Possibilities of transcatheter treatment of patients after extensive ischemic stroke

DOI: 10.4236/wjns.2013.33022   PDF   HTML     4,975 Downloads   7,312 Views   Citations


The research investigates the efficacy of brain transcatheter laser revascularization in patients who have had extensive ischemic stroke. 1125 patients aged 29 - 81 (average age 75) with cerebral atherosclerosis were examined. The examination plan included: CT brain scan, magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG), cerebral multi-gated angiography (MUGA), laboratory tests, assessment of severity of dementia (CDR), cognitive impairment (MMSE) and activities of daily living (IB). 93 patients suffered extensive ischemic stroke of whom 7 (7.53%) had 10 - 15 IB points, 25 (26.88%)—20 - 30 IB points, 61 (65.59%)—35 - 45 IB points. 69 patients underwent transcatheter treatment (Test Group). 24 patients underwent conservative treatment (Control Group). High-energy laser systems were used for revascularization of major intracranial arteries; lowenergy laser systems were used for revascularization of distal intracranial branches. Test Group: 67 (97.10%) patients had good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization. 12 - 24 months later the following positive trend was observed: 14 (20.59%) patients demonstrated good clinical outcome (IB 90 - 100); 26 (38.24%) patients had satisfactory clinical outcome (IB 75 - 85); 28 (41.18%) patients showed relatively satisfactory clinical outcome (IB 60 - 70); relatively positive clinical outcome (IB < 60) was not obtained in any case. Control Group: 4 (16.67%) patients showed relatively satisfactory clinical outcome (IB 60 - 70), relatively positive clinical outcome (IB < 60) was achieved in 20 (83.33%) cases. Evaluating the data obtained, it can be concluded that the method of transluminal laser revascularization of cerebral blood vessels is an effective one for the treatment of extensive ischemic strokes. The effect is maintained for a long time; it causes regression of mental, intellectual and motor disorders, promotes regression of post-stroke dementia and significantly improves the quality of life, which makes it noticeably different from the conservative methods of treatment.

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Maksimovich, I. (2013) Possibilities of transcatheter treatment of patients after extensive ischemic stroke. World Journal of Neuroscience, 3, 171-185. doi: 10.4236/wjns.2013.33022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Crozier, S. (2012) Withdrawing and withholding treatments in acute severe stroke patients in the elderly. La Revue du Praticien , 62, 1243-1245. http://www.ncbi.nlm.nih.gov/pubmed/23272475
[2] Abou-Chebl, A. (2013) Management of acute ischemic stroke. Current Cardiology Reports, 15, 348-354. http://www.ncbi.nlm.nih.gov/pubmed/23420444 doi:10.1007/s11886-013-0348-4
[3] Gillum, R.F., Kwagyan, J. and Obisesan, Th.O. (2011) Ethnic and geographic variation in stroke mortality trends. Stroke, 42, 3294-3296. http://www.ncbi.nlm.nih.gov/pubmed/21940976 doi:10.1161/STROKEAHA.111.625343
[4] Pendlebury, S.T., Wadling, S., Silver, L.E. and Rothwell, P.M. (2011) Transient cognitive impairment in TIA and minor stroke. Stroke, 42, 3116-3121. doi:10.1161/STROKEAHA.111.621490
[5] Pasi, M., Poggesi, A., Salvadori, E. and Pantoni, L. (2012) Post-stroke dementia and cognitive impairment. Front Neurol Neurosci, 30, 65-69. http://www.ncbi.nlm.nih.gov/pubmed/22377866 doi:10.1159/000333412
[6] ElAli, A., Doeppner, T.R. and Hermann, D.M. (2011) Increased blood-brain barrier permeability and brain edema after focal cerebral ischemia induced by hyperlipidemia: Role of lipid peroxidation and Calpain-1/2, matrix Metalloproteinase-2/9, and Rho A overactivation. Stroke, 42, 3238-3244. http://www.ncbi.nlm.nih.gov/pubmed/21836084 doi:10.1161/STROKEAHA.111.615559
[7] Frolich, A.M., Psychogios, N.M., Klotz, E., et al. (2012) Angiographic reconstructions from whole-brain perfusion CT for the detection of large vessel occlusion in acute stroke. Stroke, 43, 97-102. doi:10.1161/STROKEAHA.111.630954
[8] Tu, H.T., Campbell, B.C., Christensen, S., et al. (2013) Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation. International Journal of Stroke, 8, 12. http://www.ncbi.nlm.nih.gov/pubmed/23489996
[9] Moustafa, R.R., Momjian-Mayor, I., Simon Jones, P., Morbelli, S., Day, D.J., Aigbirhio, F.I., Fryer, T.D., Warburton, E.A. and Baron, J.C. (2011) Microembolism versus hemodynamic impairment in rosary-like deep watershed infarcts: A combined positron emission tomography and transcranial doppler study. Stroke, 42, 3138-3143. doi:10.1161/STROKEAHA.111.616334
[10] Polak, J.F., Pencina, M.J., O’Leary, D.H. and D’Agostino, R.B. (2011) Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis. Stroke, 42, 3017-3021. http://www.ncbi.nlm.nih.gov/pubmed/?term=Polak+JF%2C+Pencina+MJ%2C+O'Leary+DH%2C+D'Agostino+RB doi:10.1161/STROKEAHA.111.625186
[11] Liebeskind, D.S. (2005) Collaterals in acute stroke: Beyond the clot. Neuroimaging Clinics of North America, 15, 553-573. http://www.ncbi.nlm.nih.gov/pubmed/?term=Collaterals+in+acute+stroke%3A+beyond+the+clot doi:10.1016/j.nic.2005.08.012
[12] Zhulev N.M., Pustozertsev, V.G. and Zhulev, S.N. (2002) Cerebrovascular diseases. BINOM, Moscow. http://www.combook.ru/product/158808/
[13] Maksimovich, I.V. (2012) Transcatheter treatment of atherosclerotic lesions of the brain complicated by vascular dementia development. World Journal of Neuroscience, 2, 200-209. http://www.scirp.org/journal/PaperInformation.aspx?paperID=24664&#abstract doi:10.4236/wjns.2012.24031
[14] Albers, G.W. and Olivot, J.M. (2007) Intravenous alteplase for ischaemic stroke. Lancet, 369, 249-250. http://www.ncbi.nlm.nih.gov/pubmed/17258646 doi:10.1016/S0140-6736(07)60120-2
[15] Hacke, W., Kaste, M., Bluhmki, E., et al. (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. The New England Journal of Medicine, 359, 1317-1329. http://www.ncbi.nlm.nih.gov/pubmed/18815396
[16] Liu, R., Yuan, H., Yuan, F. and Yang, S.H. (2012) Neuroprotection targeting ischemic penumbra and beyond for the treatment of ischemic stroke. Journal of Neurology Research, 34, 331-337. http://www.ncbi.nlm.nih.gov/pubmed/22643076
[17] Takaiwa, A., Kuwayama, N., Akioka, N., Kurosaki, K., et al. (2013) Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis. Acta Neurochirurgica, 155, 627-633. http://link.springer.com/article/10.1007/s00701-013-1625-0
[18] Silver, F.L., Mackey, A., Clark, W.M., Brooks, W., Timaran, C.H., Chiu, D., Goldstein, L.D., Meschia, J.F., Ferguson, R.D., Moore, W.S., Howard, G. and Brott, T.G. (2011) Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Stroke, 42, 675-680. doi:10.1161/STROKEAHA.110.610212
[19] Muroi, C., Khan, N., Bellut, D., Fujioka, M. and Yonekawa, Y. (2011) Extracranial-intracranial bypass in atherosclerotic cerebrovascular disease: Report of a single centre experience. British Journal of Neurosurgery, 25, 357-362. http://www.ncbi.nlm.nih.gov/pubmed/21501047 doi:10.3109/02688697.2010.551673
[20] Papanagiotou, P., Roth, C., Walter, S., Behnke, S., Grunwald, L.Q., Viera, J., Politi, M., Korner, H., Kostopoulos, P., Haass, A., Fassbender, K. and Reith, W. (2011) Carotid artery stenting in acute stroke. Journal of the American College of Cardiology, 58, 2363-2369. http://content.onlinejacc.org/article.aspx?articleid=1147802 doi:10.1016/j.jacc.2011.08.044
[21] Rohde, S., Seckinger, J., Hahnel, C., et al. (2013) Stent design lowers angiographic but not clinical adverse events in stenting of symptomatic intracranial stenosis—Results of a single center study with 100 consecutive patients. International Journal of Stroke, 8, 87-94. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2011.00715.x/abstract
[22] Fjetland, L., Roy, S., Kurz, K.D., et al. (2012) Endovascular acute stroke treatment performed by vascular interventional radiologists: Is it safe and efficacious? CardioVascular and Interventional Radiology, 35, 1029-1035. http://link.springer.com/article/10.1007/s00270-012-0438-5
[23] Lee, J.S., Hong, J.M., Lee, S.J., et al. (2013) The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochirurgica, 155, 635-641. http://link.springer.com/article/10.1007/s00701-013-1649-5
[24] Ciccone, A., Valvassori, L., Nichelatti, M., et al. (2013) Endovascular treatment for acute ischemic stroke. The New England Journal of Medicine, 7, 904-913. http://www.ncbi.nlm.nih.gov/pubmed/23387822
[25] Abou-Chebl, A. (2013) Intra-arterial therapy for acute ischemic stroke. CardioVascular and Interventional Radiology, 1, 100-108. http://www.karger.com/Article/FullText/346769
[26] Maksimovich, I.V. (2006) Method for carrying out transluminal laser-induced brain revascularization in atherosclerotic injury cases. RF Patent No. 2297861. http://worldwide.espacenet.com/publicationDetails/biblio?
[27] Maksimovich, I.V. (2006) Method of transluminal laser revascularization of cerebral blood vessels having atherosclerotic lesions. US Patent No. 7490612. http://www.patentlens.net/patentlens/patents.html?patnums=US_7490612&return
[28] Mahoney, F.I. and Barthel, D.M. (1965) Functional evaluation: The barthel index. Maryland State Medical Journal, 14, 61-65. http://www.ncbi.nlm.nih.gov/pubmed/14258950
[29] Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, 2412-2414. http://www.ncbi.nlm.nih.gov/pubmed/8232972 doi:10.1212/WNL.43.11.2412-a
[30] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. http://www.ncbi.nlm.nih.gov/pubmed/1202204 doi:10.1016/0022-3956(75)90026-6
[31] Maksimovich, I.V. (2010) Transluminal Laser revascularization of cerebral blood vessels in the treatment of ischemic stroke. Journal of the American College of Cardiology, 56, B48-B49. http://www.sciencedirect.com/science/article/pii/S0735109710030809
[32] Deviatkov, N.D., Rabkin, I.Kh., Maksimovich, I.V., Rogov, R.A. and Aleinikov, V.S. (1986) Use of coppervapor laser radiation for the evaporation of atherosclerotic lesions of the major arteries in vitro. Surgery, 4, 116-121. http://www.ncbi.nlm.nih.gov/pubmed/3713043
[33] Petrovskiy, B.V., Deviatkov, N.D., Rabkin, I.Kh., Maksimovich, I.V. and Rogov, K.A. (1986) Destruction of arteriosclerotic lesions of human cadaveric arteries by laser irradiation with copper vapors. Surgery, 5, 112-116. http://www.ncbi.nlm.nih.gov/pubmed/3723942
[34] Kuleshov, E.V. and Maksimovich, I.V. (1994) Endovascular surgery in patients over 65 with disseminated atherosclerosis of the vessels of the pelvis and lower extremities. Vestnik Khirurgii Imeni I. I. Grekova, 152, 27-30. http://www.ncbi.nlm.nih.gov/pubmed/7701734
[35] Maksimovich, I.V. (2004) Transljuminal laser angioplasty in treatment of ischemic lesions of a brain. M.D. Dissertation, Russian University of Friendship of the People, Moscow. http://disseng.com/page/order/id/206426.html
[36] Deramecourt, V., Slade, J.Y., Oakley, A., Perry, R.H., Ince, P.G., Maurage, C.A. and Kalaria, R.N. (2012) Staging and natural history of cerebrovascular pathology in dementia. Neurology, 78, 1043-1050. http://www.ncbi.nlm.nih.gov/pubmed/22377814 doi:10.1212/WNL.0b013e31824e8e7f
[37] Chizhov, G.K., Kovalskaia, N.I. and Kozlov V.I. (1991) The effect of helium-neon laser radiation on the energy metabolic indices of the myocardium. Bulletin of Experimental Biology and Medicine, 111, 302-305. http://www.ncbi.nlm.nih.gov/pubmed/2054512 doi:10.1007/BF00840904
[38] Kozlov, V.I. and Azizov, G.A. (2007) Pathophysiological characteristics of microcirculatory disorders in chronic arterial ischaemia of lower limbs. Angiology and Vascular Surgery, 13, 17-23. http://www.ncbi.nlm.nih.gov/pubmed/17679971
[39] Moskvin, S.V. (2008) System analysis of efficiency in controlling biological systems with low-energy laser radiation. Thesis for Degree of Doctor of Biological Sciences, City of Tula. http://www.dissers.info/disser_323120.html
[40] Starck, T., Nissila, J., Aunio, A., Abou-Elseoud, A., Remes, J., Nikkinen, J., Timonen, M., Takala, T., Tervonen, O. and Kiviniemi, V. (2012) Stimulating brain tissue with bright light alters functional connectivity in brain at the resting state. World Journal of Neuroscience, 2, 81-90. http://www.scirp.org/journal/PaperInformation.aspx?paperID=19417#abstract
[41] Heinrich, C., Blum, R., Gascón, S., et al. (2010) Directing astroglia from the cerebral cortex into subtype specific functional neurons. PLOS Biology, 8, e1000373. http://www.ncbi.nlm.nih.gov/pubmed/20502524

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