Hany Aref

Background: Mechanical thrombectomy (MT) is now widely recognized as the primary intervention for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). MT techniques include aspiration, stent-retrieval, and a combined technique. Despite growing interest, direct comparisons of the safety and effectiveness of these techniques remain sparse; accordingly, we designed the present study to evaluate stent-retriever and contact aspiration techniques with respect to procedural safety, complication rates, and clinical, functional, and radiological outcomes. This prospective cohort investigation was carried out in the stroke unit, enrolling 100 anterior-circulation AIS patients who fulfilled the criteria for MT between March 2020 and March 2023. Patients were grouped into two cohorts: 50 received MT via a stent-retriever (Group 1) and 50 underwent contact aspiration (Group 2). Results: Participants had a median age of 64 years (an interquartile range of 52.5–71.5 years), with 53% males and 47% females. The two groups did not differ significantly with regard to procedure duration ( p = 0.551), time to recanalization ( p = 0.090), National Institute of Health Stroke Scale (NIHSS) ( p = 0.474), Thrombolysis in Cerebral Infarction (TICI) scores ( p = 0.461), modified Rankin Scale (mRS) scores ( p = 0.841), or complication rates ( p > 0.05) at three months. Conclusion: In patients with anterior circulation AIS treated with MT, contact aspiration and stent retriever techniques demonstrated comparable results in terms of functional outcomes, recanalization rates, and complication profiles at three months of follow up.

Background: Multiple sclerosis is a chronic neurological disorder affecting the central nervous system. It is classified as the foremost neurological contributor to disability among young adults. In 2017, Ocrelizumab, a humanized IgG1 monoclonal anti-CD20 antibody, received approval for the treatment of relapsing and progressive forms of MS. Results: This prospective cohort investigation sought to track total CD19 B-cell counts throughout the course of B-cell depletion therapy in MS patients, correlating these counts with disease activity. A total of 30 Egyptian patients diagnosed with Relapsing-Remitting Multiple Sclerosis, according to the 2017 McDonald criteria, were enrolled in the study. All participants underwent comprehensive assessments at baseline, 6 months, and 12 months post-therapy. Clinical, radiological, and laboratory assessment involved cerebral and spinal MRI, and CD19 B-cell counts were determined through flow cytometry for immunophenotyping. Our patients were predominantly female (73.3%). We observed a significant drop in CD19 B-cell counts from a median of 30.65 cells/µL pre-treatment to 2.76, 4.43, and 4.74 cells/µL at 1, 6, and 12 months, respectively. This B-cell depletion was strongly linked to a substantial reduction in the median Annualized Relapse Rate, which decreased from 2.0 before treatment to 0 after 12 months of Ocrelizumab therapy. Clinical outcomes showed a drop in the EDSS median score from 4.5 pre-treatment to 3.5 at 6 months and 2.5 at 12 months. Radiologically, most patients maintained a stable lesion burden in their brain and spinal cord in both number and size. A statistically significant reduction ( p < 0.05) in gadolinium-enhancing lesions was noted after 12 months. Conclusion: Ocrelizumab proved highly effective in reducing relapses, preventing disability progression, and decreasing disease activity (both clinical and radiological) in our group of Egyptian MS patients over 12 months using a fixed dose schedule.

Background: The issue of sex differences in stroke has gained concern in the past few years. However, multicenter studies are still required in this field. This study explores sex variation in a large number of patients and compares stroke characteristics among women in different age groups and across different countries. Methods: This multicenter retrospective cross-sectional study aimed to compare sexes regarding risk factors, stroke severity, quality of services, and stroke outcome. Moreover, conventional risk factors in women according to age groups and among different countries were studied. Results: Eighteen thousand six hundred fifty-nine patients from 9 countries spanning 4 continents were studied. The number of women was significantly lower than men, with older age, more prevalence of AF, hypertension, and dyslipidemia. Ischemic stroke was more severe in women, with worse outcomes among women (p: < 0.0001), although the time to treatment was shorter. Bridging that was more frequent in women (p:0.002). Analyzing only women: ischemic stroke was more frequent among the older, while hemorrhage and TIA prevailed in the younger and stroke of undetermined etiology. Comparison between countries showed differences in age, risk factors, type of stroke, and management. Conclusion: We observed sex differences in risk factors, stroke severity, and outcome in our population. However, access to revascularization was in favor of women.

Background: Ticagrelor is one of the most recent antiplatelet drugs to be approved to treat ischemic heart disease. Its efficacy may exceed aspirin in improving clinical outcomes in patients with acute ischemic stroke who are ineligible for rt-PA. Objectives: We evaluated the safety regarding hemorrhagic complications (as a primary endpoint) and the efficacy (as a secondary endpoint) of a 180-mg loading dose of ticagrelor given within 9 h from the onset of the first-ever non-cardioembolic ischemic stroke. Methods: We conducted our study on patients aged 18–75 years who presented with their first clinically manifested non-cardioembolic ischemic stroke and were recruited from the emergency department OF Kafr El-Sheik University Hospitals, Egypt. Eligible patients randomly received ticagrelor or aspirin loading and maintenance doses. Screening, randomization, and initiation of treatment all occurred within the first 9 h of stroke onset. Results: Eighty-five patients received ticagrelor, and 84 received aspirin. Patients who received ticagrelor had a better clinical outcome in terms of NIHSS improvement at 2 days and 1 week of discharge and a favorable mRS score after 1 week of discharge and at 90-day follow-up. There was no significant difference between the two groups regarding hemorrhagic adverse effects. Conclusion: This pilot study found that ticagrelor had a better clinical outcome than aspirin based on NIHSS and mRS in acute ischemic stroke patients who received it within 9 h from symptom onset and had a shorter hospital stay duration. Ticagrelor was non-inferior to aspirin regarding hemorrhagic complications. Trial registration: We registered our trial on ClinicalTrials.gov, named after “ticagrelor versus aspirin in ischemic stroke,” and with a clinical trial number (NCT03884530)—March 21, 2019.

Background: It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods: Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results: During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion: COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

Background: Over the past few years, the incidence and prevalence of stroke has been rising in most African countries and has been reported as one of the leading causes of morbidity and mortality. To study this problem, we need to realize the quality and availability of stroke care services as a priori to improve them. Methods and Results: In this study, we investigated the availability of different stroke-related services in 17 countries from different African regions. An online survey was conducted and fulfilled by stroke specialists and included primary prevention, acute management, diagnostic tools, medications, postdischarge services, and stroke registries. The results showed that although medications for secondary prevention are available, yet many other services are lacking in various countries. Conclusion: This study displays the deficient aspects of stroke services in African countries as a preliminary step toward active corrective procedures for the improvement of stroke-related health services.

Egypt, a low-middle-income country, is the most populated nation in the Middle East with a high overall crude prevalence rate of stroke (963/100,000 inhabitants), accounting for 6.4% of all deaths. In this article, we discuss how, through a corrective plan, we could change the landscape of stroke services in Egypt, in a relatively short time, raising thrombolysis rate from <1% to 12.3%, with shortening of door-to-needle time. We could build a database that now exceeds 5,000 patients, our centers received international accreditation and several awards, and we developed tele-stroke service.

Background: Thrombolysis with tissue-type plasminogen activator (IV-tPA) is a well-proved, widely used treatment in acute ischemic stroke patients, many predictors of functional outcome have been proposed as Age, vascular risk factors, initial clinical evaluation on admission using National institute of health stroke scale(NIHSS), functional state of patient(b.L) baseline before stroke and 3 months (3m) after stroke using modified Rankin stroke scale (MRS)and the most controversial Diffusion weighted image characteristics (volume, heterogeneity) Objective: To evaluate DWI MRI characteristics (volume, heterogeneity) as a predictor for outcome in Acute stroke patients treated by IV-tPA Patients and Methods: This study will be done on a sample of 100 acute ischemic stroke Egyptian patients receiving intra-venous tissue -type plasminogen activator presenting to Ain-Shams university hospitals Results: Highly statistically significant (p-value < 0.001) Positive correlation (r = 0.394) between volume (DWI) and MRS (3m) post discharge in studied patients, No statistically significant (pvalue > 0.05) relation between heterogeneity and other studied parameters (MRS, NIHSS D & ADC values) in studied patients Conclusion: DWI infarct volume is a predictor for outcome in acute ischemic stroke patients treated by tPA

Introduction: Ticagrelor is one of the most recent antiplatelet drugs used to treat ischemic heart disease. Its efficacy may equal or exceed aspirin in improving clinical outcomes in patients with acute ischemic stroke who are ineligible for rt-PA. Aim of the Work: We aimed at evaluating the safety (as a primary endpoint) and efficacy (as a secondary endpoint) of a 180 mg loading dose of ticagrelor given within 9 h from the onset of first-ever ischemic stroke. Methods: We conducted an open-label, randomized prospective controlled clinical trial between May 2019 and September 2020 on patients who presented with their first-ever ischemic stroke and were recruited from the emergency department, of Kafr el-sheik University Hospitals, Egypt. Eligible patients randomly received aspirin or ticagrelor loading and maintenance doses. Treatment began within 9 h of stroke onset. Results: Aspirin was given to 84 patients; ticagrelor was given to 85. There was no significant difference between the 2 groups regarding the hemorrhagic and nonhemorrhagic complications. Patients who received ticagrelor had a better outcome regarding NIHSS improvement at 2 days and 1 week or discharge and a favorable mRS score after 1 week or discharge and at 90-day follow-up. Conclusion: Ticagrelor was noninferior to aspirin regarding safety profile. Compared with aspirin, ticagrelor had a better clinical outcome based on NIHSS and mRS in first-ever acute ischemic stroke patients who received it within 9 h from symptom onset, leading to a shorter hospital stay.