Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020. Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively. Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016. Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.
This case report aims to demonstrate the clinical significance of the left internal carotid artery (ICA) hypoplasia in a young woman who received a combined oral contraceptive (COC) and its association with arterial occlusion and the development of a lacunar stroke/lacunar cerebral infarct (LACI). Brain magnetic resonance imaging (MRI) of the left frontal lobe revealed multiple subcortical and periventricular amplification/ischemia foci (49.0×17.0 mm), and lacunar infarct loci (2.0×4.0 mm). Brain magnetic resonance angiography revealed a markedly narrowed lumen of the left ICA (2.0–3.0 mm). MRI diffusion-weighted imaging-fluid attenuated inversion recovery revealed a moderate diffuse wall thickening and reinforcement of the left ICA. The patient was diagnosed with LACI and congenital hypoplasia of the left ICA and underwent antiplatelet drug therapy (aspirin - 100 mg) and a complete withdrawal of COC. A full amelioration of neurological symptoms was observed after one month of treatment.
По специальной программе проведено эпидемиологическое исследование инсульта в Кыргызстане (г. Бишкек) методом регистра в 2015-2016 годах. Общее количество охваченного взрослого населения составило 567218 человек. Всего за два года зарегистрировано 3200 новых случаев острых нарушений мозгового кровообращения. Заболеваемость инсультом на 1000 населения составила 2,82, смертность – 1,18, летальность – 41,8%. Госпитализировано в стационар 42,4% заболевших, летальность при этом 25,7%, тогда как у получающих лечение дома 53,6%. Сделан вывод о необходимости проведения долгосрочного регистра для получения данных о динамике заболеваемости и оценки эффективности реформы программ оказания медико-социальной помощи больным.
The objective is to study morphometry of the restoration processes of the cerebral vascular bed in the progressive course of ischemic stroke. We studied the structure of the vessels and parenchyma of the brain of patients who died of ischemic stroke in the angio-neurological department of the National Hospital under the Ministry of Health of the Kyrgyz Republic. With a progressive course of ischemic stroke, brain vessel lesions are characterized by peculiar changes in the shape and contents of the vessels, different from the vessels surrounding the ischemic area, and tissues of the opposite hemisphere. The study showed that reparative processes appear early and are expressed by a change in the number of capillaries, angiogenesis and recalibration of existing vessels. With a progressive ischemic stroke, dystrophic processes prevail over the compensatory-adaptive reactions of the central nervous system, while the latter are insufficient to restore lost functions.
Целью настоящего исследование явилось изучение влияния стенозирующего и окклюзирующего процесса на формирование ишемического инсульта и особенности их клинического течения. Нами всего обследованы 633 больных в возрасте от 45 до 74 лет (средний возраст 61 лет). У 578 (91,4%) больных при первичном измерении были повышенное артериальное давление. У 219 (92,4%) из 237 умерших макроскопически на здоровой стороне были выявлены стенозирующие и окклюзирующие процессы вызывая хроническую ишемию и инфаркта мозга (ИМ). Указанные патологии и аномалии сосудов в “здоровом” полушарии выявлены в 198 (83,5%) случаях, т.е. по отношению пораженному полушарию в 5 раз чаще. Поэтому неврологические синдромы не всегда укладываются в рамки привычных, классических течений ИМ, т. е. наблюдался полиморфизм и прогрессирующее течение инсульта вплоть до тяжелой утраты функций органов и летального исхода.
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