Risk factors of acute kidney injury during hospitalization in acute ischaemic stroke patients undergoing mechanical thrombectomy.

Introduction: Acute kidney injury (AKI) seems to worsen the prognosis of acute ischaemic stroke (AIS) patients treated with mechanical thrombectomy (MT). At the same time, the procedure of MT increases AKI risk by iodinated contrast use. Identification of factors predisposing to AKI after MT is important for recognizing vulnerable patients and successful prevention. Aim: To identify factors associated with the occurrence of AKI during hospitalization in MT-treated AIS patients. Material and methods: The study included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. The diagnosis of AKI during hospitalisation was based on serum creatinine concentration levels, according to the Kidney Disease Improving Global Outcomes guidelines. We compared patients with and without AKI in terms of age, sex, comorbidities, stroke course and laboratory test results at admission. We identified factors associated with the occurrence of AKI using univariate logistic regression analysis, with significant variables subsequently added to the multivariate analyses. Results: Among 593 MT-treated AIS patients the incidence of AKI during hospitalisation was 12.6%. AKI development was associated with diabetes, chronic kidney disease, total volume of iodinated contrast obtained during hospitalisation, posterior circulation stroke, lack of intravenous thrombolysis, and laboratory test results at admission: haemoglobin, glucose, urea, potassium, and creatinine. Total contrast volume and urea level were the most important independent risk factors associated with occurrence of AKI. Conclusions: AKI is common in MT-treated AIS patients. There is a need to establish a protocol for decreasing the risk of AKI in AIS patients undergoing MT and, in case it occurs, a procedure for its treatment.

The influence of embolization of internal carotid artery aneurysms on arterial tortuosity: a prospective cohort study.

PURPOSE: To compare quantitative tortuosity descriptors of Internal Carotid Artery (ICA) on aneurysmal and non-aneurysmal side before and after embolization of aneurysm and to determine possible factors associated with its change. MATERIAL AND METHODS: An analysis of 52 patients with intracranial aneurysm, treated with endovascular procedure, was performed. Based on their Digital Subtraction Angiography images, obtained prior to the procedure and after first follow-up examination, tortuosity of ICA, both on the side of embolization and on the other side was analysed. For each patient tortuosity descriptors were calculated: Relative Length, Sum of Angle Metrics, Triangular Index, Product of Angle Distance, and Inflection Count Metric. To represent changes in tortuosity, for each descriptor delta value (Δ) was defined as value of the descriptor prior to embolization - value of the descriptor on follow-up examination. RESULTS: In the follow-up We found no statistically significant changes in tortuosity on non-embolized side. On the embolized side SOAM (2.89±0.92 vs. 2.38±0.94;p<0.001), PAD (5.01±1.83 vs. 3.95±1.72 ;p<0.001) and ICM (12.18±4.55 vs. 9.76±4.04 vs.;p = 0.006) was significantly higher after embolization than before embolization. Mean ΔRelative Length (-0.02 [-0.045--0.002] vs. -0.01 [-0.02-0.003];p - 0.003),ΔProduct of Angle Distance (0.84 [0.30 - 1.82] vs. 0.10 [-0.001 - 1.10];p<0.001) and ΔInflection Count Metric (2.05 [0.42 - 3.50] vs. 0.27 [0.02 - 2.16];p = 0.004) were significantly higher on the embolized side. CONCLUSION: Following study showed that embolization may increase the tortuosity of ICA.

Safety and Efficacy of Low-Dose Eptifibatide for Tandem Occlusions in Acute Ischemic Stroke.

OBJECTIVES: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the safety and efficacy of low-dose eptifibatide administration in stroke patients with tandem lesions. METHODS: We evaluated the results of endovascular treatment in 148 stroke patients with tandem lesions. Patients in whom balloon angioplasty alone resulted in satisfactory cerebral flow did not receive eptifibatide (33 patients); others received this drug together with stent implantation (115 patients). Eptifibatide was given as an intravenous bolus of 180 µg/kg and then in a modified low dose of 1 µg/kg/min for 24 hours. RESULTS: There were no statistically significant differences between both groups regarding 30-day mortality, frequency of thrombotic events, or hemorrhagic complications. An analysis of clinical status at 30-day follow-up revealed that the administration of eptifibatide was associated with a statistically significant better outcome: a higher rate of either no neurological symptoms or only mild symptoms (4 NIHSS points maximally). CONCLUSIONS: The administration of eptifibatide in stroke patients presenting with tandem lesions is relatively safe. Moreover, treatment with this drug can improve clinical outcomes in these challenging patients.

A case of early obliteration of the sagittal suture without effect on cranial deformation.

This paper describes a unique case of craniosynostosis in a female skull in which sagittal sutures were completely fused by adolescence. Despite sagittal synostosis, the skull was of normal shape and size. Regarding craniometric features, the synostotic normocephalic skull was markedly different than that of scaphocephalic skulls which typically result from premature obliteration of the sagittal suture.

Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity.

OBJECTIVE: Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. METHODS: We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS: A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. CONCLUSIONS: Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.

The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches.

Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits.

Dual energy computed tomography in differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with ischaemic stroke treated with thrombectomy.

INTRODUCTION: The aim of this study was to assess the value of dual energy computed tomography (DECT) in the differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. MATERIAL AND METHODS: The group analysed consisted of 66 hyperdense areas in 64 patients with acute ischaemic stroke treated with mechanical thrombectomy and controlled in DECT performed within the first 24 hours after thrombectomy. In every area both qualitative and quantitative analysis of iodine and water material density (MD) maps was performed for the differentiation of iodine and blood, as well as CT density analysis. RESULTS: 66.7% of hyperdense areas were classified as iodine, 18.2% as iodine + blood, and 15.1% as blood. The density of iodine was significantly higher in the iodine (median 9.64 100ug/cm3) group compared to the blood (median 3.97 100ug/cm3) and iodine + blood (median 7.57 100ug/cm3) groups. The density of water was significantly higher in the blood (median 1,051.50 mg/cm3) and iodine + blood (median 1,038.00 mg/cm3) groups compared to the iodine (median 1,021.00 mg/cm3) group. CONCLUSIONS: DECT with iodine-water material decomposition maps is a valuable tool in the differentiation of prolonged staining of iodine contrast agent from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. The value of 6 100ug/cm3 (0.6 mg/cm3) seems a good threshold in quantitative differentiation of iodine from blood on iodine (water) MD maps. The value of 1,030 mg/cm3 seems a good threshold in quantitative differentiation of iodine from blood on water (iodine) MD maps.

Venous return in acute ischaemic stroke patients measured during computed tomography angiography of head and neck.

INTRODUCTION: The aim of this study was to analyse the general features and usefulness of the time elapsed between the start of contrast agent infusion and its appearance in the aortic arch in acute ischaemic stroke patients subjected to baseline computed tomographic angiography. This is, to the best of our knowledge, the first study of this parameter in a clinical context. We will refer to it hereafter as 'needle-to-aorta delay' (NAD). MATERIAL AND METHODS: The following were recorded: the time it took iodinated contrast media to reach the aorta, the site of occlusion, and automatic perfusion assessments of infarct and salvageable tissue volumes. Demographic data such as age and sex, comorbidities, and clinical factors including heart rate, blood pressure, time elapsed from symptom onset, initial stroke severity, and course of disease, were also assessed. RESULTS: We analysed 252 cases of stroke. NAD correlated with tissue at risk volume, and was greater for patients with hypertension and atrial fibrillation. The observed time was significantly shorter with less favourable core-to-penumbra ratios. No link was found between NAD and either the rate of infarct progression or the long-term clinical result. CONCLUSIONS: Although no clinical benefit was proven as a result of measuring the time it took contrast media to reach the aorta, our study implies that not only is the brain subject to circulation, but it may also affect its functioning.

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection.

INTRODUCTION: Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited. AIM: This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients. MATERIAL AND METHODS: We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During long-term follow-up we assessed new neurological events and stenoses of implanted stents. RESULTS: The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During long-term follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events. CONCLUSIONS: Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

Iatrogenic pericallosal artery aneurysm after endovascular procedure.

Iatrogenic brain aneurysms are rare and are usually a result of direct trauma to the arterial wall during various neurosurgical or endovascular procedures. Single cases of pericallosal posttraumatic and postsurgical aneurysms were previously reported. Herein, we report the first confirmed case of iatrogenic pericallosal artery aneurysm caused by an arterial wall injury during the endovascular treatment of another aneurysm. A 50-year-old woman with ruptured anterior communicating artery aneurysm was initially treated with balloon-assisted coiling. During the procedure the tip of a microwire inserted into balloon catheter placed in the pericallosal artery caused a local injury of the inner layer of the vessel wall and vasoconstriction, without bleeding, dissection, or flow disturbances visible in digital subtraction angiography (DSA). Control examination revealed dissecting pericallosal aneurysm. After standard dual-antiplatelet oral preparation, stent-assisted coiling of the pericallosal artery aneurysm was performed with residual contrast filling of the base of the aneurysm sac in control angiography (RROC III). After 6 months the control DSA examination showed entirely cured pericallosal aneurysm (RROC I) and reconstruction of the parent artery. Successful endovascular treatment of an iatrogenic pericallosal aneurysm was previously reported, and this method seems to be the first-choice treatment. In our case, endovascular stent-assisted coiling also allowed for safe exclusion from circulation of pericallosal dissecting aneurysm, and the implanted stent caused reconstruction of the parent artery, restoring the normal lumen diameter. The second endovascular treatment option considered was implantation of a flow-diverted stent into the pericallosal artery.

Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis.

BACKGROUND: The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms. MATERIAL AND METHODS: Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted. RESULTS: A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%. CONCLUSIONS: The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.

Real-World Comparison of Human and Software Image Assessment in Acute Ischemic Stroke Patients' Qualification for Reperfusion Treatment.

Our aim was to compare human and computer accuracy in reading medical images of acute stroke patients. We analyzed data of patients who underwent assessment of Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion (CTP) via Rapid Processing of Perfusion and Diffusion (RAPID) software RAPID ASPECTS, and RAPID CTP), compared to radiologist reports and manual measurements. We compared volumes calculated by RAPID CTP software with those selected by scanner-equipped software (GE). For reference, follow-up images were manually assessed in accordance with the Alberta Stroke Program Early CT Score (ASPECTS) territories retrospectively. Although exact ASPECTS score agreement between the automatic and manual methods, and between each method and follow-up, was poor, crossing of the threshold for reperfusion therapy was characterized by an 80% match. CT perfusion analyses yielded only slight agreement (kappa = 0.193) in the qualification of patients for therapy. Either automatic or manual scoring methods of non-contrast images imply similar clinical decisions in real-world circumstances. However, volume measurements performed by fully automatic and manually assisted systems are not comparable. Thresholds devised and validated for computer algorithms are not compatible with measurements performed manually using other software and should not be applied to setups other than those with which they were developed.

Ineffective endovascular treatment of a giant internal carotid artery aneurysm.

PURPOSE: Despite a growing range of therapeutic possibilities, including various intravascular methods, treating cerebral aneurysms can be still a therapeutic challenge. A growing number of patients previously treated with older techniques require additional therapy. Treatment options as well as their efficiency may be influenced by previous procedures. CASE REPORT: We report a rare case of a giant treatment-resistant aneurysm in a 65-year-old woman. The aneurysm was first diagnosed due to visual disturbances in the right eye. Computed tomography angiography showed large (20 × 18 mm) wide neck aneurysm of the right internal carotid artery. The patient was subsequently treated with several methods including coiling with regular stent implantation, two flow diverter stent implantations, and hybrid neurosurgery. Full occlusion was not achieved after any of those procedures. After the last procedure (hybrid neurosurgery) the patient, in vegetative state, was transferred to the intensive care unit and then to the Health and Care Centre. CONCLUSIONS: Discussion focuses on endovascular treatment options after failure of previous treatment such as "stent in stent" technique. We conclude that three subsequent stent implantations are technically possible; however, subsequent procedures are associated with technical difficulties and their effectiveness is questionable. Ventriculoperitoneal shunt may influence the outcome of flow diversion therapy.

Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development.

OBJECTIVES: We analysed tortuosity of basilar artery (BA) to determine its relationship with the presence of aneurysm. METHODS: We retrospectively analysed 71 patients with BA aneurysms along with 71 age- and risk factors-matched control patients without BA aneurysm. From patients' medical records, we obtained their history including previous and current diseases and medications. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD) and inflexion count metrics (ICM). We used t-test and Mann-Whitney U test for continuous variables and χ2 test for dichotomised variables. To find independent predictors of BA aneurysm, we employed logistic regression analysis. RESULTS: We found significant positive correlation between age and SOAM (R = 0.195, p = 0.02) and PAD (R = 0.199, p = 0.018). Our study also showed that patients with BA aneurysm had significantly higher SOAM (0.21 ± 0.16 vs. 0.11 ± 0.08; p < 0.01), PAD (0.30 ± 0.19 vs. 0.18 ± 0.11; p < 0.01), TI (0.23 ± 0.23 vs. 0.10 ± 0.16; p < 0.01) and ICM (0.20 ± 0.16 vs. 0.15 ± 0.11; p = 0.045). In multivariate logistic regression analysis, after adjustment for all possible confounders, SOAM (OR = 1.086; 95% CI 1.046-1.136; p < 0.01) and TI (OR = 1.004; 95%C: 1.002-1.006; p < 0.01) remained independently associated with higher risk of BA aneurysm. CONCLUSIONS: Increased tortuosity of BA is associated with higher risk of its aneurysm development. KEY POINTS: • Basilar artery sum of angle metrics and product of angle distance are correlated with age. • Basilar artery tortuosity is independently associated with higher risk of its aneurysm development. • Basilar artery tortuosity is positively correlated with its diameter and bifurcation angle.

Fasting Hyperglycemia and Long-term Outcome in Patients with Acute Ischemic Stroke Treated with Mechanical Thrombectomy.

BACKGROUND: Little is known about the prognostic role of fasting glucose after mechanical thrombectomy (MT). AIMS: We investigated whether fasting glucose on the next day after MT was associated with long-term outcome in acute ischemic stroke patients according to diabetes. METHODS: We retrospectively analyzed 181 consecutive patients with acute anterior circulation ischemic stroke who underwent MT in 2 comprehensive stroke centers in Poland. Glucose levels were evaluated on admission and on the next day after MT. Fasting hyperglycemia (FHG) was defined as the glucose level above 5.5 mmol/L. Unfavorable outcome was defined as modified Rankin scale (mRS) of 3-6 at day 90 from stroke onset. RESULTS: Patients with FHG had higher mRS at 3-month follow-up compared with those without FHG (3.71 ± 2.56 versus 1.87 ± 2.22, P < .001). In the subgroup analyses, FHG was associated with poor neurological outcome in the group without diabetes (3.74 ± 2.52 versus 1.81 ± 3.74, P < .001) but not with diabetes (3.64 ± 2.67 versus 2.30 ± 3.74, P= .11). Patients without diabetes who had FHG were older, had higher glucose on admission, higher prevalence of atrial fibrillation, cardioembolic stroke etiology and bleeding brain complications compared with the group with normal fasting glucose. After adjustment for potential confounders, fasting glucose (odds ratio [OR] 1.46; 95% CI 1.19-1.79, P < .001), age (OR 1.06; 95% CI 1.02-1.10, P = .001), successful reperfusion (OR 0.09; 95% CI 0.04-0.22, P < .001) and baseline NIHSS score (OR 1.18; 95% CI 1.08-1.29, P < .001) were predictors of mRS 3-6 at 3-month follow-up in the whole group. In the subgroup without diabetes, fasting glucose (OR 1.57; 95% CI 1.17-2.11, P = .002), age (OR 1.05; 95% CI 1.01-1.08, P = .008), successful reperfusion (OR 0.11; 95% CI 0.04-0.30, P < .001) and baseline NIHSS score (OR 1.14; 95% CI 1.04-1.26, P = .011) were independent predictors of unfavorable 3-month outcome. CONCLUSIONS: Fasting glucose on the next day after MT in patients with acute ischemic stroke is an independent risk factor for worse 3-month outcome.

Coexistence of posterior cerebral circulation anatomical variations and basilar artery aneurysms: Case-control study.

B a c k g r o u n d: The anatomy of arteries supplying blood to the brain often varies among the population. It applies particularly to posterior cerebral circulation. The impact of its anatomy variabilities on the formation of intracranial aneurysms has not been determined yet. The aim was to find out if posterior cerebral circulation anatomy variations coexist with basilar artery aneurysms (BAAs). We retrospectively analyzed 27 patients with BAA and a group of 30 patients matched by gender and age but without BAA. In both groups together most (66.67%) of patients were female and the average age was 59.75 ± 10.91. All of the patients had Computed Tomography performed. We assessed the occurrence of BAA, basilar artery (BA) diameter, vertebral artery (VA) diameter, posterior cerebral artery (PCA) diameter, and if patients had hypoplastic VA or PCA. Results: The presence of right VA hypoplasia significantly increased the risk of BAA occurrence (48.15% vs. 16.67%; p = 0.011). The occurrence of hypoplastic VA on either side was significantly associated with the risk of BAA formation (59.26% vs. 26.67%; p = 0.013). Patients with BAA had slightly larger left PCA diameter 1cm after division (1.96 ± 0.51 vs. 1.64 ± 0.42; p = 0.014) in comparison to those without BAA. Additionally, hypoplastic right PCA occurred more often in patients with BAA (22.22% vs. 0%; p = 0.022). Conclusions: We can conclude that the anatomy of PCA and VA affects the occurrence of BAA. Hypoplastic VA, the presence of wider left PCA and hypoplastic right PCA may be factors that coexist with BAA occurrence.

Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome.

INTRODUCTION: The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear. AIM: Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke. MATERIAL AND METHODS: We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality. RESULTS: We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures. CONCLUSIONS: In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.

Endovascular treatment of middle cerebral artery aneurysms - single-centre results.

PURPOSE: The middle cerebral artery (MCA) is the second most common location of intracerebral aneurysms. Traditionally, they are treated by microsurgical clipping, but with the development of new techniques and devices endovascular embolisation is gaining more importance. The aim of this study was to summarise six years of experience of our department in endovascular treatment of MCA aneurysms. MATERIAL AND METHODS: Forty patients with 41 MCA aneurysms treated in a single centre were included in this study. Data on patients' comorbidities, aneurysm morphology, and treatment course were collected, with special emphasis on complications. RESULTS: There were no statistically significant differences in terms of aneurysm morphology between males and females and between ruptured and unruptured aneurysms. None of the diseases analysed in the current study were linked with significantly increased risk of SAH. Unruptured aneurysms were significantly more frequently treated by stent-assisted coiling (30.4% vs. 5.6%, p = 0.0388) than were ruptured aneurysms, while ruptured aneurysms were treated more frequently by coiling alone (77.8% vs. 34.8%, p = 0.0062). After an initial course of treatment 63.4% (n = 26) of patients had class I in Raymond-Roy occlusion classification, 22% (n = 9) had class II, and 14.6% (n = 6) had class III. Complications of the procedure were observed in 17.5% (n = 7) of patients: 22.2% (n = 4) with ruptured and 13.6% (n = 3) with unruptured aneurysms. CONCLUSIONS: Endovascular treatment of MCA aneurysms is feasible, and our results are convergent with other studies. Ruptured MCA aneurysms may be treated endovascularly with similar effects as unruptured MCA aneurysms. The complication rate of such treatment is low.

Endovascular management of carotid and vertebral artery dissections with new generation double-mesh stent and protection systems - single-center early and midterm results.

INTRODUCTION: Symptomatic dissections (SD) of cervical arteries are still a therapeutic problem. Although endovascular management (EM) is currently a preferred method of treatment of SD, complications associated with this method of treatment in published reports are quite frequent (3-16%). AIM: In this retrospective study we analyzed the results of EM with novel, double-mesh stent and protection systems (PS) for SD of the internal carotid (IC) or vertebral arteries (VA) that coexisted with hemodynamically significant stenosis or aneurysmatic dilatation of the dissected artery. MATERIAL AND METHODS: We evaluated the results of EM in 19 patients (men 15, median age: 55, range: 25-83), presenting with SD of the IC or VA with coexisting stenosis and/or aneurysmatic dilatation of the artery in segments C1-C5 of IC or V0-V4 of VA. Twelve patients had a stroke, 6 TIA, and 3 patients a headache and/or a neck pain with Horner syndrome. Stents and PS were tailored according to the location, length of dissection and coexisting stenotic or aneurysmatic lesions. RESULTS: There were no new strokes, in-hospital deaths or other serious morbidities during the procedure and postprocedural hospital stay. There were no fatalities during 6-40 months of follow-up. In control angiographies performed after interventions all patients demonstrated a patent target artery, complete coverage of the dissection and aneurysm by stents and no new lesions in the area of the previous dissection. CONCLUSIONS: The results of this study indicate that EM of SD of IC and VA with the new stents and PS is safe and effective with good early and midterm results.