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Background: Stroke is a leading cause of death worldwide, with a prevalence of nearly 13.7 million people every year. Approximately 80% of strokes are ischemic, and although the prevalence is growing among cerebrovascular diseases, its mortality and morbidity decreased during the last decade. Carotid artery stenosis is responsible for up to 12% of all ischemic strokes. Aim of the Work: Our study Aim was to assess the safety and efficacy of simultaneous bilateral internal carotid artery stenting in patients with bilateral extra-cranial internal carotid artery stenosis. Patients and Methods: Our study is a prospective analytical study carried on 20 Patients with bilateral extra-cranial internal carotid artery stenosis whether (symptomatic > 50) or (asymptomatic >70%). That was determined by duplex ultrasound and confirmed during the procedure with digital subtraction angiography. Results: In our study we found among those 20 patients the mean time of the procedure was (in minutes) 60.50 6 7.76 also 8 of them (40.0%) had hemodynamic depression which required medical treatment intra procedural with no prolonged reported cases for HD post procedural, none of them (0.0%) had Vascular access complications and post-operative hospital stays ranged from 2-3 days in all patients yet most of them was discharged in the post-procedural day. Among those 20 patients, only one patient 1 (5.0%) had post procedural complication in the form of hyperperfusion syndrome which manifested as headache and seizures (behavioural arrest and focal colonic seizures) which lasted shortly and was self limited with no evidence of IChge on CT brain. No one had post procedural stroke, cardiac, renal complications and no mortality happened. Regarding MRS and NIHSS post procedural there were no progression or change in comparison with these scaled pre procedural. All 20 patients underwent MRI brain especially post procedural with especial attention to Diffusion weighted image sequence (DWI), among them 19 patients (95 %) had no abnormalities while only 1 patient (5%) had few new restricted spots in DWI without any significant neurological deficit. Conclusion: SbCAS is found to be a relatively safe and effective procedure for meticuslouy selected patients with bilateral carotid stenosis and can decrease the risk of repeated cerebrovascular events. Therefore, patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be evaluated using a multidisciplinary approach considering the possibility of sbCAS. Although the rate of HPS was higher than that of unilateral CAS, the absolute number of patients who suffered HPS remained small and was suffering from mild sympotoms that spontaneously resolved. Except for HPS, all other periprocedural complications including HD, stroke, MI, and their combinations were non inferior in comparison to those given in the literature reporting unilateral cases. [ABSTRACT FROM AUTHOR]

Background: Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but also the high morbidity. Recent studies revealed that up to 50% of survivors being chronically disabled in 2022. Thrombolysis has limited efficacy in the presence of large volume clots, thrombus ultrastructure, hemorrhagic transformation, high National Institutes Of Health Stroke Scale (NIHSS) prior to rtPA and thrombolysis resistance due to the presence of plasminogen activator inhibitor-1(PAI-1) and alpha 2-antiplasmin. Plasminogen is converted to plasmin by plasminogen activator and plasminogen activator can be inhibited by plasminogen activator inhibitors 1 and 2. On the other hand, plasmin itself is directly inhibited by alpha 2-antiplasmin, an ultrafast covalent inhibitor, which accounts for about 90% of plasmin inhibition in vivo and antagonizes the action of rtPA which consequently prolong clot lysis. Aim of the Work: To identify the relationship between serum alpha 2-antiplasmin, various risk factors and clinical response to recombinant tissue plasminogen activator in ischemic cerebrovascular stroke. Patients and Methods: This is prospective cohort study was conducted at Ain Shams University Hospitals on acute ischemic stroke patients who received thrombolysis, met the inclusion and exclusion criteria. A blood sample to measure serum alpha 2-antiplasmin was obtained before receiving thrombolysis and patients were followed up for 3 months. Results: A study on 35 patients showed that there is significant correlation between atrial fibrillation and poor functional outcome in stroke patients who received thrombolysis with pvalue =0.033. Also, it shows there is significant correlation between hypertriglyceridemia and poor outcome with p-value= 0.043. It also shows there is a significant correlation between serum alpha 2-antiplasmin level and resistance to thrombolysis with subsequent poor functional outcome with a cut-off point 493 ng/L with a sensitivity 100% and a specificity 81.8% (pvalue =0.001). Conclusion: This study shows that alpha 2-antiplasmin levels are correlated with cerebrovascular stroke outcome, high levels are associated with poor functional outcome and resistance to IV thrombolysis. Therefore, its inhibition may be crucial to improve the clinical outcome of stroke in the future. [ABSTRACT FROM AUTHOR]

Background: Acute ischemic stroke (AIS) after percutaneous cardiac catheterization (PCI) is a known complication with incidence reports of ranges between 0.2% and 0.5%. It is associated with an in-hospital mortality rate of 20%, with markedly increased long-term mortality (1). Administration of Intravenous thrombolysis (IVT) is the recommended standard of care in acute ischemic stroke during the first 4.5 hours from stroke onset. However, current guidelines exclude intravenous thrombolysis in heparinized patients with partial thromboplastin time (PTT) greater than 40 seconds (2) Protamine is an efficient antidote known for the anticoagulant effect of heparin, and it can neutralize its effect within 5 minutes (3). Aim of the Work: To assess the safety of IVT after heparin reversal by protamine sulfate in ischemic Stroke patients After PCI. Patient and Method: The total number of patients who developed early IP stroke (within 4.5 hours from the end of PCI) was 42. All of them received loading antiplatelets before PCI. Results: out of 21 patients received IVT after heparin reversal by protamine, no patient had died, 2 cases had non symptomatic intracranial hemorrhage (ICH), with significant improvement in stroke parameters and shorter length of stay Conclusion: IVT following heparin reversal by protamine in appropriately selected AIS patients appears to be safe from a symptomatic ICH standpoint and may be beneficial. Extreme caution is warranted in applying these results to routine clinical practice. Rather, we suggest that thrombolysis may still be considered in AIS patients on therapeutic heparin who are not candidates for MT. [ABSTRACT FROM AUTHOR]