Vol 51, No 5 (2017)

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Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Agnieszka Słowik1, Marcin Wnuk1, Paweł Brzegowy1, Joanna Chrzanowska-Waśko1, Aleksandra Golenia1, Bartłomiej Łasocha2, Dorota Włoch-Kopeć1, Antoni Ferens2, Wojciech Serednicki1, Piotr Jarocki1, Halina Bartosik-Psujek3, Rafał Kaczorowski4, Edward Filip4, Monika Grzegorzak4, Jarosław Homa4, Janusz Darocha4, Daniel Dudek4, Wiesław Guz3, Konrad Rejdak5, Piotr Luchowski5, Joanna Wojczal5, Michał Sojka5, Michał Górnik6, Sylwia Stachowicz5, Jacek Jaworski5, Kinga Buraczyńska5, Remigiusz Ficek5, Anna Szczepańska-Szerej5, Tomasz Jargiełło5, Małgorzata Szczerbo-Trojanowska5, Anetta Lasek-Bal7, Przemysław Puz7, Aldona Warsz-Wianecka7, Arkadiusz Stęposz7, Krzysztof Ziaja7, Wacław Kuczmik7, Tomasz Urbanek7, Damian Ziaja7, Witold Tomalski78, Adam Kobayashi9, Przemysław Richter9, Andrzej Płoński10, Marcin Kotkowski9, Wojciech Czepiel9, Iwona Kurkowska-Jastrzębska9, Halina Sienkiewicz-Jarosz9, Anna Członkowska9, Beata BłażejewskaHyżorek9, Danuta Ryglewicz9, Magdalena Konopko9, Edyta Brelak11, Jacek Antecki11, Igor Szydłowski11, Maciej Włosek11, Adam Stępień12, Krzysztof Brzozowski12, Jacek Staszewski12, Piotr Piasecki12, Piotr Zięcina12, Izabela Wołoszyńska12, Norbert Kolmaga12, Jerzy Narloch12, Tomasz Hasiec13, Jacek Gawłowicz13, Monika Pędracka13, Jacek Porębiak13, Bogumił Grzechnik13, Vadym Matsibora13, Michał Frąszczak13, Marcin Leus13, Maciej Mazgaj13, Violetta Palacz-Duda14, Grzegorz Meder15, Wojciech Skura15, Piotr Płeszka14, Milena Świtońska14, Krzysztof Słomiński14, Józef Kościelniak14, Paulina Sobieszak-Skura14, Magdalena Konieczna-Brazis14, Olgierd Rowiński10, Andrzej Opuchlik10, Anatol Mickielewicz10, Beata Szyluk10, Piotr Szczudlik10, Anna Kostera-Pruszczyk10, Maciej Jaworski10, Rafał Maciąg10, Jarosław Żyłkowski10, Bożena Adamkiewicz16, Wojciech Szubert16, Jarosław Chrząstek16, Marek Raźniewski16, Agnieszka Pawelec16, Paweł Wilimborek16, Ryszard Wagner16, Paweł Pilarski16, Paweł Gierach16, Jan Baron7, Wojciech Gruszka7, Stanisław Ochudło7, Agnieszka Krzak-Kubica7, Monika Rudzińska-Bar7, Miłosz Zbroszczyk17, Kamila Smulska17, Michał Arkuszewski18, Dorota Różański19, Dariusz Koziorowski19, Izabela Meisner-Kramarz19, Stanisław Szlufik19, Artur Zaczyński20, Krzysztof Kądziołka20, Kazimierz Kordecki2021, Michał Zawadzki20, Mirosław Ząbek20, Bartosz Karaszewski22, Dariusz Gąsecki22, Paweł Łowiec22, Waldemar Dorniak22, Tomasz Gorycki23, Edyta Szurowska24, Ewa Wierzchowska-Cioch25, Tomasz Smyk25, Beata Szajnoga25, Marcin Bachta25, Kajetan Mazurek25, Magdalena Piwowarska25, Wojciech Kociemba26, Artur Drużdż27, Adrian Dąbrowski27, Michał Glonek28, Małgorzata Wawrzyniak28, Radosław Kaźmierski29, Robert Juszkat30, Adam Heliosz8, Adam Ryszczyk8, Jacek Zwiernik31, Grzegorz Wasilewski32, Andrzej Tutaj32, Grzegorz Dałek32, Krzysztof Nosek32, Sławomir Bereza33, Katarzyna Lubkowska33, Jerzy Kamienowski33, Piotr Sobolewski34, Adam Bielecki35, Maciej Miś36, Marcin Miś36, Maria Krużewska-Orłowska37, Jan Kochanowicz21, Zenon Mariak21, Marta Jakoniuk21, Grzegorz Turek21, Urszula Łebkowska21, Andrzej Lewszuk21, Tomasz Dziedzic1, Tadeusz Popiela1
DOI: 10.1016/j.pjnns.2017.05.004
Neurol Neurochir Pol 2017;51(5):339-346.

Abstract

Objectives

Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland.

Methods and results

We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures.

Results

Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases.

Conclusion

Our results can help harmonize standards for MT in Poland according to international guidelines.

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Neurologia i Neurochirurgia Polska