First experience of international proctoring hands-on stroke course using Tegus telemedical system for overcoming education challenges during the war in Ukraine.

Interventional neuroradiology (INR) has not yet received official certification as a surgical subspecialty in Ukraine. Consequently, there is uncertainty surrounding the availability of a neurosurgical internship and a structured INR training program to provide neuroendovascular procedures. In recent years, mechanical thrombectomy has become the standard of care for acute ischemic stroke caused by large vessel occlusion, as supported by evidence-based guidelines. This emphasizes the need for INR specialists, which far exceeds the current supply. Although stroke centres with interventional neuroradiological facilities have been established to address this shortage in Ukraine, they lack highly skilled staff. Following the relaxation of COVID-19 migration restrictions, the Ukrainian medical system faced new limitations due to ongoing wartime conditions. In such circumstances, international cooperation becomes crucial to ensuring the safe and effective implementation of new technologies into routine medical practice. We successfully integrated teleproctoring into our hands-on course and found it to be an effective and promising approach, especially considering the uncertainty of the future and the presence of wartime migration restrictions in Ukraine. Teleproctoring hands-on course has the potential to provide young specialists with experienced mentors and valuable initial experience and can serve as a valuable adjunct for the improvement of surgeons confidence.

Simultaneous bilateral angioplasty and stenting for carotid stenosis - a single center experience.

Carotid artery stenosis is responsible for up to 12% of all ischemic strokes. The prevalence of bilateral carotid artery stenosis is nearly 8-39% among patients with stroke, and its management is still controversial. This study aimed to report the treatment results of bilateral carotid artery stenosis with simultaneous bilateral angioplasty and stenting (sbCAS) in a single institution during the last 10 years. 315 patients underwent carotid stenting in the Scientific-Practical Center of Endovascular Neuroradiology, NAMS of Ukraine during 2010-2020. 39 (12.4%) patients (mean age 57.9±2.1 - 28 men) underwent sbCAS. Primary clinical endpoints (stroke, myocardial infarction, or death) and secondary endpoints (hemodynamic depression (HD) - hypotension (<90 mmHg) or bradycardia (<60 bpm) and hyperperfusion syndrome (HPS) were evaluated. All sbCAS were technically successful, and a reduction of stenosis was noted in each case. There were two periprocedural neurological complications, one transient ischemic attack (TIA), and one minor stroke with the Modified Rankin Scale (mRS) - 3 at discharge. No myocardial infarction (MI) or death during hospitalization was noted. 28 patients (71.8%) had HD, and 2 (5.1%) had HPS. All patients except those with periprocedural stroke were discharged or transferred to another hospital without neurological deterioration. sbCAS is an effective and relatively safe procedure for carefully selected patients with bilateral carotid stenosis. Patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be assessed using a multidisciplinary approach taking into account the possibility of sbCAS.

Changes in cerebral hemodynamics in boxers with repeated traumatic brain injury.

There are currently insufficient study and analysis of changes in cerebral hemodynamics of boxers who have suffered repeated traumatic brain injury (TBI). To identify such changes, the most informative is the study of blood flow in the vessels of the neck and head using ultrasound duplex scanning (USDS) of the main vessels of the neck and transcranial duplex scanning (TCDS). AIM: The aim of study was to investigate the features of cerebral hemodynamics in boxers with repeated TBI. MATERIALS AND METHODS: A study of blood flow in the vessels of the neck and head was performed for 156 amateur boxers aged 16 to 42 years who had a history of repeated TBI. In the control group, 30 practically healthy people of a similar age were examined. Patients were analyzed by gender and the number of fights held. Obtained results were analyzed statistically. RESULTS: Boxers who have had a history of repeated TBI have hemodynamic disorders. They are characterized by an increase in the velocity of blood flow in extracranial vessels of the carotid basin and a decrease in the vessels of the vertebrobasilar basin with a change in the indicators of vascular resistance. For vessels of the intracranial section of the carotid basin, a decrease in blood flow velocity without changes in the indicators of vascular resistance was typical. Disorders of venous cerebral circulation was noted in most boxers, which was manifested by an increase in speed indicators in the internal jugular vein and veins of Rosenthal. CONCLUSIONS: The study of features of the cerebral hemodynamic in boxers with repeated TBI allows them to predict their competitive activity, correctly select the appropriate therapy and recommendations of the sports regime to prevent possible long-term consequences of injury.