Middle cerebral artery flow after angioplasty and stenting of symptomatic internal carotid artery stenosis.

BACKGROUND AND PURPOSE: Improved haemodynamics in the middle cerebral arteries (MCAs) after carotid artery endaterectomy (CEA) has been demonstrated in a number of studies, whereas similar analyses on carotid angioplasty and stenting (CAS) remain insignificant. The purpose of the study was to test whether CAS affects haemodynamic parameters of MCA ipsilaterally and contralaterally to the side of the procedure in patients with symptomatic internal carotid artery (ICA) stenosis, assessed by transcranial Doppler (TCD) examination. MATERIAL AND METHODS: Carotid angioplasty and stenting was performed in 51 patients (39 men and 12 women) aged 45-86 (mean age: men 65.5 years, women 69 years) after first ever ischaemic stroke. Patients were divided into three groups: with CAS of the left stenotic ICA - group I, with CAS of the right stenotic ICA - group II and group III with CAS of the left stenotic ICA and right ICA occlusion. RESULTS: Increase of MCAs flow after CAS was recorded both in ipsilateral MCAs and contralateral MCAs. Although an increase of MCAs flow was observed, it was not significant in either MCAs of group I and II patients, or in ipsilateral MCAs of individuals in group III. An evident increase of blood flow after CAS occurred in cMCAs of group III individuals. Similar results were received with reference to Gosling's pulsatility index. CONCLUSIONS: Carotid angioplasty and stenting improves blood flow in both the ipsilateral and contralateral middle cerebral artery in patients with symptomatic carotid artery stenosis. Carotid angioplasty and stenting seems to be more effective in patients with symptomatic carotid artery stenosis combined with contralateral carotid artery occlusion than in individuals with symptomatic carotid artery stenosis alone.

Differences in the course of acute phase of spontaneous intracerebral haemorrhage in the elderly.

BACKGROUND AND PURPOSE: The aim of this study was to examine the correlation between age and clinical course of spontaneous intracerebral haemorrhage (SICH) in its acute phase (within 30 days), including severity of neurological deficit, characteristics and frequency of medical complications as well as 30-day mortality. We also attempted to determine independent predictors of early mortality. MATERIAL AND METHODS: This study comprised 153 patients with SICH admitted within 24 hours after SICH onset who were treated pharmacologically and had complete clinical data. The analysis concerned the correlation between age and neurological deficit on admission and on discharge, assessed with NIHSS score; the types and the frequency of general complications that occurred in the acute phase of SICH; characteristics of head CT images; early mortality; and survival time. Multiple logistic regression analysis was used to determine independent predictors of early mortality. RESULTS: Age of patients correlated with NIHSS score on admission (p = 0.000003) and on discharge (p = 0.02); 35.2% of patients developed medical complications, presumably infectious ones, and the age of patients who developed complications was significantly higher (p = 0.004). Patients who died (21.5%) were significantly older (p = 0.0001). Predictors of death were: age (OR 1.1, 95% CI 1.02-1.19, p = 0.002) and severity of neurological deficit on admission (OR 1.3, 95% CI 1.1-1.6, p < 0.001). CONCLUSIONS: In elderly patients with SICH, the neurological deficit and risk of medical complications are more evident. Greater neurological deficit in these patients may result from coincidence of SICH with earlier brain lesions. Age and greater neurological deficit on admission constitute predictors of early mortality in elderly patients with SICH.

Patients' and bystanders' awareness of stroke and pre-hospital delay after stroke onset: perspectives for thrombolysis in West Pomerania Province, Poland.

OBJECTIVE: Thrombolysis is a time-dependent therapy. It is therefore very important how fast stroke patients can reach hospital. The present study was designed to assess which proportion of patients with stroke (from the population of Szczecin, the capital of West Pomerania Province, Poland) reaches hospital within the recommended time from the thrombolytic therapy point of view. The purpose of our study was also to elucidate which factors can influence the time before the ambulance service is called. PATIENTS AND METHODS: The study involved 1,015 patients with stroke admitted to the Emergency Department of the University Hospital, Szczecin. RESULTS: 235 patients (23.1%) were admitted to the hospital within the appropriate period for thrombolytic therapy. Hospital arrival time was significantly earlier in older patients and in patients with severer neurological deficits. We also observed a tendency for faster hospitalization of women, the highly educated, and patients regularly using antiplatelet drugs for cardiovascular disease prevention. CONCLUSIONS: The percentage of stroke patients hospitalized within 2 h after stroke onset should be increased. The most susceptible subpopulations in our country seem to be older patients, the highly educated and patients regularly using antiplatelet drugs for cardiovascular disease prevention.

Circulation monitoring in anterior cerebral arteries in hypertensive patients with ischemic stroke, without hemodynamically significant stenosis in extracranial arteries.

INTRODUCTION: The current project was aimed at elucidating whether blood pressure fluctuations in hypertensive patients with ischemic stroke, not characterized by hemodynamically significant stenosis in carotid arteries and proximal segments of intracranial arteries lead to circulation disturbances in anterior cerebral arteries (ACAs) as visualized by transcranial Doppler ultrasound (TCD). MATERIAL AND METHODS: Sixty two hypertensive patients with the first ever ischemic stroke were included in the study with the average age of 65.16 +/- 11.52 years. Systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure values were analyzed. The following parameters were calculated based on the obtained blood flow velocity spectra: mean velocity (Vmean), pulsatility index (PI) and resistance index (RI). RESULTS: A significant decrease of SBP, DBP and MBP occurred between the first and second day of observation, and no correlation between a reduction in arterial pressure and ACAs blood flow parameters was observed. CONCLUSIONS: In hypertensive patients with ischemic stroke, not characterized by hemodynamically significant stenosis within carotid arteries and proximal segments of anterior cerebral arteries, fluctuations of arterial blood pressure do not cause substantial disturbances of circulation in the ACAs, as visualized by TCD.

An approach of patients with ischemic stroke to primary and secondary stroke prevention in Poland.

INTRODUCTION: The stroke mortality rate in the Polish population is significantly higher than the average stroke mortality in Western Europe. It may prove a poor "initial" health condition of the Polish population which is afflicted with many life-threatening diseases which are at the same time the major risk factors for both: first ever and recurrent stroke. The aim of our study was to evaluate what is an attitude of Polish people with first-ever or recurrent stroke to keeping under control the most important risk factors for ischemic stroke. MATERIAL AND METHODS: 1282 consecutive patients with ischemic stroke were examined and categorized as individuals with first ever (group I - 980 patients) and recurrent stroke (group II - 302 patients). The data on the patients' previous history of stroke and vascular modifiable risk factors diagnosed before the onset of stroke: arterial hypertension (AH), type 2 diabetes mellitus (DM), ischemic heart disease (IHD), atrial fibrillation (AF), cigarette smoking and alcohol consumption were determined. The treatment with antiplatelet agents or oral anticoagulants was also taken into account. RESULTS: More than one-third ofpatients, irrespective of group admitted that they had treated AH unsystematically or not treated at all. Based on initial blood pressure, it may be suspected, that also individuals declaring systematic AH treatment, did not do it effectively. It also concerned the type 2 DM - glycemic control remained unsatisfactory within the period preceding first-ever and recurrent stroke. After first stroke, the patients haven't changed their habits considering tobacco smoking and alcohol consumption. The anticoagulants were used relatively seldom in relation to recommendations in both group of patients. CONCLUSIONS: The main risk factors for ischemic stroke are poorly controlled by Polish patients before first ever stroke. After the first cerebrovascular event they usually don't change their habits, which lead to recurrent stroke. In Poland the educational strategies regarding repetitive public information on benefits resulting from stroke prevention and fatal stroke consequences should be centered around the general public and the groupof high-risk patients.