[Optimization of secondary prevention in patients with high-risk atherothrombotic ischemic stroke or transient ischemic attacks]. / Optimizatsiya vtorichnoi profilaktiki serdechno-sosudistykh sobytii u patsientov s aterotromboticheskim ishemicheskim insul'tom ili tranzitornymi ishemicheskimi atakami vysokogo riska.

High and very high risk atherothrombotic ischemic stroke (ATIS) includes patients with severe extracranial atherosclerosis, any intracranial atherosclerosis, and aortic arch atheromatosis. The article discusses the most effective approaches to medical short- and long-term secondary prevention of ATIS, major vascular events and death, based on the results of modern research and current clinical guidelines. Clinical studies of recent years have proven the possibility of individualization and intensification of secondary prevention of ATIS. In the treatment of high-risk patients, it is advisable to use more widely short-term dual antiplatelet therapy (combination of ASA with clopidogrel or ticagrelor), long-term dual antithrombotic therapy (combination of ASA and rivaroxaban at a dose of 2.5 mg twice a day not earlier than 30 days from the development of stroke or TIA) to reduce the risk of recurrent stroke and death, as well as intensive lipid-lowering therapy (including the use of a combination of statins and ezetimibe or PCSK9 inhibitors).

[Ischemic stroke associated with patent foramen ovale: hospital database analysis]. / Ishemicheskii insul't, assotsiirovannyi s otkrytym oval'nym oknom: analiz dannykh gospital'nykh registrov.

OBJECTIVE: To analyze clinical and instrumental characteristics of patients with ischemic stroke (IS) due to paradoxical embolism according to the data of hospital registers of Moscow and Perm. MATERIAL AND METHODS: A comprehensive study of 114 patients, aged 18 to 55 years, with IS by the mechanism of paradoxical embolism was carried out. All patients underwent clarification of the cause of IS (electrocardiography, ultrasound scanning of the brachiocephalic arteries, CT or MRI of the brain, CT or MR angiography, transthoracic and/or transesophageal echocardiography). The presence of right-left shunt blood flow (RLS) was confirmed by transcranial dopplerography with a bubble test. The clinical significance of patent foramen ovale (PFO) was assessed according to The PFO-Associated Stroke Causal Likelihood Classification System (PASCAL). RESULTS: Clinical and instrumental characteristics of patients with IS due to paradoxical embolism were obtained from two hospital registries. In both groups, the leading trigger for the development of IS was the Valsalva phenomen (>20%), the share of other provoking factors did not exceed 10%. Significant differences between the analyzed groups related to the ultrasonic characteristics of RLS/PFO: patients with a grade 4 shunt predominated in the Research Center of Neurology (RCN) population, while patients with a grade 3 shunt predominated in the City Clinical Hospital (CCH) №4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH №4 group. In accordance with the PASCAL classification, in 93% of RCN patients, PFO can be considered as a probable cause of IS, while in the CCH No. 4 group, a probable causal relationship was traced only in 51% of cases, in 18% of patients, the role of an anomaly in the development of stroke was unlikely. CONCLUSION: The analysis showed that the primary screening of RLS in a regional vascular center allows classifying PFO as a probable cause of IS in only half of the patients. For a more accurate selection of patients for whom endovascular occlusion of the PFO will be most effective, an in-depth examination in a specialized hospital is recommended.

[The experience of using thrombolysis in patients with acute disturbances of cerebral circulation: efficacy, safety, predictors of outcome and hemorrhagic transformation]. / Opyt provedeniia tromboliticheskoi terapii u bol'nykh s ostrymi narusheniiami mozgovogo krovoobrashcheniia: éffektivnost', bezopasnost', prediktory iskhoda i gemorragicheskoi transformatsii.

AIM: To evaluate neurological and functional outcomes of early stage of ischemic stroke, their determining factors and predictors of hemorrhagic transformation in patients who received thrombolysis. MATERIAL AND METHODS: A retrospective analysis of 147 patients, who underwent thrombolysis, and 127 patients, matched for basic parameters, who did not receive thrombolysis, was performed. Anamnesis, results of clinical examination, a spectrum of laboratory-instrumental parameters were evaluated. Functional status was assessed at discharge from the hospital using the Rivermead mobility index and the modified Rankin scale. Along with standard computed tomography (CT) at admission and after 24h, 73 patients receiving thrombolysis underwent CT-perfusion examination. RESULTS: The insufficient number of patients (37%) are admitted to a hospital in the first 2 h after stroke. The high prevalence of cardioembolic stroke and aphasia disorders in patients treated with thrombolysis was identified compared to the control group. CT revealed acute cerebral infarction in 14% of patients admitted within 2h. CT-perfusion examination determined brain ischemia only in half of patients. There was a low prevalence of symptom hemorrhagic transformation (0.7%). Thrombolysis was correlated with the higher rate of good functional outcomes of acute stroke, reduced neurological deficit, better mobility at discharge and shorter duration of the first rehabilitation period. Age, smoking, Rankin scale score at baseline, acute infarction on the primary CT, pathogenetic variant of stroke, myocardial hypertrophy, atherosclerosis of carotid arteries and volume of MRI lesions were the main factors associated with the efficacy of thrombolysis. The main predictors of hemorrhagic transformation were the severity of stroke, glomerular filtration rate, atrial fibrillation, treatment with antiaggregants before admission and hemispheric stroke. CONCLUSION: The analysis has demonstrated the safety and efficacy of thrombolysis in ischemic stroke in real clinical practice of a regional Vascular center.

[Characteristics of ischemic stroke according to hospital register data: a role of neuroreparative therapy].

AIM: To study characteristics of the acute stage of ischemic stroke (IS) basing on the data of a hospital register of the Perm Regional vascular center and to assess the efficacy and safety of the drug cellex in patients with IS. MATERIAL AND METHODS: Authors have analyzed the group of 128 patients with MRI-confirmed acute ischemic lesion. The subgroup of 40 patients, which beside the basic therapy received cellex in dose of 0.1 mg during 10 days, was randomized. RESULTS: The following data were analyzed: gender and age, prevalence of risk factors, primary prevention, time before admission, clinical presentations, results of instrumental diagnostic methods, pathogenic structure of stroke, use of intravenous thrombolysis, regimens of secondary prevention, functional outcome and its predictors. CONCLUSION: The group of patients was characterized by the high prevalence of risk factors, insufficient primary prevention, prolonged time before the admission, low rate of thrombolysis use and significant prevalence of large artery disease associated with stroke. The main independent predictors of low mobility level at discharge were severe neurological deficit on admission, cognitive impairment and age. Patients treated with cellex were characterized by the lower level of neurologic deficit, higher mobility and better global cognitive status in comparison with controls.