Search

Introduction: While the Thrombite device differs from the Solitare stent with its Helical open-side structure feature, it shows great similarity with its other features. We assessed the Thrombite device's effectiveness and safety in this study. Materials and methods: The study was a retrospective analysis of patients who were included in the Turkish Interventional Neurology database and who had mechanical thrombectomy with the Thrombite device as the first choice between January 2020 and January 2023. The type of study is descriptive research. Result: Using the Thrombite thrombectomy device, 525 patients received treatment. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 13, the median initial Alberta Stroke Program Early Computed Tomography (ASPECT) score was 8, and the mean patient age was 68.6+11.7 years. Between the groin puncture and the successful recanalization, the median time was 34 minutes (interquartile range [IQR]: 15-45). 48.2% (modified treatment in cerebral infarction; mTICI) 2b/3% and 33.9% (mTICI 2c/3) were the first-pass recanalization rates. In the end, 87.7% of patients had effective recanalization (thrombolysis in cerebral infarction 2b/3). In the "first-pass" subgroup, the favorable functional result (modified Rankin Scale 0-2) was 51.8%, while it was 41.6% for the entire patient population. The rate of embolization into new territory/different territory were 2.1/0.1%. 23 patients (4.5%) had symptomatic hemorrhage. Conclusion: The Thrombite device showed a good safety profile and high overall successful recanalization rates in our experience. [ABSTRACT FROM AUTHOR]

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neurointerventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0--2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 ± 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 ± 6; hospital stay, 24 ± 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 ± 13 years; NIHSS: 14.1 ± 6.5; length of hospital stay, 33 ± 31 days), 19% in those who received combined treatment (age: 66 ± 14 years; NIHSS: 15.6 ± 5.4; length of hospital stay, 26 ± 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 ± 13 years; NIHSS: 7.6 ± 7.2; length of hospital stay, 21 ± 28 days). The symptom-to-door time was 87 ± 53 minutes in the IV treatment group and 200 ± 26 minutes in the neurointerventional group. The average door-to-needle time was 66 ± 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 ± 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0--2 was 41%, while the rate of mRS 0--1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0--2 was 31% and mRS 0--1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 ± 107 and 95 ± 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the "Directive on Health Services to be Provided to Patients with Acute Stroke." [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the frequency of admission to hospital in patients with acute ischemic stroke before the COVID 19 pandemic, during the pre-vaccination period, and after the start of vaccination for COVID 19, and to evaluate the time window period between symptom onset to door time, door to CT scan time, door to needle time, and door to puncture time. In addition, it aimed to investigate the effects of the COVID-19 pandemic on the admission, evaluation, and initiation of acute treatment of patients with acute ischemic stroke. Methods: Patients presenting with acute ischemic stroke between March 2019 - December 2019 (pre-pandemic), March 2020 - December 2020 (prevaccination pandemic period), and March 2021 - December 2021 (post-vaccination pandemic period) were included in the study. NIHSS was calculated by accordance with the neurological examination findings of the patients, cranial CT for the exclusion of bleeding and CT angiography images for the large vessel occlusions were performed, and the vital signs of the patients were recorded. IV tPA treatment was applied within the first 4.5 hours, and mechanical thrombectomy (MT) was performed in patients with large vessel occlusion. Results: Three hundred nineteen patients were included in the study. The times from symptom onset to emergency admission and from symptom onset to CT scan were found to be similar in all periods. The time from symptom onset to examine by a neurologist was found to be significantly longer in the vaccination period compared to the pandemic period. It was observed that the time from the door to needle time and the time from examine by a neurology doctor to needle time was statistically significantly shorter during the pandemic period (p<0.05). Conclusion: In our study in a tertiary hospital in Turkey, it was determined that the number of patients who was admitted with acute stroke clinic during the pandemic period was similar to other years and there was no delay in the initiation of treatment during the pandemic period. Door to needle times, as well as the time taken by the neurologist to examine and initiate IV-tPA treatment, were found to be shorter in the pre-vaccination pandemic period than in the pre-pandemic and post-vaccination periods. [ABSTRACT FROM AUTHOR]

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF. [ABSTRACT FROM AUTHOR]

Objective: Acute ischemic stroke (AIS) is a major cause of mortality and morbidity throughout the world. Intravenous thrombolysis (IVT) and endovasculary treatments (EVT) are recomended currently in eligible patients admitted within the therapeutic window. In this study, the data of AIS patients who were treated with intravenous and EVT methods in Istanbul Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital between 2017-2020 were evaluated retrospectively. Materials and Methods: Five hundred and ninety patients who received IVT and/or EVT were included in the study. Demographic, clinical, radiological characteristics, risk factors and post-treatment clinical characteristics of these patients were analyzed. Results: Of the 590 patients, 324 (54.9%) underwent IVT, 164 (27.8%) EVT and 102 (17.3%) combined IVT+EVT. The median National Institutes of Health Stroke Scale (NIHSS) scores were 9 (1-21) in the iv tPA group, 13 (3-27) in the EVT group, 12 (4-23) in the combined treatment group at admission In the IVT group, 220 patients had no artery occlusion (67.9%), M2 segment of the middle cerebral artery (MCA) was found to be the most frequently occluded artery with 32 patients (9.9%). In the EVT and combined IVT+EVT groups, the M1 segment of the MCA had the highest occlusion rate [76 (44.2%), 49 (45%), respectively]. Asymptomatic hemorrhage rate was higher in the EVT group than the other groups. Symptomatic hemorrhage rate was lower in the IVT group compared to the other groups. A total of 182 (56.2%), 67 (39%) and 53 (48.6%) patients in the IVT, EVT and combined IVT+EVT groups had good outcome, respectively. Conclusion: Acute stroke treatment has been proven to significantly reduce the serious burden of stroke on patients, caregivers and society. For this reason, the societal awareness of the importance of urgent admission to emergency departmentsand the number and capacity of centers that provide AIS treatments should be increased. [ABSTRACT FROM AUTHOR]

The most up-to-date stroke statistics for Turkey are presented using the Global Burden of Disease e-research system. In 2019, the incidence of stroke for Turkey was estimated as 125,345 (154 per hundred thousand), the prevalence was 1,080,380 (1.3%), the death rate due to stroke was 48,947 and the number of life years lost due to stroke-related death/disability was estimated to be 993,082 years. Of strokes 17.4% occurred under the age of fifty, 58.5% under the age of seventy, and 54.3% in women. 65.1% of strokes are acute ischemic stroke, 24% intracerebral and 10.9% subarachnoid hemorrhage. Although there is a numerical increase in all stroke types with the aging of our country's population, it has been observed that the increase in the frequency of hemorrhagic strokes are limited over time when frequency standardization is made according to age. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the relationship between the empathy level of emergency department physicians and nurses and the referral of patients for intravenous thrombolytic and/or endovascular thrombectomy treatment. Material and Methods: This cross-sectional study was carried out with the emergency department physicians and nurses of hospitals that did not have a stroke clinic in Bursa in July 2019, and included 198 emergency personnel. Participants' sociodemographic characteristics, professional working conditions, and stroke history in their immediate environment (friends and family) were recorded and empathy level was measured. The health professions version of the Jefferson Scale of Empathy was used in the assessment of empathy status among emergency physicians and nurses. Results: The mean empathy score of the study group, by the Jefferson scale of empathy, was found 98.63±14.83 points. In this study, no significant relationship was found between the empathy score and the number of referrals (p=0.962). The total empathy score did not differ by the role of the participants in the hospital (p=0.161) or observation of stroke cases in their family or their friends (p=0.694). Healthcare professionals who had received emergency education (p<0.001), were older (p<0.001), spent more time in their profession (p=0.005), and had observed stroke cases in their family or friends (p=0.005) transferred more stroke cases. Conclusion: This study suggests that interventions for increasing the empathy levels of emergency medicine specialists and nurses will not have a general effect on the referral of acute stroke cases for intravenous thrombolytic and endovascular thrombectomy treatment. [ABSTRACT FROM AUTHOR]

Objectives: Data on the co-occurrence of stroke and coronavirus disease 2019 (COVID-19) infection are limited and need to be improved. In our study, we aimed to evaluate the clinical and laboratory characteristics of COVID-19-related patients admitted to our center with acute stroke and compare them with acute stroke patients without COVID-19 infection during the same period. Methods: One hundred and eighty-four patients admitted with acute stroke from March 11, 2020, to May 11, 2020, were included in the study. Demographic and clinical characteristics, work-up studies, and clinical scales including National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) scores were examined retrospectively. All patients diagnosed with acute stroke who were also evaluated for COVID-19 before hospitalization were divided into two groups: COVID-19-related and unrelated cases. Results: COVID-19-related and unrelated acute stroke patients had similar characteristics in terms of age, gender, and stroke risk factors. The admission NIHSS (mean NIHSS: 9.8 vs. 5.9) scores and the discharge mRS values (mean mRS: 3.9 vs. 2.4) were significantly higher in the COVID-19-related stroke group (p=0.002 and p=0.001, respectively). The prognosis of the COVID-19-related stroke group was significantly worse (69.6% vs. 39.8%) and the mortality rate (39.1% vs. 6.2%) was significantly higher than the COVID-19-unrelated stroke group (p=0.007 vs. p=0.000, respectively). The proportion of patients with large infarcts in the COVID- 19-related acute ischemic stroke group was significantly higher than the one in the COVID-19-unrelated acute ischemic stroke group (57.9% vs. 21.9%, p=0.003). Conclusion: This is the first comparative study to evaluate the clinical presentation and outcome of COVID-19-related acute ischemic and hemorrhagic stroke patients in Turkey. Our results suggest that COVID-19-related acute stroke is associated with more severe clinical presentation and worse outcome. This seems to be linked to the coagulation abnormalities induced by COVID-19 infection. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the evidence-based acute stroke knowledge level in nurses. Materials and Methods: This descriptive study consisted of 245 nurses who work in Farabi Hospital of Karadeniz Technical University Health Application and Research Center in Trabzon city center. Data are collected using "Introductory Information Form" and "Acute Stroke Knowledge Level Measurement and Awareness Form" created within the scope of "T.R. Ministry of Health Stroke Clinical Protocol". The suitability of data for normal distribution was evaluated with the Shapiro-Wilk and Kolmogorov-Smirnov tests. One-Way analysis of variance and independent samples t-test to were used to compare the data with normal distribution, whereas the Kruskal-Wallis and Mann-Whitney U test to compare data without normal distribution and chi-square test for categorical data. The significance level was taken as p values of <0.05. Results: The average age of the nurses was 32.19±7.76 (minimum: 20, maximum: 60) years, wherein 64.9% had a bachelor's degree and 93.1% were clinical/service nurses. The common correct answers were given to questions about nursing care in acute stroke, whereas wrong answers to questions about stroke scale, tPA dose, and stroke time management. A positive, weak, and statistically significant relationship was found between the knowledge score of the nurses and their ages (r=0.158; p=0.013). Nurses who followed professional publications and attended congresses, courses, and symposium programs answered the questions more accurately. Conclusion: Improving the knowledge level of nurses on acute stroke is necessary to organize postgraduate and in-service training programs to ensure the participation of nurses in scientific meetings and develop stroke care clinical practice guidelines for quality patient care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of published case series originating from Turkey, which may be useful for system planning and institutional goal setting in the clinical practice of intravenous tissue plasminogen activator therapy for acute stroke. Materials and Methods: A meta-analysis of case series, published in the last 10 years, from Turkish hospitals / institutions about intravenous thrombolytic therapy in acute stroke was performed. Weighted averages and 95% confidence intervals, Q and I2 values were calculated using the standard method based on random-effect model. Results: A total of 2349 patients (52% female, mean age 65±12 years) in 21 articles were included. The mean symptom-to-needle time was 111±16 minutes; pre-thrombolysis average NIH stroke score was 13.8±4.2; mean good prognosis (modified Rankin's score, 2 or lower) rate was 59.6%; mortality rate was 16.5%, and symptomatic thrombolytic-related intracerebral bleeding was 5.6%. There was no large grade heterogeneity among the enrolled series. Conclusion: Results of published Turkey-based thrombolysis case series meet the current world standards. The values produced herein can be used as standards for center-based quality metrics. [ABSTRACT FROM AUTHOR]

In Turkey, the incidence of acute stroke is increasing, obviously with the contribution of the aging population. With the publication of "Directive on Health Services to be Provided to Patients with Acute Stroke" on July 18, 2019 and its entry into force in March 2021, an important period of catching up and updating has begun in the management of acute stroke patients in our country. During this period, 57 comprehensive stroke centers and 51 primary stroke centers were certified. These units have covered approximately 85% of the country's population. In addition, around 50 interventional neurologists were trained and became the directors of many of these centers. In the following 2 years, the "inme.org.tr campaign" was launched. This campaign, aimed at increasing the public's knowledge and awareness about stroke, continued unabated during the pandemic period. Now is the time to continue the efforts to ensure homogeneous quality metrics and to develop and continuously improve the established system., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© European Stroke Organisation 2022.)

This study was performed in acute stroke patients in the Turkish population to determine the frequency of the A1166C polymorphism in the AT1 gene and to examine the role of this polymorphism in acute stroke development. In this study, 257 genomic DNA samples were analysed (from 206 acute stroke patients and 51 healthy individuals). Genomic DNA was prepared from peripheral blood using the salt-extraction method. The presence of the A1166C polymorphism in the AT1 gene was determined using the polymerase chain reaction ( PCR)-restriction fragment length polymorphism ( RFLP) method. PCR products were separated by 2% agarose gel electrophoresis and visualized by a charge-coupled device ( CCD) camera. In this study, the allele frequency at the A1166C position was 92% A and 8% C for control and 97% A and 3% C for patients. This difference in allele frequency between the control group and the patient group was not statistically significant. However, genotype and allele frequencies showed a significant difference ( P < 0.001) in the control and the patient groups. The results of this study show no relationship between the A1166C polymorphism in the AT1 gene and acute stroke in the Turkish population. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate gender differences in Turkish stroke patients. Material and Methods: Demographics, risk factors, clinical and etiologic subtypes, laboratory findings, clinical course, and in-hospital prognosis of 1 522 patients with ischemic stroke (IS) and 320 patients with intracerebral hemorrhage prospectively registered in the Istanbul Medical School Stroke Registry (1994-2004) were analyzed separately. Results: The mean age of IS patients was higher in females (n : 751) (P<0.0001). In males, smoking, ischemic heart disease, peripheral arterial disease, posterior circulation syndromes, and strokes due to large-artery atherosclerosis were more common (P<0.0001 for each). Prestroke disability, atrial fibrillation (P<0.0001), hypertension (P=0.041), modified Rankin Scale (mRS) 3-5 at admission (P<0.0001), total anterior circulation syndrome (P<0.0001), and cardioembolic stroke (P<0.0001) were more frequent in females. Female gender was an independent predictor of poor outcome (mRS 3-6). Conclusion: Gender differences were observed exclusively in patients with IS. Although our patients were younger than those reported, gender differences were similar. [ABSTRACT FROM AUTHOR]

Background and Aims: Intracranial internal carotid artery calcification (IICAC) is a frequent and readily available finding in acute stroke patients treated with intravenous (IV) tissue plasminogen activator (tPA). We aimed to investigate the effects of IICAC subtype (medial and intimal) on the response to IV tPA., Methods: In this retrospective study, 91 (57% female, age 69 ± 13 years) consecutive acute anterior circulation stroke patients treated with IV tPA were included. IICAC were diagnosed and classified according to Kockelkoren's methods., Results: IV tPA was effective at 24 h in 48% of patients with no IICAC (n = 27), 60% of intimal IICAC (n = 50) and 43% of medial IICAC (n = 14) (p=0.408). Presence of medial IICAC tended to be linked negatively to early dramatic response to IV tPA (p=0.052). IICAC status had no significant effect on the third month good (mRS≤2; 48% in no IICAC, 36% in intimal IICAC and 29% in medial IICAC; p=0.189) and favorable outcome (mRS≤1; 56% in no IICAC, 48% in intimal IICAC, 43% in medial IICAC, p=0.411). Frequency of symptomatic post-tPA cerebral hemorrhage was marginally higher in patients with non-intimal IICAC (21% vs. 4% in no-IICAC, 4% in intimal-IICAC, p=0.052). Exploratory multivariate analysis documented that this effect was stable (p=0.004) after adjustment for age, admission NIHSS and door-to-needle time., Conclusions: Medial type IICAC has been associated with numerical increase of symptomatic intracerebral hemorrhage and decrease of early dramatic response in stroke patients receiving IV tPA. Acknowledging that these preliminary observations should be replicated in larger cohorts, it is currently reasonable to say that "the treatment" is still useful in these patients and the presence of medial IICAC does not justify withholding IV tPA., (Copyright © 2018 Elsevier B.V. All rights reserved.)