are the predictors of unfavorable short-term prognosis

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

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

Cladribine tablets for highly active relapsing-remitting multiple sclerosis in Poland: a real-world, multi-centre, retrospective, cohort study during the COVID-19 pandemic

Introduction. Treatment with cladribine tablets is indicated in highly active relapsing-remitting multiple sclerosis (RRMS). Cladribine tablets proved safe and effective in the pivotal CLARITY trial, but that trial included primarily treatment-naïve patients. In clinical practice however, cladribine tablets are often given to patients who have failed other treatments. Therefore, this study investigated the real-world safety and efficacy of cladribine tablets. Material and methods. We gathered data from nine MS clinical centres across Poland for patients with RRMS who started treatment with cladribine tablets from December 2019 to June 2022. Results. We enrolled 140 patients, with follow-up data available for 136 in year 1 and for 66 in year 2. At baseline, the mean age was 35.6 years, mean disease duration was 7.3 years, median EDSS score was 2.5, and 94% of patients were treatment- -experienced. Thirty-nine patients (27.9%) had undergone COVID-19, and 94 (67.1%) were vaccinated against COVID-19. The annualised relapse rate (ARR) decreased from 1.49 at baseline to 0.33 in year 1 (p < 0.001) and to 0.25 in year 2 (p < 0.001). The percentage of relapse-free patients increased from 11.5% at baseline to 70.2% in year 1 and 82.1% in year 2. The percentage of patients with active lesions decreased from 91.4% at baseline to 36.2% in year 1 and 18.2% in year 2. EDSS score remained stable or improved in 83.7% of patients in year 1 and 89.6% in year 2. No evidence of disease activity (NEDA-3) was achieved in 42.7% of patients in year 1 and 66.7% in year 2. Only one patient (0.72%) had grade 4 lymphopenia and 21 (15.1%) had grade 3 lymphopenia. Varicella zoster virus infections occurred in three patients. Eight patients discontinued treatment with cladribine: five due to inefficacy, one due to lymphopenia, and two due to a personal decision. Conclusions. Cladribine tablets proved safe and effective in a real-world cohort of treatment-experienced patients. However, the efficacy measures improved to a lesser extent in our cohort than in the pivotal clinical trial, which is probably due to a higher proportion of treatment-experienced patients in our cohort

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

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies — the Polish experience

Introduction. The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited.Materials and methods. This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health.Results. There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used.Conclusions and clinical implications. Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs

Riwaroksaban we wtórnej profilaktyce kardiogennego udaru mózgu: dwuletnie doświadczenie jednego ośrodka obejmujące 209 chorych

Background: The main goal of treatment in patients with atrial fibrillation is to counteract the effects of embolisation, considering the relatively high risk of cerebral embolic events. Aim: An assessment of the efficacy and safety of rivaroxaban in secondary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Methods: The study concerned 209 NVAF patients (male/female: 117/92; mean age 65.3 years [41–85]), who used rivaroxaban as secondary prevention of cardiogenic stroke. The patients were followed up for 24 months: the control visits were performed 12 and 24 months after the onset of the inclusion. The following aspects were analysed: the occurrence of recurrent stroke and/or transient ischaemic attack (TIA) during rivaroxaban treatment, bleeding episodes with their placement and severity assessment, drug tolerance, and evaluation of the patient’s medical records including laboratory tests (e.g. creatinine clearance) and concomitant therapy. All patients underwent physical examination as well as neurological assessment. Results: The mean CHA2DS2-VASc in the study group was 4.16, and the mean HAS-BLED value was 3.31. During the follow-up 13 deaths were noted (6.22%), ischaemic stroke was diagnosed in five (2.39%) subjects, and TIA in three (1.43%) patients. Bleeding complications were reported in 25 (11.96%) patients, two of which were classified as major bleedings (0.95%): an intracranial bleeding (1) and a bleeding from the genital tract (1). Conclusions: For patients with NVAF and cerebrovascular events, the use of rivaroxaban in a real-world clinical setting results in a highly efficacious treatment profile and acceptable safety.Wstęp: Migotanie przedsionków (AF) stanowi przyczynę 18–23% udarów mózgu. Biorąc pod uwagę wysokie ryzyko niedokrwienia mózgu, głównym celem terapii pacjentów z AF jest przeciwdziałanie zatorowości mózgowej. Cel: Celem niniejszego badania była ocena skuteczności, bezpieczeństwa i tolerancji riwaroksabanu we wtórnej profilaktyce udaru mózgu u pacjentów z niezastawkowym AF (NVAF). Metody: Do prospektywnego badania obserwacyjnego w latach 2011–2014 zakwalifikowano 209 pacjentów z NVAF [117 mężczyzn i 92 kobiety w śr. wieku 65,3 roku (41–85 lat)], u których we wtórnej profilaktyce udaru mózgu zastosowano riwaroksaban. Pacjentów objęto 2-letnim okresem obserwacji z planowymi wizytami w 12. i 24. miesiącu od włączenia terapii, podczas których przeprowadzono wywiad z uwzględnieniem incydentów neurologicznych, zdarzeń krwotocznych, tolerancji leczenia i oceny wyników badań, w tym klirensu kreatyniny. Wyniki: W całej grupie pacjentów średni wynik wg skali CHA2DS2-VASc wynosił 4,16 (4–9) punktów, a średni wynik w skali HAS-BLED — 3,31 (2–8) punktów. Udar mózgu wystąpił u 5 (2,39%) chorych, a przejściowy atak niedokrwienny — u 3 (1,43%). Incydenty krwotoczne zaobserwowano u 25 (11,96%) pacjentów, w tym u 2 (0,95%) sklasyfikowane jako duże: wewnątrzczaszkowe (1) oraz z dróg rodnych (1). Podczas badania 45 (21,53%) chorych przerwało terapię riwaroksabanem, a 13 (6,22%) pacjentów zmarło. Wnioski: 1. Zastosowanie riwaroksabanu w warunkach praktyki klinicznej (tzw. real-world) u pacjentów z ostrym niedokrwieniem mózgu w przebiegu NVAF wiąże się z wysoką skutecznością i akceptowalnym profilem bezpieczeństwa w obserwacji długoterminowej. 2. Włączenie riwaroksabanu w pierwszym miesiącu od wystąpienia udaru mózgu u pacjentów z NVAF nie powoduje wzrostu częstości krwawień istotnych klinicznie w ostrym okresie choroby. 3. Współpraca z chorym i względnie rzadki wskaźnik rezygnacji z terapii riwaroksabanem są czynnikami zachęcającymi do poszerzenia grupy pacjentów stosujących lek w profilaktyce wtórnej udaru mózgu. 4. W celu uzyskania optymalnej skuteczności i profilu bezpieczeństwa terapii riwaroksabanem każdy chory przed jej włączeniem wymaga ewaluacji ryzyka krwawienia oraz określenia ścisłych wskazań do terapii