Tatiana V. Kiseleva

Background. Reducing time from the onset of first symptoms of acute cerebrovascular accident to patient admission to a stroke center and performing neuroimaging (CT or MRI) for diagnosis verification not only aids in diagnosing emergency conditions in emergency vascular neurology but also helps shorten the time to treatment initiation, thereby contributing to improved clinical outcomes. Aim. To assess the use of MRI as the first-choice diagnostic method in adults transported by emergency medical services (EMS) with suspected acute cerebrovascular accident. Materials and methods. This single-center observational study included adults (≥18 years) transported to the Federal Center of Brain Research and Neurotechnologies from January 1 to December 31, 2025 with suspected acute cerebrovascular accident were included. MRI was used as the initial imaging modality in the absence of contraindications; CT was performed when MRI was contraindicated. Time metrics, imaging utilization, reperfusion therapy and in-hospital mortality were analyzed. Results. During the observation period, 712 patients with suspected acute stroke were transported by EMS; acute cerebrovascular accident was confirmed in 482 (67.7%) patients, while in 230 (32.3%) cases another diagnosis was made: 80 (11.2%) patients were found to have other neurological pathologies that required hospitalization, 15 (2.1%) cases were diagnosed with somatic pathologies, and these patients were also hospitalized, while 135 (19%) cases did not require hospitalization. MRI was performed in 611 cases (85.8%) and CT in 101 (14.2%). Median door-to-imaging time was 17 min. Reperfusion therapy for ischemic stroke was delivered in 59 patients. Overall in-hospital mortality among admitted patients was 3.1%, and mortality in acute cerebrovascular accidents was 4.1%. Conclusion. The use of MRI as a first-choice diagnostic method in patients with suspected acute stroke in a 24/7 hospital allows for rapid neuroimaging, providing a more accurate diagnosis and reducing unnecessary hospital admissions of patients with alternative diagnoses – «stroke mimics».

Ischemic stroke remains a major medical, social, and economic concern due to high disability rates and substantial treatment and rehabilitation costs. Reperfusion therapy (thrombolysis and thrombectomy) is one of the most effective therapeutic options, considerably reducing mortality and disability rates. However, 2%–7% of thrombolysis cases are associated with symptomatic hemorrhagic transformation, which causes clinical deterioration and limits rehabilitation. Hemorrhagic transformation is caused by a disruption of the blood-brain barrier, which has a protective function and is characterized by selective permeability. The blood-brain barrier is formed by endothelial cells, astrocytes, pericytes, neurons, and the extracellular matrix. Tight junction proteins in endothelial cells are essential for maintaining blood-brain barrier integrity. In ischemic stroke, neuroinflammatory mechanisms are activated, leading to the degradation of tight junction proteins and extracellular matrix components, which results in increased blood-brain barrier permeability and dysfunction. Reperfusion therapy may exacerbate blood-brain barrier injury due to reactive hyperemia caused by impaired cerebral autoregulation. Existing imaging markers of hemorrhagic transformation (infarct volume, hyper dense middle cerebral artery sign on computed tomography, severity of leukoaraiosis, presence and extent of collateral circulation, etc.) are not always easily accessible or interpretable. Therefore, there is ongoing interest in identifying simple and reliable biomarkers that can serve as laboratory indicators. These include routine parameters (serum glucose, urinary albumin, lipid profile parameters, thromboelastography indices, B-type natriuretic peptide) as well as more specific markers such as matrix metalloproteinases, tight junction proteins, intercellular and vascular adhesion molecules, and endogenous fibrinolysis inhibitors. This review discusses promising biomarkers and their role in the pathogenesis of hemorrhagic transformation, with a particular emphasis on their sensitivity, specificity, and the availability of threshold values.

Objective. To compare the technical aspects and clinical outcomes of endovascular thrombectomy (EVT) in patients with acute M1 or M2 middle cerebral artery (MCA) occlusion, according to the use of intravenous thrombolysis (IVT), in real-world clinical practice in the hospitals of the Moscow Stroke Network. Material and methods. The retrospective observational study included 801 patients from the Moscow Stroke Registry, hospitalized within 4.5 hours of symptom onset, with confirmed occlusion of the M1 or M2 segments of the MCA and EVT performed. The reperfusion grade (mTICI score), number of thrombectomy attempts, functional outcome at discharge (mRS score), and complication rates were assessed. The EVT group with IVT included 383 patients, and the EVT without IVT included 418 patients. Results. In patients who received systemic IVT, first-pass reperfusion was achieved more often (49.4% vs. 40.2%; aOR 1.44; 95% CI 1.09—1.91; p=0.011) and the number of thrombectomy attempts was lower (Me 1 [1; 3] vs. 2 [1; 3]; aOR 0.72; 95% CI 0.56—0.94; p=0.014). The rate of successful reperfusion (mTICI 2b—3) did not differ between the groups (p=0.373). When clinical outcomes were compared, combined reperfusion therapy was associated with a more favorable distribution of mRS scores, a higher proportion of patients with mRS 0—3, and lower mortality. After adjustment for potential confounding factors, the statistical significance of the differences persisted only for in-hospital mortality (23.0% vs. 34.0%; aOR 0.61; 95% CI 0.44—0.84; p=0.003). The frequency of symptomatic hemorrhagic transformation did not differ between the groups (p=0.670). Conclusion. IVT was associated with a more frequent first-pass reperfusion, fewer thrombectomy attempts, and reduced in-hospital mortality with a comparable rate of symptomatic hemorrhagic transformation.

Introduction. Ischemic stroke (IS) remains a serious medical and social issue due to its high prevalence, mortality, and resulting disability. Reperfusion therapy is an effective method of treating patients with IS. Objective. The aim of this study was to examine the results of implementation of reperfusion technologies for the treatment of IS in the Russian Federation. Material and methods. The analysis was based on nationwide data collected from 2015 through the first quarter of 2025. The following indicators were assessed: the proportion of IS patients admitted to stroke units within the first 4.5 hours after symptom onset; the frequency of intravenous thrombolytic therapy (IVT), including the use of telemedicine technologies for IVT administration; the rate of thrombectomy; and the hospital mortality rate from IS. The implementation of telemedicine technologies was evaluated based on the presence of teleconsulted primary stroke units (tele-PSUs) in each region and the proportion of IS patients who received IVT in tele-PSUs. Results. Over the study period, an increase was observed in the proportion of IS patients admitted within 4.5 hours of symptom onset — from 23% in 2015 to 31% in 2024. The frequency of IVT and thrombectomy procedures increased from 2% and 0.1% in 2015 to 10.2% and 2.8% in the first quarter of 2025, respectively. The rate of IVT performed in tele-PSUs in 2024 was 13.6% of IS patients admitted to tele-PSUs. The ischemic stroke mortality rate decreased from 16.8% in 2015 to 12.6% in the first quarter of 2025. Conclusions. Reperfusion therapy technologies for IS are being actively implemented across the country, significantly improving clinical approaches to stroke management. Increasing the number of reperfusion procedures will contribute to improved patient outcomes, reduced mortality, and increase the number of individuals achieving favorable recovery of neurological functions.

Objective. To analyze the impact of primary vascular units using teleconsulting (tele-PVU) on the accessibility and quality of specialized medical care for patients with cerebrovascular accidents (CVAs). Material and methods. The study is based on data from a survey of the chief neurology consultants of 85 constituent entities of the Russian Federation and anonymized information about patients treated in tele-PVUs in 2023. The analysis included accessibility to care, the percentage of patients receiving thrombolytic therapy (TLT), and mortality. Statistical analysis was carried out using IBM SPSS Statistics v.25.0 and Microsoft Excel 2016. Results. Establishing tele-PVUs has increased the accessibility of TLT in regions with a low population density. The frequency of TLT among patients with ischemic stroke in tele-PVUs was 9.8%, exceeding the average for the Russian Federation. Tele-PVUs also contributed to a reduction in the time from the onset of stroke symptoms to the start of treatment. In several regions, there has been a significant increase in the percentage of patients receiving reperfusion therapy. However, limitations were identified regarding the lack of qualified specialists and technical conditions for telemedicine consultations. Conclusion. The establishment of new units has increased the accessibility of medical care, including reperfusion therapy for stroke patients in regions with a low population density and/or prolonged medical evacuation to the nearest specialized unit. However, for further implementation of this system, it is necessary to continue work on solving technical and organizational issues and ensure the integration of telemedicine into the existing medical system.

Introduction. Routing patients with large cerebral artery occlusions to specialized centers is a critical aspect of stroke care, improving clinical outcomes after thrombectomy (TE). Clinical scales, such as the Los Angeles Motor Scale (LAMS), are the most accessible prehospital screening tools for patients selection for endovascular centers, but their real-world effectiveness requires validation.The aim of the study — to evaluate the diagnostic accuracy of the LAMS for detecting acute large cerebral vessels occlusions (LVO) within the Moscow stroke network.Materials and methods. The study included 336 patients with suspected stroke assessed by emergency medical services (EMS) using LAMS. LVO were confirmed in-hospital via CT angiography. Sensitivity and specificity were calculated for LAMS thresholds of 4–5 points, accompanied by ROC analysis. Retrospective LAMS scoring based on initial neurological examination was also analyzed.Results. Sensitivity and specificity of LAMS were 50.47 % and 76.86 %, respectively. Performance varied with time since symptoms onset: 6 hours — 61.54 % and 87.50 %. Retrospective LAMS assessment based on in-hospital neurological examination had 72.90 % sensitivity and 77.73 % specificity. ROC analysis revealed higher predictive value for retrospective scoring (AUC = 0.80; 95 % CI — 0.75–0.85) compared to prehospital assessment (AUC = 0.67; 95 % CI — 0.61–0.73).Conclusion. LAMS can identify patients at high risk of LVO, but its accuracy is limited within the first two hours after symptoms onset. Low early sensitivity necessitates adjustments to routing algorithms. Discrepancies between prehospital and retrospective in-hospital assessments may indicate the advisability of targeted training programs for EMS physicians to optimize LAMS application.

Introduction. The severity of endothelial destruction in patients with the new COVID-19 new coronavirus infection may be correlated with the risk of developing acute cerebrovascular accident (ACVA).Objective. To study the role of hemostasis system activation markers and vascular wall damage markers in the development of stroke in patients with the new coronavirus infection.Materials and methods. The study included 38 patients with the new coronavirus infection and ACVA and 40 patients with the new coronavirus infection without ACVA. All patients were tested for antibodies to β2-glycoprotein, antibodies to cardiolipin, plasminogen activator inhibitor type 1 (PAI-1), α2-antiplasmin, intercellular adhesion molecule type 1 (ICAM-1), von Willebrand factor, and homocysteine.Results. No statistically significant differences were found between the groups in terms of antiphospholipid antibody levels; however, increased antibodies to β2-glycoprotein relative to the reference interval were more frequent in the group without ACVA. Significant differences in PAI-1 levels were found between the group with ACVA and the comparison group (p < 0.001), with the PAI-1 concentration being 1.6 times higher in the comparison group. No significant differences were observed between the groups in terms of α2-antiplasmin, ICAM-1, and von Willebrand factor levels. Significant differences for homocysteine were found between the ACVA group and the comparison group (p < 0.001), with the concentration in the comparison group being 1.8 times higher.Conclusions. The development of acute cerebrovascular accident in patients with lower concentrations of homocysteine and PAI-1 may be explained by weaker compensatory mechanisms aimed at repairing of the vascular wall and harmonization of interaction of hemostasis system links, which eventually led to vascular wall damage.

The incidence of neurological complications in COVID-19 can reach 8–10% of all cases of new coronavirus infection; acute cerebrovascular accidents (ACA) dominate in their structure, which cause significant social and economic costs due to the high mortality and disability rates in this group of patients. The main pathophysiological mechanism leading to the development of ischemic cerebrovascular accidents (ischemic stroke, transient ischemic attack) is the phenomenon of hypercoagulation, which, together with the systemic inflammatory response to the viral infection, leads to the formation of macro- and microthrombi and the development of ischemic disorders of cerebral circulation. The ischemic stroke associated with COVID-19 is characterized by the onset at a younger age, the predominance of cryptogenic and cardioembolic pathogenetic variants, a more frequent occlusion of large cerebral vessels and thus a more pronounced clinical picture of the disease. The reserves for reducing mortality and disability in patients with cerebrovascular disease, especially stroke, during the spread of COVID-19 lie both in the prevention, treatment and rehabilitation of COVID-19 in patients at high risk of developing cardiovascular diseases and in ensuring specialized medical care for this category of patients.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка безопасности и эффективности тромболитической терапии (ТЛТ) препаратом Ревелиза (алтеплаза) у пациентов с ишемическим инсультом (ИИ) в реальной клинической практике. МАТЕРИАЛ И МЕТОДЫ Проведено открытое проспективное многоцентровое неинтервенционное регистровое исследование, в которое были включены 550 пациентов с ИИ — 259 (47,1%) женщин и 291 (52,9%) мужчина; средний возраст 67,7±12,6 года. Всем пациентам в течение 4,5 ч от начала развития заболевания была проведена ТЛТ препаратом Ревелиза и согласно протоколу реперфузионной терапии ИИ выполнялось клиническое, инструментальное и лабораторное обследование. Симптомную геморрагическую трансформацию (ГТ) определяли в соответствии с критериями исследования ECASS 3. РЕЗУЛЬТАТЫ Большинство (95,8%) пациентов страдали гипертонической болезнью, у 69,6% — была выявлена хроническая сердечная недостаточность, у 53,8% — ишемическая болезнь сердца, у 38,7% — отмечались различные нарушения сердечного ритма, 20,7% — страдали сахарным диабетом 2-го типа. Через 1 сут после ТЛТ улучшение на 4 балла и более по шкале NIHSS было отмечено у 45% пациентов. Средний показатель динамики по шкале инсульта NIHSS через 1 сут составил –3,2±4,7, на 7-е сутки — –4,4±6,1 (p<0,0001). ГТ очага поражения головного мозга развилась в 10,9% случаев, симптомная ГТ была диагностирована у 12 (2,3%) больных. Показатель больничной летальности составил 12,7%. Доля пациентов с хорошим функциональным восстановлением (0—2 балла по модифицированной шкале Рэнкина) при выписке, на 30 и 90-й дни составила 44,7, 59,2 и 68,5% соответственно. ЗАКЛЮЧЕНИЕ Проведение ТЛТ препаратом Ревелиза у пациентов с ИИ приводит к статистически значимому регрессу неврологических симптомов. Значительная доля пациентов достигает благоприятного клинического исхода при выписке из стационара и в отдаленном периоде. Полученные данные по эффективности и профилю безопасности соотносятся с ранее опубликованными регистровыми исследованиями алтеплазы при ИИ.