[Myocardial Infarction Due to Coronary Artery Embolism].

Coronary artery embolism (CAE) takes an important place among non-atherosclerotic causes of acute myocardial infarction (AMI). The features of embolic AMI are difficulties in diagnostics and absence of evidence-based guidelines for the management of CAE. Purpose of this review - to present synthesis of available data on embolic AMI. We also report here three cases demonstrating new approaches to treatment of CAE.

[Fibrinogen concentration in the evaluation of safety and efficiency of thrombolytic therapy in patients with ischemic stroke].

AIM: To identify and investigate threshold fibrinogen concentrations as predictors of hemorrhagic transformation (HT), fatal outcome (FO), and the efficiency of thrombolytic therapy (TLT) in patients with ischemic stroke (IS). SUBJECTS AND METHODS: One hundred and eighty-one patients with IS were examined; all the patients received TLT. Fibrinogen concentrations were determined by the Clauss method on admission, immediately after TLT, and daily during the first 7 days of observation; the efficacy of thrombolysis was evaluated using the NIH stroke scale every day, the Rankin scale, and the Barthel Index on days 14 and 21. RESULTS: The patients with a fibrinogen concentration of below 330 mg/dl showed the lowest frequency of asymptomatic HT (AHT) as hemorrhagic stroke (HS) type 1 in the absence of clinically worsening HT (CWHT), as well as FO and the highest rate of good functional recovery. Those with a fibrinogen concentration of 330-385 mg/dl most commonly displayed AHT as HS types 1 and 2 equally frequently, as well as the highest frequency of a positive effect according to the criteria for good and/or satisfactory functional recoveries. The fibrinogen concentration range of 385-423 mg/dl compared to the above range was characterized by an increased risk for AHT as HS type 2, for CWHT as equally distributed parenchymal hematoma types 1 and 2, by higher death rates and less chance of functional recovery. The elevated fibrinogen concentration above 423 mg/dl was accompanied by high death rates and CWHT as parenchymal hematoma type 2 and the higher frequency of poor outcome in the evaluation of functional recovery. CONCLUSION: The revealed three threshold fibrinogen concentrations of 330, 385, and 423 mg/dl allow one to predict HS, FO, and the efficiency of TLT in patients with IS.

[Dynamics of perfusion CT parameters in the early acute phase of ischemic stroke].

Perfusion computed tomography (CT) allows to evaluate brain perfusion and provides additional information about local cerebral hemodynamics in stroke patients. Twenty-seven patients underwent CT-perfusion in the early acute phase of ischemic stroke. Significant differences between ischemic lesion and contralateral hemisphere on CBF and MTT scans during the first 3 hours after stroke were revealed. In the following 24 h, the differences were seen in all perfusion parameters. CT-perfusion allows to reveal perfusion parameters associated with stroke severity and outcome that is relevant for prescription of reperfusion treatment beyond the boundaries of 3-4.5h "therapeutic window".

[Association of factors of vascular tone regulation with the development of hemorrhagic transformation in patients with ischemic stroke].

Concentrations of plasma vascular tone regulation markers that are indicators of endothelium dysfunction in the acute phase of ischemic stroke and their effect on the development of hemorrhagic transformation (HT) of the lesion focus have been studied. Concentrations of renin, endothelin 1-21, neuron-specific enolase, NT-proCNP, soluble adhesion molecules (sICAM) were measured in 67 patients on days 1, 3-4. Significantly higher concentrations of renin, endothelin 1-21, neuron-specific enolase were found in patients with HT in the first day compared to patients without HT. The level of NT-proCNP was lower in patients with HT; the increase in the severity of hemorrhagic component led to the elevation of neuron-specific enolase and sICAM concentrations. In conclusion, both markers of blood-brain barrier damage and regulating factors of vascular tone may play a predictive role in the development of HT in ischemic stroke.

[Prognostic value of hemorheologic and morphodensitometric parameters of blood cells for the progression of cerebrovascular insufficiency].

Authors have studied 484 patients, aged from 35 to 55 years (mean - 41.0+/-1.4 years), in the early stages of cerebrovascular insufficiency. Computed morphodensitometry of erythrocytes, the study of their deformation and aggregation capacity have been used. It have studied the subpopulation content of erythrocytes and determined their morphometric parameters. The morphodensitometric changes in erythrocytes were correlated with disturbances of their functions (aggregation properties, deformation, gas transfer ability) that had the most impact on the hemodynamics of the microcirculation stream. Clinical and laboratory studies revealed that the morphofunctional changes in erythrocytes appeared earlier and played a key pathogenetic role in the formation and progression of cerebral ischemic hypoxia.

[Computer tomographic and laboratory predictors of clinical outcomes of acute ischemic stroke patients after the systemic thrombolytic therapy].

Today the systemic thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is the most effective treatment of ischemic stroke. We included 116 patients with stroke, 82 received rt-PA, 34 were enrolled to the control group. Median NIHSS score was 16,2 +/- 5,4 in the main group and 16,2 +/- 5,4 in the control group. The trial revealed the prognostic significance of some early CT sings of ischemic brain damage for the hemorrhagic transformation and functional outcomes to the 90th day. It was shown that hyperfibrinogenemia (over 450 mg/dl) might be a risk factor of the hemorrhagic transformation. The excess of segmental leukocytes over 78% might be a predictor of the lethal outcome. The initial activity of tissue plasminogen inhibitor (first type) over 11,65 IU/L might be a risk factor of the vascular reocclusion after successful thrombolysis. The analysis of characteristic curves of leukocyte elastase revealed the informativeness of its initial values in the prognosis of reocclusion and hemorrhagic transformation.

[Application of thrombolytic therapy of ischemic stroke in the Russian Federation].

To study the efficacy and safety of thrombolytic therapy (TLT) with the recombinant tissue plasminogen activator (rt-PA) in stroke, we treated 691 patients in 48 clinical units using systemic or selective TLT. Safety and high efficacy of TLT was shown: the three-months fatality rate was 18.2%, the symptomatic hemorrhage transformation rate related to clinical worsening was 6.1%. The good functional recovery (scores 0 or 1 on the modified Rankin scale) was observed in 48.6% of patients.

[Efficacy and safety of the combined therapy with citicholine and actovegin in the acute period of ischemic stroke].

One hundred and four patients with acute carotid ischemic stroke were included in the study. Patients were divided into 4 groups. Patients of control group (group 1) were treated with equal basic and reperfusional therapy without any cytoprotectors. Patients of the 2nd group received citicholine in dose 1000 mg per day. Patients of the 3rd group were treated with 250 ml actovegin per day. The NIH stroke scale, the modified Rankin scale and the Barthel index were used to assess neurological status dynamics. The significant decrease of neurological deficit and improvement of functional recovery were seen in patients treated both with citicholine and actovegin (p < 0.005) to the 30th day compared to the control group. There was a trend towards the decrease of brain infarction volume within 5 days after stroke in patients of the 4th group. No side-effects of citicholine and actovegin were found.