Semih Giray

Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers

Background and Purpose. Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. Methods. A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0–2 at 90 days was considered as a good outcome. Results. From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216–313 min) compared with poor outcome patients (315 (IQR: 240–360 min); P = 0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P = 0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. Conclusion. To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT.

Does stroke etiology play a role in predicting outcome of acute stroke patients who underwent endovascular treatment with stent retrievers

AIMS The goal of the study was to identify whether the stroke etiology play a role in the recanalization and outcome of patients who underwent mechanical thrombectomy with stent retrievers. METHODS AND RESULTS A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We included patients with cardioembolic stroke and large vessel atherosclerotic disease and compared risk factors for stroke, baseline NIHSS and Alberta Stroke Program Early CT scores (ASPECTS), stroke outcome, recanalization rate, onset-to-recanalization, onset-to-groin puncture time and the procedural time between two groups. Male sex was statistically more common in patients with large vessel atherosclerotic disease. Mean time from symptom onset- to the achievement of recanalization in patients with LVAD was 242±72.4 compared with cardioembolic stroke patients (301±70.7; p=0.014). Time for groin puncture to recanalization was longer in patients with cardioembolic stroke compared to LVAD group (97.5±44.3 vs 58.2±21.8; p=0.002). Time for microcatheter to successful recanalization or procedural termination was longer in patients with cardioembolic stroke compared to LVAD group (63.6±30.2 vs 34.2±19.4; p<0.001) with cardioembolic stroke had significantly worse long-term outcome (mRS 3-6) compared to those with LVAD (60.6% vs 26.3%; p=0.036). CONCLUSION Stroke etiology may play a role in the outcome of acute stroke patients who underwent endovascular stroke therapy. Cardioembolic strokes may be more resistant to endovascular acute stroke treatment.

Nörolojik Hastalıklarda Terapötik Plazma Değişimi: 91 Hasta ile Yedi Yıllık Deneyim Sonuçları

INTRODUCTION In this study, we report the results of our experience of therapeutic plasma exchange (TPE) for neuroimmunologic disorders performed at our hospital over a seven-year period. METHODS We retrospectively reviewed the medical records of 91 patients (53 male, 38 female) who had been treated at our center with TPE. RESULTS 60 patients with Guillain-Barrè syndrome (GBS), 23 with myasthenia gravis (MG), 4 with chronic inflammatory demyelinating polyneuropathy (CIDP) and 1 patient each with polymyositis, septic encephalopathy, acute disseminated encephalomyelitis (ADEM) and Opsoclonus-Myoclonus syndrome (OMS) received TPE. 26.7% of GBS patients made complete recovery, 61.7% had partial recovery and 11.7% patients died due to respiratory failure. Despite our best efforts and effective TPE treatments, 13.4% of MG patients deceased, however, 78% had full recovery. Three patients with CIDP were discharged with full and 1 patient with partial recovery. The patient with ADEM had partial recovery with TPE at first, but deceased 2 months later due to pneumonia-related respiratory insufficiency. While, patient with polymyositis had slight-partial recovery, we obtained full recovery with TPE in septic encephalopathy and OMS patients. The side effects and complications of treatments with TPE, which included hypotension, hypocalcaemia and anemia, were mild and manageable. CONCLUSION The improvement rates were encouraging and we concluded that significant benefit can be achieved with TPE for the treatment of neuroimmunological disorders.

Supra-aortic Stenting Experiences in Over Eighty Year Old Patients

INTRODUCTION: Stroke is a common disease at any age but it is mostly seen in older population. Increasing aging of the population all over the world boostes importance of primary and secondary prevention measures for stroke. Carotid artery stenosis is observed in 10% of people over 80 years of age. Our aim is to share the clinical results and outcomes of patients over 80 years of age who underwent supraaortic stenting. MATERIAL and METHODS: In this study we examined retrospectively 25 patients which are over 80 years of age and underwent supra-aortic stenting between January 2014January 2017 in Gaziantep University Neurology Clinic. Patients were examined for vascular risk factors. Patient with symptomatic carotid artery (>50%) and vertebral artery stenosis (>60%) underwent stenting. Vascular complications and clinical results are recorded. RESULTS: Twenty-five patients were included in study. 15 (60%) of these patients were male and 10 (40%) were female. The mean age of the patients was 81.33 ± 1.63. 40% of patients had previous stroke history or transient ischemic attack (TIA), 36% of them had hypertension (HT), 20% of them had coronary artery disease (CAD), 8% of them had hyperlipidemia (HL) and 8% of them had diabetes mellitus (DM). 25 patients applied 31 stenting. 1 (4%) patient had periprocedural asystole and 4(16%) patients had periprocedural bradycardia. There was an infarction of the middle cerebral artery (MCA) ipsilateral to the stent in 1 (4%) patient. Reperfusion bleeding did not occur in any patient. 2 (8%) patients had post-procedural encephalopathy and agitation lasting shorter than 24 hours. Hypotension was observed in 8 patients (32%). Twelve (48%) patients had post-procedural headache lasting shorter than 24 hours. _____________________________________________________________________________________________________________________________ Yazışma Adresi: Yrd. Doç. Dr. Yusuf İnanç Gaziantep Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Gaziantep. E-mail: yusufinanc77@hotmail.com Telefon: 0342 360 60 60 Geliş Tarihi: 09.05. 2018 Kabul Tarihi: 08.06.2018 Received: 09.05.2018 Accepted: 08.06.2018 Bu makale şu şekilde atıf edilmelidir: İnanç Y, Yıldırım S, Giray S, Karaçay E. Seksen yaş üstü hastalarda supraaortik stentleme tecrübelerimiz. Türk Beyin Damar Hastalıkları Dergisi 2018; 24 (2): 52-57. doi: 10.5505/tbdhd.2018.97658

Creutzfeldt-Jakob disease presented with dizziness, weakness and neuropsychiatric symptoms: 2 Case Reports -

Creutzfeldt-Jakob disease (CJD) is among very rare, progressive, untreatable, neurodegenerative prion diseases. While the incidence is reported as 1/1000000 years in European countries, sporadic cases are rarely presented in Turkey. Clinical findings are in the form of rapid progressive dementia, myoclonus, cerebellar, pyramidal and extra pyramidal symptoms. Definitive diagnosis is established by histopathological examination. Our case is a 64-year-old male and 70-year-old female patients admitted with dizziness emerged as sub-acute weakness, nausea, vomiting, insomnia, imbalance and additional neuropsychiatric complaints. Focal activity slowness and common periodic sharp wave activities were observed in EEG. CJD was considered because bilateral symmetrical diffusion limitation was observed at both sides in the basal ganglia level in cranial diffusion MRI’s and 14-3-3 protein was resulted as positive in CSF examinations. CJD, which is a very rare disease in patients presenting with progressive neuropsychiatric symptoms and seizure, is one of the diagnosis to be considered and we wanted to emphasize that there is no treatment for it and preventive measures should be taken.