The influence of embolization of internal carotid artery aneurysms on arterial tortuosity: a prospective cohort study.

PURPOSE: To compare quantitative tortuosity descriptors of Internal Carotid Artery (ICA) on aneurysmal and non-aneurysmal side before and after embolization of aneurysm and to determine possible factors associated with its change. MATERIAL AND METHODS: An analysis of 52 patients with intracranial aneurysm, treated with endovascular procedure, was performed. Based on their Digital Subtraction Angiography images, obtained prior to the procedure and after first follow-up examination, tortuosity of ICA, both on the side of embolization and on the other side was analysed. For each patient tortuosity descriptors were calculated: Relative Length, Sum of Angle Metrics, Triangular Index, Product of Angle Distance, and Inflection Count Metric. To represent changes in tortuosity, for each descriptor delta value (Δ) was defined as value of the descriptor prior to embolization - value of the descriptor on follow-up examination. RESULTS: In the follow-up We found no statistically significant changes in tortuosity on non-embolized side. On the embolized side SOAM (2.89±0.92 vs. 2.38±0.94;p<0.001), PAD (5.01±1.83 vs. 3.95±1.72 ;p<0.001) and ICM (12.18±4.55 vs. 9.76±4.04 vs.;p = 0.006) was significantly higher after embolization than before embolization. Mean ΔRelative Length (-0.02 [-0.045--0.002] vs. -0.01 [-0.02-0.003];p - 0.003),ΔProduct of Angle Distance (0.84 [0.30 - 1.82] vs. 0.10 [-0.001 - 1.10];p<0.001) and ΔInflection Count Metric (2.05 [0.42 - 3.50] vs. 0.27 [0.02 - 2.16];p = 0.004) were significantly higher on the embolized side. CONCLUSION: Following study showed that embolization may increase the tortuosity of ICA.

Safety and Efficacy of Low-Dose Eptifibatide for Tandem Occlusions in Acute Ischemic Stroke.

OBJECTIVES: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the safety and efficacy of low-dose eptifibatide administration in stroke patients with tandem lesions. METHODS: We evaluated the results of endovascular treatment in 148 stroke patients with tandem lesions. Patients in whom balloon angioplasty alone resulted in satisfactory cerebral flow did not receive eptifibatide (33 patients); others received this drug together with stent implantation (115 patients). Eptifibatide was given as an intravenous bolus of 180 µg/kg and then in a modified low dose of 1 µg/kg/min for 24 hours. RESULTS: There were no statistically significant differences between both groups regarding 30-day mortality, frequency of thrombotic events, or hemorrhagic complications. An analysis of clinical status at 30-day follow-up revealed that the administration of eptifibatide was associated with a statistically significant better outcome: a higher rate of either no neurological symptoms or only mild symptoms (4 NIHSS points maximally). CONCLUSIONS: The administration of eptifibatide in stroke patients presenting with tandem lesions is relatively safe. Moreover, treatment with this drug can improve clinical outcomes in these challenging patients.

Association of Arterial Tortuosity with Hemodynamic Parameters-A Computational Fluid Dynamics Study.

BACKGROUND: Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. METHODS: We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1-3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). RESULTS: We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = -0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = -0.333; P < 0.01), TAWSSG (R = -0.473 P < 0.01), OSI (R = -0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = -0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = -0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01). CONCLUSIONS: Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs.

Results of Angioplasty With Double-Layer Mesh Stent and Protection Systems of the Extra- and Intracranial Dissection of Cephalic Arteries.

PURPOSE: Although a majority of cervical artery dissections can be managed conservatively, patients presenting with cerebral embolization or significant stenosis require a more aggressive approach. However, complications associated with endovascular repair are quite frequent and optimal interventional technique still remains to be established. MATERIALS AND METHODS: The aim of this post hoc survey was to analyze results of endovascular treatments for symptomatic dissections of the internal carotid and vertebral arteries, which were performed under protection and with the use of double-layer mesh stents. During endovascular procedure catheters, stents and protection systems were tailored according to the angioarchitecture of dissection, particularly to its location, length and coexisting stenotic or aneurysmatic lesions. We evaluated retrospectively midterm and late results of endovascular treatment of 25 patients presenting with symptomatic dissection of cervical arteries, including 11 patients with dissections of intracranial segments of the internal carotid artery. Follow-ups were scheduled 1, 3 and 6 after the procedure, and then every 6 months. Control computed tomography (CT) or digital subtraction angiography (DSA) arteriographies were performed 1-6 months and 12 months after endovascular repair. RESULTS: There were no periprocedural major adverse events. All patients completed the 12-month follow-up. There were neither fatalities nor new neurologic adverse events at the 30-day follow-up, and no such adverse events during long-term follow-up. At 12-month follow-up, in all patients, angiographies revealed patent stents, full coverage of lesions by stents and complete thrombotic closure of the pseudoaneurysms. CONCLUSIONS: A tailored endovascular management of symptomatic dissection of cervical arteries is safe and efficient, also in a long run.

Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity.

OBJECTIVE: Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. METHODS: We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS: A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. CONCLUSIONS: Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.

Dual energy computed tomography in differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with ischaemic stroke treated with thrombectomy.

INTRODUCTION: The aim of this study was to assess the value of dual energy computed tomography (DECT) in the differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. MATERIAL AND METHODS: The group analysed consisted of 66 hyperdense areas in 64 patients with acute ischaemic stroke treated with mechanical thrombectomy and controlled in DECT performed within the first 24 hours after thrombectomy. In every area both qualitative and quantitative analysis of iodine and water material density (MD) maps was performed for the differentiation of iodine and blood, as well as CT density analysis. RESULTS: 66.7% of hyperdense areas were classified as iodine, 18.2% as iodine + blood, and 15.1% as blood. The density of iodine was significantly higher in the iodine (median 9.64 100ug/cm3) group compared to the blood (median 3.97 100ug/cm3) and iodine + blood (median 7.57 100ug/cm3) groups. The density of water was significantly higher in the blood (median 1,051.50 mg/cm3) and iodine + blood (median 1,038.00 mg/cm3) groups compared to the iodine (median 1,021.00 mg/cm3) group. CONCLUSIONS: DECT with iodine-water material decomposition maps is a valuable tool in the differentiation of prolonged staining of iodine contrast agent from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. The value of 6 100ug/cm3 (0.6 mg/cm3) seems a good threshold in quantitative differentiation of iodine from blood on iodine (water) MD maps. The value of 1,030 mg/cm3 seems a good threshold in quantitative differentiation of iodine from blood on water (iodine) MD maps.

Venous return in acute ischaemic stroke patients measured during computed tomography angiography of head and neck.

INTRODUCTION: The aim of this study was to analyse the general features and usefulness of the time elapsed between the start of contrast agent infusion and its appearance in the aortic arch in acute ischaemic stroke patients subjected to baseline computed tomographic angiography. This is, to the best of our knowledge, the first study of this parameter in a clinical context. We will refer to it hereafter as 'needle-to-aorta delay' (NAD). MATERIAL AND METHODS: The following were recorded: the time it took iodinated contrast media to reach the aorta, the site of occlusion, and automatic perfusion assessments of infarct and salvageable tissue volumes. Demographic data such as age and sex, comorbidities, and clinical factors including heart rate, blood pressure, time elapsed from symptom onset, initial stroke severity, and course of disease, were also assessed. RESULTS: We analysed 252 cases of stroke. NAD correlated with tissue at risk volume, and was greater for patients with hypertension and atrial fibrillation. The observed time was significantly shorter with less favourable core-to-penumbra ratios. No link was found between NAD and either the rate of infarct progression or the long-term clinical result. CONCLUSIONS: Although no clinical benefit was proven as a result of measuring the time it took contrast media to reach the aorta, our study implies that not only is the brain subject to circulation, but it may also affect its functioning.

Mid-term and late results of endovascular treatment for symptomatic carotid artery stenosis under proximal protection.

INTRODUCTION: Although filters are still preferred during carotid stenting, proximal protection systems (PPS) are increasingly used during these procedures. PPS seem to be safer than distal systems, especially in symptomatic patients, but evidence supporting their use is limited. AIM: This was a post hoc survey with 30-day mid-term and long-term follow up, which was aimed at assessment of the safety and efficacy of stenting of the internal carotid artery under PPS in symptomatic patients. MATERIAL AND METHODS: We analysed the results of stenting in 120 symptomatic patients presenting with at least 60% stenosis. Patients were aged 67.9 ±9.8 years, and 12 patients were older than 80 years. An occlusion of contralateral artery was found in 5 patients and bilateral stenosis in 26 patients. The primary endpoint of this study was the proportion of patients who had new neurological events, including transient ischemic attack and minor or major stroke in 30-day follow-up. The secondary endpoint was a composite of technical and clinical success. During long-term follow-up we assessed new neurological events and stenoses of implanted stents. RESULTS: The incidence of new neurological events during 30-day follow-up was 0.8%. The rate of technical success defined by secondary endpoint was 100%. Mean internal carotid artery stenosis before and after stent implantation was 93.8 ±9% and 8.4 ±6.3%, respectively (p < 0.001). Procedural success was achieved in all cases. During long-term follow-up there were two (1.7%) asymptomatic in-stent stenoses and no (0%) new neurological events. CONCLUSIONS: Endovascular management of symptomatic carotid stenosis under PPS is safe, feasible, and appears to be a good alternative to surgical endarterectomy.

Iatrogenic pericallosal artery aneurysm after endovascular procedure.

Iatrogenic brain aneurysms are rare and are usually a result of direct trauma to the arterial wall during various neurosurgical or endovascular procedures. Single cases of pericallosal posttraumatic and postsurgical aneurysms were previously reported. Herein, we report the first confirmed case of iatrogenic pericallosal artery aneurysm caused by an arterial wall injury during the endovascular treatment of another aneurysm. A 50-year-old woman with ruptured anterior communicating artery aneurysm was initially treated with balloon-assisted coiling. During the procedure the tip of a microwire inserted into balloon catheter placed in the pericallosal artery caused a local injury of the inner layer of the vessel wall and vasoconstriction, without bleeding, dissection, or flow disturbances visible in digital subtraction angiography (DSA). Control examination revealed dissecting pericallosal aneurysm. After standard dual-antiplatelet oral preparation, stent-assisted coiling of the pericallosal artery aneurysm was performed with residual contrast filling of the base of the aneurysm sac in control angiography (RROC III). After 6 months the control DSA examination showed entirely cured pericallosal aneurysm (RROC I) and reconstruction of the parent artery. Successful endovascular treatment of an iatrogenic pericallosal aneurysm was previously reported, and this method seems to be the first-choice treatment. In our case, endovascular stent-assisted coiling also allowed for safe exclusion from circulation of pericallosal dissecting aneurysm, and the implanted stent caused reconstruction of the parent artery, restoring the normal lumen diameter. The second endovascular treatment option considered was implantation of a flow-diverted stent into the pericallosal artery.

Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis.

BACKGROUND: The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms. MATERIAL AND METHODS: Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted. RESULTS: A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%. CONCLUSIONS: The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.

Real-World Comparison of Human and Software Image Assessment in Acute Ischemic Stroke Patients' Qualification for Reperfusion Treatment.

Our aim was to compare human and computer accuracy in reading medical images of acute stroke patients. We analyzed data of patients who underwent assessment of Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion (CTP) via Rapid Processing of Perfusion and Diffusion (RAPID) software RAPID ASPECTS, and RAPID CTP), compared to radiologist reports and manual measurements. We compared volumes calculated by RAPID CTP software with those selected by scanner-equipped software (GE). For reference, follow-up images were manually assessed in accordance with the Alberta Stroke Program Early CT Score (ASPECTS) territories retrospectively. Although exact ASPECTS score agreement between the automatic and manual methods, and between each method and follow-up, was poor, crossing of the threshold for reperfusion therapy was characterized by an 80% match. CT perfusion analyses yielded only slight agreement (kappa = 0.193) in the qualification of patients for therapy. Either automatic or manual scoring methods of non-contrast images imply similar clinical decisions in real-world circumstances. However, volume measurements performed by fully automatic and manually assisted systems are not comparable. Thresholds devised and validated for computer algorithms are not compatible with measurements performed manually using other software and should not be applied to setups other than those with which they were developed.

Ineffective endovascular treatment of a giant internal carotid artery aneurysm.

PURPOSE: Despite a growing range of therapeutic possibilities, including various intravascular methods, treating cerebral aneurysms can be still a therapeutic challenge. A growing number of patients previously treated with older techniques require additional therapy. Treatment options as well as their efficiency may be influenced by previous procedures. CASE REPORT: We report a rare case of a giant treatment-resistant aneurysm in a 65-year-old woman. The aneurysm was first diagnosed due to visual disturbances in the right eye. Computed tomography angiography showed large (20 × 18 mm) wide neck aneurysm of the right internal carotid artery. The patient was subsequently treated with several methods including coiling with regular stent implantation, two flow diverter stent implantations, and hybrid neurosurgery. Full occlusion was not achieved after any of those procedures. After the last procedure (hybrid neurosurgery) the patient, in vegetative state, was transferred to the intensive care unit and then to the Health and Care Centre. CONCLUSIONS: Discussion focuses on endovascular treatment options after failure of previous treatment such as "stent in stent" technique. We conclude that three subsequent stent implantations are technically possible; however, subsequent procedures are associated with technical difficulties and their effectiveness is questionable. Ventriculoperitoneal shunt may influence the outcome of flow diversion therapy.

Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development.

OBJECTIVES: We analysed tortuosity of basilar artery (BA) to determine its relationship with the presence of aneurysm. METHODS: We retrospectively analysed 71 patients with BA aneurysms along with 71 age- and risk factors-matched control patients without BA aneurysm. From patients' medical records, we obtained their history including previous and current diseases and medications. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD) and inflexion count metrics (ICM). We used t-test and Mann-Whitney U test for continuous variables and χ2 test for dichotomised variables. To find independent predictors of BA aneurysm, we employed logistic regression analysis. RESULTS: We found significant positive correlation between age and SOAM (R = 0.195, p = 0.02) and PAD (R = 0.199, p = 0.018). Our study also showed that patients with BA aneurysm had significantly higher SOAM (0.21 ± 0.16 vs. 0.11 ± 0.08; p < 0.01), PAD (0.30 ± 0.19 vs. 0.18 ± 0.11; p < 0.01), TI (0.23 ± 0.23 vs. 0.10 ± 0.16; p < 0.01) and ICM (0.20 ± 0.16 vs. 0.15 ± 0.11; p = 0.045). In multivariate logistic regression analysis, after adjustment for all possible confounders, SOAM (OR = 1.086; 95% CI 1.046-1.136; p < 0.01) and TI (OR = 1.004; 95%C: 1.002-1.006; p < 0.01) remained independently associated with higher risk of BA aneurysm. CONCLUSIONS: Increased tortuosity of BA is associated with higher risk of its aneurysm development. KEY POINTS: • Basilar artery sum of angle metrics and product of angle distance are correlated with age. • Basilar artery tortuosity is independently associated with higher risk of its aneurysm development. • Basilar artery tortuosity is positively correlated with its diameter and bifurcation angle.

Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome.

INTRODUCTION: The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear. AIM: Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke. MATERIAL AND METHODS: We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality. RESULTS: We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures. CONCLUSIONS: In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.

Endovascular treatment of middle cerebral artery aneurysms - single-centre results.

PURPOSE: The middle cerebral artery (MCA) is the second most common location of intracerebral aneurysms. Traditionally, they are treated by microsurgical clipping, but with the development of new techniques and devices endovascular embolisation is gaining more importance. The aim of this study was to summarise six years of experience of our department in endovascular treatment of MCA aneurysms. MATERIAL AND METHODS: Forty patients with 41 MCA aneurysms treated in a single centre were included in this study. Data on patients' comorbidities, aneurysm morphology, and treatment course were collected, with special emphasis on complications. RESULTS: There were no statistically significant differences in terms of aneurysm morphology between males and females and between ruptured and unruptured aneurysms. None of the diseases analysed in the current study were linked with significantly increased risk of SAH. Unruptured aneurysms were significantly more frequently treated by stent-assisted coiling (30.4% vs. 5.6%, p = 0.0388) than were ruptured aneurysms, while ruptured aneurysms were treated more frequently by coiling alone (77.8% vs. 34.8%, p = 0.0062). After an initial course of treatment 63.4% (n = 26) of patients had class I in Raymond-Roy occlusion classification, 22% (n = 9) had class II, and 14.6% (n = 6) had class III. Complications of the procedure were observed in 17.5% (n = 7) of patients: 22.2% (n = 4) with ruptured and 13.6% (n = 3) with unruptured aneurysms. CONCLUSIONS: Endovascular treatment of MCA aneurysms is feasible, and our results are convergent with other studies. Ruptured MCA aneurysms may be treated endovascularly with similar effects as unruptured MCA aneurysms. The complication rate of such treatment is low.

Angiographic and clinical results of anterior communicating artery aneurysm endovascular treatment.

INTRODUCTION: The anterior communicating artery (ACoA) is the most common location of intracranial aneurysms, observed in 35% of cases. Endovascular treatment has become an alternative to surgical clipping and the primary method of choice. AIM: To assess the treatment results of ruptured and unruptured ACoA aneurysms and to assess the incidence of intraprocedural complications and various factors influencing these aspects. MATERIAL AND METHODS: One hundred and eleven embolizations of ACoA aneurysms (80.7% ruptured and 19.3% unruptured) were retrospectively analysed. The methods of embolization were: coiling, balloon-assisted coiling, stent-assisted coiling. Morphology and dimensions of aneurysms were assessed on 3D digital subtraction angiography (DSA) images. Medical records were analysed for patient's clinical status at admission, intraprocedural complications, follow-up examination and modified Rankin Scale (mRS) score 1 month after discharge. RESULTS: Immediately after the procedure 56.9% of patients had Raymond-Roy Occlusion Classification (RROC) class I, 37.6% class II and 5.5% class III. The overall intraprocedural complication rate was 6.6%. There were significantly more cases of bleeding (p = 0.012) and coil prolapse (p = 0.012) during the procedures ending with higher packing density. Twenty-eight (25.7%) patients died during hospital stay, 27 (96.4%) with ruptured aneurysm. In the follow-up of 41 patients, RROC was the same or improved in 73.2% of cases and recanalization occurred in 26.8%. Six patients with aneurysm recanalization underwent repeat embolization. CONCLUSIONS: Endovascular embolization of ACoA aneurysms is an effective and safe treatment method. The most powerful factor influencing the incidence of complications is packing density. Superior orientation of the dome, initial incomplete embolization and poor outcome in mRS scale are factors predisposing to ACoA aneurysm recurrence.

Outcome estimation based on multimodal computed tomography examination in acute ischaemic stroke patients treated with mechanical thrombectomy.

INTRODUCTION: Reperfusion therapy for acute ischaemic stroke used within a time window of 6 h following symptom onset, although currently the treatment of choice, is characterised by certain limitations and carries certain risks. AIM: To assess the potential for predicting the risks and limitations of reperfusion therapy by means of advanced neuroimaging. MATERIAL AND METHODS: For this purpose, the baseline CT scans of patients with ischaemic stroke treated by means of mechanical thrombectomy were assessed retrospectively using the Combined Multimodal Computed Tomography Score (CMCTS), modified to account for the perfusion examination of a limited area. These data were then combined with radiological and clinical outcomes, in particular haemorrhagic stroke transformation and scoring on a modified Rankin scale (mRS). RESULTS: Based on material from 85 patients, the scoring system we employed enabled us to distinguish a group that did not benefit from treatment with specificity and a positive predictive value of 100%, and a negative predictive value of 64%. Neither the relationship between the score and early haemorrhagic complications, nor the effectiveness or severity of the course of the thrombectomy procedure itself was confirmed. CONCLUSIONS: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores.

Treatment of high- and intermediate-risk pulmonary embolism using the AngioJet percutaneous mechanical thrombectomy system in patients with contraindications for thrombolytic treatment - a pilot study.

INTRODUCTION: Intravenous thrombolysis is the treatment of choice in patients presenting with high- and intermediate-risk pulmonary embolism. The role of percutaneous mechanical pulmonary thrombectomy (PMPT) is not fully established, although selected patients can be managed with this method. AIM: This open-label single-centre prospective pilot study was aimed at assessing the feasibility of PMPT for the treatment of severe pulmonary embolism in a Polish hospital. We also evaluated the safety and efficacy of such management. MATERIAL AND METHODS: We managed 7 patients, aged 52.7 ±16.6 years, presenting with high- and intermediate-risk pulmonary embolism (4 patients with class 5 and one patient with class 4 of the Pulmonary Embolism Severity Index), with occlusion of at least 2 lobar arteries and contraindications for thrombolysis. Percutaneous mechanical pulmonary thrombectomy was performed using the AngioJet system. RESULTS: It was possible to introduce the thrombectomy system to the pulmonary arteries in all patients. The procedure was successful in 6 patients (technical success rate: 85.7%). Two (28.6%) patients died during the hospital stay, one patient with unsuccessful thrombectomy and the other due to pneumonia. In all survivors control echocardiography demonstrated normalised function of the right ventricle. Also, dyspnoea disappeared and blood gas parameters normalised. There was no recurrent thromboembolism during 3-14 months of follow-up. CONCLUSIONS: In the Polish setting, in selected patients, management of high- and intermediate-risk pulmonary embolism with PMPT is technically feasible. Such treatment is relatively safe and effective. It can be an alternative to standard management, especially in patients with contraindications for fibrinolysis or surgical embolectomy.

Mechanical thrombectomy in acute stroke - Five years of experience in Poland.

OBJECTIVES: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. METHODS AND RESULTS: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. RESULTS: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b-TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0-2 - in 31.4% and mRS of 6 in 22% of cases. CONCLUSION: Our results can help harmonize standards for MT in Poland according to international guidelines.