Reperfusion therapy for ischemic stroke without prior neuroimaging
Authors:   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia, Kolomentsev S. V. ,   FSAEI HE Immanuel Kant Baltic Federal University, Kaliningrad, Russia, Savello A. V. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia; FSBEI HE Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russian Federation, St. Petersburg, Russia, Shermatyuk E. I. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia, Tokarev P. A. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia, Vorobyovskiy D. A. ,   SBHI City Hospital No. 40 of the Kurortny District, St. Petersburg, Russia; Research Center «St. Petersburg Institute of Bioregulation and Gerontology», St. Petersburg, Russia, Litvinenko I. V. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia, Tsygan N. V. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia, Voznyuk I. A. ,   FSAEI HE Immanuel Kant Baltic Federal University, Kaliningrad, Russia; FSBEI HE Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russian Federation, St. Petersburg, Russia, Polezhaev P. A. ,   FSBMEI HE S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
Published: May 2024

Clinical guidelines and the order of providing care in acute cerebrovascular accidents (CVA) have been developed for standard clinical situations, primarily for patients admitted to medical institutions in an emergency state. However, there are clinical situations when a generally accepted order of therapeutic and diagnostic measures concerning patients with stroke is unjustified and, on the contrary, its implementation threatens life and health of a patient. These situations include ischemic strokes developing intraoperatively during such endovascular interventions as diagnostic cerebral and coronary angiography and transcutaneous neuro- and cardiovascular surgery. Ischemic cerebral events after diagnostic endovascular procedures are relatively rare complications, but their development can lead to unfavorable consequences. Thus, the rates of transient cerebral circulatory disorders after cerebral angiography, a stroke with a reversible neurological deficit, and an ischemic stroke with a persistent neurological deficit are 2.45 %, 0.3 %, and 1.0 % respectively, while total mortality due to acute cerebrovascular pathology is 0.14 %. The rate of cerebral stroke after coronary angiography and percutaneous coronary interventions is up to 0.4 %. Prevention of neurologic complications in diagnostic and surgical transcutaneous interventions is strongly dependant on their correct technique, rational perioperative antithrombotic therapy, and lesser duration of endovascular operations.