Renal Dysfunction Increases Risk of Adverse Cardiovascular Events in 5-Year Follow-Up Study of Intermediate Coronary Artery Lesions.

BACKGROUND Progression of chronic coronary syndrome (CCS) is influenced by chronic kidney disease (CKD). This 5-year follow-up study aimed to assess 100 patients with 118 intermediate coronary artery lesions evaluated by fractional flow reserve (FFR) and intravascular imaging stratified according to renal function. MATERIAL AND METHODS This prospective study enrolled patients with intermediate coronary stenosis identified by coronary angiogram. Patients with severe renal dysfunction (estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m²) were excluded from the study. The remaining were divided into 2 groups according to eGFR: 45-60 ml/min/1.73 m² for mild-to-moderate renal dysfunction and >60 ml/min/1.73 m² for no renal dysfunction. We analyzed intermediate-grade stenoses (40-80% as assessed in coronary angiography) with the use of optical coherence tomography (OCT), FFR, and intravascular ultrasound (IVUS). RESULTS Renal dysfunction patients were older (67.7±8.1 vs 63.6±9.7 years, P=0.044). Lesion characteristics, including plaque type and minimal lumen area in OCT, showed no significant differences between the renal dysfunction and no renal dysfunction groups. Thin-cap fibroatheroma, calcific plaques, lipidic plaques, and fibrous plaques had similar prevalence. FFR values and IVUS parameters did not significantly differ between the groups. Over a 5-year follow-up, individuals with mild-to-moderate renal dysfunction had an elevated risk of all-cause mortality and major adverse cardiovascular events in multivariate analyses adjusted for age and sex. CONCLUSIONS Mild-to-moderate renal dysfunction was not associated with significant differences in OCT- and IVUS-derived plaque morphology nor with functional indices characterizing intermediate-grade coronary stenoses. Renal dysfunction was related to a higher risk of all-cause mortality and major adverse cardiovascular events prevalence in 5-year follow-up.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

INTRODUCTION: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. MATERIAL AND METHODS: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. RESULTS: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. CONCLUSIONS: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

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.

Acute ischemic stroke in a third trimester of pregnancy - cesarean section followed by mechanical thrombectomy.

Background: Acute ischemic stroke (AIS) in pregnancy, despite being a rare event, poses a serious risk for mother's and child's health. There are no strict treatment guidelines in this group of patients, with safety and efficacy of intravenous recombinant tissue-plasminogen-activator (rtPA) and mechanical thrombectomy (MT) being uncertain.Case Presentation: We present a case of gravid 27-year-old patient with left middle cerebral artery (MCA) proximal occlusion causing AIS that was successfully treated with MT. Being in 35th gestational week, it was decided to perform caesarean section before endovascular treatment. The outcome of treatment was good, with no mother's neurological deficit and proper child development in the 5-year observation.Conclusions: MT is probably safe and efficient treatment method in selected pregnant women. No harmful effects on further pregnancy course and parturition have been observed to date.

Mild hyponatremia discovered within the first 24 hours of ischemic stroke is a risk factor for early post stroke mortality.

BACKGROUND: Comorbidities, complications and laboratory abnormalities are common in stroke patients. One of the common problems is hyponatremia (serum sodium (Na) level <135 mmol/L), but the relationship between hyponatremia and the prognosis in patients with stroke is not well understood. OBJECTIVES: The aim of this study was to investigate the prevalence and severity of hyponatremia, as well as its impact on prognosis in stroke patients on admission to hospital. MATERIAL AND METHODS: The study involved the analysis of the first measurement of the Na level after the admission and its correlations with comorbidities, the scale of clinical assessment of stroke severity (NIHSS), the size and location of the stroke, and mortality. A retrospective study was conducted on 502 patients (among them 263 women) admitted to the hospital on stroke onset (440 ischemic stroke (IS) and 62 hemorrhagic stroke (HS) patients). The post-stroke mortality was defined as early if death occurred within 30 days. RESULTS: Hyponatremia was found in 18.4% of patients with IS and 25.8% of patients with HS, irrespective of age and gender. Hyponatremia is an independent prognostic factor of mortality in people with IS (p = 0.003). Na levels were lower in IS patients who died than in those who remained alive (134.8 ±4.99 mmol/L vs 136.6 ±3.01 mmol/L; p = 0.02). Higher mortality rate was observed among IS patients under 75 years of age and Na level ≤132 mmol/L. In patients with IS, hyponatremia correlates with NIHSS (p = 0.005) and the size and location of the stroke (p = 0.002). CONCLUSIONS: Hyponatremia is more frequently observed in patients with HS than IS. Mild hyponatremia is already known to be an independent prognostic factor in the mortality of people with IS and it may also have value as a prognostic factor in the mortality of the IS population. In a patient with a suspected stroke, there is a need to control electrolyte levels at the onset of the stroke, especially in patients with comorbidities, irrespective of age.

Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center.

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center. METHODS: We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016). Among subjects confirmed with LVO: time-to-presentation, premorbid functional and on-admission neurological state, site of occlusion and initial imaging data were further assessed. Two sets of criteria based on recent trials and recommendations were used to determine MT eligibility. The onset-to-evaluation time limit was set to 5h allowing ≤60min procedure initiation delay. RESULTS: 895 patients with the final diagnosis of AIS were admitted to our stroke center as the initial treatment facility. 246 (27.5%) presented within 5h of symptom onset and had non-invasive imaging performed. Among those 102 (41.5%) had causative LVO. The number of ≤5h presenting patients eligible for MT was 51 (20.7%) when applying restrictive or 80 (32.5%) with more permissive criteria. CONCLUSION: Among AIS patients, in whom onset-to-arrival time allowed to initiate the endovascular procedure within 6h of symptom duration, 21% were eligible for MT treatment according to more and 33% to less restrictive criteria. It accounts for about 6% and 9% of all AIS cases, respectively.

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.

Single-center experience of stent retriever thrombectomy in acute ischemic stroke.

BACKGROUND AND PURPOSE: Recently, positive data from several randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke (AIS) has emerged. The aim of this retrospective study is to present our clinical experience in cerebral vessel occlusion treatment using retrievable intracranial stents. METHODS: Forty-three consecutive patients with ischemic stroke (median age 75, range 22-87) treated by stent retriever thrombectomy (Solitaire™ FR) between January 2013 and December 2015 were identified. We retrospectively assessed Thrombolysis in Cerebral Infarction (TICI) scale (2b-3 considered as successful recanalization), clinical outcome using modified Rankin scale (mRs) at 3 months (regarding score 0-2 as good clinical outcome), device-related complications and symptomatic intracranial hemorrhage (sICH; parenchymal hematoma Type 1 or 2 and National Institutes of Health Stroke Scale [NIHSS] score increment ≥4 points) rate. RESULTS: The mean NIHSS score on admission was 16.4 (median 16). The mean time from onset to groin puncture (time to treatment) was 290min (median 254min). Successful recanalization was achieved in 30 (69.8%) cases. The mean time from onset to successful reperfusion or procedure termination (time to reperfusion) was 394min (median 375min). Good outcome was observed in 17 (39.5%) patients and mortality was 27.9% (n=12). We found 2 (4,7%) sICHs, one (2,3%) thromboembolic event in different vascular territory and one (2,3%) groin hematoma. CONCLUSION: Stent retriever thrombectomy for the treatment of ischemic stroke is safe, provides high rate of recanalization and good clinical outcomes in the setting of large vessel occlusion.