Search

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., (Copyright © 2017 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Objective: Most common tumors of the jugular foramen are paragangliomas. However, other lesions, also malignant, may involve the jugular foramen and mimic radiographic presentation of paragangliomas. Therefore, a correct preoperative diagnosis is crucial for best treatment planning. This study analyzes imaging characteristics of non-paraganglioma neoplasms involving the jugular foramen, with attention given to features helpful in differential diagnosis., Study Design: A retrospective chart search., Setting: Teritary referral university centre., Subjects and Methods: During the years 1997-2010, 11 cases of jugular foramen tumors other than paragangliomas, with available imaging studies, were identified. Histopathology revealed: 3 schwannomas, 1 malignant schwannoma, 2 meningiomas, 1 hemangiopericytoma, 1 ependymoma, 1 endolymphatic sac carcinoma (ELST) and 2 nasopharyngeal carcinoma metastases. CT, MRI and angiography were assessed to determine tumor growth directions, bone involvement, tumor morphology and vascular composition., Results: Schwannomas were characterized by parapharyngeal space involvement, jugular foramen expansion, preservation of cortical margins, irregular contrast enhancement. Meningiomas presented diffuse bone infiltration, sclerotic changes, erosion of the cortical bone. Ependymoma showed diffuse skull base infiltration, permeative erosion, heterogeneity, abundant vascularization. Hemangiopericytoma radiologically imitated paraganglioma. ELST showed permeative/geographic bony destruction, heterogeneity, intratumoral bony fragments. Metastases were lytic, solid lesions characterized by circumferential growth, internal carotid artery encasement and stenosis., Conclusions: A combination of certain radiological features including tumor epicenter, growth vectors, skull base infiltration, bony changes and tumor morphology help establish correct preoperative diagnosis and differentiate less common jugular foramen tumors, from most common paragangliomas. Hemangiopericytoma may radiologically mimic paraganglioma., (Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

We present a 59 year old patient with advanced heart failure who underwent lead extraction. The lead was implanted 11 years ago, and 2 years later looped spontaneously following its fracture. The transvenous extraction process through inferior vena cava was complicated by knotting of the inactive lead over the active ventricular lead. The patient was pacemaker-dependent. Finally, the old lead was successfuly explanted. The active intact lead was used to create resynchronisation system.

Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed. On completion of the diagnostic process the patients were randomly assigned either to the endovascular or microsurgical treatment. Group I: 21 (70%) embolization procedures were carried out, while in 9 (30%) cases with 10 aneurysms embolisation was impossible or regarded as too risky due to various causes. The total occlusion of aneurysm SAC was achieved in 17 (77%) aneurysms, subtotal in 5 (23%). The morbidity rate was 8%, mortality-0%. Group II: Microsurgical clipping was performed in 27 (90%) cases, 3 (10%) patients were disqualified from treatment due to their poor clinical status. An excellent technical result was achieved in 24 (86%) patients, in 4 (14%) cases the neck remnant was observed in control angiography. The morbidity rate was 14%, mortality-0%.

Due to improvement in intravascular therapeutic procedures significant stenoses of vertebral and basilar arteries can presently be treated by means of percutaneous transluminal angioplasty (PTA). The reported case was a 34-year-old man with symptomatic stenosis of the distal left vertebral artery and hypoplastic right vertebral artery. The patient underwent PTA and the lesion was sufficiently dilated. No complications occurred during or after the procedure. After a year duplex Doppler follow-up examination showed normal blood flow and patency of both vertebral arteries. PTA may prove to be a useful therapeutic option in patients with symptoms of vertebro-basilar insufficiency.

A giant, unclippable right ICA aneurysm located partially intracavernously is reported with neck deriving at C3 level. The aneurysm caused optic chiasm compression, progressive left eye vision loss and exophthalmus as well as persistent headache. The presence of the aneurysm was first found in CT and confirmed by angiography. After having performed the temporary occlusion test of right ICA the ICA was permanently occluded with a detachable balloon. Control angiography showed complete occlusion of right ICA and no opacification of the aneurysm sac from vertebral and left carotid arteries.

Embolization of bronchial and systemic arteries is a method of choice in treatment of pulmonary hemorrhages in patients with existing contraindications to surgical therapy. Embolization was carried out in 57 patients with pulmonary hemorrhages in the course of pulmonary tuberculosis, mycetomas, bronchiectases, malignancy, vessel malformations and post-traumatic changes. In all patients it terminated hemorrhages. During the 5 year follow-up period recurrencies were seen in 14% of the patients warranting additional embolization.

A female patient is reported who had subarachnoid haemorrhage and in whom angiography demonstrated presence of an aneurysm and an arteriovenous angioma in the territory of the left middle cerebral artery. During surgical intervention an intracerebral haematoma was found additionally in the posterior part of the left temporal lobe. The postoperative course was uneventful. The patient was discharged without evidence of focal brain injury.