ABSTRACT
AIM: To identify the optimal timing of CEA in patients with hemodynamic significant stenosis of carotid arteries in the acute period of ischemic stroke (IS). MATERIAL AND METHODS: Five samples (n=30 911) based on the search results from January 2008 to April 2016 in Russian and English-language scientific databases were analyzed. The main endpoints of the studies in both groups (repeated stroke, death, cardiac complications, frequency of restenosis) were studied depending on the timing of operative intervention and preoperative selection criteria. Perioperative morbidity and mortality were analyzed within 30 days after disease onset. RESULTS AND CONCLUSION: There are heterogeneous and contradictory information on the safety of CEA in patients with symptomatic carotid stenosis in acute period of IS. Fundamentally, a new individual approach is required to select best candidates for timed surgery after disease onset, taking into account the severity of the condition, risk factors, comorbidity and surgical techniques.
Subject(s)
Brain Ischemia , Carotid Stenosis , Endarterectomy, Carotid , Stroke , Brain Ischemia/therapy , Carotid Stenosis/therapy , Humans , Retrospective Studies , Risk Factors , Russia , Stroke/therapy , Treatment OutcomeABSTRACT
OBJECTIVE: The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing. RESULTS: The study included 3160 patients hospitalized to 22 medical institutions in 2017. Of these, 1808 patients were treated in RVCs, and 1352 patients were treated in FCs. We analyzed factors affecting the treatment outcome in CA patients. We identified features of CA treatment in clinics with a different amount of surgical intervention. CONCLUSION: An increase in the surgical activity in centers and simultaneous development of microsurgical and endovascular treatments for cerebral aneurysms reduce postoperative mortality. Due to the presence of a RVC network in the Russian Federation, many patients could receive necessary specialized treatment. The number of operations for cerebral aneurysms has increased 6-fold for the past 10 years.
Subject(s)
Aneurysm, Ruptured , Intracranial Aneurysm , Subarachnoid Hemorrhage , Embolization, Therapeutic , Humans , Intracranial Aneurysm/surgery , Neurosurgical Procedures , Retrospective Studies , Russia , Treatment OutcomeABSTRACT
Factor XIII (FXIII) plays an important role in formation and stabilization of the fibrin clot. It is known that FXIII-A gene G163T (Val34Leu) polymorphism leads to increased activation of this factor, however participation of the 34Leu variant in thrombogenesis remains disputable. The present work was aimed at studying peculiarities of distribution of variants of FXIII-A polymorphisms in patients with early onset of venous thromboembolism (VTE), as well as revealing associative links between the carrier state of this mutation and the character of clinical course of the disease. We examined a total of 250 patients with VTE. Of these, there were 119 (47.6%) men and 131 (52.4%) women, mean age 37.42 years (range 10-45 years). In the group of patients with VTE, the proportion of homozygous carriers of allele 163T (Leu34) turned out to be more than 1.5-fold higher as compared with the corresponding parameter in the control group (OR=1.8, 95% CI: 0.9-4.0; p=0.14). Analysing FXIII-A G163T polymorphism depending on gender revealed a considerable increase in the incidence rate (IR) of 163TT genotype in women with VTE as compared to male patients (13.0% versus 5.1 %, respectively, OR=2.8, 95% CI: 1.1-7.4; p=0.047) and to the control group (OR=2.7; 95% CI: 1.2-6.1; p=0.023). Analysing gene FXIII-A polymorphism in the groups of patients with various clinical manifestations of VTE revealed a decrease in the proportion of heterozygotes in the group of deep vein thrombosis + pulmonary artery thromboembolism (PATE) and, vice versa, an increase in the proportion of homozygotes by the Leu34 variant in patients with signs of PATE. The obtained findings make it possible to consider the genotype 163TT of FXIII-A gene as a new independent risk factor for the development of VTE in young women living in the North-West region of Russia, which is observed for the first time. Additional studies are necessary.
