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Atherosclerotic changes in carotid arteries play an important role in the pathogenesis of ischaemic stroke. To a high extent there is evident asymmetry within the development of these changes, affecting just one artery. The aim of the study was to determine the impact of the cardiovascular risk factors on the presence of haemodynamically significant atherosclerotic changes or occlusion only in one compared to both of the carotid arteries in patients with ischaemic stroke.Patients diagnosed with ischaemic stroke were retrospectively assessed towards stenosis of ≥70% or occlusion in at least one of the internal or common carotid arteries. There were 104 patients enrolled in the study. Group I consisted of individuals with haemodynamically significant (≥70%) stenosis or occlusion in one carotid artery (n = 48). Group II consisted of patients with bilateral significant (≥70%) stenosis or occlusion in carotid arteries (n = 56).There were no changes found in the presence of non- -modifiable stroke risk factors between the groups. In group I higher HDL level (45.7 vs 38.9 mg/dL, p = 0.038) and significantly more frequent calcifications in the atherosclerotic plaques of carotid arteries were found (p = 0.03). There were no differences in other tested factors between groups.The protective properties of HDL cholesterol and the slow formation of more stable, calcified plaques play an important role only in the development of unilateral advanced atherosclerosis in carotid arteries. The role of HDL cholesterol in stroke pathomechanism needs further studies.

Atrial fibrillation (AF) is an independent factor increasing the risk of an ischemic stroke (IS) fivefold. The objective of the study was to evaluate the frequency of coexistence of non-valvular AF and IS during the acute stroke and to analyze the attitude of AF patients to treatment. The study included 3712 successive patients presenting either an IS or a transient ischemic attack. The analysis revealed a significant increase in the rate of patients with AF and IS in the years 2010-2013 (31.9%) compared with 2002-2005 (20.2%). A rise in the proportion of AF and IS patients was recorded over the course of consecutive years in group II. The proportion of newly detected AF cases during hospital stay differed significantly between the groups (16.9% vs. 31.9%). Group I and II patients differed essentially with regards to hypertension incidence and female rates. Antiplatelet medications or OACs were taken by a significantly greater number of AF patients in group II. Low number of therapeutic levels of INR was recorded in both groups. IS and AF coexist more frequently than indicated by previous assessments and demographic data from other countries. Increase in the number of IS and AF patients may result from higher detectability of AF and older age of patients affected with stroke, women in particular. Despite a well grounded knowledge about the benefits of OACs use in the prophylaxis of thrombotic-embolic events in AF patients, they are rarely used. A surprisingly low proportion of patients taking OACs reaches a therapeutic INR level.

Background: The question about the role of CD4 + CD28 – lymphocytes in the pathogenesis of atherosclerosis-related ischemic stroke is still open. Material and methods: The study included patients, who underwent endarterectomy of internal carotid arteries. The group consisted of patients after stroke and ones without previous stroke. The histopathologic examination of obtained plaques has been performed. The percentage of CD4 + CD28 – lymphocytes in peripheral blood and their cytotoxicity has been assessed for each patient. Results: The global percentage of CD4 + CD28 – lymphocytes in blood was higher in the group of patients with plaques where connective tissue fibers consisted significantly of collagen fibers. The cytotoxicity of analysed cells related to less plaques calcification and presence of cholesterol crystals in the plaque. A multifactor regression of dependent variable presented the last relationship above as a only strong. Conclusions: CD4 + CD28 – cytotoxic lymphocytes seem to be involved in carotid atherosclerotic plaques development.

Disorders of haemostasis which result in ischaemic stroke usually appear as thromboembolism in peripheral veins and the pulmonary circulation, and to a lesser extent as coagulopathy. The S-100 protein, a marker of stroke, correlates positively with the neurological deficit National Institutes of Health Stroke Scale (NIHSS). We adopted the hypothesis that early death of patients with acute ischaemic stroke can be explained by changes in blood coagulation and fibrinolysis. The study included 84 patients hospitalized with acute ischaemic stroke. Three groups were created: I (death between 1 and 2 days), II (death between 5 and 7 days) and III (with no deaths in hospital). We measured levels of fibrinogen, antithrombin, D-dimers, plasmin-antiplasmin complexes, plasminogen and clotting times (prothrombin time and activated partial thromboplastin time), platelet number, euglobulin clot lysis time (ECLTindex) and S-100 protein, C-reactive protein and white blood cells (WBCs). Group I had lower concentrations of fibrinogen compared to groups II (3.13 vs. 4.18, P

The only method giving the possibility of a thorough assessment of plaques instability, is a histologic examination. Three plaques categories were distinguished: unstable, potentially unstable and stable. The distribution of particular types of plaques was similar in symptomatic and asymptomatic patients. Over three quarters of lesions which could correspond to stable plaques in a macroscopic assessment, microscopically fulfilled the criteria for unstable or potentially unstable ones (the number of confirmed stable lesions vs the number of unconfirmed ones, 13 vs. 51 respectively, p0.0001). In a microscopic assessment made for all the plaques altogether, 52 plaques (58.4%) were considered unstable; 18 (20.2%) fulfilled the criteria for potentially unstable ones. The remaining 19 plaques (21.4%) were classified as plaques of stable structure. Unstable plaques constituted a significant majority (unstable vs potentially unstable and unstable vs. stable, p = 0.0006 and p = 0.0008 respectively). Due to the fact that majority of carotid atheromatous plaques appear to be unstable or potentially unstable because of the inflammation and related mechanisms, the role of the inflammatory-immunologic component of atherosclerosis should be used in prophylaxis of stroke and the new therapeutic concepts worked out.

Background and purpose The aim of the study was to search for differences between clinical characteristics of recurrent ischaemic stroke which occurred within the fifth year after the first event or later, and early recurrence, i.e. within the first year after first-ever ischaemic stroke. We also tried to determine prognostic factors of late recurrent ischaemic episodes. Material and methods The patients were divided into two groups: group I comprised 124 individuals with recurrence within the first year, and group II − 98 individuals in whom the recurrent episode appeared within the fifth year or later. Results A significantly higher percentage of patients in group I demonstrated evident stenosis (70% or more) of internal carotid artery ipsilateral to stroke ( p = 0.023). In this group more cardioembolic strokes were found compared to group II, while in the latter, predominantly lacunar strokes appeared ( p = 0.046 and 0.0002, respectively). Group II patients significantly more frequently reported acetylsalicylic acid application, including systematic drug use ( p = 0.001). No evident differences were found between groups considering other important non-modifiable and modifiable risk factors of stroke. Conclusions Small differences between risk factors of ischaemic stroke profiles in patients with early and late recurrent episodes do not allow us to distinguish unequivocally a group of patients with better prognosis regarding the time of recurrent stroke. Use of antiplatelet drugs, either systematic or non-systematic, and lacunar stroke are independent, positive prognostic factors of delay of potential recurrent stroke.

The aim of this study was to examine the correlation between age and clinical course of spontaneous intracerebral haemorrhage (SICH) in its acute phase (within 30 days), including severity of neurological deficit, characteristics and frequency of medical complications as well as 30-day mortality. We also attempted to determine independent predictors of early mortality.This study comprised 153 patients with SICH admitted within 24 hours after SICH onset who were treated pharmacologically and had complete clinical data. The analysis concerned the correlation between age and neurological deficit on admission and on discharge, assessed with NIHSS score; the types and the frequency of general complications that occurred in the acute phase of SICH; characteristics of head CT images; early mortality; and survival time. Multiple logistic regression analysis was used to determine independent predictors of early mortality.Age of patients correlated with NIHSS score on admission (p = 0.000003) and on discharge (p = 0.02); 35.2% of patients developed medical complications, presumably infectious ones, and the age of patients who developed complications was significantly higher (p = 0.004). Patients who died (21.5%) were significantly older (p = 0.0001). Predictors of death were: age (OR 1.1, 95% CI 1.02-1.19, p = 0.002) and severity of neurological deficit on admission (OR 1.3, 95% CI 1.1-1.6, p0.001).In elderly patients with SICH, the neurological deficit and risk of medical complications are more evident. Greater neurological deficit in these patients may result from coincidence of SICH with earlier brain lesions. Age and greater neurological deficit on admission constitute predictors of early mortality in elderly patients with SICH.

The stroke mortality rate in the Polish population is significantly higher than the average stroke mortality in Western Europe. It may prove a poor "initial" health condition of the Polish population which is afflicted with many life-threatening diseases which are at the same time the major risk factors for both: first ever and recurrent stroke. The aim of our study was to evaluate what is an attitude of Polish people with first-ever or recurrent stroke to keeping under control the most important risk factors for ischemic stroke.1282 consecutive patients with ischemic stroke were examined and categorized as individuals with first ever (group I - 980 patients) and recurrent stroke (group II - 302 patients). The data on the patients' previous history of stroke and vascular modifiable risk factors diagnosed before the onset of stroke: arterial hypertension (AH), type 2 diabetes mellitus (DM), ischemic heart disease (IHD), atrial fibrillation (AF), cigarette smoking and alcohol consumption were determined. The treatment with antiplatelet agents or oral anticoagulants was also taken into account.More than one-third ofpatients, irrespective of group admitted that they had treated AH unsystematically or not treated at all. Based on initial blood pressure, it may be suspected, that also individuals declaring systematic AH treatment, did not do it effectively. It also concerned the type 2 DM - glycemic control remained unsatisfactory within the period preceding first-ever and recurrent stroke. After first stroke, the patients haven't changed their habits considering tobacco smoking and alcohol consumption. The anticoagulants were used relatively seldom in relation to recommendations in both group of patients.The main risk factors for ischemic stroke are poorly controlled by Polish patients before first ever stroke. After the first cerebrovascular event they usually don't change their habits, which lead to recurrent stroke. In Poland the educational strategies regarding repetitive public information on benefits resulting from stroke prevention and fatal stroke consequences should be centered around the general public and the groupof high-risk patients.

Objective: Thrombolysis is a time-dependent therapy. It is therefore very important how fast stroke patients can reach hospital. The present study was designed to assess which proportion of patients with stroke (from the population of Szczecin, the capital of West Pomerania Province, Poland) reaches hospital within the recommended time from the thrombolytic therapy point of view. The purpose of our study was also to elucidate which factors can influence the time before the ambulance service is called. Patients and Methods: The study involved 1,015 patients with stroke admitted to the Emergency Department of the University Hospital, Szczecin. Results: 235 patients (23.1%) were admitted to the hospital within the appropriate period for thrombolytic therapy. Hospital arrival time was significantly earlier in older patients and in patients with severer neurological deficits. We also observed a tendency for faster hospitalization of women, the highly educated, and patients regularly using antiplatelet drugs for cardiovascular disease prevention. Conclusions: The percentage of stroke patients hospitalized within 2 h after stroke onset should be increased. The most susceptible subpopulations in our country seem to be older patients, the highly educated and patients regularly using antiplatelet drugs for cardiovascular disease prevention.