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Possibilities of Transcatheter Treatment of Patients after Extensive Ischemic Stroke

An ischemic stroke occurs when an artery supplying the brain with blood is obstructed by a blood clot. It is almost always caused by the accumulation of fatty deposits along blood vessel walls—a condition known as atherosclerosis, or hardening of the arteries. It is one of the most common pathological conditions both in neurological practice and in all clinical medicine.

In this study, the authors investigated the efficacy of brain transcatheter laser revascularization in patients who had extensive ischemic stroke. 1125 patients aged 29 - 81 (average age 75) with cerebral atherosclerosis were examined. The examination plan included: CT brain scan, magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA), laboratory tests, assessment of severity of dementia (CDR), cognitive impairment (MMSE) and activities of daily living (IB). 93 patients suffered extensive ischemic stroke of whom 7 (7.53%) had 10 - 15 IB points, 25 (26.88%)—20 - 30 IB points, 61 (65.59%)—35 - 45 IB points. 69 patients underwent transcatheter treatment (Test Group). 24 patients underwent conservative treatment (Control Group). High-energy laser systems were used for revascularization of major intracranial arteries; lowenergy laser systems were used for revascularization of distal intracranial branches.

The result showed that test Group: 67 (97.10%) patients had good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization. 12 - 24 months later the following positive trend was observed: 14 (20.59%) patients demonstrated good clinical outcome (IB 90 - 100); 26 (38.24%) patients had satisfactory clinical outcome (IB 75 - 85); 28 (41.18%) patients showed relatively satisfactory clinical outcome (IB 60 - 70); relatively positive clinical outcome (IB < 60) was not obtained in any case. Control Group: 4 (16.67%) patients showed relatively satisfactory clinical outcome (IB 60 - 70), relatively positive clinical outcome (IB < 60) was achieved in 20 (83.33%) cases.

In conclusion, the method of transluminal laser revascularization of cerebral blood vessels was an effective one for the treatment of extensive ischemic strokes and its effect was maintained for a long time; it caused regression of mental, intellectual and motor disorders, promoted regression of post-stroke dementia and significantly improved the quality of life, which made it noticeably different from the conservative methods of treatment.

Article by Ivan V. Maksimovich, from Clinic of Cardiovascular Diseases named after Most Holy John Tobolsky, Moscow, Russia.

Full access: http://mrw.so/1v2C3n

Image by Slickclic, from Flickr-cc.

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