Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.
Objective ‒ to determine the dependence of unfavourable treatment outcomes of spontaneous intracerebral hematomas (ICH) on the peculiarities of microstructural changes in the perihematomal area.Materials and methods. A prospective study was conducted that included 68 patients with haemorrhagic stroke and chronic arterial hypertension, as well as signs of ICH. Patients’ clinical condition and treatment outcomes were assessed. The brain data of five patients who died at different stages after the haemorrhagic stroke were analysed using the method of optical microscopy of autopsy material. Results. Patients’ age ranged from 38 to 59. At the time of hospitalization, the Glasgow Coma Scale score was 8 to 15. The inpatient period was less than 1 day for three patients with stem and medial ICH, and 10 and 34 days in case of subarachnoid haemorrhage (in the latter cater, there was an aneurism re-rapture 3 days before death). Blood in the ventricular system was observed in all patients. Gross examination data during the autopsy showed that the cortical layer above the affected area is thin; after 12‒24 hours, the perihematomal area is swollen, with small dotted, and sometimes coalesced haemorrhaging; after 3 and more days, it increased to 4–5 mm and turned reddish-brown. During histologic examination: brain tissue with signs of the swelling, perihematomal area is cell-like with nerve cells – ranging from minor changes to extreme dystrophia and coagulative necrosis (nuclei with signs of pyknosis, rhexis, lysis), homogenous eosinophilic cytoplasm, apparent pericellular swelling, cell shaft formed by lymphocytes, leukocytes, macrophages, hemosiderophages, and reactive increase in oligodendrocytes and astrocytes.Conclusions. Perihematomal area has been found to be not just a «perihematomal swelling» as described in the literature. The unfavourable course of the ICH of different localization (basal, stem) can be explained by a complex of pathomorphological changes in this area: reactive inflammatory activation of glia, dystrophic nerve cell changes, pericellular swelling. As seen from our observations, early development of these processes – as early as on the 1st day – and their progressing indicate the presence of common mechanisms of unfavourable outcome regardless of haemorrhagic stroke localisation.
Львівський національний медичний університет ім. Данила Галицького, 2 ДУ «Інститут нейрохірургії ім. акад. А.П. Ромоданова НАМН України», м. Київ Резюме. Проведено динамічне дослідження групи пацієнтів із тяжкою черепно-мозковою травмою, яких розподілили за різними ступенями наслідків: смерть, інвалідизація та одужання з оцінкою за шкалою ком Глазго та класифікацією Маршала. До чинників ризику, наявність яких у пацієнтів із тяжкою ЧМТ у подальшому може призвести до смерті, можна віднести-вік старше 40 років, відносно малий термін госпіталізації (у середньому 15 днів), середній бал ШКГ у межах вось-ми, стан коми-ІІІ чи коми-ІІ, відсутність рухів при надходженні чи будь-якої реакції на подразники, відсутність реакції обох зіниць на світло, наявність гіпоксії та евакуйованого об'ємного ушкодження. Ключові слова: черепно-мозкова травма, кома, сопор, оглушення, дифузне ушкодження, неевакуйоване об'ємне ушкодження, евакуйоване об'ємне ушкодження, гіпоксія, травматичний субарахноїдальний крововилив.
Ìåòà. Äîñë³äèòè âçàºìîçâ'ÿçîê ´àçîòðàíñì³òåðà îêñèäó àçîòó òà êèñëèõ ³ ëóaeíèõ ôåðìåíò³â ðèáîíóêëåàç ó ïàö³ºíò³â ³ç òÿaeêîþ ÷åðåïíî-ìîçêîâîþ òðàâìîþ òà âñòàíîâèòè îñîáëèâîñò³ äèíàì³êè ¿õ çì³í ïðîòÿãîì ïåð³îäó ë³êóâàííÿ. Ìàòåð³àë ³ ìåòîäè. Ó ðîáîò³ äîñë³äaeóâàëèñü äàí³ ä³àãíîñòèêè òà ðåçóëüòàòè ë³êóâàííÿ 72 ïàö³ºíò³â ³ç òÿaeêîþ ÷åðåïíî-ìîçêîâîþ òðàâìîþ â³êîì 18-76 ðîê³â (ñåðåäí³é â³ê 42,26±15,02 ðîêè), ÿê³ áóëè ïîãðó-ïîâàí³ íà ÷îòèðè ãðóïè çà øêàëîþ íàñë³äê³â Ãëàçãî: "Ñìåðòü", "Çíà÷íà ³íâàë³äèçàö³ÿ", "Ïîì³ðíà ³íâàë³-äèçàö³ÿ", "³äíîâëåííÿ". Ðåçóëüòàòè é îáãîâîðåííÿ. Äîâåäåíî çíà÷íå äîñòî-â³ðíå çðîñòàííÿ ïîêàçíèêà îêñèäó àçîòó â ïàö³ºíò³â ³ç íåáëàãîïîëó÷íèìè íàñë³äêàìè (ÿê³ â ïîäàëüøîìó ïîìåðëè ÷è çàëèøèëèñü îñîáàìè ç ³íâàë³äí³ñòþ) òà çíèaeåííÿ éîãî ç ÷àñîì ë³êóâàííÿ äëÿ ãðóï ïàö³ºíò³â ³ç â³äíîñíî áëàãîïîëó÷íèìè íàñë³äêàìè ë³êóâàííÿ (ïî-ì³ðíîþ ³íâàë³äèçàö³ºþ òà â³äíîâëåííÿì). ijà´íîñòè÷íèìè ìàðêåðàìè ïîäàëüøîãî íåñïðèÿòëèâîãî íàñë³äêó äëÿ aeèòòÿ ìîaeóòü áóòè íà ïî÷àòêó ë³êóâàííÿ (ïåðøà äîáà) ð³âåíü îêñèäó àçîòó â ñå÷³ íèae÷å 1,1 ìêìîëü/ë òà ð³âåíü ÐÍÊàç ìåíøå 25 ìÎ/ìë. Äîâåäåíî ïðÿìèé êîðåëÿö³éíèé âçàºìîçâ'ÿçîê çíà÷åíü ð³âíÿ îêñèäó àçîòó òà ð³âíÿ ÐÍÊàç íà 1, 3, 7 ³ 9-é äí³ ë³êóâàííÿ (ð<0,05). Âèñíîâêè. Ðåçóëüòàòè ðîáîòè áóäóòü âàaeëèâèìè äëÿ îïåðàòèâíî¿ îö³íêè ñòàíó ïàö³ºíòà òà ïðèéíÿòòÿ ð³øåííÿ ñòîñîâíî ìåòîä³â ë³êóâàííÿ, ùî äîçâîëèòü ì³í³ì³çóâàòè åôåêò â³ä îòðèìàíî¿ òðàâìè é ñïðî´íîçóâàòè éìîâ³ðí³ íàñë³äêè ÷åðåïíî-ìîçêîâî¿ òðàâìè.
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