Background and Objectives: Thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) is used to treat acute ischemic stroke. Dabigatran is a reversible thrombin inhibitor approved for stroke prevention in patients with nonvalvular atrial fibrillation. In such cases, thrombolytic therapy can be administered to certain patients after idarucizumab treatment. We evaluated the effectiveness of idarucizumab in dabigatran-treated patients receiving rt-PA. Materials and Methods: We included the data of nine idarucizumab-treated patients from the Riga East University Hospital Stroke Registry from 2018 to 2022 in our retrospective medical records analysis. We used the National Institutes of Health Stroke Scale (LV-NIHSS) score and modified Rankin scale (mRS) on admission and discharge to evaluate neurological deficit and functional outcomes. Results: We analyzed the data of nine patients (seven males and two females) with a mean age of 75.67 ± 8.59 years. The median door-to-needle time for all patients, including those who received idarucizumab before rt-PA, was 51 min (IQR = 43–133); the median LV-NIHSS score was 9 (IQR = 6.0–16.0) on admission and 4 (IQR = 2.5–4.0) at discharge; and the intrahospital mortality rate was 11.1% due to intracranial hemorrhage as a complication of rt-PA. Conclusions: Our study shows that idarucizumab as an antidote of dabigatran appears to be effective and safe in patients with acute ischemic stroke. Furthermore, the administration of idarucizumab slightly prolongs the door-to-needle time; however, the majority of cases showed clinical improvement after receiving therapy. Further randomized controlled trials should be performed to evaluate the safety and effectiveness of idarucizumab for acute ischemic stroke treatment.

Background and Objectives: A hospital-based stroke registry is a useful tool for systematic analyses of the epidemiology, clinical characteristics, and natural course of stroke. Analyses of stroke registry data can provide information that can be used by health services to improve the quality of care for patients with this disease. Materials and Methods: Data were collected from the Riga East University Hospital (REUH) Stroke Registry in order to evaluate the etiology, risk factors, clinical manifestations, treatment, functional outcomes, and other relevant data for acute stroke during the period 2016–2020. Results: During a five-year period, 4915 patients (3039 females and 1876 males) with acute stroke were registered in the REUH Stroke Registry. The causative factors of stroke were cardioembolism (45.7%), atherosclerosis (29.9%), lacunar stroke (5.3%), stroke of undetermined etiology (1.2%), and stroke of other determined causes (1.2%). The most frequent localizations of intracerebral hemorrhage were subcortical (40.0%), lobar (18.9%), and brainstem (9.3%). The most prevalent risk factors for stroke were hypertension (88.8%), congestive heart failure (71.2%), dyslipidemia (46.7%), and atrial fibrillation (44.2%). In addition, 1018 (20.7%) patients were receiving antiplatelet drugs, 574 (11.7%) were taking statins, and 382 (7.7%) were taking anticoagulants. At discharge, 35.5% of the patients were completely independent (mRS (modified Rankin Scale) score: 0–2), while 49.5% required some form of assistance (mRS score: 3–5). The intrahospital mortality rate was 13.7%, although it was higher in the hemorrhage group (30.9%). Conclusions: Our stroke registry data are comparable to those of other major registries. Analysis of stroke registry data is important for improving stroke care and obtaining additional information for stroke studies.

The Significance of the Ultrasound Parameters of Carotid Artery Atherosclerosis in Neuroangiosurgical Practice Introduction. Atherosclerosis of the extracranial part of the cerebral arteries is a major pathogenetic risk factor of cerebral infarction (CI) and transitory ischemic attacks (TIA). An ischemic stroke is one of the leading causes of death and long-term disability in many developed countries and is a condition that becomes more prevalent with age. Aim of the study. To define the diagnostic implications of the US examinations of the extracranial part of the carotid arteries in respect of neurological practice and taking into consideration the age, gender and the localisation of the ischemic damage of patients with atherothrombotic MCA infarction. Materials and methods. 540 patients treated in the Stroke Unit of Gailezers University Clinic who were diagnosed as having a first MCA infarction of atherothrombotic genesis in the acute phase were examined. The patients were 36 to 91 and were divided into 6 age groups. The group of patients examined comprised of 267 people - 49.4%- females and 273 - 50.6% - males. US examinations of the carotid arteries were performed with a high resolution Philips iU22 ultrasonographic device with a multifrequency linear probe of 3.0 to 9.0 MHz. Results. The ultrasonologic parameters of the carotid artery atherosclerosis in patients with first atherothrombotic infarction of MCA revealed that 70.8% were aged between 60 to 79. This indicated that the risk of atherotrombotic MCA infarction was highest in this age group and this needs to be taken into account in angiosurgical practice. The largest number of women - 50.6% - with an MCA infarction were in the 70 to 79 age group but the largest number of men - 41.0% were found in the 60 to 69 age group. In patients with a first MCA infarction stable carotid artery plaques with lumen stenosis of less than 50% in the age group below 59 were found in 47.2% of cases among other parameters, i.e. 7.4% more frequently than in the age group from 60 to 79 (p<0.1) and 11.8% more than in the age group above 79 (p<0.05). The frequency of carotid artery extracranial segment stenosis of less than 50% did not differ significantly in different age groups and was 12.6% on average. Occlusion as a delayed pathogenetic risk factor of atherotrombotic infarction was observed in 62 - 11.5% - of patients. In a large number of patients, 34.3% on average, unstable plaques with an uneven surface, ruptures, craters, wall thrombosis and with hemorrhages were found less frequently. This frequency increased significantly with age. There was frequent evidence of the localization of carotid artery atherosclerotic lesions in relation to the locality of CI to be bilateral as well as heterolateral. Conclusion. To diagnose atherosclerotic lesions of the carotid artery and to confirm indications of surgical and pharmaceutical therapy more statistically significant information needs to be obtained through specialized neuroangio-US examinations.